Investigation of Occupational Exposure to and Infection by MRSA in Rural Iowa

描述（由申请人提供）：我致力于将我在基础微生物学和传染病研究方面的经验和背景与我在职业和环境卫生方面的培训相结合，以便更好地了解工作场所接触传染性病原体与随后与这些接触相关的疾病发展和/或传播之间的复杂关系。虽然迄今为止我在这里的经历使我处于成为一名独立调查员的绝佳位置，但我仍然需要在职业和农业健康方面进行额外的培训（正式课程和指导），这一奖项将提供。这将有助于我在满足我的近期职业目标（集中时间在本申请中提出的研究，并采取额外的职业和环境健康课程，以扩大我在这些领域的背景），以及我的长期目标获得认可，作为一个领导者在这一领域，并最终成为一个全职教授与终身职位。环境职业和环境卫生系由来自各种学科的19个主要教师组成。这个多元化的教职员工群体每年带来1400万美元的校外资金。资金来自广泛的联邦和州机构，以及私人基金会。主要资助者包括国家伤害预防和控制中心，国家职业安全和健康研究所，国家环境健康科学研究所和环境保护局。该部和选定的导师是农村卫生研究的领导者，包括农业卫生和医学。研究计划最近的一份报告记录了耐甲氧西林金黄色葡萄球菌（MRSA）的临床影响，表明MRSA在2005年在美国造成了94，000多例侵入性感染和18，000多例死亡，使艾滋病毒成为主要的传染病杀手。2005年，这些感染大多与医疗保健暴露有关;然而，这一趋势正在发生变化。社区相关MRSA菌株USA 300最近在从美国大都市地区收集的31.5%的侵袭性MRSA分离株中发现。随着MRSA的流行病学发生变化，出现了新的感染MRSA的人群。最初，与卫生保健接触的个人是MRSA携带和感染的主要风险群体;然而，在过去的十年中，运动员，注射吸毒者和囚犯也成为MRSA感染的风险群体。来自欧洲和加拿大的报告还报告了另一个潜在的MRSA风险群体：与牲畜和家禽接触的个人。 由于我们小组的试点研究已经记录了MRSA在美国猪中的存在，我们试图扩大这项研究，并在职业暴露于牲畜和家禽的个体中更广泛地检查金黄色葡萄球菌的流行病学。我们的主要目标是确定S。金黄色葡萄球菌（包括MRSA）在爱荷华州牲畜和家禽农场，从动物，人类工人，和环境采样。在这项研究中，我们将检查30个农场，包括生猪、牛和家禽农场。在我们研究计划的第二部分，我们将研究S。金黄色葡萄球菌由殖民农民密切的家庭接触，以确定生物体的运动，以个人缺乏职业暴露。最后，我们将与在牲畜高度集中地区工作的乡村医生合作，以检查由沙门氏菌引起的症状感染。金黄色葡萄球菌在职业暴露的个人。 我们的中心假设是，在接近牲畜和家禽的地方工作的个人将有职业性接触S的风险。金黄色葡萄球菌，这种微生物将传播给配偶和其他与工人密切接触的家庭成员。我们进一步假设，与牲畜（特别是猪）接触的农民可能会被“猪相关”菌株（如ST 398）定殖，并且这些菌株也会在我们的乡村医生发现的症状性感染中发现。这项研究的结果将使我们能够计划干预措施，以减少对这种生物的职业暴露，并在未来的研究中实施这些干预措施。 公共卫生相关性：在欧洲和加拿大进行的研究中，在高比例的猪和养猪工人中发现了耐甲氧西林金黄色葡萄球菌（MRSA）。最近，我们的小组在爱荷华州和伊利诺斯州的猪和农民的一项小型研究中发现了MRSA。我们试图确定MRSA定植和感染在爱荷华州牲畜中的常见程度，并确定牲畜暴露是否代表MRSA定植和感染的新职业风险因素。

DESCRIPTION (provided by applicant): I am committed to integrating my experience and background in basic microbiology and infectious disease research with my training in occupational and environmental health so as to better understand the complex relationships between exposure to infectious agents in the workplace and the subsequent development and/or spread of disease related to these exposures. While my experience here to date has put me in an excellent position to become an independent investigator, I still need additional training (formal coursework and mentoring) in occupational and agricultural health, which this Award would provide. This would assist me in meeting my immediate career goals (focusing time on the research proposed in this application, and taking additional coursework in Occupational and Environmental Health in order to broaden my background in these areas), as well as my long-term goals of gaining recognition as a leader in this field, and eventually becoming a full Professor with tenure. Environment The Department of Occupational and Environmental Health is comprised of 19 primary faculty from a wide variety of disciplines. This diverse group of faculty members brings in $14 million in extramural funding each year. Funding comes from a wide range of federal and state agencies, as well as from private foundations. Lead funders include the National Center for Injury Prevention and Control, National Institute for Occupational Safety and Health, the National Institute of Environmental Health Sciences, and the Environmental Protection Agency. The Department and selected mentors are leaders in the study of rural health, including agricultural health and medicine. Research Plan A recent report has documented the clinical impact of methicillin-resistant Staphylococcus aureus (MRSA), suggesting that MRSA caused over 94,000 invasive infections and more than 18,000 deaths in the United States in 2005, eclipsing HIV as a leading infectious disease killer. In 2005, the majority of these infections were associated with healthcare exposure; however, this trend is changing. Community-associated MRSA strain USA300 was recently found in 31.5% of invasive MRSA isolates collected from US metropolitan areas. As the epidemiology of MRSA has changed, new groups at risk of acquiring MRSA have emerged. Initially individuals with health care contact were the main risk group for MRSA carriage and infection; however, in the past decade, athletes, injection drug users, and prisoners have also emerged as groups at risk of MRSA infection. Reports from Europe and Canada have reported another potential MRSA risk group: individuals in contact with livestock and poultry. As pilot studies by our group have documented the presence of MRSA in US swine, we seek to expand upon this research and examine the epidemiology of Staphylococcus aureus more broadly in individuals with occupational exposure to livestock and poultry. Our primary objectives are to determine the prevalence of S. aureus (including MRSA) on Iowa livestock and poultry farms, sampling from animals, human workers, and the environment. We will examine 30 farms during this research, including farms with live swine, cattle, and poultry. In the second part of our research plan, we will examine transmission of S. aureus by colonized farmers to close family contacts, in order to determine movement of organisms to individuals lacking occupational exposure. Finally, we will partner with rural physicians working in areas of high livestock concentration, in order to examine symptomatic infections caused by S. aureus in individuals with occupational exposure. Our central hypothesis is that individuals working in close proximity to livestock and poultry will be at risk of occupational exposure to S. aureus, and that this organism will be transmitted to spouses and other family members in close contact to the worker. We further hypothesize that farmers in contact with livestock (and swine in particular) will be likely to be colonized with "swine-associated" strains (such as ST398), and that these strains will also be found in symptomatic infections identified by our rural physicians. Findings from this research will allow us to plan interventions to reduce occupational exposure to this organism, and implement such interventions in future studies. PUBLIC HEALTH RELEVANCE: Methicilin-resistant Staphylococcus aureus (MRSA) has been found in a high proportion of swine and swine workers in studies carried out in Europe and Canada. Recently, our group has identified MRSA in a small study of swine and farmers in Iowa and Illinois. We seek to determine how common MRSA colonization and infection are in Iowa livestock, and to determine if livestock exposure represents a new occupational risk factor for MRSA colonization and infection.