Enhanced Surveillance for New Vaccine Preventable Diseases

项目摘要/摘要 核心组成部分：急性胃肠炎(AGE)和急性呼吸道疾病(ARI)是 全球5岁以上儿童死亡人数超过新生儿期。初创领先的病毒 AGE的病因是轮状病毒、诺如病毒和呼吸道合胞病毒(RSV)，ARI的病因是流感。我们的 对年龄和ARI流行病学的理解由于季节波动而不断变化，发现 新的或重新出现的病原体，以及轮状病毒和流感疫苗的使用。因此，监视工作是 必须更好地了解年龄和ARI疾病负担、致病病原体、结果和疫苗 冲击力。我们的范德比尔特调查团队在进行基于人群的前瞻性调查方面经验丰富 用实验室确认的肠道和呼吸道病毒监测年龄和ARI。对于这个项目，我们 建议在田纳西州戴维森县进行预期年龄和ARI监测，具体如下 针对核心部分：1)确定特定年龄的年龄与特定肠道的关联率 对实验室确诊的儿童胃肠炎病毒进行积极的、基于人群的监测 在急诊科和住院儿童中出现。2)确定特定年龄的关联 使用主动的、以人群为基础的监测实验室的特定呼吸道病毒的ARI比率- 在到急诊科就诊的儿童和住院患者中确诊呼吸道病毒 孩子们。3)确定年度流感疫苗在预防儿童住院方面的效力 使用试验阴性研究设计的实验室确诊的流感患者的年龄。 可选部分：作为赠款可选部分的一部分，我们计划建立一个出生队列 250名儿童；婴儿将从出生到两岁生日，死亡或失去随访， 以先到者为准。我们将系统地收集样本(如呼吸道、粪便和血液)以了解 儿童早期年龄和ARI病原体的自然历史，并了解免疫学和 可影响症状和无症状状态的流行病学因素。该计划的具体目标 可选部分包括：1)建立居住儿童的预期出生队列 田纳西州纳什维尔/戴维森县研究病因、社会人口学、环境和免疫因素 与儿童ARI和年龄以及家庭呼吸道和呼吸道感染传播的动态有关 在生命的头两年发生胃肠道感染。2)确定呼吸系统的自然历史 出生队列中与症状和无症状期相关的感染和宿主免疫反应 两年多了。3)确定胃肠道感染和宿主免疫反应的自然病史 与出生队列中超过两年的症状和无症状期有关。

PROJECT SUMMARY / ABSTRACT CORE Component: Acute gastroenteritis (AGE) and acute respiratory illness (ARI) are the leading causes of death worldwide in children <5 years old beyond the neonatal period. The primary established leading viral etiologies of AGE are rotavirus and norovirus and respiratory syncytial virus (RSV) and influenza for ARI. Our understanding of AGE and ARI epidemiology is constantly changing due to seasonal fluctuations, discovery of new or re-emerging pathogens, and use of rotavirus and influenza vaccines. Hence, surveillance efforts are imperative to better understand AGE and ARI disease burden, causative pathogens, outcomes, and vaccine impact. Our team of Vanderbilt investigators is highly experienced in conducting prospective, population-based AGE and ARI surveillance with laboratory-confirmed enteric and respiratory viruses. For this project, we propose to conduct prospective AGE and ARI surveillance in Davidson County, TN, with the following specific aims for the core component: 1) To determine age-specific association rates of AGE with specific enteric viruses using active, population-based surveillance for laboratory-confirmed gastroenteritis viruses in children presenting to the emergency department and in hospitalized children. 2) To determine age-specific association rates of ARI with specific respiratory viruses using active, population-based surveillance for laboratory- confirmed respiratory viruses in children presenting to the emergency department and in inpatient hospitalized children. 3) To determine annual influenza vaccine efficacy (VE) in preventing hospitalizations of children <18 years of age due to laboratory-confirmed influenza using a test-negative study design. OPTIONAL Component: As part of the optional component of the grant, we plan to establish a birth cohort of 250 children; infants will be followed from birth through their second birthday, death, or lost to follow-up, whichever comes first. We will systemically collect specimens (e.g., respiratory, stool, and blood) to understand the natural history of AGE and ARI pathogens during early childhood and to understand immunological and epidemiological factors that can affect symptomatic and asymptomatic status. The specific aims for the optional component include:1) To establish a prospective birth cohort of children who reside Nashville/Davidson County, TN to study etiologic, sociodemographic, environmental, and immunologic factors associated with childhood ARI and AGE and the dynamics of household transmission of respiratory and gastrointestinal infections during the first two years of life. 2) To determine the natural history of respiratory infections and host immune responses related to symptomatic and asymptomatic periods in the birth cohort over two years. 3) To determine the natural history of gastrointestinal infections and host immune responses related to symptomatic and asymptomatic periods in the birth cohort over two years.