Preventing Lyme Disease Exposure Among Outdoor Workers

 描述（由申请人提供）：莱姆病和其他蜱传疾病对户外工作者构成重大健康威胁。在一项双盲随机对照试验（RCT）中， 在北卡罗来纳州的户外工作者中，我们先前表明，长效氯菊酯浸渍（LLPI）服装在北卡罗来纳州的户外工作者中提供了>80%的一年保护，防止星星蜱叮咬。但是，在这一发现转化为政策之前，有三个问题需要解决：1）LLPI服装是否能防止黑腿蜱、莱姆病、巴贝西虫病和无形体病的传播媒介以及孤独星星蜱？2)氯菊酯及其代谢物的吸收水平如何，它们是否具有潜在毒性？3)为什么在我们之前的研究中，LLPI服装在一年后失去了功效？为了回答这些问题，我们提出了一个为期两年的双盲随机对照试验与200名户外工作者在莱姆病流行区的东北部。来自国家公园管理局、罗得岛环境管理部和国家电网的户外工作者将被随机分配到治疗组或对照组。所有研究受试者将填写每周蜱虫日志，收集附着的蜱虫用于以后的物种形成和病原体检测，并提交年度血清样本以检测蜱虫传播的病原体暴露。还将要求随机选择的受试者亚组在随访期间的几个时间点提交尿样进行氯菊酯代谢物分析。其他人将被要求在第一年和第二年的实地测试结束时提交磨损的衣物进行蜱虫击倒测试和氯菊酯含量分析。这个项目 具体涉及以下NIOSH校外研究的优先目标：目标2：减少有害的健康和安全结果，更容易受伤或生病的工人，由于环境限制了保障自己的安全和健康的选择，目标7：通过减少职业原因或促进因素，以改善林业工人的健康和福祉急性和慢性疾病和疾病。这项研究将解决农业，林业和渔业部门和个人防护技术跨部门的评估的保护有效性和毒理学风险的长效氯菊酯浸渍的衣服，以防止蜱叮咬和蜱传疾病的林业和公用事业工人和公园护林员。这项研究的结果可以帮助保护数十万暴露于蜱虫和蜱传病原体的户外工作者。

 DESCRIPTION (provided by applicant): Lyme and other tick-borne diseases pose a significant health threat to outdoor workers. In a double - blind randomized controlled trial (RCT) in North Carolina outdoor workers, we previously showed that long-lasting permethrin-impregnated (LLPI) clothing provided >80% protection for one year against Lone Star tick bites among outdoor workers in North Carolina. But there are three issues that need to be addressed before this finding can be translated into policy: 1) Do LLPI clothing protect t against blacklegged ticks, the vector for Lyme disease, babesiosis and anaplasmosis, as well as against the Lone Star tick? 2) What levels of permethrin and its metabolites are absorbed, and are they potentially toxic? 3) Why did the LLPI clothing in our previous study lose efficacy after a year? To answer these questions, we propose a two year double-blind RCT with 200 outdoor workers in Lyme endemic areas of the Northeast. Outdoor workers from the National Park Service, the Rhode Island Department of Environmental Management, and NationalGrid will be randomly assigned to the treatment or control group. All study subjects will fill out weekly tick logs, collct attached ticks for later speciation and pathogen detection, and submit annual serum samples to test for exposure to tick-borne pathogens. A randomly selected subset of subjects also will be asked to submit urine samples for permethrin metabolite analysis at several time points during follow-up. Others will be asked to submit worn items of clothing for tick knockdown testing and permethrin content analysis at the end of the first and second years of field testing. This project specifically addresses the following NIOSH Priority Goals for Extramural Research: Goal 2: Reduce deleterious health and safety outcomes in workers more susceptible to injury or illness due to circumstances limiting options for safeguarding their own safety and health, Goal 7: Improve the health and well-being of forestry workers by reducing occupational causes or contributing factors to acute and chronic illness and disease. This research will address the agriculture, forestry, and fishing sector and personal protective technology cross-sector by evaluating the protective effectiveness and toxicological risk of long-lasting permethrin impregnated clothing for prevention of tick bites and tick-borne disease among forestry and utility workers and park rangers. The results of this study could help protect hundreds of thousands of outdoor workers with exposure to ticks and tick-borne pathogens.