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Adjusting Pneumonia Vaccination to Save Lives

Publication date: December 8, 2011

Nearly a million children die from pneumonia each year, making it a leading cause of death in children, and the single most important public health problem for children under the age of five. Most babies with access to preventive care receive three doses of the vaccine at 6, 10, and 14 weeks of age. The schedule is not ideal, as children are highly vulnerable until five years of age—and the vaccination schedule is designed to provide protection for the earlier years.

“The children’s doctors there said, ‘We don’t know why the children are dying in the hospital. Come and help.’ So that’s why we started working there. What we found was that the most important cause of serious illness in the hospital was pneumonia.”

— Andrew Pollard, director, Oxford Vaccine Group

The Oxford Vaccine Group is conducting a program in Nepal to determine if altering the vaccination schedule can extend childhood immunity throughout those critical first five years. For the trial, the team is scheduling the first two doses to infants who are 6 and 14 weeks old. The third dose is then administered when the infants are eight months old. The team is hopeful that this delay in administering the final vaccination will protect children until a much later age, thus reducing mortality from this serious disease.

Andrew Pollard, director, Oxford Vaccine GroupAndrew Pollard, director, Oxford Vaccine Group"I’m passionate about Nepal because it is one of the poorest countries in the world, where there’s a huge need," said Andrew Pollard, director of the Oxford Vaccine Group and professor of Paediatric Infection and Immunity, University of Oxford. "I believe that with this project, there are things we can do, which will make a difference to the lives of children there."

Building Solutions with Everyday Technology

One of the biggest problems in medical informatics is keeping track of data and all of the associated details. Researchers must meticulously log who collected the data, how it was collected, and any associated information. Manually inputting this level of detail takes time away from actual research, while incomplete entries may cause problems for other researchers attempting to follow up.

Jim Davies, professor, Software Engineering, OxfordJim Davies, professor, Software Engineering, Oxford"If you can sort out some of the paperwork for [researchers] by building large-scale scientific office solutions that work," says Jim Davies, professor of Software Engineering at the University of Oxford, "then you have more time for them to display their genius and solve the health—or social, or government, or scientific—problems that they’re there to do."

A team of six people from Oxford’s Department of Computer Science is working on software support for medical informatics. "Since 2005, we’ve been developing what you might call semantics-based solutions," Davies says. "That is the meaning of the data. It is associated with the data at the point of capture and that association is maintained throughout the whole lifecycle of the data, so that whenever that data is processed and used as evidence, you know where it came from."

“So what we were able to do was give them full document management support for their clinical studies—both in this country and in Nepal—using a combination of Microsoft tools.”

— Jim Davies, professor of Software Engineering, University of Oxford

The University of Oxford team, with support from Microsoft Research, developed software to address these issues in support of clinical trials and clinical studies in cancer. Based on Microsoft SharePoint and Microsoft InfoPath, the system—called CancerGrid—can be used to create and deploy clinical trial support infrastructure in a fraction of the time, at a fraction of the cost, of conventional methods. The system can collect semantically well-defined and standardized data from multiple sources; however, the greater benefit is its ability to combine data simply and efficiently.

The University of Oxford Department of Computer Science team recognized that their colleagues in the Oxford Vaccine Group needed support for their clinical trial operations, and believed the CancerGrid technology could be of use.

Evolving Technology

New software uses Microsoft technologies to provide full document management support for clinical vaccine studies.New software uses Microsoft technologies to provide full document management support for clinical vaccine studies.By applying the technologies that they had developed for cancer research, the University of Oxford team created new software to support clinical studies of vaccines. The new software, called Vaccine Data Management (VDM), used a combination of InfoPath, SharePoint, Microsoft Excel, and Windows Azure services to provide full document management support for the Oxford Vaccine Group’s clinical cancer vaccine studies in both England and Nepal.

"We’re using Microsoft InfoPath, which was exactly what they needed so that the researchers, the domain experts, could use this on their own desktops to create the forms they needed to acquire data," Davies said. "These forms could then be fed into a SharePoint server and accessed from within rather than a broad collaboration." The InfoPath and SharePoint technologies enable the team to distribute and manage forms securely, a critical requirement for ensuring patient privacy during clinical trials.

The researchers in Nepal now transmit data back to the University of Oxford in real time through a secure Internet connection. The level of data input that is required has been reduced, allowing them to spend more time performing actual research. The CancerGrid tool, and now VDM, were both developed with financial and technical support from Microsoft Research. It has been a very satisfying collaboration for both teams.