School of Public Health

The Gambia, Mali, and Kenya

Rotavirus vaccine effectiveness in sub-Saharan Africa

Lauren Schwartz
PhD Student, Epidemiology

Doctoral candidate, Lauren Schwartz, won a prestigious F31 research fellowship grant from the National Institutes of Health. The purpose of these pre-doctoral awards is to enable students to obtain funding while conducting dissertation research in scientific health-related fields relevant to the missions of a variety of NIH Institutes and Centers. 

The multi-year award is for about $43,000 per year to cover the trainee’s doctoral stipend and tuition. The awards are notoriously difficult to get, with success rates well below 20% for most NIH Institutes/Centers. We sat down with Lauren to learn more.

Saliva collection on the first baby in the study, taken in Mali

What is your research topic?
I was awarded funding from the National Institute of Allergy and Infectious Diseases (NIAID). This grant focuses on an ongoing project in collaboration with the University of Maryland’s Center for Vaccine Development to enroll cases with severe diarrhea and healthy matched controls among children under five years old in Mali, Kenya, and The Gambia. The study aims to estimate the effectiveness of rotavirus vaccine and to understand the causes of severe diarrhea. My sub-study leverages the infrastructure from this larger ongoing study to try to determine the reasons that vaccine effectiveness in sub-Saharan Africa and Southeast Asia is only 40-60% compared to 90% in the U.S. and Europe. There are several proposed mechanisms for a decreased effectiveness, including the role of the microbiome, malnutrition, co-enteric infection, and others. By collecting saliva in cases and controls who have received rotavirus vaccine, the study hopes to determine how genetic determinants may influence vaccine failure, a previously unstudied hypothesis of low vaccine effectiveness.

You traveled to Africa for this project?
In January I went to The Gambia for the annual investigators meeting. I presented my scientific rationale for the study before any work began so that local investigators would be on board for what we were planning to do. There was also representation from the Gates Foundation, the funder of the parent study. That’s when we found out that they were providing supplementary money to assist with this project. The F31 grant funds my stipend and my tuition and the Gates Foundation is funding the purchase of saliva collection kits, laboratory testing, and my travel to study sites. I also spent about a week at the field site in The Gambia starting saliva collection training. 

I also traveled to Mali and Kenya to lead saliva collection training to all of the staff who would be collecting saliva on the kids. Although it is relatively straightforward, it allowed us to talk through some of the site-specific logistics and potential challenges, such as making sure that we are getting the saliva into the refrigerator and eventually into the freezer in the right amount of time (the laboratory can be a two-hour drive in 85-degree heat) or how to best collect saliva in severely dehydrated children. 

Taking a ride on a donkey cart with Dr. Jones, one of the clinical investigators in the GambiaHow has the experience impacted your work?
I was lucky to be able to see saliva collected from the very first child enrolled in the sub-study while I was in Mali. After almost a year of reading and writing about this subject, seeing that first child in the clinic was such an important experience for me. In a couple of weeks, I’ll be going back to Mali to review some of those protocols. I’ll be able to see how everything is going and gain more experience with the larger study overall. Although I am mostly focused on my sub-study, it’s a huge study which will eventually have thousands enrolled, so it’s important that I understand all of the larger components.