Methods of Prioritizing Target Areas for Vaccination Campaigns in the Context of the 2010 Measles Epidemic in Malawi
Open Access
- Author:
- Kundrick, Avery Lynne
- Area of Honors:
- Immunology and Infectious Disease
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Matthew Joseph Ferrari, Thesis Supervisor
Dr. Pamela A. Hankey-Giblin, Thesis Honors Advisor - Keywords:
- measles
epidemiology
vaccination campaign
epidemic
Malawi
vaccination coverage
susceptible recruitment
R effective - Abstract:
- Background: Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. How to prioritize target areas for vaccination campaigns continues to remain a question. We analyzed three methods of prioritizing target areas: vaccination coverage, susceptible recruitment, and the effective reproductive ratio (RE) in the context of the 2010 measles epidemic in Malawi. Methods: Using surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage and annual susceptible recruitment at the district scale and healthcare facility polygon scale to identify high priority target areas. We also estimated RE at the healthcare facility polygon scale. Results: Estimates of vaccination coverage and susceptible recruitment resulted in relatively similar prioritization of target areas, in particular, the districts of Mangochi and Kasungu had low vaccination coverage and large populations of unvaccinated children. Notably, the urban area of Blantyre, where the epidemic began, was identified as having the highest RE. A few areas within the districts of Lilongwe, Kasungu, and Mangochi were prioritized by all three methods. Additionally, we found that district scale measurements masked significant heterogeneity at the healthcare facility polygon scale. Conclusion: Each method of prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one method over another. However, in some cases, certain areas may be prioritized by all three methods. These areas should be treated with particular concern. Furthermore, the scale at which each method is conducted impacts the resulting prioritization and should also be considered when prioritizing areas for vaccination campaigns.