Methods

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Data linkage and big data

Program leader: A/Prof Bette Liu
A/Prof Heather Gidding, Dr Rob Menzies, A/Prof Anthony Newall, Dr David Muscatello, A/Prof Robin Turner, A/Prof James Wood, Dr Surendra Karki, Dr Alex Rosewell, Dr Anita Heywood
Students: Ms Amalie Dyda

We conduct analyses of large datasets linked together in order to better understand, the burden of vaccine preventable diseases in the population, factors associated with vaccine uptake, and estimate vaccine effectiveness at a population level. The large datasets used allow us to provide more reliable estimates and to look at populations that are sometimes difficult to study in smaller samples. 
Some of our current large-scale studies include:

  • Linking a cohort of over 250,000 adults, “The 45 and Up Study”, to information on notifications and hospitalisations for vaccine preventable diseases to investigate disease burden and factors associated with vaccination; 
  • Linkage of over 500,000 records of women giving birth to data on the vaccine preventable infection, hepatitis B;
  • Linkage of a cohort of 2 million Australian born children to the Australian Childhood Immunisation Register (ACIR) and to vaccine preventable disease notifications and hospitalisations. 

Epidemiology, biostatistics and clinical trials

Program Lead: A/Prof Heather Gidding , Prof Raina MacIntyre (clinical trials)
Prof Raina MacIntyre, A/Prof Bette Liu, Dr Rob Menzies, Dr Alex Rosewell, Dr David Muscatello, A/Prof Anthony Newall, Dr David Muscatello, A/Prof Robin Turner, A/Prof James Wood, Dr Surendra Karki, Dr Anita Heywood, Dr Abrar Chughtai
Students: Dr Aye Moa

Infectious diseases epidemiology is the study of the distribution and determinants of infectious diseases. Biostatistical methods (statistics applied to biology) are employed in these epidemiological studies to provide quantitative answers to research questions.

Our team includes strong quantitative epidemiologists, modellers, biostatisticians and health economists specialising in the study of vaccine preventable diseases (VPDs). Our complimentary expertise enables us to conduct a broad range of epidemiological studies including several which maximise the utility of routinely collected data, population-based surveys, and specially designed studies such as vaccine clinical trials. We are currently undertaking studies to:

  • measure VPD immunity in different populations and modelling these data to estimate the level of disease control,
  • estimate the burden of VPDs,
  • measure vaccine uptake in special risk groups,
  • determine factors associated with delayed vaccination,
  • evaluate vaccine efficacy and effectiveness in risk groups by conducting clinical trials and using linked population-based data,
  • conducting field epidemiologic research to strengthen surveillance and improve VPD control.

Health Economics

Program leader: A/Prof Anthony Newall
Dr Anurag Sharma, A/Prof James Wood, A/Prof Virginia Wiseman, Prof Raina MacIntyre.
Students: Dr Sevan Dirmesropian, Dr Shohini Mukherji

Evaluating the value for money of vaccination strategies involves the use of economic and infectious disease models. These models can be used to predict the impact of alternative control strategies and estimate the cost-effectiveness of these programs. It is important to conduct this research to ensure we are protecting the population in the most efficient way at a reasonable cost. Cost-effectiveness analysis plays a major role in policy and funding decisions for vaccines in Australia and increasingly internationally. 

Predicting herd immunity effects is a key focus when estimating the cost-effectiveness of infant vaccination programs. While programs targeted at older adults and the elderly may also induce herd effects, there are other important challenges to consider in these groups. Our research on vaccination in older adults is focused on exploring these factors, such as, age and time effects related to vaccine efficacy and duration of immunity, as well potential interactions with childhood programs targeted at the same pathogen.

We are also play an important role in teaching health economics at UNSW.

Mathematical modeling

Program leader: A/Prof James Wood
A/Prof Anthony Newall, Prof Raina MacIntyre, A/Prof Heather Gidding, Ms Valentina Costantino,Dr Duleepa Jayasundara.

Mathematical modelling has played an important role in describing and evaluating impacts of immunisation, particularly in terms of the herd immunity effects from vaccines in childhood. In simple terms, mathematical models in this context use systems of equations implemented in computer code to describe the dynamics of infection in populations and how these change when interventions such as vaccination are applied.

In elderly populations, we need to account for herd immunity effects from both childhood and adult vaccination programs and give more attention to the heterogeneity in disease risks that accumulate throughout adulthood. Here we are drawing on the extensive data-linkage studies being conducted by UNSW-VIRL to account for changing risk by age and health risk status and using models to provide inputs for cost-effectiveness evaluations and as key information for policy makers.

The modelling team at UNSW-VIRL is proud of its applied focus and direct connection with immunisation policy. We also have a strong focus on novel methodological research regarding the effects of demographic change, pathogen genetics and immunological processes on disease dynamics. With ageing populations, the role of immunosenescence in disease risks in the elderly and changing pathogen profiles in relation to influenza and pneumococcal disease, all of these are important elements for future policy relevant models to capture. 

Social and behavioural research

Program lead: Dr Holly Seale    
Dr Anita Heywood, Prof Raina MacIntyre, Dr Abrar Chughtai, Ms Telphia Joseph, Prof Mary-Louise McLaws

Religion, culture, gender and/or socio‐economic status are all known to influence a person’s decision on whether or not they will act a vaccine or immunise their child.  Whether people accept a vaccine or are hesitant can also be affected by whether the individual or group have accurate knowledge and/or awareness about the need for vaccination. Have they received any information or do they have misperceptions because they have received inappropriate or inaccurate information.  Understanding decision making theory in vaccination behaviour, the expectations and experiences of adults, and reasons why people fail to have vaccinations are crucial to bridging the gap in adult immunisation. This information allows us to build evidence based interventions such as education or communication programs that are aimed at improving uptake.  

Our social and behavioural research team have led studies focused on exploring the individual, societal and organisational factors that influence compliance with immunisation and with formulating and developing approaches and interventions to improve uptake. Our research has included a range of stakeholders including migrants and refugees, travellers, adults with immunosuppressant or underlying health conditions, and hospital/community based healthcare workers. We have collaborated with researchers from Indonesia, China, Vietnam and other countries to undertake social research studies.

Recent examples of our work include:

  • Seale, H., Kaur, R., Mahimbo, A., MacIntyre, C. R., Zwar, N., Smith, M., Worth H, Heywood, A. E. (2016). Improving the uptake of pre-travel health advice amongst migrant Australians: Exploring the attitudes of primary care providers and migrant community groups. BMC Infectious Diseases, 16(1) https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1479-1
  • Heywood A.E., Nothdurft H, Tessier D, Moodley M, Rombo L, Marano C, De Moerlooze L. Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travelers from seven countries. Journal of Travel Medicine. 2016:24(1) http://dx.doi.org/10.1093/jtm/taw069
  • Seale, H., Sitaresmi, M. N., Atthobari, J., Heywood, A., Kaur, R., MacIntyre, R., . . . Padmawati, S. (2015). Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia. BMC Health Services Research, 15(1). http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1187-3