Development and application of subnational measles incidence and mortality estimates in high burden and incidence settings - Project Summary/Abstract Vaccination against measles has been available for decades, although still a substantial number of global cases and deaths persist. Strategies to reach measles elimination goals require a more comprehensive understanding of the patterns of immunity and burden across space, time and age in local contexts throughout the world, particularly in low- and middle-income countries. These challenges, in part, can be addressed via a thorough examination of all available data on measles immunity, cases, and deaths and synthesizing these data streams through the development of novel mathematical and statistical models, particularly on subnational scales. This proposal will first quantify global measles immunity patterns via a systematic search of all available seroprevalence studies and catalytic modeling to describe patterns by location and age. Next, we will estimate subnational measles incidence in the six highest burden countries using case notifications, serology data, and subnational vaccine coverage estimates. Then, to assess local areas with highest measles mortality, we will estimate subnational case-fatality using all available literature and spatially available covariates. Finally, we will assess the economic and health benefits of subnationally-targeted immunization strategies over a nationally based approach. This project will investigate global measles immunity and mortality patterns at national and subnational scales, as well as evaluate the cost-effectiveness of subnational targeting of various vaccination strategies. The goal of this research is to provide empirical evidence for global stakeholders and local decision makers to plan informed immunization efforts as well as measles control and elimination programing. After the completion of this research and training fellowship, the applicant will have acquired advanced skills in spatiotemporal and statistical modeling, infectious disease and vaccination epidemiology, economic evaluation, scientific communication, and classroom teaching. The applicant seeks expertise in these fields in order to advance measles eradication and control efforts and to improve the overall understanding the role of subnational analyses and estimates in optimizing disease control and local health initiatives. A multidisciplinary and collaborative team will mentor and guide the applicant in research and training and assist in preparing the applicant for an academic career in infectious disease and vaccine epidemiology and mathematical modeling, with a focus on producing timely and policy-relevant research.
