Translational Epidemiology translates scientific knowledge into a health tool.

1. TRANSLATIONAL
EPIDEMIOLOGY
Dr. Adhiraj Mishra, Research Scholar
Dr. BR Singh, Head Division of
Epidemiology Indian Veterinary
Research Institute, Izatnagar
& Director CCS NIAH, Baghpat

2. “Knowing is not enough; we must apply”
“Willing is not enough; we must do.”
Johann Wolfgang von Goethe

3. Why Translation ?
(NIH, 2013)

4. Defining Translational Epidemiology
(1)The study of distribution and determinants of the health
related events in a population is Epidemiology
(2) Application of this study to control health related events
is Translational Epidemiology .
(Moyses Szklo, 2013)

5. Translational Research vs.
Translational Epidemiology
• Translational Research transforms scientific
discoveries arising out from laboratory into
clinical application to reduce incidence,
morbidity and mortality.
• Translational Epidemiology is the effective
transfer of new knowledge resulting from
epidemiologic studies (including trials) into
planning of population wide and individual level
disease control programme and policies.
(Moyses Szklo, 2013)

6. Bench & Bedside to Population
Translational Epidemiology is
stretching the discoveries of TR
beyond the bedside to reach the
population.
(American College of Epidemiology, 2006)
Bench & Bedside to Population

7. History
Adopted since mid 1800
when the Broad Street
Pump was closed after
John Snow traced Cholera
epidemic to this pump.
(Cameron D, Int J Epidemol 1983)

8. Phases of Translational
Research
Candidate
Application
Evidence Based
recommendation
of policy
Practice & Control
Programs
Population Health-
Disease Burden
Scientific
Discovery
T2
T1
T0
T4
T3
Knowledge
Synthesis

9. Bench-to-Bedside Valley
T0

10. T-0-Scientific Discovery
• New knowledge insight into the causes,
pathobiology, or natural history of disease.
• It includes the pre clinical and animal studies.
• Epidemiology describes the health outcomes by APT,
determinants and risk factors.
(Khoury MJ, Am J Epidemiol, 2010)

11. T-1- Discovery to Health Application
Discovery

12. Methods in T-1 Epidemiology
• Evaluating interaction
(Epidemiological Triad, Wheel & Web)
• Diagnostic Testing
(Sensitivity, Specificity, Predictive Values, Likelihood
Ratios, Area Under the curve & ROC)
• Proof of Concept (POC):
Establishes the safety of drug candidates in the target
population and explore the relationship between the
dose and desired activity.
• First in Human (FIH)Trials:
Experiences with animal testing is extended to
human subjects for the first time.

13. • Phase -1 Clinical Trial:
First stage of testing in human subjects in a group of
20–100 healthy volunteers.
Assessment of safety, tolerability, pharmacokinetics
and pharmaco-dynamics and dose ranging of a drug.
• Human Volunteer:
They advance medical knowledge, provide scientific
information important to developing new treatments
for disease.
• Health Economics: Cost Effectiveness.
Methods in T-1 Epidemiology

14. T-2- Health Application to
Evidence Guidelines

15. Methods in T-2 Epidemiology
• Evidence based recommendations:
 It uses the experience of a population of patients reported in the
research literature to guide decision making in practice.
 It requires the application of population-based data to the care
of an individual patient.
• Observational & Experimental Studies:
It includes the cross sectional, cohort, case control, RCTs and Non
randomised trials to determine the clinical utility.
• Phase III Clinical Trials
Assesses the effectiveness by Randomized controlled multicenter
trials on large patient groups (300–3,000) and are aimed at being
the definitive assessment of how effective the drug is, in comparison
with current 'gold standard' treatment.
Methods in T-2 Epidemiology

16. T-3- Practice Guidelines to Health
Practice

17. Methods in T-3 Epidemiology
• Implementation Research:
Scientific inquiry into questions concerning
implementation—the act of carrying an intention into effect,
which in health research can be policies, programmes, or
individual practices (collectively called interventions).
• Dissemination Research:
Examination how health promotion interventions can be
effectively created, packaged, transmitted, and adopted.
• Phase IV Clinical Trials:
Post marketing surveillance trial. Phase IV trials involve the
safety surveillance (pharmaco-vigilance) and ongoing
technical support of a drug after it receives permission to be
sold.
Methods in T-3 Epidemiology

18. T-4-Health Practice to Improved
Health

19. Methods in T-4 Epidemiology
• Surveillance Research.
• Real World Outcome research:
It studies the end results of medical care. It evaluates the
results of the health care process in the real-life world of
the doctor’s office, hospital, health clinic and even the
home.
• Feedback Mechanism.
• Social Determinants of Health:
These are the economic and social conditions – and their
distribution among the population – that influence
individual and group differences in health status.
Methods in T-4 Epidemiology

20. Drivers of Translational
Epidemiology
(Larn T K et al, AACR, 2013)
Discoveries

21. Technology
• ‘omics’ e.g proteomics,
epigenomics, metabolomics.
• Digital epidemiology
• Communication science
• Infodemiology.
Collaboration & Team Science
• Concerted effort
• Team Science initiatives across
disciplines.
• Well characterised cohort
studies with large sample size.

22. Multilevel Analysis & Interventions
Multilevel model with interaction between person(biologic,
risk factor, socio-demographic characteristics), the
provider, family and social supports, organization or
practice setting and local community environment.
.
Knowledge Integration
• Knowledge Management
• Knowledge synthesis
• Knowledge translation

23. Translational Epidemiology & One
Health
• Interface between
experts of human,
animal &
environmental field.
• Vertical One Health
Process.
• Advances in current
diagnosis & treatment
(Tang Yi-Wei, Vet Microbiol, 2013)

24. Challenges in Translational
Research
• Basic Research is not clinically relevant.
• Shortage of translational investigators.
• Inadequate collaborative approach.
• Poorly integrated activity from academia to private
sector and industry.
• Inadequate financial support.
• Regulatory impediments to translation.
• Inflexible clinical trial designs.
(Pober SJ et.al, 2001)

25. Traversing the Valley of Death
 Provide access to adequate funding.
 Adequate potential commercial market & industry
partner.
 Inference from human & animal data about likely
safety and efficacy.
 Remove physical barriers blocking collaboration.
 Restructure the academic environment.
 Provide support for administrative
facilitation & regulatory compliance.
(Coller BS et.al, 2009)

26. TE Research Institutes in India

27. Summary
• Epidemiology is a fundamental science for
translating basic discoveries into population health
benefits.
• TE provides the key data needed to document
what we know and what we do not know, and
what works and what does not work, thus
influencing further research, practice, and policy
development.
• TE is a necessary ingredient to move specific
discoveries from research into practice in an
evidence based fashion.

28. Recommendations
• Bio-medical Research Institutes should have clinic
facility.
• All research institutes & academia should adopt
translational models for research.
• Funding should be balanced between clinical &
population based research.
• Interdisciplinary collaboration & Team work.