Auzenbergs, M; (2024) Mathematical and statistical modelling to inform polio and measles vaccination programming. PhD thesis, London School of Hygiene & Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.04674998
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Abstract
An important criterion for eradication of a disease is the availability of an efficacious vaccine that can be administered to reduce the global worldwide disease incidence to zero. However, deployment strategies for vaccination vary across diseases and geographies and depend on many factors, such as disease burden, political will, vaccine availability and financial resources. Polio and measles are two vaccine preventable diseases that have been targeted for eradication and global elimination, respectively, but have different transmission dynamics, vaccines and mechanisms of vaccine administration. For this PhD, I use statistical and mathematical models to explore aspects of polio and measles vaccination programming, from measuring the efficiency and cost-effectiveness of vaccination strategies, to evaluating vaccine impact and comparing disease surveillance systems. The overall aim of my thesis is to assess the effect of different vaccination strategies for polio and measles using statistical and mathematical models. First, I explore the costs and benefits of different polio vaccination strategies using a compartmental transmission model. I evaluate outbreak risk and associated costs if a case of wild poliovirus serotype 1 (WPV1) was imported into a low- and middle-income country (LMIC) in sub-Saharan Africa. I model varying frequencies of preventative supplementary immunisation activities (SIAs) in comparison to a baseline comparator strategy consisting of only routine immunisation (RI) and outbreak response. This work concluded that both annual and biennial preventative SIAs are cost-effective when RI coverage is low. At higher levels of RI coverage, annual preventative SIAs are more costly, but result in the greatest probability of no outbreaks in comparison to the baseline strategy with no preventative SIAs. Next, I use the Dynamic Measles Immunization Calculation Engine (DynaMICE) to estimate the incremental health effects of routine measles vaccination and measles SIAs in 14 high-burden countries: India, Nigeria, Indonesia, Ethiopia, China, Philippines, Uganda, Democratic Republic of the Congo (DRC), Pakistan, Angola, Madagascar, Ukraine, Malawi, and Somalia. I evaluate the effectiveness and efficiency of historical vaccination strategies that were implemented at varying points in time in the high-burden countries. I found that adding routine measles containing vaccine (MCV) dose 2 to MCV dose 1 (MCV1) prevented fewer cases and deaths than adding SIAs to MCV1. However, despite larger incremental effects, adding SIAs to MCV1 showed reduced efficiency because of the wide age range targeted by SIAs. Finally, I explore the role of vaccination in seeding future vaccine derived poliovirus (VDPV) outbreaks. I estimate the time from emergence to VDPV outbreak detection across all poliovirus serotypes and evaluate factors associated with decreased time to detection. This work emphasises the role of surveillance in VDPV detection and the importance of maintaining surveillance for poliomyelitis even after local elimination is achieved to quickly respond to both emergence of VDPVs and potential importations. Collectively, the research included in this PhD demonstrates the utility of using statistical and mathematical models to inform global vaccination programming. Whilst measles and polio are ultimately different diseases with independent goals and targets for elimination and eradication, there are parallels in the evaluation of vaccination strategies for both diseases. Understanding the risks and benefits of different vaccination strategies and factors that can improve quality and efficiency are important for global policy and decision-making.
Item Type | Thesis |
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Thesis Type | Doctoral |
Thesis Name | PhD |
Contributors | O'Reilly, K and Abbas, K |
Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & Dynamics (2023-) |
Funder Name | Bill and Melinda Gates Foundation, Vaccine Impact Modelling Consortium |
Copyright Holders | Megan Auzenbergs |
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Filename: 2024_EPH_PhD_Auzenbergs_M.pdf
Licence: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
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