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Real-time benefit-risk assessment of vaccine exposure across a nationally representative primary care sentinel network: cutting edge technologies to prevent disease


Nuffield Department of Primary Care Health Sciences

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Prof S de Lusignan , Prof R Hobbs , Dr M Joy No more applications being accepted Funded PhD Project (Students Worldwide)

About the Project

We invite applications for an MRC iCASE Studentship starting October 2021: https://www.medsci.ox.ac.uk/study/graduateschool/mrcdtp/iCASE-2021
This is one of fourteen projects advertised as part of the DPhil in Interdisciplinary Medical Research, of which four projects will be funded at home level to our most successful candidates.

Overseas students can still apply, however available funding will at home level only.

Commercial partner: EMIS Group, Leeds
https://www.emisgroupplc.com/

Context
Despite good evidence about safety and effectiveness, vaccine ‘hesitancy’ or refusal is a contemporary problem acknowledged by both WHO and European Centre for Disease Control.

Currently there are few robust comparisons of individual brands or types of influenza vaccine, and a range of different vaccines will be introduced for coronavirus 2019 disease (COVID-19) in the coming season.

The national community surveillance system for influenza and other respiratory infections, the Oxford-Royal College of General Practitioners Research and Surveillance Centre, has expanded to >1,700 general practices (N>15,000,000). Its data are linked to hospital, death, and Public Health England’s virology databases [1]. It extracts pseudonymised data from practice records twice weekly.

We have developed with EMIS, the UK’s largest computerised medical record system (CMR) suppliers, a daily data extract, and a collaboration to be able to collect questionnaire data directly from patients through the EMIS “Patient Access” app. This is widely used by patients to request prescriptions, book appointments and look at results, for example 67,000 people in Oxfordshire are registered to use this app with 10 million users nationally (2.4 million prescriptions ordered monthly). We will use this app to enable patients to report contemporaneously about any adverse events of interest (AEIs) or if they have a vaccine preventable disease, post administration.

Aim
To develop and evaluate a real-time vaccine benefit-risk (VB-R) platform that includes direct contributions from patients, linked to their medical records.

Method
We will make use of conventional test-negative case-control (TNCC)[2] and cohort studies to measure vaccine effectiveness and use self-controlled case series (SCCS)[3] to report AEIs. Whilst patient questionnaires have had a high take up[4], they lack the immediacy of online reporting.

The novel in our study will be recruiting a representative sample of patients attending for vaccination to report AEIs, in the short term (7 days post-vaccination), medium term (3 months), or long term (one year).

MRC Priorities
Prevention and early detection are a key priority; rapid VB-R would enable more effective prevention programmes. Cellular manufacture of vaccines is rapid, enabling in-season deployment of a new vaccine if effectiveness were low.

Benefits for EMIS & Academics
EMIS would strengthen our relationships with practices and patients, and its Patient Access app would become a VB-R tool. EMIS is looking to expand its work with the research community and facilitate the uptake and automation of primary care research; this would provide an appropriate case study.

Changing from an end of season to real-time VB-R would demonstrate academic impact.

The novel in our study will be recruiting a representative sample of patients attending for vaccination to report AEIs, in the short term (7 days post-vaccination), medium term (3 months), or long term (one year).

How to apply

Before applying for these positions we recommend you contact the lead supervisors for informal discussions. To make a formal application, please complete the University’s online application form for the DPhil in Interdisciplinary Medical Research (MRC DTP) (course code R25_1) - https://www.ox.ac.uk/admissions/graduate/courses/interdisciplinary-medical-research
In your application, you must indicate that you are applying for an advertised studentship competition, using the reference code iCASE

Applications
Applications are open for entry in the 2021-22 academic year, and the main deadline is 12:00 noon on Friday 8 January 2021.

References

[1] de Lusignan S, Jones N, Dorward J, et al. The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms. JMIR Public Health Surveill. 2020;6(3):e19773. Published 2020 Jul 2. doi:10.2196/19773

[2] Pebody RG, Warburton F, Andrews N, et al. Uptake and effectiveness of influenza vaccine in those aged 65 years and older in the United Kingdom, influenza seasons 2010/11 to 2016/17. Euro Surveill. 2018;23(39):1800092. doi:10.2807/1560-7917.ES.2018.23.39.1800092

[3] Cross JW, Joy M, McGee C, Akinyemi O, Gatenby P, de Lusignan S. Adverse events of interest vary by influenza vaccine type and brand: Sentinel network study of eight seasons (2010-2018). Vaccine. 2020;3822):3869-3880. doi:10.1016/j.vaccine.2020.03.034

[4] de Lusignan S, Damaso S, Ferreira F, et al. Brand-specific enhanced safety surveillance of GSK's Fluarix Tetra seasonal influenza vaccine in England: 2017/2018 season [published online ahead of print, 2020 Mar 2]. Hum Vaccine Immunother. 2020;1-10. doi:10.1080/21645515.2019.1705112
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