Study of risk factors of tick-borne encephalitis in Poland

描述（由申请人提供）：蜱传脑炎（TBE）是波兰日益严重的公共卫生问题。尽管近年来在欧洲发表了越来越多的研究，但人们对其生态决定因素和个体风险因素知之甚少。在波兰，没有在国家一级开展研究技经性脑炎危险因素的研究项目。目的：探讨波兰最低行政级别公社媒介蜱活动相关因素和蜱人接触概率相关因素与流行性乙型脑炎发病率的关系；开发波兰TBE发病率预测模型；并采用病例对照设计研究TBE的危险因素。方法、设计：我们将利用1993- 2006年报告的2950例TBE的现有数据和在公社一级获得的几个生态变量，在公社一级进行初步的生态学研究。这些生态变量将是：莱姆病发病率、森林覆盖的公社面积百分比、公社中普遍存在的森林类型、月气温、月空气湿度、月降雨量、环境污染措施以及公社居民的社会经济地位。第二项病例对照研究将利用波兰一年内报告的所有病例。每个病例将选择三名对照受试者，频率与年龄、性别和居住地区相匹配。每个对照受试者将进行血清学检测以排除无症状的TBE。暴露与疾病之间的关系将在TBE病例和非TBE受试者之间进行比较。如果无症状的TBE病例足够多，将对无症状的TBE病例和无TBE的受试者进行额外的比较。研究的风险因素包括访问TBE高风险地区、户外活动、社会经济状况。该项目旨在确定与蜱传脑炎有关的人口水平和个人水平的风险因素，蜱传脑炎是波兰的一个严重问题。通过确定疾病流行地区和非流行地区的疾病风险，以及评估个别疾病风险因素，将有可能利用安全有效的预防和教育，采取有针对性的公共卫生干预措施。

DESCRIPTION (provided by applicant): Tick-borne encephalitis (TBE) is a growing public health issue in Poland. Its ecologic determinants and individual risk factors are poorly understood, despite growing number of studies published in Europe in the recent years. In Poland no research projects studying risk factors for TBE have been performed at the national level. Objective: To examine the association of factors related to vector ticks activity and factors related to the probability of tick/human contact with TBE incidence rates at the commune, lowest administrative level of Poland; to develop a predictive model of TBE incidence in Poland; and to study risk factors for TBE using a case-control design. Methods, design: We will perform a preliminary, ecologic study at the commune level of analysis utilizing existing data on TBE from 2,950 cases reported in 1993- 2006 and several ecologic variables obtained for the commune level. These ecologic variables will be: Lyme disease incidence rate, percent of commune area covered by forests, forest types prevalent in a commune, monthly air temperatures, monthly air humidity, monthly rainfall, measures of environmental pollution, and socio-economic status of commune inhabitants. A secondary, case-control study will utilize all cases reported in Poland in a year period. Three control subjects will be selected for each case, frequency matched by age, gender and district of residence. Each control subject will be serologically tested to exclude asymptomatic TBE. The association between exposure and disease will be compared between TBE cases and subjects free of TBE. If the number of asymptomatic TBE cases will be sufficient, an additional comparison between asymptomatic TBE cases and subjects free of TBE will be carried out. The risk factors studied will include visit to area with high risk for TBE, outdoor activities, socio-economic status. This project is aimed to identify population-level and individual-level risk factors related to tick-borne encephalitis, which is a serious problem in Poland. By establishing risk for disease both in areas endemic for the disease and non-endemic, as well as assessment of individual disease risk factors, well targeted public health interventions will be possible using safe and effective prophylaxis and education.