IP21-002, Enhanced Surveillance Network for Enteric and Respiratory Viruses in Children: Assessing Disease Burden, Natural History, and Vaccine Effectiveness

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PROJECT SUMMARY/ABSTRACT (COMPONENTS A, B and C): Viral acute respiratory infections (ARI) and acute gastroenteritis (AGE) remain major causes of morbidity in children, making vaccine development and implementation a high public health priority. The overall goal of the CDC New Vaccine Surveillance Network (NVSN) is to establish a network of US institutions that develop and implement standard research protocols to answer important questions about the burden of disease and natural history of vaccine preventable diseases, specifically, those causing ARI and AGE. A second goal of population-based NVSN surveillance is to provide accurate estimates of vaccine effectiveness (VE) in preventing pediatric hospitalization or medical care visits. A third goal is the ability to rapidly pivot to study novel agents such as enterovirus-D68 (EV-D68) or SARS-CoV-2, and syndromes such as acute flaccid myelitis (AFM) and multisystem inflammatory syndrome in children (MIS-C). The proposed work (comprising Mandatory Core A, and Optional Components B and C) will enhance the NVSN site in Rochester, NY—one of 2 original members of the now 7-site network. For 20 years we have published important studies on the burden of disease and natural history of AGE due to rotavirus and norovirus, and ARI due to influenza, (RSV), and other viruses. These data helped inform AAP and ACIP on pediatric influenza and rotavirus vaccination, and palivizumab use for RSV prevention. Our specific aims are:  Mandatory Core Component A: Perform prospective, population-based active surveillance for ARIs and AGEs in inpatient and ED settings as well as asymptomatic controls, for children 0-18 years. We will use molecular diagnostics for rotavirus, norovirus, influenza, RSV, PIV, EV-D68, SARS-CoV-2, and other viruses. We will assess VE for influenza, rotavirus, and future SARS-CoV-2 vaccines in preventing pediatric hospitalizations and ED visits. We will delineate the disease burden of ARI and AGE using our unique capture of virtually all pediatric hospitalizations and ED visits in our region. We will assess the impact of future vaccines and other immunoprophylaxis strategies. We will perform active surveillance and epidemiologic studies of acute flaccid myelitis (AFM) syndrome in children. Finally, we will perform and lead epidemiological, implementation and laboratory studies based on population-based NVSN surveillance.  Optional Component B: Implement active prospective population-based ARI/AGE surveillance studies in children seeking medical care in outpatient practices, as the burden of ARI and AGE are likely high.  Optional Component C: Investigate the incidence, spectrum of disease, and risk factors associated with SARS-CoV-2 MIS-C. Our proposed research will provide high impact information to develop sound policies for the prevention of pediatric vaccine-preventable diseases, and to improve the health of US children.