IP21-002 Enhanced Surveillance for New Vaccine Preventable Diseases

项目摘要--必备组成部分A 急性呼吸道疾病(ARI)和急性胃肠炎(AGE)是#年全球主要的死亡原因。 年幼的孩子。轮状病毒、诺如病毒和呼吸道合胞病毒是AGE的主要病毒病原 病毒(RSV)和流感病毒(ARI)。我们对急性呼吸窘迫综合征和年龄流行病学的理解 由于时空波动而变化，发现新的或重新出现的病原体[例如肠道病毒D68 (EV-D68)和严重急性呼吸综合征冠状病毒2(SARS-CoV-2)]，以及轮状病毒和 流感疫苗。因此，监测工作势在必行，以确定急性呼吸窘迫综合征和老年病负担， 致病病原体、结果和疫苗影响。美国的初级流感预防策略 各州为所有六个月或以上的个人接种疫苗。关于疫苗的数据很少。 对实验室确认的儿童流感以及流感病毒和疫苗的有效性(VE) 抗原成分每年都会发生变化。因此，需要对VE进行永久性评估，以监控 流感疫苗接种对疾病的影响以及提高规模、持久性和广度的信息策略 是一种保护。儿科SARS-CoV-2疫苗是一项紧迫的公共卫生优先事项，很可能成为 为努力遏制新冠肺炎大流行而加速提供的时间表。严谨、有远见 对SARS-CoV-2 VE的监测对于支持依赖疫苗作为一级预防至关重要。因此， 该项目的第一个主要目标是以人群为基础积极监测呼吸道和 儿科住院和急诊科环境和无症状的肠道病毒病原体 控制。我们的范德比尔特调查团队在进行预期、人口- 基于ARI和年龄监控。我们建议进行ARI和年龄监测，具体如下 目标：1)进行前瞻性的、积极的监测，以确定住院患者和 急诊科(ED)在儿科人群中传播急性病毒性呼吸道和肠道疾病。2)至 描述儿科感染(包括无症状儿童)的临床和流行病学因素 通过主动监视。3)评估疫苗和其他疫苗的效力和影响 干预措施(例如，使用抗病毒药物或其他治疗药物进行免疫预防)可用于或预计用于 在演出期间随时待命。该项目的第二个主要目标是进行 儿童急性弛缓性脊髓炎综合征监测及流行病学特征。vt.给出 EV-D68感染与急性弛缓性脊髓炎(AFM)之间的流行病学联系，将对 在连续多个季节对AFM进行严格、主动、纵向的监测；仔细 确定AFM临床谱、风险因素、发病率和实验室参数；并记录当地 EV-D68和其他ARI和AGE病原体的循环与AFM发生率的增加相一致。这部作品 为原子力显微镜的预防、诊断和治疗策略的发展奠定了基础。

PROJECT SUMMARY - Mandatory Component A Acute respiratory illness (ARI) and acute gastroenteritis (AGE) are the leading causes of death worldwide in young children. Established leading viral etiologies of AGE are rotavirus and norovirus and respiratory syncytial virus (RSV) and influenza virus for ARI. Our understanding of ARI and AGE epidemiology is constantly changing due to spatiotemporal fluctuations, discovery of new or re-emerging pathogens [e.g. enterovirus D68 (EV-D68) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], and use of rotavirus and influenza vaccines. Hence, surveillance efforts are imperative to define ARI and AGE disease burden, causative pathogens, outcomes, and vaccine impact. The primary influenza prevention strategy in the United States is vaccination for all individuals six months or older. There is a paucity of data regarding vaccine effectiveness (VE) against laboratory-confirmed influenza in children, and influenza viruses and vaccine antigenic components change annually. Therefore, perpetual assessments of VE are needed to monitor the impact of influenza vaccination on disease and inform strategies to improve magnitude, durability, and breadth of protection. Pediatric SARS-CoV-2 vaccines are an urgent public-health priority and likely will become available on an accelerated timeline in an effort to curb the COVID-19 pandemic. Rigorous, prospective surveillance of SARS-CoV-2 VE is crucial to support reliance on vaccines as primary prevention. Thus, the first main objective of this project is to conduct population-based active surveillance for respiratory and enteric viral pathogens in pediatric inpatient and emergency department settings and asymptomatic controls. Our team of Vanderbilt investigators is highly experienced in conducting prospective, population- based ARI and AGE surveillance. We propose to conduct ARI and AGE surveillance with the following specific aims: 1) To perform prospective, active surveillance to determine the etiology and burden of inpatient and emergency department (ED) acute viral respiratory and enteric diseases among the pediatric population. 2) To characterize the clinical and epidemiologic factors of pediatric infections (including in asymptomatic children) through active surveillance. 3) To evaluate vaccine effectiveness and impact of vaccines and other interventions (e.g., immunoprophylaxis with antiviral agents or other therapeutics) available or projected to become available during the period of performance. The second main objective of this project is to conduct surveillance and epidemiologic characterization of acute flaccid myelitis syndrome in children. Given the epidemiologic connection between EV-D68 infection and acute flaccid myelitis (AFM), it will be important to conduct rigorous, active, longitudinal surveillance for AFM across multiple consecutive seasons; carefully define AFM clinical spectrum, risk factors, incidence rates, and laboratory parameters; and document local circulation of EV-D68 and other ARI and AGE pathogens coincident with increased AFM occurrence. This work underpins development of preventive, diagnostic, and therapeutic strategies for AFM.