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Modelling the role of undernutrition in measles transmission and vaccination - NU/LSHTM project

Supervisors

LSHTM 

Nagasaki University

Project

Measles is a highly contagious disease and causes substantial health burden in children. Undernutrition has a profound effect on child growth and immune system development and thus may change measles susceptibility and treatment outcomes. As a socioeconomic indicator, undernutrition was also associated with access to immunisation services. Nevertheless, the role of undernutrition in measles transmission and vaccination has yet to be thoroughly investigated and addressed in modelling research. 

This PhD project aims to understand the interplay between measles and undernutrition and assess the potential interventions in at least one setting facing the dual health burden (e.g. Ethiopia), with three proposed objectives: (1) A literature review will be conducted on (1a) the epidemiological and socioeconomic association between undernutrition and measles and (1b) current applications of the nutritional aspect to vaccine-preventable disease modelling. The review will also help identify the relevant data sources and methods to inform the burden estimation and control measures for measles and undernutrition in the selected setting. (2) The student will then use the findings from the literature review to develop a mechanistic model of measles transmission dynamics and vaccination and incorporate the risk structure of undernutrition into the model. The geographical scope of the model can be regional, national, or subnational, depending on the data availability. Characterisation of the model will account for multiple types and sources of data, such as demographics, measles serological surveys and surveillance data, and programmatic data on vaccination and nutrition (e.g. coverage in the target populations). (3) Historically, measles immunisation and vitamin A were provided together to children through mass campaigns, demonstrating the feasibility of integrated programmes. Following stakeholder engagement with both immunisation and nutrition teams, the student will identify potential intervention strategies for measles vaccination and nutrition supplements. The impacts of the nominated strategies (individually and in combination) on the measles outbreak and overall health will be assessed using the model developed for the selected setting. 

The project can be extended to evaluate the cost-effectiveness of potential strategies based on the policy interest and feasibility of collecting cost data. The student will also have an opportunity to engage with the NutriVax Project, which trials the provision of nutrition supplement as an incentive to increase vaccine coverage. 

References:

  1. Noori N, Skrip LA, Oron AP, et al. Potential Impacts of Mass Nutritional Supplementation on Measles Dynamics: A Simulation Study. The American Journal of Tropical Medicine and Hygiene. 2022;107(4):863-72. doi: 10.4269/ajtmh.21-1083
  2. Auzenbergs M, Fu H, Abbas K, et al. Health effects of routine measles vaccination and supplementary immunisation activities in 14 high-burden countries: a Dynamic Measles Immunization Calculation Engine (DynaMICE) modelling study. Lancet Glob Health. 2023;11(8):e1194-e204. doi: 10.1016/S2214-109X(23)00220-6
  3. Funk S, Knapp JK, Lebo E, et al. Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination. BMC Med. 2019;17(1):180. doi: 10.1186/s12916-019-1413-7
  4. .

The role of LSHTM and NU in this collaborative project

  • Dr Han Fu works closely with Vaccine Impact Modelling Consortium and has expertise in assessing the health and economic impacts of measles vaccination strategies in low- and middle-income settings.
  • Dr Laura Skrip has expertise in estimating the impact of nutrition programme on immunisation and collaborating with field researchers and social scientists to guide context-specific policy and practice.  
  • Prof Stefan Flasche has extensive experiences in vaccine epidemiology and stakeholder engagement at the country and global levels.

We also identify potential advisors who can bring extra expertise to the project, including Prof Sebastian Funk (LSHTM, analytical methods and application of serological data) and Prof Hirotsugu Aiga (NU, nutrition and health system strengthening).  

Particular prior educational requirements for a student undertaking this project

  • Essential: Proven experience and training in quantitative methods for health research (e.g. epidemiology, statistics, mathematics); Proficiency in at least one programming language (e.g. R)
  • Desired: Experience in infectious disease modelling, vaccine epidemiology, nutrition.

Skills we expect a student to develop/acquire whilst pursuing this project

  • Understand epidemiology of measles and undernutrition.
  • Develop literature review skills and potentially field experience in data collection.
  • Appraise and analyse multiple types of data, including serological surveys, disease surveillance, vaccination and nutrition programmes.
  • Construct a mathematical model for measles transmission and vaccination and incorporate the risk structure of undernutrition.
  • Engage with stakeholders and policy makers in the local study context.