Project of Febrile Illness Surveillance in the Andean and Amazon Countries (PISAAC)

项目摘要/摘要 急性热病(AFI)是拉丁美洲发病率和生产力丧失的重要原因。 尽管在监测和诊断能力方面做出了努力，但AFI的病因仍然是 超过50%的病例是未知的。我们在安第斯山脉和亚马逊地区的热病监测项目 各国(“PISAAC”)建议研究AFI病原学和流行病学，以加强核心公众 预防并在疫情爆发前及时采取应对措施的卫生系统。 PISAAC由赫雷迪亚大学的Eduardo Gotuzzo博士领导，是一个多机构 与秘鲁卫生部的主要行为者和机构密切合作制定的倡议 卫生部(MoH)，包括秘鲁国家卫生研究所(INS)。这一倡议将得到实施 与国家卫生研究所合作，Leopoldo Izquieta Perez(INSPI)和Escuela 厄瓜多尔高级国民议会(西班牙)，旨在制定一项协调努力，以 在南部沿海、安第斯和亚马逊地区建立系统的监测系统 美国。其他主要合作伙伴包括美国海军医学研究单位N：6和加州大学 加尔维斯顿的德克萨斯医疗分部。 我们的具体目标是确定急性未分化发热的病因和流行病学。 在秘鲁和厄瓜多尔战略选择的地区感染疾病，提高实验室能力 诊断疾病，产生及时和准确的监测数据，并培养一支能够 继续采取这些措施。此外，我们的目标是确定抗菌剂的普及率 耐药性以及急性腹泻的病原学和抗菌素耐药性。 这项研究将于第一年在秘鲁的两个地区开始。随后，在第二年， 厄瓜多尔将增加两个地区，每个国家每年将增加1至2个新地区。这个 最初阶段是一项关于哨兵监测的前瞻性研究，将招募出现以下情况的受试者 具有AFI的初级和二级医疗保健中心。血液和血清样本将被 在急性表现时采取基于聚合酶链式反应的检测和血清学。此外，尿液和鼻腔样本 将被收集并与血清蛋白一起储存在生物储存库中，以供未来研究。 对于结果为阴性的患者，将收集恢复期血清进行配对血清学测试 用于分子方法的初步检测。在第二年，抗菌剂的成分 将实施耐药性(AMR)监测和腹泻病监测，因为这两个 健康问题被认为是秘鲁的公共卫生优先事项。 PISAAC在加强国家监控和应急响应方面处于独特地位 这些系统建立在现有的基础设施和公共卫生服务平台上，提供 从实验室诊断到疾病控制的战略互补伙伴关系，并解决核心问题 全球卫生安全议程所要求的技术领域。

Project Summary/Abstract Acute febrile illness (AFI) is an important cause of morbidity and productivity loss in Latin America. Despite efforts for surveillance and advancements in diagnostic capacity, the etiology of AFI is still unknown in over 50% of cases. Our Project of Febrile Illness Surveillance in the Andean and Amazon Countries (“PISAAC”) proposes to study AFI etiology and epidemiology, to strengthen the core public health systems that prevent and mount prompt containing responses in front of outbreaks. PISAAC, led by Dr. Eduardo Gotuzzo at Universidad Cayetano Heredia, is a multi institutional initiative developed in close collaboration with key actors and institutions at the Peruvian Ministry of Health (MoH), including the Peruvian National Health Institute (INS). This initiative will be carried out in partnership with the National Institute of Health Leopoldo Izquieta Perez (INSPI) and Escuela Superior Politécnica del Litoral (ESPOL), in Ecuador, aiming to develop a coordinated effort to establish a systematic surveillance system within the Coastal, Andean and Amazon regions of South America. Additional key partners include U.S. Naval Medical Research Unit Nº6, and the University of Texas Medical Branch in Galveston. Our specific aims are to determine the etiology and epidemiology of acute undifferentiated febrile illness in strategically selected regions of Peru and Ecuador, improve laboratory capacity for the diagnosis of illness, produce timely and accurate surveillance data, and develop a workforce that can continue with these measures. Additionally, we aim to determine the prevalence of antimicrobial resistance, and the etiology and antimicrobial resistance of acute diarrheal disease. The study will start in two regions in Peru during the first year. Subsequently, during the second year, two regions in Ecuador will be added, and 1 to 2 new regions per country will be added per year. The initial stage is a prospective study of sentinel surveillance that will enroll subjects that present to healthcare centers of primary and secondary care level with AFIs. Blood and serum samples will be taken at acute presentation for PCR based tests and serology. Additionally, urine and nasal samples will be collected and stored along with serum alliquotes in a biorepository for future studies. Convalescent sera will be collected for paired serology testing in those patients that resulted negative for initial testing with molecular methods. During the second year, components of antimicrobial resistance (AMR) surveillance and diarrheal disease surveillance will be implemented, as these two health problems are considered public health priorities for Peru. PISAAC is in a unique position to strengthen the national surveillance and emergency response systems as it builds upon the pre-existing infrastructure and public health delivery platforms, provides strategic complementary partnerships across lab diagnosis to disease control and addresses the core technical areas demanded by the Global Health Security Agenda.