This study will develop and test spatial analytical methods for vaccine trials to control for spatially heterogeneous disease exposures (spatial effect modifiers) and spatial bias in disease outcomes (spatial confounders). In 1985, a community-based individually randomized oral cholera vaccine trial was conducted in Matlab, Bangladesh. The double-blind trial measured the efficacy of two vaccines, the B subunit-killed whole cell (BS-WC) and the killed whole cell only (WC) vaccine. Women over 15 and children aged 2 to 15 were the target group in the trial. To identify the cholera cases from the study area, the investigators conducted a passive surveillance at one hospital and two community-based treatment centers. Passive surveillance can introduce bias because access to treatment centers, which is usually a function of distance, influences health-seeking behavior. Also, efficacy might differ in different parts of the study area because socio-environmental circumstances and therefore disease exposure levels vary in space. This study will use a geographic information system (GIS) to determine: (1) how cholera vaccine efficacy varies spatially in the study area; (2) what ecological socio-environmental variables are related to cholera vaccine efficacy (i.e., which variables are effect modifiers); (3) how protective efficacy varies with access to treatment facilities (i.e., whether access is a spatial confounder); and (4) whether cholera incidence in the placebo group is related to vaccine coverage rates (i.e., is herd immunity important?). The study will use three data sets, previously collected by the investigators, including: (1) a large cholera vaccine trial database, (2) a comprehensive longitudinal demographic database of the rural population of approximately 200,000 from which the vaccine trial participants were selected, and (3) an accurate household-level spatial database of the same study area population. The results of this project can help with the design of all future vaccine trials.
| Emch, Michael; Ali, Mohammad; Root, Elisabeth D et al. (2009) Spatial and environmental connectivity analysis in a cholera vaccine trial. Soc Sci Med 68:631-7 |
| Ali, Mohammad; Emch, Michael; Yunus, Mohammad et al. (2008) Vaccine Protection of Bangladeshi infants and young children against cholera: implications for vaccine deployment and person-to-person transmission. Pediatr Infect Dis J 27:33-7 |
| Emch, Michael; Ali, Mohammad; Acosta, Camilo et al. (2007) Efficacy calculation in randomized trials: global or local measures? Health Place 13:238-48 |
| Emch, Michael; Ali, Mohammad; Park, Jin-Kyung et al. (2006) Relationship between neighbourhood-level killed oral cholera vaccine coverage and protective efficacy: evidence for herd immunity. Int J Epidemiol 35:1044-50 |
| Ali, Mohammad; Emch, Michael; von Seidlein, Lorenz et al. (2005) Herd immunity conferred by killed oral cholera vaccines in Bangladesh: a reanalysis. Lancet 366:44-9 |
