2026-27 Project (Khan & McCreesh & Sumner)
Investigating the effect of influenza on risk of tuberculosis in South Africa
SUPERVISORY TEAM
Supervisor
Dr Palwasha Khan at LSHTM
Faculty of Infectious & Tropical Diseases, Department of Clinical Research
Email: palwasha.khan@lshtm.ac.uk
Co-Supervisor
Dr Nicky McCreesh at LSHTM
Faculty of Epidemiology & Population Health, Department of Infectious Disease Epidemiology and Dynamics
Email: nicky.mccreesh@lshtm.ac.uk
Co-Supervisor
Dr Tom Sumner at LSHTM
Faculty of Epidemiology & Population Health, Department of Infectious Disease Epidemiology and Dynamics
Email: tom.sumner@lshtm.ac.uk
PROJECT SUMMARY
Project Summary
In order to substantially reduce the global TB burden, additional control interventions are urgently required. Identifying modifiable factors which risk of progression to TB could lead to innovative interventions to curtail the epidemic. The public health benefit of identifying common viral infections, such as influenza, which increase the risk of TB, and which can be targeted with vaccine interventions, may be substantial. For the first phase of the PhD, the student will use curated datasets from the Western Cape Provincial Health Data Centre to investigate the association between influenza and tuberculosis using 2 different study designs. During the second phase, the student will develop and calibrate a mathematical model of tuberculosis and influenza transmission in South Africa, incorporating the impact of influenza on risk of developing TB. They will model different levels of influenza vaccine coverage in different risk groups, and estimate the impact on TB incidence and mortality.
Project Key Words
influenza, tuberculosis, influenza vaccination, South Africa
MRC LID Themes
- Infectious Disease
- Global Health
- Health Data Science
Skills
MRC Core Skills
- Quantitative skills
- Interdisciplinary skills
Skills we expect a student to develop/acquire whilst pursuing this project:
The student will develop or improve their skills in quantitative data analysis and mathematical modelling. They will also develop an understanding of causal inference, TB epidemiology and mathematical modelling.
Routes
Which route/s are available with this project?
- 1+4 = Yes
- +4 = Yes
Possible Master’s programme options identified by supervisory team for 1+4 applicants:
- LSHTM – MSc Epidemiology
- LSHTM – MSc Health Data Science
- LSHTM – MSc Medical Statistics
Full-time/Part-time Study
Is this project available for full-time study? Yes
Is this project available for part-time study? Yes
Location & Travel
Students funded through MRC LID are expected to work on site at their primary institution. At a minimum, all students must meet the institutional research degree regulations and expectations about onsite working and under this scheme they may be expected to work onsite (in-person) more frequently. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training for research degree study and training. Other travel expectations and opportunities highlighted by the supervisory team are noted below.
Day-to-day work (primary location) for the duration of this research degree project will be at: LSHTM – Bloomsbury, London
Travel requirements for this project: None
Eligibility/Requirements
Particular prior educational requirements for a student undertaking this project
- Minimum standard institutional eligibility criteria for doctoral study at LSHTM
- We would normally expect applicants to have a Master’s in a quantitative field, e.g. epidemiology, statistics, maths, computing. We may recommend that some applicants apply for a 1+4 studentship, such as applicants with a Master’s in a public health related field with only basic quantitative skills.
Other useful information
- Potential Industrial CASE (iCASE) conversion? = No
PROJECT IN MORE DETAIL
Scientific description of this research project
It is well known that HIV infection increases the risk of progression from M. tuberculosis infection to tuberculosis, but the effect of other viral infections, such as influenza, on the natural history of TB remains ill-defined. An association between influenza and TB has been postulated since the 1918 influenza and increases in TB burden and/or mortality associated with influenza epidemics have continued to be widely reported. This potential association between influenza and TB may explain the globally consistent seasonality of TB with peak case notifications in spring/summer, 20-25% higher than in autumn/winter. Influenza infections in winter months may trigger a detrimental host immune response leading to progression of a previously contained M. tuberculosis infection over the ensuing 3 to 6 months, manifesting as TB in the spring or summer. We hypothesize that influenza triggers progression to TB in those with M. tuberculosis infection, and that vaccination-induced prevention of influenza reduces the risk of TB.
Research questions
- Does influenza increase the risk of TB in South Africa?
- Does prevention of influenza through vaccination reduce the risk of TB in South Africa?
- What would be the impact on TB incidence in South Africa of increased influenza vaccine coverage?
This project will investigate the relationship of influenza and TB in adults using large, validated datasets of electronic health records curated from the Western Cape Provincial Health Data Centre in South Africa. We will use two study designs to address the research questions 1 and 2: a longitudinal cohort study and a self-controlled case series (SCCS). The cohort study will provide an absolute measure and relative incidence of influenza-associated TB incidence. Whilst the SCCS only estimates a relative incidence, it implicitly controls for time-fixed confounders (a major strength)as each individual acts as its own control, and also has high statistical efficiency relative to the cohort method. Both designs determine whether there is a temporal association between influenza and TB.
For research question 1 the exposures of interest will be (i) laboratory-confirmed influenza and (ii) influenza-like illness.
For research question 2 the exposure of interest will be influenza vaccination. The exposed period will be the 6 months following vaccination, to reflect the period when influenza is circulating.
For research question 3, the student will develop and calibrate a mathematical model of tuberculosis and influenza transmission in South Africa, incorporating the impact of influenza on the risk of developing TB. They will model different levels of influenza vaccine coverage in different risk groups, and estimate the impact on TB incidence and mortality.
Further reading
Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)
Other pre-application materials:
Additional information from the supervisory team
The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.
Khan & McCreesh & Sumner Recording
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