Outpatient VE for seasonal flu, pandemic flu and RSV in a large, diverse network

流感、呼吸道合胞病毒(RSV)和人类偏肺病毒(HMPV)继续流行 是主要的健康负担，每年导致数百万人患病和数万人死亡 美国的住院和死亡人数虽然旨在减轻这一负担，但流感 疫苗每年的效力(VE)因宿主因素、环境和 病毒和疫苗特性。来自美国流感VE网络的数据帮助疾控中心评估 疫苗政策方面，世卫组织选择疫苗毒株和临床医生使用抗病毒药物。 我们提出了一项试验阴性病例对照研究(TNCC)来确定UPMC中的流感VE， 为500个临床站点的不同人群提供服务。UPMC荣获最多奖项之一 美国有线医疗系统UPMC优先使用大剂量疫苗 多年来，它定期在其电子病历中记录疫苗接种状态，并具有双向 与国家免疫登记处对接。 我们的提案具有目前参与美国流感VE网络的坚实基础，具有 跟踪调查完成率和招生人数最高的多学科研究团队 数量超过要求。我们屡获殊荣的高通量实验室提出分析 流感、呼吸道合胞病毒和人乳头状瘤病毒。每个病毒季节定义都得到了14,000名临床医生的支持 多重呼吸道病毒检测和持续的症状监测。我们添加了基于代理的 匹兹堡超级计算机中心的模特。我们是疾控中心住院VE网络网站， 因此，我们可以比较门诊患者和住院患者的VE。 具体目标包括：1)使用TNCC方法，确定年度流感和RSV(之后 许可证)VE预防实验室确认的、医疗护理的急性呼吸道感染 在3个年龄组的门诊患者中：6个月-18岁，19-49岁，50岁；2)确定 同一年龄组基于人群的流感、呼吸道合胞病毒和人类免疫缺陷病毒年负担，使用 参与的初级保健地点作为来源人群，进行敏感性分析和 基于代理的疫苗接种方案影响建模；3)准备与 流感大流行，描述流行病学、抗病毒药物的有效性和/或大流行 疫苗，包括关于患者门户/电话登记的试点研究。

Influenza, respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) continue to be major health burdens, each year causing millions of illnesses and tens of thousands of hospitalizations & deaths in the U.S. Although designed to reduce this burden, influenza vaccine has variable effectiveness (VE) from year to year due to host factors, environment, and virus & vaccine characteristics. Data from the US Flu VE Network helps CDC to evaluate vaccine policy, WHO to select vaccine strains and clinicians to use antivirals. We propose a test-negative case-control (TNCC) study to determine influenza VE in UPMC, which serves diverse populations in 500 clinical sites. UPMC wins awards as one of the most wired health systems in the U.S. UPMC preferentially uses high-dose vaccine for persons >65 years, routinely records vaccination status in its electronic medical record and has a two-way interface with the state immunization registry. Our proposal has a strong foundation of current participation in the US Flu VE Network with a multidisciplinary research team with the highest follow-up survey completion rate and enrollment numbers exceeding requirements. Our award-winning, high-throughput lab proposes analyses of influenza, RSV and HMPV. Each virus season definition is supported by >14,000 clinical multiplex respiratory virus tests and ongoing syndromic surveillance. We add agent-based modeling at the Pittsburgh Supercomputer Center. We are a CDC inpatient VE network site, thus we can compare VE for outpatients and inpatients. Specific aims include: 1) Using TNCC methods, determine annual influenza and RSV (after licensure) VE against laboratory-confirmed, medically-attended, acute respiratory infections among outpatients in 3 age groups: 6 mos.-18 yrs., 19-49 yrs., and >50 yrs.; 2) Determine the annual, population-based burden of influenza, RSV and hMPV in the same age groups, using the participating primary care sites as the source population, conduct sensitivity analyses and agent-based modeling on the impact of vaccination options; 3) Prepare for studies related to an influenza pandemic, describing the epidemiology, effectiveness of antivirals and/or pandemic vaccines, including pilot studies on patient portal/phone enrollment.