Hospital-Associated Respiratory Virus Infections: Molecular Epidemiology, Clinical Outcomes, and Cost-Effectiveness of Interventions

项目概要/摘要 医院相关呼吸道病毒感染（HA-RVI）导致发病率、死亡率和医疗保健增加 但这些感染往往诊断不足或误诊，特别是对呼吸道病毒以外的 流感。通过适当的治疗和感染控制措施，HA-RVI是可以预防的， 不完全的诊断导致错失干预的机会。利用这些机会 干预可能需要额外的诊断测试和扩大感染控制措施。的 这些方法的成本效益程度尚不清楚。因此，有必要定义 呼吸道病毒在医院环境中的负担和临床影响， 感染预防策略。该项目的总体目标是支持乔希皮特里，博士在 发展卫生保健流行病学的专业知识，最先进的分子方法， 建模技术这一目标将通过有重点的培训和职业发展来实现 医疗流行病学、下一代测序、生物信息学、成本效益分析、 和数学建模，由一个优秀的导师团队监督。这些技能是由 培训和职业发展目标将通过指导研究得到加强， 以下具体目标：（1）定义社区获得性和医院获得性的流行病学和负担， 相关的呼吸道病毒感染，并比较病毒种类的临床影响;（2）提高敏感性 和病例定义的特异性，以通过整合临床， 流行病学和分子数据;（3）确定增加呼吸道病毒的成本效益 筛选和扩大感染控制措施，以减少HA-RVI使用数学模型。完成 培训和研究计划的一部分将代表皮特里博士实现他的目标的下一步 长期目标是建立一个独立的研究计划，利用多学科实验室， 调查流感和其他呼吸道病毒传播的分析方法。预期 拟议项目的研究成果包括：1）鉴定呼吸道病毒， 流感是导致最多HA-RVI的原因，并导致最严重的临床结果; 2)通过整合临床， 流行病学和分子数据; 3）确定具有成本效益的诊断检测和干预措施 实施HA-RVI预防战略。这项研究的重要性在于， 这项工作的成果和今后在此基础上开展的研究将导致发病率的降低， 死亡率和与HA-RVI相关的医疗费用。这项研究的创新之处在于， 一组重要的呼吸道病毒及其跨学科方法的使用， 研究的途径。

PROJECT SUMMARY / ABSTRACT Hospital-associated respiratory virus infections (HA-RVI) lead to increased morbidity, mortality, and healthcare costs, but these infections are often under- or misdiagnosed particularly for respiratory viruses other than influenza. HA-RVI are preventable through appropriate treatment and infection control measures, but incomplete diagnosis leads to missed opportunities for intervention. Taking advantage of these opportunities for intervention might require additional diagnostic testing and expanded infection control measures. The degree to which these approaches would be cost-effective is unclear. Therefore, there is a need to define the burden and clinical impact of respiratory viruses in the hospital setting to inform optimal diagnostic, treatment and infection prevention strategies. The overall objective of this project is to support Josh Petrie, PhD in the development of expertise in healthcare epidemiology, state-of-the-art molecular methods, and advanced modeling techniques. This objective will be completed through focused training and career development activities in healthcare epidemiology, next generation sequencing, bioinformatics, cost-effectiveness analysis, and mathematical modeling that is overseen by an excellent team of mentors. The skills developed by the training and career development objectives will be strengthened by mentored research to accomplish the following Specific Aims: (1) Define the epidemiology and burden of community-acquired and hospital- associated respiratory virus infections and compare clinical impact by viral species; (2) Improve the sensitivity and specificity of case definitions to identify hospital-associated influenza cases by integrating clinical, epidemiologic, and molecular data; and (3) Determine the cost-effectiveness of increased respiratory virus screening and expanded infection control measures to reduce HA-RVI using mathematical models. Completion of the training and research programs will represent the next step on Dr. Petrie's path toward achieving his long term goal of establishing an independent research program that uses multidisciplinary laboratory and analytic methodologies to investigate the transmission of influenza and other respiratory viruses. The expected research outcomes of the proposed project are, 1) identification of respiratory viruses that, in addition to influenza, are responsible for the greatest number of HA-RVI and result in the most severe clinical outcomes; 2) development of methodology for improved identification of HA-RVI through integration of clinical, epidemiologic, and molecular data; and 3) determination of cost-effective diagnostic testing and intervention implementation strategies for HA-RVI prevention. The proposed research is significant because it is expected that the outcomes of this work and future studies that build upon it, will lead to reductions in morbidity, mortality, and healthcare costs associated with HA-RVI. This research is innovative both in its focus on a large panel of important respiratory viruses and its use of cross-disciplinary methodology that allows for new avenues of research.