Epidemiology of Arboviral Encephalomyelitis in Houston

描述（由申请人提供）：自从1964年在休斯顿发现圣路易斯脑炎病毒（SLEV）以来，休斯顿一直保持着黄病毒活动的地方性，偶尔流行。该地区在生态上有利于维持病媒和病毒的活动。2002年，在休斯顿大都市区发现了西尼罗河病毒，导致105例确诊或可能的人间病例。同年，美国疾病控制与预防中心（CDC）报告了4156例西尼罗河病毒阳性病例。在2003年传播季节，休斯顿又发现了49例人间病例。本建议的第一个目标是描述通过监测确定的成人和儿童疾病的临床谱和感染的自然史。第二个目标是确定康复率，并估计感染造成的身体和精神后遗症的频率。第三个目标是通过病例对照研究确定与进展为脑炎和/或死亡相关的重要危险因素。我们将测试高血压史或高血压诱导药物和免疫抑制条件与严重疾病发展相关的假设。此外，血液标本将用于进一步检查低聚腺苷酸合成酶（OAS）基因中的单核苷酸多态性（SNP）作为个体易患严重疾病的遗传易感性因素的作用。最后，我们将描述宿主的免疫反应。实现这些目标将使我们更好地了解这种病毒的临床方面，这种病毒将继续在美国持续存在并导致人类疾病，并使我们能够确定和针对有脑炎和死亡风险的人群进行干预。该候选人是一名兽医，也是休斯顿德克萨斯大学公共卫生学院流行病学助理教授。在担任这一职位之前，她在疾病预防控制中心的流行病情报局接受了应用流行病学培训，并且是1999年纽约市西尼罗河病毒暴发调查小组的一员。她目前正在德克萨斯大学医学分部攻读预防医学和社区卫生临床科学课程博士学位。她的时间将用于完成该提案的具体目标和她的博士学位。

DESCRIPTION (provided by applicant): Since St. Louis encephalitis virus (SLEV) was recognized in Houston in 1964, Houston has remained endemic, and occasionally epidemic, with flavivirus activity. The area is ecologically conducive to maintaining vector and virus activity. In 2002, West Nile virus (WNV) was identified in the Houston metropolitan area, resulting in 105 confirmed or probable human cases. Nationally, 4,156 WNV-positive cases were reported to the Centers for Disease Control and Prevention (CDC) that same year. During the 2003 transmission season, another 49 human cases were identified in Houston. The first objective of this proposal is to describe the clinical spectrum of illness and natural history of infection in both adults and children identified through surveillance. The second objective is to determine the rate of recovery and estimate the frequency of physical and mental sequelae as a result of infection. The third objective is to determine significant risk factors associated with progressing to encephalitis and/or death using case controls studies. We will be testing the hypothesis that history of hypertension or hypertension-inducing drugs and immunosuppressing conditions are associated with the development of severe disease. Additionally, blood specimens will be used to further examine the role of single nucleotide polymorphisms (SNP) in oligoadenylate synthase (OAS) genes as a genetic susceptibility factor predisposing an individual to severe disease. Finally, we will characterize the host immunologic response. Obtaining these objectives will provide us with a better understanding of the clinical aspects of a virus that will continue to persist and cause human illness in the United States, and allow us to identify and target interventions for populations at risk for encephalitis and death. The candidate is a veterinarian and Assistant Professor of Epidemiology at the University of Texas School of Public Health in Houston. Before taking this position, she received applied epidemiology training through the Epidemic Intelligence Service (EIS) at CDC, and was part of the investigation team of the WNV outbreak in New York City in 1999. She is currently working on her PhD in Preventive Medicine and Community Health, Clinical Science Curriculum at the University of Texas Medical Branch. Her time will be directed toward completion of the specific aims of this proposal and her PhD.