IMPRINT network supports scientific as well as public engagement projects. The scientific activities consist of pump priming grants which are organised around six thematic challenges representing the network’s focus areas. The public engagement projects' purpose is to facilitate imaginative, high-quality and inclusive public engagement which reaches new, global and diverse audiences.
Pregnant women sometimes carry a bacterium called Group B Streptococcus (GBS) in their vagina or rectum. During pregnancy or upon delivery, GBS may be transmitted to the baby resulting in the death of the baby in the womb or go on to cause infections such as sepsis or meningitis soon after birth. GBS disease is more serious in some low- and middle-income countries (LMICs) where pregnant women do not have access to proper antenatal care and antibiotics. A solution would be to vaccinate mothers against GBS, so they can produce antibodies protective proteins (antibodies) that can be transferred to the baby through the placenta and protect them from developing an infection in the first place. Interestingly, LMICs situated in South-East Asia report a low GBS disease burden while high GBS disease rates are documented on the African continent, in countries such as Malawi or South Africa.
In this project we aim to collect the blood of GBS-colonised mothers from high vs. low GBS disease burden countries (U.K. vs. Malawi vs. Bangladesh) and compare how the immune system of the women reacts to GBS by measuring anti-GBS antibody concentrations, the ability of the antibody to kill the bacteria, as well its ability to bind to factors present on the surface of the GBS bacteria. We also aim to examine how effectively the antibodies are transferred across the placenta and give protection to babies.
By comparing the properties of antibodies collected from high- vs low- disease burden countries, we hope to understand the criteria that are essential for the optimal transfer of GBS protective antibodies from mother to baby. Altogether this knowledge will significantly help towards the design of more efficient and safe vaccines to protect new born babies from life-threatening GBS disease.
Department of Clinical Infection, Microbiology and Immunology,
Institute of Infection and Global Health,
University of Liverpool, United Kingdom
Prof. Aras Kadioglu
University of Liverpool, United Kingdom
Prof. Neil French
University of Liverpool, United Kingdom
Prof. Samir Kumar Saha
Child Health Research Foundation (CHRF) Bangladesh Institute of Child Health Research Foundation, Dhaka Shishu (Child) Hospital, Bangladesh
Shadia is a Clinical Microbiologist who possess an intrinsic aspiration for research in paediatric infectious disease and its prophylactic management. She is currently finishing her PhD thesis as a Commonwealth Scholar in the Institute of Infection and Global Health at the University of Liverpool. She holds a M. Phil in Microbiology as well as a Bachelor in Medicine and Surgery.
From 2012 on she has been serving as an Assistant Professor at the Department of Microbiology, Ibrahim Medical College, Bangladesh and will return to her position after completing her postdoctoral research. Her career history entails a variety of positions including academic, laboratory consultant, teacher and researcher in the field of medical microbiology.
Young infants are more susceptible to infection than individuals at any other life stage. Their immune systems are inexperienced and they are too young to benefit from infant vaccination, most of which are given several weeks after birth. In the first weeks of life, babies rely on protective proteins called antibodies, which are transferred across the placenta from the mother to the baby whilst still in the womb. In some cases, the amount of antibody transferred to the baby is not sufficient to protect the baby from infections, such as whooping cough. Vaccines given in pregnancy aim to increase the amount of antibody in the mother’s blood, so that more antibody is transferred across the placenta to the baby so that the infant is protected until they are old enough to receive infant vaccines.
Antibody is transferred across the placenta by binding to specialised receptors on the surface of placental cells. In this project, we aim to study each part of the antibody-receptor interaction, namely:
We aim to understand how these factors change throughout pregnancy, by testing stored blood and placental samples. We will also look at how vaccination in pregnancy can affect these factors.
In developing countries, a significant proportion of pregnant women are affected by HIV infection. This can affect how well antibody is transferred across the placenta. We aim to understand how HIV affects the maternal antibody and how well it binds to the receptor in the placenta.
We hope that this project will help us understand more about the way babies are protected by vaccines in pregnancy and in the future, help us design vaccines that are more effective at protecting the mother and infant.
Associate Professor and Honorary Consultant in Paediatric Infectious Diseases Clinical and Experimental Sciences,
Room LF102, F Level, South Academic Block University Hospital Southampton NHS Foundation,
Trust Tremona Road, Southampton SO16 6YD, United Kingdom
London School of Hygiene and Tropical Medicine, London, UK
During pregnancy, the placenta is the interface between mother and baby. Its specialised structure allows nutrients and protective molecules such as antibodies to be transferred to the developing baby. These antibodies help project the infant in the first weeks of life, when the infant is exposed to viruses and bacteria for the first time. In several countries, we now vaccinate women against certain diseases, which increases the amounts of specific antibodies passed to the baby, therefore protecting them against disease.
Surprisingly, despite the importance of trans-placental antibody transfer, there is lots we still do not know about this process. This includes how the antibody crosses all the different cell layers between the mother’s and baby’s bloodstream, how changes in the mother’s immune system may affect antibody transport, and how differences in the structure of antibodies can increase or decrease their transport to the baby. Understanding these issues will help us to optimize maternal vaccination programmes to protect infants in early life.
One way to address some of these gaps in our knowledge is through use of placental perfusion. This technique uses a piece of the human placenta donated after birth, which is kept in a warm chamber and bathed in fluids to copy how it functions during pregnancy. We can therefore track the movement of different types of antibodies across the human placenta in the laboratory, without the need for animal models. This will help us understand what regulates how well certain antibodies are passed to the baby. Our project brings together a placental biologist and an expert in antibody function, in order to answer pressing questions around how infants are protected from early-life infections, and how we can develop new vaccines in order to improve this.
Department of Pediatrics,
London School of Hygiene and Tropical Medicine, United Kingdom
Dr Margaret Ackerman
Thayer School of Engineering, Dartmouth College, USA
Dr Paul Brownbill
Division of Developmental Biology & Medicine,
The University of Manchester, United Kingdom
Babies have more protection against some diseases (e.g. whooping cough, tetanus) in the first few months of life if their mothers are vaccinated during pregnancy. Vaccines given to mothers produce antibodies that fight disease. These ‘maternal’ antibodies are passed on to babies before birth and protect them whilst they are too young to be vaccinated themselves.
Naturally, over time, maternal antibodies in babies decline. It is therefore important that, at some point, babies receive their own vaccinations to keep them protected. Timing is important. If maternal antibodies still exist in babies when they receive their first vaccinations, they may have a lower antibody response. This may mean that they are not protected as well as they could be.
In planning vaccine programmes, therefore, it is important to understand how quickly maternal antibodies decline in babies.
Currently, there is little information about the rate at which maternal antibodies decline in babies for some common vaccines. Antibody levels may decline at different rates for different vaccines. Until we know more, it is difficult to find out the best time to vaccinate babies.
We can find out more by using information from studies that have already finished. We will collect data from studies that have looked at antibody levels in two blood samples in babies. We will work out the rate at which maternal antibody levels decline in them. Combining data in this way means that we will have enough data for accurate calculations without taking any further blood samples.
Our project will provide information that will help improve the planning of vaccine programmes in order to provide the best protection for babies against disease.
Nuffield Dept Primary Care Health Sciences,
University of Oxford, United Kingdom
Dr Elke Leuridan
University of Antwerp, The Netherlands
Dr Flor Munoz-Rivas
Baylor College of Medicine, USA
Dr Ha Thi Thu Hoang
National Institute of Hygiene and Epidemiology, Vietnam
Dr Nasamon Wanlapakorn
Department of Pediatrics, Chulalongkorn University, Thailand
Prof. Andrew Pollard
Department of Paediatrics, University of Oxford, United Kingdom
Whether vaccines given to women in pregnancy (maternal immunization) have an effect on the developing immune system of the newborn baby are still not well understood. However, this knowledge is important to make sure that current and future vaccines used in pregnancy can be used in the most efficient and protective way. Whilst we have better insights into the effect of the maternal vaccines on the antigen-specific, acquired immune responses in the newborn, but there remains a gap in knowledge about effects of maternal vaccination on infant natural defense cells (innate immunity) and any potential modification of these cells.
This project will use cord blood samples collected within an ongoing large-scale observational study of neonatal vaccine responses to develop a prototype of assays in the lab that will allow us to investigate the effects of maternal antibody on the natural defense cells in the newborn. Initially we will use the model of tetanus vaccination, given that this vaccine is already routinely given to pregnant women in The Gambia. This model can then serve to assess the potential impact of other maternal vaccines on neonatal innate responses, such as pertussis or future vaccines. In addition, we will examine in another lab assay whether “training” of specific cells generated from cord blood (monocytes) by BCG -another vaccine used in the newborn- can induce changes in gene expression. We will also have the opportunity to measure if the early natural cellular responses have an influence on the antibody levels measured in response to vaccines the baby receives in the first few months of life.
This knowledge will help us to estimate if there is potential for clinical impact on longer term antigen-specific immunity in the infants or not.
The fellowship is embedded in an existing strong research partnership between the three research sponsors in Gambia, Vancouver and Brussels and will provide the fellow with the opportunity to develop an independent complimentary aspect of the research around one of the key challenges identified by the IMPRINT network.
Vaccine & Immunity Theme
Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine
Prof. Beate Kampmann
London School of Hygiene and Tropical Medicine, United Kingdom
Prof. Tobias Kollmann
University of British Columbia, Canada
Prof. Arnaud Marchant
Université Libre de Bruxelles, Belgium
Alansana received his BSc. (Hons) Biomedical Science in 2010 from the University of Manchester and his Doctorate of Philosophy in 2017 from the University of London, at the London School of Hygiene & Tropical Medicine. His career at the MRC Unit the Gambia at the London School of Hygiene & Tropical Medicine started in 2003 where he, among other positions held, served as High Scientific Officer from 2012-2016. Since 2017 he holds a postdoc position at MRC with a strong focus on Systems Biology to Identify Biomarkers of Neonatal Vaccine Immunogenicity and breakthrough infections of hepatitis B virus after vaccination. His IMPRINT funded 2 years fellowship project will tie up with his existing projects and scientific knowledge.
Whooping cough can cause serious disease, particularly in young infants. In the UK, and other countries around the world, it is recommended that pregnant women receive the whooping cough vaccine in order to protect mothers and infants against whooping cough. Antibodies (protective proteins) are transferred across the placenta from the mother to the infant and protect the infant in the first months of life, before the infant is protected by infant whooping cough vaccination. There are concerns that high levels of maternal antibody in the infant at birth may prevent the infant from producing such a good response to their own vaccines.
There is a type of blood cell in the circulation called “T Follicular Helper” cells (or TFH cells for short.) These cells are thought to be important for how well the body produces the protective antibody proteins in response to vaccination. It is important to understand if vaccination in pregnancy can affect how well these specialised cells develop in the infant’s blood stream and therefore how well the infant responds to their own vaccines. Other specialised cells that are important to how well the infant responds to infections like whooping cough, such as “T” cells, may also potentially be affected by vaccination in pregnancy.
In this study, we will work with partners in Thailand who are already carrying out studies looking at whooping cough vaccination in pregnancy. We will work with samples that have already been collected, from infants born to vaccinated mothers and infants born to unvaccinated mothers. This will allow us to compare the infant’s cellular response to vaccination in these different groups of infants.
We hope that this study will improve our understanding of infant immunity and inform future vaccination strategies.
Senior Lecturer in Immunology,
Institute of Infection and Global Health,
University of Liverpool, United Kingdom
Dr Elke Leuridan
University of Antwerp, Belgium
Prof. Yong Poovorawan
Chulalongkorn University, Thailand
The ultimate aim of our work is to develop vaccines that will be taken by pregnant women and which will then protect babies from catching infections caused by, for example, HIV, hepatitis B and Zika, during birth. The vaccines will be taken by mouth, but will have their effects in the mother’s vagina. The oral route of vaccine taking has been chosen as this route is expected to have higher acceptability and be cheaper than injections, which have to be sterile, need to be given by medically-trained personnel and can be painful. The cost factor is especially relevant in LMIC, for poorer people and where healthcare costs are largely borne by individuals, rather than the state.
For oral vaccines to have an influence in the vagina, they have to be prepared using specific chemicals, such that once a vaccine is swallowed, it is only processed in the large bowel (and nowhere else in the gut). In this project, we will: i) identify those chemicals, ii) prepare the vaccines, and iii) test whether the prepared vaccines will be processed in the large bowel following swallowing.
The results of this study will be used to apply for follow-on funding to determine whether such vaccines will have an influence in the mother’s vagina and protect newborns during birth.
Reader in Pharmaceutics,
UCL School of Pharmacy, University College London
London, United Kingdom
Prof. Abdul Basit
University College London, United Kingdom
Dr Fatme Mawas
National Institute for Biological Standards and Control, MHRA, United Kingdom
Infections and nutritional deficiencies, including iron deficiency, affect millions of young children in Low- and Middle-Income Countries (LMICs). Moreover, iron deficiency has recently been reported as the most common cause of preventable death and disability in such settings. Recent evidence indicates that iron is essential for effective immune responses, so iron deficiency could therefore contribute to impaired immunity leading to poor responses to vaccines and infection susceptibility in infants. However, the ways in which iron deficiency, and treating infants with iron supplements, influence infant immunity in LMIC settings remains poorly explored.
This proposal will address this issue by applying a state-of-the-art immunological method termed CyTOF to blood samples obtained from infants participating in a large clinical trial of iron supplementation in Bangladesh; this trial is investigating the relative pros and cons of iron treatments for infants. CyTOF will enable us to study how iron affects the array of different types of white blood cells in circulation, and the functioning of these different immune cell types. We will link this information with data collected concurrently from the same infants including their immune responses to the measles-rubella vaccine, the diversity of microorganisms found in their intestine, as well as data on infection, growth and developmental.
Together, the study will advance understanding of how nutrition can shape development of the immune system in infants in settings were the ability to mount competent immune responses to immunisations and infections is of great importance. The data will also inform global health policy makers in developing guidelines regarding the use of iron treatments in infants in infection-susceptible populations.
Senior Postdoctoral Scienti,
MRC HIU, MRC WIMM, University of Oxford, United Kingdom
Dr Sant-Rayn Pasricha
Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Australia
Dr Jena Hamadani
Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
Dr Giorgio Napolitani
MRC HIU, MRC WIMM, University of Oxford, United Kingdom
Globally each year more than 1 million infants die from infections, and most of these deaths occur in low-income countries. The time that children are at highest risk of serious infections is during the first few months after birth.
A large study conducted in India found that supplementing newborns during the first 10 days of life with probiotics, which are live, harmless bacteria, lowered the risk for sepsis, diarrhoea and lower respiratory tract infections. The beneficial effect of probiotics on preventing respiratory tract infections in particular was unexpected and intriguing, suggesting that the effect of probiotics goes beyond that of a healthy gut.
Infants in Papua New Guinea (PNG) have one of the highest risk in the world for severe respiratory infections caused by Streptococcus pneumoniae (pneumococcus), including pneumonia. Before the pneumococcus causes disease, it first colonises the infant’s nose. In PNG, almost all infants have been colonized with pneumococci by the age of 1 month.
The aim of this project is to conduct a pilot study to test two probiotic supplementations for safety and possible effects on early pneumococcal colonization and pneumococcal vaccine responses in PNG infants. This pilot study will support the implementation of a subsequent large clinical trial that will aim to study in PNG infants the direct and indirect impacts (by improving vaccine responses) of probiotics on serious infections including severe pneumonia, blood poisoning and meningitis. If proven to be efficient, probiotics supplementation could be a simple, safe and affordable intervention to safe infants’ lives.
Papua New Guinea Institute of Medical Research, Papua New Guinea
Dr Anita van den Biggelaar
Vaccine Trials Group, Telethon Kids Institute, Australia
Dr Tobias Strunk
Centre for Neonatal Research and Education University of Western Australia
Prof. Tobias Kollmann
Division of Infectious and Immunological Diseases, Department of Pediatrics, University of British Columbia, Canada
Prof. Peter Richmond
Division of Pediatrics, University of Western Australia (UWA)
Dr Andrew Greenhill
Federation University, Victoria, Australia
Oral vaccines are less effective in low-income than high-income countries, significantly limiting their potential public health impact. Despite considerable effort, the mechanisms responsible for this phenomenon remain elusive. However, there is good reason to suspect that intestinal viruses may be important. Indeed, these viruses have consistently been shown to interfere with the oral poliovirus vaccine and might also affect other vaccines given by mouth.
Recent developments in genetic sequencing techniques have enabled us to examine intestinal viruses with more precision than ever before. Rather than testing for viruses one by one, we can now detect many different families of viruses simultaneously. These ‘deep sequencing’ methods are likely to offer valuable insight into the impact of early-life viral exposure on immune development and vaccine response.
We plan to use deep sequencing to measure the composition of intestinal viruses among infants in the UK and Malawi who recently took part in a study of oral rotavirus vaccine. By measuring viral exposure at multiple times in the first 4 months of life, we will determine whether infants in the two cohorts are exposed to different viruses (a question that has not previously been explored using deep sequencing) and also whether viral exposure is greater among Malawian infants that failed to respond to the rotavirus vaccine.
The virome remains one of the unexplored frontiers of our microbiome. Our study will help to establish the impact of the virome on oral vaccine response in early life, potentially helping to identify interventions that will improve vaccine effectiveness.
Research Fellow in Systems Biology,
Department of Clinical Research, London School of Hygiene & Tropical Medicine
Dr Khuzwayo Jere
Malawi-Liverpool-Wellcome Trust Clinical Research Centre (MLW), University of Malawi
Prof Beate Kampmann
London School of Hygiene & Tropical Medicine
Prof Miren Iturriza-Gomara
University of Liverpool
Dr Nadim Ajami
Vaccination during pregnancy, also known as maternal immunization, has the potential to prevent disease and death among mothers and their infants. Maternal immunization can have tremendous impact in low and middle-income countries (LMICs) where burden of disease is very high and access to adequate healthcare can be problematic. However, not everyone is willing to accept vaccines, especially during pregnancy, due to safety and other concerns. Available maternal vaccines are safe and effective in preventing disease. Not taking vaccines puts the women and their children at risk of what can often be severe disease and this poses a significant public health challenge that needs to be addressed.
Our research project aims to identify factors of practical value that may affect individual vaccine acceptance during pregnancy. We will consider individual concerns and priorities, and factors beyond individual decision-making. This would include the influence of healthcare provider recommendation, facilitators and barriers to healthcare provider recommendation and the influence of policies and policy-maker priorities on vaccine acceptance. We also seek to understand the influence of contextual social, cultural, historical, political, economic, religious and media-related factors on vaccine acceptance.
We think that it is important to take a broad approach. Focussing on individual factors alone without considering wider influences of provider-level, policy/programme-level and contextual factors on vaccine acceptance is akin to studying diet and nutrition as determined purely by individual choice without consideration of social, cultural or financial circumstances.
We will conduct this research in India using a number of methods, including in-depth interviews, focus groups discussions and document review. Research participants will include pregnant women and new mothers, public and private healthcare providers, and policy-makers and key stakeholders. As a study outcome we will develop a comprehensive framework that looks at the relationship between public, provider, policy, structural and contextual factors on individual vaccine acceptance in order to identify ways to maximise access to and acceptance of safe and effective maternal vaccines.
Department of Infectious Disease Epidemiology
London School of Hygiene and Tropical Medicine
Prof. Heidi Larson, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
Dr Clarence Tam, Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore, Singapore
Dr G.V.S. Murthy, Indian Institute of Public Health, Hyderabad, India
Neisha (MSc, PhD; Swiss Tropical and Public Health Institute and University of Basel, Switzerland) holds a research fellowship awarded by the Swiss National Science Foundation at the London School of Hygiene and Tropical Medicine and a visiting position at the Saw Swee Hock School of Public Health, National University of Singapore. Her research interests lie in the prevention and control of infectious diseases, with a focus on vaccine confidence and acceptance. Her research focuses on human papillomavirus (HPV) vaccine implementation in Southeast Asia and global mapping of HPV vaccine confidence. Her research portfolio includes identifying individual and institutional determinants of influenza vaccination among healthcare workers in Singapore, evaluating tuberculosis control in Cambodia, pandemic influenza vaccine acceptance and influenza control in Western India, and sociocultural determinants of oral cholera vaccine acceptance in Kenya. She has a growing interest in behavioural economics and economic evaluation of vaccines and a special interest in the integration of qualitative and quantitative research methods.
Giving vaccines to pregnant women is a useful public health measure. It will help to reduce death and disease among pregnant women and newborn infants from infectious diseases. This will be most important in low- and middle-income countries (LMIC). New vaccines are being developed for use in pregnant women e.g. for Group B streptococcus, respiratory syncytial virus and cytomegalovirus. The safety of vaccines administered to pregnant women is most important for pregnant women, healthcare providers, researchers, regulators, ethics committees, vaccine developers and communities. There is a need for a global coordinated approach to determine the safety of vaccines used for pregnant women and for Maternal and Child Health (MCH) studies. The GAIA (Global Alignment of Immunization safety Assessment in pregnancy) project has developed 21 globally consistent tools (case definitions of key terms) to determine the safety of vaccines in pregnancy. These can also be used for MCH studies. Assessment of these tools in LMIC is required. This study will assess key case definitions and terms using data from clinical studies conducted in South Africa and The Gambia. The study will determine how possible it is to utilize the case definitions, the quality and accuracy of the data collected, the challenges and advantages of using the case definitions and collection of any possible edits to the case definitions that would make them easy to use in LMIC.
Global Healthcare Consulting
Department of Public Health
Erasmus University Medical Center
Rotterdam, The Netherlands
Clare Cutland, University of the Witwatersrand, South Africa
Ed Clarke, MRC Unit The Gambia, Banjul, The Gambia
Vaccines have prevented millions of child deaths; however, 45% of remaining under-5 deaths occur during the neonatal period, when infants are vulnerable to disease. Immunisation of pregnant women with tetanus toxoid to protect mother and newborn from tetanus has been widely implemented and accepted.
Maternal immunisation has the potential to reduce or prevent stillbirths and neonatal deaths from other diseases including influenza, pertussis, Group B streptococcus and Respiratory Syncytial virus. Pregnant women have not been included in clinical trials for most vaccines and medicines, due to concerns about potentially detrimental side effects on foetus/ infant and mother.
It is important to understand knowledge, perceptions and acceptance of maternal immunisation programs in different countries, especially low- middle income countries, where the vast majority of stillbirths, neonatal infections and deaths occur. Additionally, understanding of the suitability of and resources available at local health care facilities to implement large-scale maternal immunisation programs is important to enable smooth and effective roll-out of maternal immunisation programs.
South African sites have been involved in vaccine-preventable disease (VPD) surveillance programs and maternal immunisation trials, and the large burden of VPD in new-borns encourages rapid roll-out of MI programs.
In this study, we aim to first describe the perceptions about and acceptability of maternal immunisation amongst communities in urban (Soweto, Johannesburg, Gauteng) and rural (Somkhele, Mtubatuba, KwaZulu-Natal) communities in South Africa; second to understand the social and cultural factors which impact on the acceptability of maternal immunisation; and third to assess health care worker and facility preparedness for roll-out of MI programs. In order to fulfill these outcomes, we will conduct interviews and group discussions with community members, and an electronic survey of health care workers.
Respiratory and Meningeal Pathogens Research Unit, Wits Health Consortium
University of the Witwatersrand
Johannesburg, South Africa
Prof. Janet Seeley, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Social Science and Research Ethics and the University of KwaZulu-Natal, South Africa
Dr Nellie Myburgh, Respiratory and Meningeal Pathogens Research Unit, Wits Health Consortium, University of the Witwatersrand, South Africa
Dr Nothando Ngwenya, Africa Health Research Institute, South Africa
The InVxSIM project will setup a vaccine safety monitoring system in rural Uganda within the Iganga Mayuge health and demographic surveillance system (HDSS). It will focus on maternal and neonatal vaccine acceptability and safety. This project will be implemented in a population of over 90,000 individuals of which 18% are women in reproductive age. The HDSS demographic updates data that we routinely collect will be linked to the health facility electronic health records system which captures antenatal care for the mother and vaccinations in mothers and children.
The InVxSIM project will first assess the ability to measure obstetric and neonatal outcomes as defined in the GAIA project. It will also monitor the safety of maternal immunization to ensure that potential concerns are addressed rapidly. Lastly, we will build a system for identification, follow-up and delivery of reminders to get immunized to pregnant women. We hope that the project will improve information on vaccine safety, uptake and coverage, and thereby facilitate to maintain and improve trust in the maternal and neonatal immunization programs by being able to provide requested information rapidly. This may ultimately reduce mortality and morbidity because of better prevention of vaccine preventable diseases and be an example for other LMIC that may have similar fragmented information systems.
Centre Leader & Executive Director
Iganga Mayuge HDSS & Makerere University Centre for Health and Population Research
Dr Daniel Weibel, Erasmus Medical Centre, Den Haag, The Netherlands
Dr Miriam Sturkenboom, University Medical Center Utrecht, The Netherlands
Dan is the Centre Leader at the Iganga Mayuge HDSS and Executive Director of Makerere University Centre for Health and Population Research in Uganda.
He is a Biostatistician in public health with more than 15 years’ experience of coordinating and managing research projects, designing studies, analyzing and managing data from clinical trials, pharmacoepidemiological studies, large hospital and survey databases, national health information systems. He received his MSc Biostatistics (Epidemiology) from Hasselt University, Belgium, certificates in public health, project monitoring and evaluation and a PhD in Public Health from Université Catholique de Louvain (UCL), Belgium – the doctoral research title was Use of data mining methods for Pharmacovigilance in Africa setting. He has mentored students and researchers to conduct research that have contributed to influencing policy in low and middle income country (LMIC) settings. In the past, he co-facilitated the review of Uganda’s health system strategic and investment plan which has helped inform national health policy.
Tuberculosis (TB) is a disease caused by a germ that can affect the lungs and in severe cases, the blood and the brain. Almost one million children, mostly from the tropics, suffered from TB in the year 2015. A vaccine called BCG is used to prevent this disease. It is given to babies and is able to prevent severe forms of TB that involve the blood and the brain but does not provide adequate protection from the lung form which is the most common. New vaccines that are able to do a better job at preventing TB in babies are needed. VPM1002 is a vaccine that has been developed to work better than BCG. It has been tested in adults and babies and the results show that it is safe, however we need to know how well it is able to kill TB germs. This study aims to use a tool in the lab to show how well the new vaccine, VPM1002 works in babies from Uganda, an African country where TB is common.
Immunomodulation and Vaccines
Medical Research Council/UVRI Uganda Research Unit on AIDS
Prof. Alison Elliott, Medical Research Council/UVRI Uganda Research Unit on AIDS, Uganda
Prof. Gerhard Walzl, Stellenbosch University, South Africa
Dr Helen Fletcher, London School of Hygiene & Tropical Medicine, United Kingdom
Games can provide a format for reaching a large audience to disseminate important educational messages in a fun and readily available manner. Therefore, we aim to develop a game that allows the user to ‘design’ a vaccine and understand how a vaccine can protect populations against spreading infections. The goal is the full development and beta testing of the game, and its release via conduits available to us through well-established public engagement activities in Oxford, the UK, as well as in LMICs (e.g. MRC Gambia, KEMRI, icddr,b). The target group includes science teachers, sixth-form students, women thinking about pregnancy, researchers running vaccine trials (who may need to help educate intended vaccinees), and organizations who promote vaccination. After release, we will evaluate the impact of the game via monitoring numbers of downloads, collecting generic information about the player population, and asking the players themselves to describe their views on vaccination before and after playing.
MRC Human Immunology Unit & MRC Weatherall Institute of Molecular Medicine, University of Oxford, UK
Traditional birth attendants (TBAs) are community based, informally trained providers of maternal care during pregnancy, childbirth and after delivery; and they form an integral part of the social, cultural and religious fabric in most communities in Nigeria. Therefore, TBAs have the potential to contribute significantly to the uptake of maternal and neonatal immunization. Despite their limitations in handling the complications of childbirth and the Government’s promotion of hospital based skilled birth attendants as the safer option, the TBAs are widely accepted and patronized, especially in resource limited environments. The aim of the project will be to engage and empower the TBAs to be more knowledgeable with positive attitude in order to develop the willingness to promote uptake of maternal and neonatal immunization.
Ninety TBA participants will be selected from proximal rural areas within each of the three senatorial geopolitical zones of Imo State, Nigeria. The TBAs will be engaged and linked to Health Facility Immunization Focal Persons through an audio-visually structured workshop that will take into cognizance their level of education, customs and traditions. A pre and post training interviewer administered questionnaire will be used to evaluate the program with respect to the level of knowledge, attitude and willingness to promote immunization.
Imo State University Teaching Hospital, Orlu, Nigeria
Role play as an information, education and communication (IEC) tool can influence people’s choices and behaviors. This project is aimed at creating awareness of the risks associated with non-immunization and to stir up the women’s risk perception and improve uptake of maternal vaccination with Tetanus toxoid (TT). This will be a quasi-experimental study with a before and after design among women in the reproductive age group (15-49 years) in rural communities in Ebonyi State, Nigeria. A multi-staged sampling technique will be used to select 600 participants.
The study will employ short-films and role plays performed by role model actors in the communities during their public events. Pamphlets will also be designed and distributed in the local language. A baseline evaluation of knowledge, risk perception and trust in maternal vaccination among the respondents will be carried out using questionnaire pre- and post-intervention and focus group discussions prior to the commencement of the intervention. The role play and film scripts will be written to convey the health benefits of tetanus toxoid and Hepatitis B vaccinations and negative effects of the disease.
The proportion of women who are aware, have good knowledge, good perception of and are able to take up maternal vaccinations will be compared before and after the intervention.
Alex-Ekwueme University Teaching Hospital Abakaliki (Ae-Futha),
Ebonyi State, Nigeria
This project seeks to raise awareness on available maternal vaccines like tetanus in existing government health facilities of Mukono and Wakiso districts in Uganda through mass media communication by use of existing local FM radio stations. Our focus is on fishing communities as they have limited access to health facilities.
We seek to build the capacity of 50 Community Health Extension Workers (CHEWs) on the available maternal vaccines. This will include knowledge of advantages, disadvantages of maternal vaccination as well as mobilization and counseling skills. Capacity will also be built in recording, reporting vaccinations and health unit referral systems to ensure improved access, providing ongoing education and support services for the mothers. We also hope to strengthen awareness on maternal vaccination by integrating it with antenatal care, maternal and child health services among 400 expectant mothers and children through antenatal outreach at health facilities.
We furthermore aim to build the capacity of 50 secondary students to develop skits on maternal vaccines to be presented at fishing communities and /or the Uganda Virus Research Institute (UVRI).
Community education sessions on maternal vaccines will be conducted and student drama groups will be engaged and trained on maternal vaccine information. They will be supported to conduct drama shows. Local radio stations will also be engaged to support the cause.
To realize the above objectives, these activities will be implemented in collaboration with the government health facilities with UVRI-IAVI being the lead agency.
UVRI-IAVI HIV Vaccine Program, Uganda
Our project aims to capture and share perceptions of maternal and neonatal vaccination in 3 nations – the UK, Malawi and Bangladesh – which contrast in their socio-economical status, immunisation policies, ready access to antenatal health care resources and vaccine confidence levels. Using consultation groups and semi-structured interviews, we aim to produce a short-film portraying multi-national perceptions of maternal and neonatal immunisation. This short-film will then be presented to communities and audiences located within these same three locations. We will evaluate the impact of the short-film viewing and shared experiences on vaccine confidence and/or changes in perspectives around vaccination. Written feedback from participants will also be used to inform future funding initiatives, and disseminate similar short-films.
Our proposal is timely in that it builds upon an existing platform of collaborating researchers based in 3 different countries and has the ultimate goal of promoting communication about vaccination with parents and communities living in low- and middle-income countries (LMICs).
Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, UK
The goal of this project is to address risk perceptions around maternal vaccination that contribute to vaccine hesitancy in Kilifi, a rural coastal area, and in Kibera, an informal settlement, in Nairobi.
To achieve our goal, we will use magnet theatre – a form of community theatre that takes place in public spaces. Magnet theatre allows community members to participate in the dialogue and thus offers them an opportunity to reflect on the issues being addressed. A baseline evaluation of the awareness and risk perception on maternal vaccination will be carried out in women of reproductive age (15-45 years) using questionnaires and focus group discussions. The script for the magnet theatre will be written to convey the health benefits of maternal vaccination while addressing the risk perceptions. We will also produce podcasts that will be posted online to reach a wider audience.
For ownership and sustainability purposes, the Ministry of Health (MoH) will be a crucial partner in this project. We will work closely with them to develop the play. At the end of the study, the recorded play will be shared with the MoH so that it can be used by them during community health outreach events. By addressing barriers to maternal immunisation, we aim to contribute to increased vaccination rates and ultimately help reduce vaccine-preventable neonatal mortality.
Kesho Kenya, Kilifi, Kenya
Our project aim is to increase awareness of maternal immunisation in the ten parishes surrounding a maternal health specialty, Kawempe National Referral Hospital, in Uganda. Our primary target audience are pregnant women and women of child-bearing age and their influencers. The focus will be on community education emphasizing the benefits and dispelling myths and misconceptions of maternal vaccines; using these to trace and refer women who default on the maternal immunisation schedule. Using mixed methods of health promotion, the project will leverage various media channels including mobile films at community level, radio messaging, and women influencers' support groups.
Our first approach is to create folk media content by utilising a mix of video, audio and art to create awareness of maternal vaccination at community level. The media content will be developed together with pregnant women (peers), older women and men who are exemplary in the community in supporting primary health programmes.
The second strategy is to use women influencers to create awareness at household level, trace and refer eligible cases for immunisation and babies with neonatal infections for treatment. The influencers will undergo training using the Ministry of Health village health team curriculum with additional content customised to our project.
The third strategy is to develop and disseminate tailored radio spot messages and infographics on vaccination to create positive perceptions of immunisation. We will work with the district health teams to engage with communities in live information and question sessions on maternal immunisation in local radio programmes.
MU-JHU Care Ltd, Kampala, Uganda
Tetanus toxoid (TT) vaccine provided during antenatal clinic visits has proven to protect newborns from neonatal tetanus, which has a mortality rate between 30% and 70% in developing countries. The recommended dosage of TT is 5 doses; but due to a lack of awareness of TT vaccination in the communities and among women of child-bearing age, most women in Tanzania receive only 1 TT shot. Factors contributing to the receipt of two or more TT doses are higher education, wealth, and urban residence. Aspects reducing the probability of receiving the recommended dosage include a lack of awareness and misconceptions about the vaccination, specific socio-cultural beliefs, a long distance between residence and health facilities as well as different barriers related to the health system.
Our project aims to strengthen maternal vaccination awareness among communities in remote areas of the Kilimanjaro region, which will in turn improve the uptake of maternal vaccines in the future. It includes three phases:
Phase one is to educate and sensitise healthcare workers (nurse-midwives) in the importance of maternal vaccination.
Phase two is to educate community leaders to enhance one-on-one promotion of the importance of maternal vaccination with the assistance of midwives from phase one.
Phase three is to educate communities during their local meeting sessions with trained midwives and community leaders from phase one and two.
The study is expected to have a positive impact on maternal vaccination awareness especially in remote areas and will act as a precursor for sustainable programmes in other remote areas of the country.
Kilimanjaro Clinical Research Institute, Moshi, Tanzania
This project aims to increase the knowledge and promote change in social norms and behaviour pertaining to vaccination during pregnancy and the neonatal period among tribal communities in India. It will give emphasis to establishing a system within the communities, which resolves challenges and barriers related to antenatal and postnatal care, institutional delivery, neonatal health, and early immunisation. It includes the support of discussions on maternal and child-related issues in various local forums such as traditional village assemblies, Village Health Sanitation and Nutrition Days, and planning meetings of the local government. The project will also focus on capacity building and strengthening the healthcare system by promoting community-based actions with a sustainable model of community media action led by tribal people.
This model comprises the use of community radio, podcasts, and other media produced by tribal people, primarily women, to propagate their views and experiences in maternal and child health including vaccination. Thus, health communication will be done by the community members themselves, especially the women, which contributes to an enhanced comprehensibility and a strong engagement and ownership of the tribal people. The active facilitation of the dialogue between the tribal population and service providers will help break down barriers existing for many years and strengthen community capacities towards sustainable developments in the area of maternal immunisation.
Manbhum Ananda Ashram Nityananda Trust, Kolkata, India
This project aims to establish a pool of school-going adolescent girls and boys as 'immunisation ambassadors' and change agents able to engage and empower mothers and community members and link them to maternal and neonatal immunisation services.
One way of linking mothers and communities to immunisation services is by educating their daughters and sons as 'immunisation ambassadors' and mediators between their mothers and immunisation services. Up to 400 girls and 100 boys aged 15-19 years from 10 rural secondary schools in Entebbe, Uganda, will be asked to participate in this project. They will be trained on vaccines, on the importance of timely vaccination and maternal immunisation, and on leadership skills. This will equip them to become 'immunisation ambassadors' and community leaders, who will link their mothers and communities to maternal and neonatal immunisation services.
This project will reduce maternal and neonatal morbidity and mortality, and will contribute to achieving the Sustainable Development Goal target of ending preventable deaths of newborns and children under five years of age by 2030.
Uganda Virus Research Institute, Entebbe, Uganda
The IMPRINT network is coordinated by London School of Hygiene and Tropical Medicine and supported by the GCRF Networks in Vaccines Research and Development, co-funded by the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC). It is part of the EDCTP2 programme, supported by the European Union.