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Priorities in the Measles and Rubella Research Agenda. William Moss, MD, MPH Johns Hopkins Bloomberg School of Public Health. 11 th Annual Meeting of The Measles and Rubella Initiative September 18, 2012. Global Measles and Rubella Strategic Plan

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Priorities in the measles and rubella research agenda

Priorities in the Measles and Rubella Research Agenda

William Moss, MD, MPH

Johns Hopkins Bloomberg School of Public Health

11th Annual Meeting of The Measles and Rubella Initiative

September 18, 2012


Global Measles and Rubella Strategic Plan

  • High population immunity and vaccine coverage

  • Effective surveillance, monitoring evaluation

  • Outbreak preparedness and response

  • Public confidence and demand for immunization

  • Research and development


Developing a research agenda
Developing a Research Agenda

Clear and explicit program goals

Specified target audience

Answerable research questions

Strategies to address research questions

Milestones and review of progress

Flexibility in adapting research agenda


Measles landscape analysis for the bill and melinda gates foundation december 2008
Measles Landscape Analysis for the Bill and Melinda Gates FoundationDecember 2008

  • Effect of measles activities on health systems

  • Improve monitoring by:

    • developing field-friendly laboratory assays to validate coverage

    • developing immunization (and child-health) registries

  • Improve surveillance by obtaining:

    • data on measles age-specific sero-prevalence

    • baseline data on rubella

  • Commission a MCV market supply study


  • Public health questions to which modelling can have a major contribution
    Public health questions to which modelling can have a major contribution

    Improve existing modelling methods to estimate mortality

    Assess the burden of CRS

    Optimize strategies for measles and rubella control

    birth rate

    population density

    rural-urban migration

    seasonality of infection

    contact patterns

    Potential impact of waning immunity

    Cost-effectiveness of different goals and strategies

    Measles Landscape Analysis


    Global measles and rubella research meeting may 2011
    Global Measles and Rubella Research Meeting contributionMay 2011

    Organizational structure

    Measles epidemiology

    Vaccine Development and Effectiveness, Alternative Delivery Methods and Laboratory Methods

    Immunization Strategies

    Mathematical Modeling and Economic Analyses

    Rubella Control and Elimination

    Key research questions distilled from 137 questions


    Working group members
    Working Group Members contribution

    Measles Epidemiology

    Lead author: James Goodson

    Other members of working group: Abhijeet Anand, Nino Khetsuriani, William Moss, David Sniadack

    Vaccine Development and Effectiveness, Alternative Delivery Methods and Laboratory Methods Research Agenda

    Lead authors: Paul Rota, David Featherstone

    Other members of working group: William Bellini, Ana-Maria Henao-Restrepo, Robert Keegan, Sara Lowther, Claude Muller.

    Immunization Strategies Research Agenda

    Lead authors: Peter Strebel, Rebecca Martin, Lisa Cairns

    Other members of working group: Steve Cochi, Vance Dietz, Alan Hinman, Edward Hoekstra, Eric Mast, Linda Quick, Maya Van Den Ent, Margie Watkins

    Mathematical Modeling and Economic Analyses Research Agenda

    Lead authors: Kim Thompson, Maya Vijayaraghavan

    Other members of work group: Walt Dowdle, Matthew Ferrari, Manoj Gambhir, Chris Gregory, Katrina Kretsinger, Kathleen Wannemuehler

    Rubella Research Agenda

    Lead author: Susan Reef

    Other members of work group: Emilia Vynnycky, Joseph Icenogle, Leo Weakland, Robert Linkins, Louis Cooper


    Measles epidemiology
    Measles Epidemiology contribution

    Epidemiologic characteristics of measles in India

    Causes of outbreaks in high coverage settings

    Age infants lose protection from maternal antibodies

    Implications of administering MCV1 prior to 9 months

    Susceptibility and transmission among adults

    Susceptibility among HIV-infected adults


    Vaccine development and effectiveness and alternative vaccine delivery methods
    Vaccine Development and Effectiveness, and Alternative Vaccine Delivery Methods

    Vaccine effectiveness in densely-populated settings

    Improved vaccines:

    thermo-stable

    vial temperature monitors

    self-reconstituting vials

    alternative delivery methods


    Surveillance and laboratory methods
    Surveillance and Laboratory Methods Vaccine Delivery Methods

    Global distribution of measles virus genotypes

    Rapid diagnostic tests for measles and rubella

    High-throughput assays for neutralizing antibodies

    Higher resolution for virologic surveillance

    Differentiate wild-type and vaccine immunity


    Immunization strategies
    Immunization Strategies Vaccine Delivery Methods

    Increase uptake of routine 1st and 2nd doses

    Maximize SIA coverage

    Monitoring vaccination coverage (RI and SIA)

    Vaccinating difficult to reach populations

    Misconceptions and attitudinal barriers

    Increase demand for vaccination

    Outbreak response immunization activities


    Mathematical modeling and economic analyses
    Mathematical Modeling and Economic Analyses Vaccine Delivery Methods

    Modeling progress toward measles eradication

    Threshold population size and susceptible density required to sustain measles virus transmission

    Economic burden of measles outbreaks and response in low and middle income countries


    Rubella control and elimination
    Rubella Control and Elimination Vaccine Delivery Methods

    Birth rates and the epidemiology of rubella and CRS

    Methods and costs for identifying CRS cases

    Refusal and acceptance of MMR vaccine

    Global distribution of rubella virus genotypes

    Economic burden of rubella and CRS


    Research questions from measles management meeting
    Research Questions from Measles Vaccine Delivery MethodsManagement Meeting

    Americas

    Identification of high risk groups

    Transmission in settings of high vaccine coverage

    Europe

    Role of adolescents and adults

    Waning immunity

    Economic analyses and disease burden modeling

    Burden of rubella and CRS

    Communication strategies

    Western Pacific

    Transmission among infants, adolescents and adults

    Outbreak response: triggers, threshold and scope


    Sage working group on measles and rubella

    SAGE Working Group Vaccine Delivery Methods

    on Measles and Rubella


    Terms of reference
    Terms of Reference Vaccine Delivery Methods

    Identify gaps in essential evidence and programme barriers to achieving measles and rubella/CRS elimination targets and present SAGE with proposed areas for operational or basic science research.


    Approach
    Approach Vaccine Delivery Methods

    • Define the context for research priority setting

    • Identify research questions and knowledge gaps

    • Define criteria for research priority setting

    • Score listed research questions using criteria

    • Address stakeholder values

    • Refine questions and implementation process

    • Periodic re-evaluation of research priorities


    Summary
    Summary Vaccine Delivery Methods

    Many key research questions have been identified

    Next steps

    Consensus on highest priority research questions to advance strategic plan

    Develop strategies to address these questions

    Identify milestones and targets

    Assess progress

    Adapt research agenda to changing need


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