Study of risk factors of tick-borne encephalitis in Poland

描述(由申请人提供)：壁虱传播脑炎(TBE)在波兰是一个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，尚未在国家一级开展研究结核病风险因素的研究项目。目的：在波兰最低行政级别的公社，研究与媒介蚤活动相关的因素和与蜱虫/人类接触概率相关的因素与TBE发病率的关系；建立波兰TBE发病率的预测模型；并采用病例对照设计研究TBE的危险因素。方法，设计：我们将在公社层面进行初步的生态研究，利用1993-2006年报告的2950例TBE的现有数据和公社层面获得的几个生态变量进行分析。这些生态变量将是：莱姆病发病率、公社面积被森林覆盖的百分比、公社普遍存在的森林类型、月气温、月空气湿度、月降雨量、环境污染指标以及公社居民的社会经济状况。第二项病例对照研究将利用一年内在波兰报告的所有病例。将为每个病例选择三个对照对象，频率与年龄、性别和居住地区相匹配。将对每个对照受试者进行血清学检测，以排除无症状的TBE。暴露与疾病之间的联系将在特发性肺病病例和非特发性肺炎者之间进行比较。如果无症状脑血栓形成病例的数量足够，将在无症状脑血栓形成病例和无脑血栓形成的受试者之间进行额外的比较。研究的危险因素将包括访问TBE高危地区、户外活动、社会经济状况。该项目旨在确定人群一级和个人一级与森林脑炎有关的风险因素，这在波兰是一个严重的问题。通过确定疾病流行和非流行地区的疾病风险，以及对个别疾病风险因素的评估，通过安全和有效的预防和教育，将有可能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.