Priorities in the Measles and Rubella Research Agenda

1. 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

2. 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

3. 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

4. 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

5. 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

6. Global Measles and Rubella Research MeetingMay 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

7. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. SAGE Working Group on Measles and Rubella

17. 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.

18. Approach • 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

19. 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