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Spatial Patterns of Cholera Transmission and the Performance of Reactive Vaccination in and Epidemic Setting

Summary

Throughout much of sub-Saharan Africa cholera is an epidemic disease causing considerable morbidity and mortality. In urban centers the burden of cholera transmission is not even across neighborhoods, and particular locations within a city may drive the entire epidemic. Reactive vaccination has been proposed as a method for understanding and controlling cholera epidemics. Here we propose a research collaboration with Epicentre, the research affiliate of Médecins Sans Frontières to better understand the spread of cholera in epidemic settings and the effectiveness of reactive vaccination in an cholera epidemic in sub-Saharan Africa. We propose to collect data on the spatial distribution of cholera cases and matched controls, and to assess the distribution of vaccine in the two populations. We propose to use novel methods for the analysis of point pattern data to identify clusters of cholera cases within an urban setting, determine the overall level of clustering of cases, and whether this clustering changes over time. These methods will also be used to identify spatial clustering in vaccine uptake. Spatial data from a single epidemic of cholera will be used to parameterize stochastic spatial models of cholera transmission in an urban setting using Markov-Chain Monte Carlo techniques. Simulations based on stochastic models will be used to estimate the population effectiveness of reactive vaccination and optimal strategies for the distribution of limited vaccine stockpiles.

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