Applied epidemiology of vaccine-preventable diseases in the Asia-Pacific

Abstract

From 2015-2016 I undertook the Master of Philosophy in Applied Epidemiology (MAE) whilst under the employment of the Murdoch Childrens Research Institute (MCRI) in Melbourne as a research officer for a study based in the People’s Democratic Republic of Laos (Lao PDR). To satisfy the requirements of the MAE, I completed projects in the areas of data analysis, public health surveillance, epidemiological research and outbreak investigation.

The work I was employed for with MCRI formed the basis of my data analysis competency. The aim of this project was to determine the pneumococcal conjugate vaccine (PCV) coverage required to achieve herd immunity using pneumococcal carriage surveillance at Mahosot Hospital in Lao PDR. Beyond the analysis of these data, I was responsible for overseeing and coordinating the larger body of work for this project based in Lao PDR. This work is ongoing and a final publication will be published later in 2017.

With guidance from my field supervisor, I was responsible for establishing the epidemiology of acute gastroenteritis (AGE) in Kiribati pre- and post-rotavirus (RV) vaccine introduction. As part of this review, I established post-marketing surveillance of intussusception (IS) as part of RV vaccine introduction. The World Health Organization (WHO) recommends the surveillance of IS post-RV vaccine introduction due to experiences with a previous formulation of the vaccine. This evaluation is ongoing and will be completed in 2017.

In response to vaccine preventable disease (VPD) outbreaks in Lao PDR, the Ministry of Health, National Immunization Programme (NIP) requested information regarding evidence of serological protection of H. influenzae type b (Hib) in their population. This study was the basis of my epidemiological research for the MAE. The results from this study would provide data on Hib protection in their population to help inform NIP if changes to their current schedule were necessary.

For my outbreak investigation competency, I was involved with the team at WHO Lao PDR country office in responding to a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak in Lao PDR from October 2015 to mid-2017. As part of this work I will contribute to the outbreak investigation section of the larger WHO report to be submitted to NIP.

This thesis presents my experience as a MAE scholar; the skills gained, knowledge learnt and the impact this body of work had on public health in the Asia-Pacific region for VPD. Keywords: Vaccine-preventable disease, Laos PDR, pneumococcal conjugate vaccine, Kiribati, intussusception, rotavirus vaccine, Haemophilus influenzae type b, vaccination evidence, serology, poliovirus, circulating vaccine-derived poliovirus