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，该项目将利用一批持续注射吸毒者 (PWID) 在美国-墨西哥边境地区研究猴痘病毒（HMPXV）的流行病学，为预防提供信息 诊断和治疗 HMPXV 并减少传播的干预措施。尽管众所周知，吸毒者面临着 存在许多健康差异，包括艾滋病毒、丙型肝炎病毒和性传播感染 (STI) 的发病率高于 专家们对 HMPXV 的持续爆发表示担忧，该病毒是最大规模的 自该病毒于 1970 年代首次出现以来，该病毒已在国际范围内暴发，很快将造成不成比例的影响 无家可归者 (PEH)，其中吸毒者比例很高。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来解决 这些目标： 目标 1. 确定亚临床和有症状 HMPXV 的患病率和相关性 圣地亚哥/蒂华纳 (SD/TJ) 边境地区注射吸毒者感染情况，为预防工作的开展提供信息 干预措施。 H1。居住不稳定的吸毒者 (H1.1)、拉丁裔 (H1.2) 或感染艾滋病毒且未接受治疗的吸毒者 ART (H1.3) 将更有可能检测出 HMPXV 感染阳性。目标 2. 估计发生率 吸毒者一年内 HMPXV 感染的危险因素。 H2.1 最近报告的吸毒者 患有与注射吸毒相关的脓肿、性传播感染或开放性疮口更有可能感染 HMPXV 随访期间。 H2.2。自称从事性工作以及性伴侣数量较多的吸毒者 随访期间更有可能感染 HMPXV。目标 3. 确定与以下相关的网络特征 吸毒者之间 HMPXV 跨境传播。 H3.1 SD 和 TJ 之间的跨境毒品旅游（由 参与者及其网络联系人）将与 HMPXV 感染相关。 H3.2。网络层面的风险因素 例如接触者总数以及属于 MSM、性工作者、居住不稳定的接触者数量，或者 在控制了以下因素后，有监禁史将与 HMPXV 感染独立相关 个人层面的风险因素。目标 4：对循环中的 HMPXV 变种进行系统发育特征分析 SD/TJ 区域，包括突变特征（例如 APOBEC3）。 H4.1 循环 HMPXV 将有一个 起源（谱系 B.1），然后是局部扩散。我们将利用 NIDA 的两国基础设施 资助了两国注射吸毒者队列，并得到了加州大学圣地亚哥分校新的流行病防备研究所的支持， 对从任何可疑病变/囊泡收集的拭子以及 口腔和肛门拭子。 HMPXV 血清学检测将由 CDC 进行实物检测。调查结果将告知潜在的 干预措施和政策，包括是否应建议将吸毒者和/或 PEH 纳入常规 疫苗接种以及后续干预措施是否增加 HMPXV 检测、疫苗接种和治疗 这个弱势群体应该是基于网络或场所的，遵循 NIMHD 的概念模型 结构性干预。