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
1. High population immunity and vaccine coverage
2. Effective surveillance, monitoring evaluation
3. Outbreak preparedness and response
4. Public confidence and demand for immunization
5. Research and development
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
1. Effect of measles activities on health systems
2. Improve monitoring by:
a) developing field-friendly laboratory assays to validate coverage
b) developing immunization (and child-health) registries
3. Improve surveillance by obtaining:
a) data on measles age-specific sero-prevalence
b) baseline data on rubella
4. Commission a MCV market supply study
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
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
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
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 effectiveness in densely-populated settings
Improved vaccines:
thermo-stable
vial temperature monitors
self-reconstituting vials
alternative delivery methods
Surveillance and Laboratory 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
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
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
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
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
16
Terms of Reference
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.
17
Approach
1.
2.
3.
4.
5.
6.
7.
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
18
Summary
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