Prospective Studies of Avian Influenza Transmission in Asia

描述（由申请人提供）：H5 N1禽流感疫情在亚洲肆虐了多个物种，现在威胁到美国。国家应对计划要求积极识别人类病例，使用抗病毒药物，隔离，并可能隔离。流行病计划所依赖的数学模型缺乏基本的客观数据，如传播率和病毒传染性。由于亚洲的人类疾病检测是基于临床接触，对亚临床感染或H5 N1感染的风险因素知之甚少。本研究的长期果阿/是从流行病学角度描述H5 N1的临床和亚临床传播，以便公共卫生官员设计适当的H5 N1监测和控制措施。在这项工作中，我们将在900名职业性暴露于家禽的成年人（家禽养殖者、家禽业工人、肉类加工工人、开放的家禽市场工人）和300名年龄组和性别匹配的非暴露对照者中进行一项为期三年的H5 N1传播前瞻性对照研究，这些人生活在亚洲三个H5 N1流行地区：印度尼西亚的丹格朗、印度尼西亚的巴厘和柬埔寨的干丹省。本研究将包括对研究受试者中的流感样疾病进行积极主动监测（鼻咽拭子和血清采样），每年对受试者进行一次系列血清学随访，并通过家庭访视对暴露于发生流感感染的研究受试者的家庭成员进行类似研究。将使用中和血清学技术、RT-PCR和病毒培养来确定流感感染结局。我们的目标是确定既往H5 N1流感感染证据的血清阳性率，估计H5 N1流感感染的年发病率，估计继发性H5 N1流感感染率，并确定H5 N1流感感染的危险因素。根据初步数据，我们的主要假设是，H5 N1流感感染将在这些工人中频繁发生，我们将能够估计H5 N1感染的流行率和发病率，我们将能够确定H5 N1感染风险最高的人。我们特别适合开展这项工作，因为我们在流感传播的流行病学和实验室研究方面拥有丰富的经验，我们在国家和地方公共卫生官员之间在实地开展了出色的合作。这项研究的创新之处在于，没有在H5 N1流行地点的职业接触家禽的人中进行禽流感感染的前瞻性研究。

DESCRIPTION (provided by applicant): The H5N1 avian influenza epidemic that has ravaged multiple species in Asia, now threatens the United States. National response plans call for aggressive human case identification, antiviral use, isolation, and possibly quarantine. The mathematical models upon which the pandemic plans rely lack fundamental objective data such as transmission rates and virus infectiousness. As human disease detection in Asia is based upon clinical encounters, little is known regarding subclinical infections or risk factors for H5N1 infection. Our long term goa/in this proposed research is to epidemiologically describe clinical and subclinical H5N1 transmission such that public health officials might design appropriate H5N1 surveillance and control measures. In this effort we will conduct a controlled, three-year, prospective study of H5N1 transmission among 900 adults occupationally exposed to poultry (poultry farmers, poultry industry workers, meat processing workers, open poultry market workers), and 300 age-group and gender matched non-exposed controls living in three H5N1 endemic areas in Asia: Tangerang, Indonesia; Bali, Indonesia; and Kandaal Province, Cambodia. The study will involve aggressive active surveillance for influenza-like illness among study participants (with nasopharyngeal swab and serum sampling), annual serial serological follow-up of participants, and through home visits, similar studies of the family members exposed to study subjects who develops influenza infection. Microneutralization serologic techniques, RT-PCR, and viral culture will be used to determine influenza infection outcomes. Our objectives are to determine the seroprevalence of evidence of previous H5N1 influenza infection, to estimate the annual incidence of H5N1 influenza infection, to estimate secondary H5N1 influenza infection rates, and to determine risk factors for H5N1 influenza infection. Based upon preliminary data, our central hypotheses are that H5N1 influenza infection will be frequent among these workers, that we will be able to estimate the prevalence and incidence of H5N1 infection, and that we will be able to identify persons at highest risk of H5N1 infection. We are particularly well-suited to conduct this work as we have extensive experience conducting both epidemiological and laboratory-based studies of influenza transmission, and we have exceptional cooperation among public health officials nationally and locally at the field sites. This study is innovative in that no such prospective studies of avian influenza infection have been performed among those person's occupationally exposed to poultry in H5N1 endemic sites.