Surveillance for Respiratory Syncytial Virus (RSV) and Other Viral Respiratory Infections Among American Indians/Alaska Natives

项目摘要 呼吸道合胞病毒（RSV）是急性下呼吸道感染（ALRI）的主要病毒原因， 包括细支气管炎和肺炎。婴儿期RSV疾病与大量发病率相关 严重呼吸道合胞病毒感染的婴儿发生反复喘息和哮喘的风险增加 在以后的生活中美国印第安人和阿拉斯加原住民（AI/AN）经历了许多健康差异， 与一般美国人群相比，RSV的风险显著增加。众多产品， 目前，预防婴儿和儿童RSV的研究处于后期阶段，包括母体疫苗 和单克隆抗体。AI/AN社区迫切需要这种干预措施。 目前的CDC监测系统不测量AI/AN人群中的RSV疾病。此外，负担 RSV在孕妇中的感染率及其对妊娠和分娩结局的影响很差， 明白量化当前负担并描述AI/AN中RSV疾病的流行病学特征 儿童和孕妇是告知最佳使用RSV预防产品以减少感染的关键一步 促进健康公平。 这项拟议中的研究将建立在部落伙伴约翰霍普金斯之间的长期合作基础上 美国印第安人健康中心（JHCAIH）和阿拉斯加土著部落健康联盟（ANTHC）， 创建美国原住民RSV监测（RSV-SuNA）系统。RSV-SuNA将量化并描述 西南部三个社区5岁以下AI/AN儿童和孕妇中的RSV疾病 美国和阿拉斯加的两个社区超过五个RSV季节。该平台将由活跃的，人口- 在多个环境和季节对ALRI进行基于住院患者和门诊患者的监测， 对本土人群中RSV疾病的深入了解。鼻拭子将从知情同意的患者中采集 参与者，并使用经验证的 实验室方法这一点，以及使用标准化的病例定义和工具中的数据收集， 促进各研究中心之间的比较，并与其他主动监测网络（例如CDC现有的新 疫苗监测网）。本研究将确定RSV相关的年龄特异性发病率， 这些AI/AN社区的住院和门诊访视，并表征RSV和非RSV 相关ALRI，包括危险因素，临床过程和后遗症。 这种协作的多地点方法将填补我们对RSV流行病学了解的关键空白， 产生有意义的数据，为政策提供信息，并监测AI/AN人群中的RSV疾病。RSV-SuNA 该系统可以在其他AI/AN群体中复制，并且可以在引入RSV后使用 预防产品，以量化其对RSV和非RSV ALRI负担的影响。

Project Summary Respiratory Syncytial virus (RSV) is the leading viral cause of acute lower respiratory tract infection (ALRI), including bronchiolitis and pneumonia, globally. RSV disease in infancy is associated with substantial morbidity and mortality, and infants who experience severe RSV are at increased risk of recurrent wheeze and asthma later in life. American Indians and Alaska Natives (AI/AN), who experience many health disparities, are at substantially increased risk of RSV compared to the general US population. Numerous products for the prevention of RSV in infants and children are currently in late stage development, including maternal vaccines and monoclonal antibodies. Such interventions are urgently needed in AI/AN communities. Current CDC surveillance systems do not measure RSV illness in AI/AN populations. Furthermore, the burden of RSV in pregnant women and the effect it may have on pregnancy and delivery outcomes are poorly understood. Quantifying the current burden and characterizing the epidemiology of RSV disease in AI/AN children and pregnant women is a critical step to inform optimal use of RSV-prevention products to reduce disease and promote health equity. The proposed research will build upon long-standing collaborations between tribal partners, the Johns Hopkins Center for American Indian Health (JHCAIH) and the Alaska Native Tribal Health Consortium (ANTHC) to create the RSV Surveillance in Native Americans (RSV-SuNA) system. RSV-SuNA will quantify and describe RSV disease in AI/AN children under five years and pregnant women in three communities in the southwestern US and two communities in Alaska over five RSV seasons. The platform will consist of active, population- based, in-patient and outpatient surveillance for ALRI across multiple settings and seasons in order to provide a robust understanding of RSV disease in Native populations. Nasal swabs will be collected from consenting participants and tested for the presence of RSV and other pathogens associated with ALRI using validated laboratory methods. This, and the use of standardized case definitions and data collection in instruments, will facilitate comparison across sites and with other active surveillance networks (e.g. CDC’s existing New Vaccine Surveillance Network). This study will determine the age-specific incidence of RSV-associated hospitalizations and outpatient visits in these AI/AN communities and characterize RSV- and non-RSV associated ALRI, including risk factors, clinical course, and sequalae. The collaborative, multi-site approach will fill key gaps in our understanding of the epidemiology of RSV and produce meaningful data to inform policy and monitor RSV disease in AI/AN populations. The RSV-SuNA system could be replicated in other AI/AN populations and could be used after the introduction of RSV prevention products to quantify their impact on the burden of both RSV and non-RSV ALRI.