Epidemiologic Studies of HMPXV Infection among PWID in the US-Mexico Border Region to Inform Prevention Responses

美墨边境地区吸毒者 HMPXV 感染的流行病学研究，为预防措施提供信息

• 批准号: 10674322
• 负责人: STEFFANIE A. STRATHDEE
• 金额: $ 38万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10674322
• 关键词: 2019-nCoV; Abscess; Address; Adult; Affect; Africa; Animals; Anus; Behavior; Blood specimen; California; Centers for Disease Control and Prevention (U.S.); Central America; Communicable Diseases; Contact Tracing; Country; Crowding; Detection; Development; Diagnosis; Disease Outbreaks; Epidemic; Epidemiologist; Epidemiology; Equipment; Evolution; Face; Funding; General Population; HIV; HIV Infections; Health system; Hepatitis A Virus; Hepatitis C virus; Homelessness; Human; Immunosuppression; Imprisonment; Incidence; Individual; Infection; Infrastructure; Injecting drug user; Injections; Institutes; International; Intervention; Interviewer; Investigation; Latin America; Latinx; Leisures; Lesion; Letters; Location; Masks; Mediating; Mexico; Migrant; Molecular; Monkeypox virus; Mutation; National Institute of Drug Abuse; National Institute on Minority Health and Health Disparities; Oral; Participant; Persons; Pharmaceutical Preparations; Physicians; Policies; Population; Prevalence; Prevention; Primary Prevention; Recording of previous events; Reporting; Risk Factors; Rocky Mountain Spotted Fever; Rodent; Scientist; Secondary Prevention; Serology; Serology test; Sexual Partners; Sexually Transmitted Diseases; Shigella; South America; Structural Models; Substance Use Disorder; Surveys; Swab; Syphilis; Testing; Tuberculosis; Ulcer; Vaccination; Variant; Vesicle; Virus; Vulnerable Populations; Work; base; cohort; cost; epidemiology study; experience; follow-up; health disparity; high risk; housing instability; injection drug use; male; men who have sex with men; pandemic disease; pandemic preparedness; pathogen; preventive intervention; public health emergency; response; sex; substance use; transmission process

In response to NOT-OD-22-159, this project will leverage an ongoing cohort of people who inject drugs (PWID) in the U.S.-Mexico border region to study the epidemiology of monkeypox virus (HMPXV) to inform prevention interventions to diagnose and treat HMPXV and curtail transmission. Although it is well known that PWID face numerous health disparities including higher rates of HIV, HCV and sexually transmitted infections (STIs) than the general population, experts are concerned that the ongoing outbreak of HMPXV, which is the largest international outbreak recorded since this virus first emerged in the 1970’s, will soon disproportionately affect people experiencing homelessness (PEH), which includes a high proportion of PWID. Our team includes epidemiologists, prevention interventionists, molecular virologists and infectious disease physicians to address these aims: Aim 1. To determine the prevalence and correlates of subclinical and symptomatic HMPXV infection among PWID in the San Diego/Tijuana (SD/TJ) border region to inform the development of prevention interventions. H1. PWID who are unstably housed (H1.1), Latinx (H1.2) or living with HIV and not receiving ART (H1.3) will be significantly more likely to test positive for HMPXV infection. Aim 2. To estimate incidence and risk factors of HMPXV infection among PWID over a one-year period. H2.1 PWID who report recently having abscesses associated with injection drug use, STIs or open sores will be more likely to acquire HMPXV during follow-up. H2.2. PWID who report engaging in sex work and those with higher numbers of sex partners will be more likely to acquire HMPXV during follow-up. Aim 3. To determine network features associated with cross-border transmission of HMPXV among PWID. H3.1 Cross-border drug tourism between SD and TJ (by participants & their network contacts) will be associated with HMPXV infection. H3.2. Network-level risk factors such as total number of contacts and number of contacts who are MSM, sex workers, unstably housed, or have a history of incarceration will be independently associated with HMPXV infection after controlling for individual-level risk factors. Aim 4: To conduct phylogenomic characterization of circulating HMPXV variants in the SD/TJ region including mutation signatures (e.g., APOBEC3). H4.1 Circulating HMPXV will have a single origin (lineage B.1) followed by local dispersal. We will leverage the binational infrastructure of our NIDA- funded binational cohort of PWID, and support from a new pandemic preparedness institute at UCSD to conduct HMPXV PCR testing and sequencing on swabs collected from any suspect lesions/vesicles as well as oral and anal swabs. Serologic HMPXV testing will be done in-kind by the CDC. Findings will inform potential interventions and policies, including whether PWID and/or PEH should be recommended for routine vaccination and whether subsequent interventions to increase HMPXV testing, vaccination and treatment in this vulnerable population should be network or venue-based, following NIMHD’s conceptual model for structural interventions.

为了响应NOT-OD-22-159，本项目将利用正在进行的注射毒品人群（PWID） 在美国-墨西哥边境地区研究猴痘病毒（HMPXV）的流行病学，以提供预防信息 干预措施，以诊断和治疗HMPXV和减少传播。虽然众所周知，PWID面临 许多健康方面的差距，包括艾滋病毒、丙型肝炎病毒和性传播感染率高于 专家们担心，目前正在爆发的HMPXV，这是最大的 自20世纪70年代这种病毒首次出现以来， 无家可归者（PEH），其中包括很高比例的PWID。我们的团队包括 流行病学家、预防干预专家、分子病毒学家和传染病医生， 这些目标：目标1。确定亚临床和症状性HMPXV的患病率和相关因素 圣地亚哥/蒂华纳（SD/TJ）边境地区PWID中的感染，以告知预防的发展 干预措施。H1。居住不稳定（H1.1）、拉丁裔（H1.2）或感染艾滋病毒但未接受 ART（H1.3）将显着更有可能测试阳性HMPXV感染。目标2.估计发病率 以及PWID中HMPXV感染的危险因素。H2.1最近报告的PWID 与注射毒品、性传播感染或开放性溃疡相关的疾病更容易感染HMPXV 在后续行动中。H2.2。报告从事性工作和性伴侣数量较多的残疾人 在随访期间更有可能获得HMPXV。目标3.要确定与 HMPXV在PWID中的跨境传播。H3.1南苏丹和TJ之间的跨境毒品旅游（按 参与者及其网络接触者）将与HMPXV感染相关。H3.2。网络级风险因素 如接触者总数和接触者中男男性行为者、性工作者、居住不稳定者的数量，或 在控制了以下因素后，有监禁史者将与HMPXV感染独立相关： 个人层面的风险因素。目的4：进行HMPXV循环变异体的基因组学表征， SD/TJ区包括突变标记（例如，APOBEC3）。H4.1循环HMPXV将具有单个 起源（谱系B.1），其次是本地分散。我们将利用我们的NIDA的两国基础设施- 资助的两国PWID队列，以及UCSD新的流行病准备研究所的支持， 对从任何可疑病变/囊泡采集的拭子进行HMPXV PCR检测和测序，以及 口腔和肛门拭子血清学HMPXV检测将由CDC进行实物检测。调查结果将告知潜在的 干预措施和政策，包括是否应建议将PWID和/或PEH用于常规 疫苗接种以及后续干预措施是否能增加HMPXV检测、疫苗接种和治疗， 这种脆弱的人群应该是基于网络或场所的，遵循NIMHD的概念模型， 结构性干预。