Understanding the epidemiology and natural history of unrecognized Ebola virus infection

了解未被识别的埃博拉病毒感染的流行病学和自然史

• 批准号: 10224704
• 负责人: John Daniel Kelly
• 金额: $ 19.91万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224704
• 关键词: Address; African; Animals; Antibodies; Antibody Response; Area; Biometry; Blindness; Caring; Clinical; Comprehensive Health Care; Counseling; Data Analyses; Data Collection; Detection; Development; Diagnosis; Disease; Disease Outbreaks; Ebola; Ebola Hemorrhagic Fever; Ebola virus; Emerging Communicable Diseases; Enrollment; Epidemiology; Exposure to; Filovirus; Follow-Up Studies; Future; Glycoproteins; Health care facility; Healthcare; Immunoglobulin G; Individual; Infection; Inflammatory Response; International; Lead; Liberia; Link; Longitudinal Studies; Longitudinal cohort; Low Prevalence; Marburgvirus; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Monkeypox; National Institute of Allergy and Infectious Disease; Natural History; Observational Study; Outcome; Patients; Policies; Population; Population Sizes; Prevalence; Public Health; Publishing; Quality of life; Recording of previous events; Reporting; Research; Resolution; Resources; Risk; Serology; Services; Survivors; Symptoms; Uveitis; Viral; Viral Hemorrhagic Fevers; Virus; Virus Diseases; Work; World Health Organization; anxiety symptoms; base; career development; clinical care; cohort; data management; depressive symptoms; design; disability; improved; programs; psychosocial; recruit; seropositive; serosurvey; skills; tool

PROJECT SUMMARY/ABSTRACT A large number of Ebola virus infections may have been unrecognized during the 2013-2016 West African outbreak, both undiagnosed Ebola virus disease (EVD) as well as mildly symptomatic and asymptomatic infection. The epidemiology and natural history of infection in this unrecognized population, which is defined by positive Ebola serology and a history of exposure, are poorly understood. For instance, it is unknown if individuals with unrecognized infection have similar clinical and psychosocial sequelae as recognized cases, such as uveitis, depression, and work-related disability. Understanding the extent to which post-infectious sequelae occur and the predictors of unrecognized infection will bolster efforts to screen and link unrecognized, infected individuals - both symptomatic and asymptomatic - to survivor services and to better identify this population in future outbreaks. I will study a well characterized cohort of individuals with serological evidence of past, unrecognized, Ebola virus infection. I will utilize an existing cohort of close contacts of EVD survivors developed by the National Institute of Allergy and Infectious Diseases' Partnership for Research on Ebola Virus in Liberia (PREVAIL). The PREVAIL program began a natural history study of EVD survivors and their close contacts in June 2015. Over 1,100 EVD survivors have been enrolled with the aim of characterizing their post-EVD clinical sequelae, viral persistence, and durability of antibody response. Over 2,300 close contacts have also been enrolled as the comparison population. A total of 230 (10%) close contacts of EVD survivors were found to be seropositive by the quantitative FANG Ebola EIA and had not been reported as having had EVD. At study baseline, 57% of this population reported having had symptoms in the three-week period after exposure to Ebola virus, and 43% did not. This will be the first systematic, longitudinal study of unrecognized survivors of Ebola virus infection. This K23 proposal aims to: (1) identify the clinical sequelae of unrecognized, symptomatic Ebola virus infection, (2) identify the predictors and clinical sequelae of unrecognized, asymptomatic Ebola virus infection, and (3) identify psychosocial sequelae among unrecognized, symptomatic EVD survivors. My career development aims involve: (1) design of observational studies, (2) advanced biostatistics, and (3) field epidemiology in low-resource settings. This plan will be carried out with coursework, directed study, and the guidance of an international team of mentors. In addition to future study of longer-term sequelae of EVD, I will apply these skills and expertise to an R01 application in which I study the epidemiology and natural history of other viral hemorrhagic fever and emerging infectious diseases such as Marburg virus and monkeypox.

项目概要/摘要 2013-2016年西方国家可能没有认识到大量埃博拉病毒感染 非洲疫情爆发，既有未确诊的埃博拉病毒病（EVD），也有轻度症状和 无症状感染者。这个未被识别的人群的流行病学和感染自然史， 它是由埃博拉血清学阳性和接触史定义的，但人们对此知之甚少。例如，它是 未知感染者是否具有与以下类似的临床和心理社会后遗症 公认的病例，例如葡萄膜炎、抑郁症和与工作相关的残疾。了解程度 感染后后遗症的发生和未识别感染的预测因素将加强筛查和预防工作 将未被识别的感染者（有症状和无症状）与幸存者服务和联系联系起来 在未来的疫情爆发中更好地识别这一人群。 我将研究一组特征明确的个体，这些个体具有过去未被识别的血清学证据， 埃博拉病毒感染。我将利用由埃博拉病毒病幸存者建立的现有密切接触者群体 国家过敏和传染病研究所在利比里亚开展埃博拉病毒研究合作伙伴关系 （获胜）。 PREVAIL 项目开始对埃博拉病毒病幸存者及其密切接触者进行自然史研究 2015 年 6 月。已招募了超过 1,100 名埃博拉病毒病幸存者，旨在描述他们的埃博拉病毒病后临床特征 后遗症、病毒持续性和抗体反应的持久性。超过2,300名密切接触者也已被隔离 纳入为比较人群。共有 230 名（10%）埃博拉病毒病幸存者的密切接触者被发现 定量 FANG 埃博拉埃博拉 EIA 呈血清阳性，尚未报告患有埃博拉病毒病。学习中 基线时，该人群中 57% 的人报告在接触 埃博拉病毒，43% 没有。这将是第一个针对未被承认的幸存者的系统性纵向研究 埃博拉病毒感染。 该 K23 提案旨在：(1) 识别未被识别的、有症状的埃博拉病毒的临床后遗症 感染，(2) 确定未被识别的无症状埃博拉病毒感染的预测因子和临床后遗症， (3) 识别未被识别的、有症状的埃博拉病毒病幸存者的心理社会后遗症。我的职业生涯 发展目标包括：（1）观察研究的设计，（2）高级生物统计学，以及（3）现场 资源匮乏地区的流行病学。该计划将通过课程作业、定向学习和 国际导师团队的指导。除了未来对埃博拉病毒病长期后遗症的研究之外，我还将 将这些技能和专业知识应用到 R01 应用程序中，我在该应用程序中研究流行病学和自然史 其他病毒性出血热和新出现的传染病，如马尔堡病毒和猴痘。