Prospective Studies of Avian Influenza Transmission in Asia

亚洲禽流感传播的前瞻性研究 在亚洲肆虐多个物种的H5N1禽流感疫情，现在威胁着美国 各州。国家应对计划呼吁积极的人类病例识别、抗病毒药物的使用、隔离和 可能是隔离的。大流行计划所依赖的数学模型缺乏基本原理 传播率、病毒感染度等客观数据。因为亚洲的人类疾病检测是 根据临床接触，对h5n1的亚临床感染或风险因素知之甚少。 感染。在这项拟议的研究中，我们的长期目标是从流行病学角度描述临床和 潜在的H5N1传播，公共卫生官员可能会设计适当的H5N1监测 和控制措施。 在这项工作中，我们将对900人中的H5N1传播进行一项为期三年的受控前瞻性研究 职业接触家禽的成年人(家禽养殖户、家禽业工人、肉类加工工人、 开放家禽市场工作人员)，以及300名年龄组和性别匹配的非接触者，生活在三个 亚洲的H5N1流行区：印度尼西亚的坦格朗、印度尼西亚的巴厘岛和柬埔寨的坎大省。这个 这项研究将涉及对研究参与者进行积极主动的流感样疾病监测(与 鼻咽拭子和血清采样)，参与者的年度系列血清学跟踪，并通过 家访，对暴露在患流感研究对象中的家庭成员的类似研究 感染。将使用微量中和血清学技术、RT-PCR和病毒培养来确定 流感感染后果。我们的目标是确定以前的证据的血清阳性率 H5N1流感感染，估计每年H5N1流感感染的发病率，估计 二次H5N1流感感染率，并确定H5N1流感感染的危险因素。基座 根据初步数据，我们的中心假设是H5N1流感感染将在这些人中频繁出现 我们将能够估计H5N1感染的流行率和发病率，我们将 能够识别感染H5N1病毒风险最高的人。 我们特别适合进行这项工作，因为我们在这两项工作中都有丰富的经验 对流感传播的流行病学和实验室研究，我们有特殊的 国家和地方公共卫生官员在实地开展合作。这项研究在以下方面具有创新性 没有在这些人中进行过关于禽流感感染的前瞻性研究 职业接触H5N1流行地区的家禽。

Prospective Studies of Avian Influenza Transmission in Asia The H5N1 avian influenza epidemic that has ravaged multiple species in Asia, now threatens the United States. National response plans call for aggressive human case identification, antiviral use, isolation, and possibly quarantine. The mathematical models upon which the pandemic plans rely lack fundamental objective data such as transmission rates and virus infectiousness. As human disease detection in Asia is based upon clinical encounters, little is known regarding subclinical infections or risk factors for H5N1 infection. Our long term goa/in this proposed research is to epidemiologically describe clinical and subclinical H5N1 transmission such that public health officials might design appropriate H5N1 surveillance and control measures. In this effort we will conduct a controlled, three-year, prospective study of H5N1 transmission among 900 adults occupationally exposed to poultry (poultry farmers, poultry industry workers, meat processing workers, open poultry market workers), and 300 age-group and gender matched non-exposed controls living in three H5N1 endemic areas in Asia: Tangerang, Indonesia; Bali, Indonesia; and Kandaal Province, Cambodia. The study will involve aggressive active surveillance for influenza-like illness among study participants (with nasopharyngeal swab and serum sampling), annual serial serological follow-up of participants, and through home visits, similar studies of the family members exposed to study subjects who develops influenza infection. Microneutralization serologic techniques, RT-PCR, and viral culture will be used to determine influenza infection outcomes. Our objectives are to determine the seroprevalence of evidence of previous H5N1 influenza infection, to estimate the annual incidence of H5N1 influenza infection, to estimate secondary H5N1 influenza infection rates, and to determine risk factors for H5N1 influenza infection. Based upon preliminary data, our central hypotheses are that H5N1 influenza infection will be frequent among these workers, that we will be able to estimate the prevalence and incidence of H5N1 infection, and that we will be able to identify persons at highest risk of H5N1 infection. We are particularly well-suited to conduct this work as we have extensive experience conducting both epidemiological and laboratory-based studies of influenza transmission, and we have exceptional cooperation among public health officials nationally and locally at the field sites. This study is innovative in that no such prospective studies of avian influenza infection have been performed among those person's occupationally exposed to poultry in H5N1 endemic sites.