Preventing Lyme Disease Exposure Among Outdoor Workers

 描述(申请人提供)：莱姆病和其他由壁虱传播的疾病对户外工作者的健康构成重大威胁。双盲随机对照试验(RCT) 在北卡罗来纳州的户外工作人员中，我们之前曾证明，在北卡罗来纳州的户外工作人员中，长期使用氯菊酯浸渍(LLPI)的服装可以在一年内提供80%的保护，防止孤星虱叮咬。但在将这一发现转化为政策之前，有三个问题需要解决：1)LLPI服装是否能保护你免受莱姆病、巴贝斯虫病和无浆体病以及孤星扁虱的媒介--黑腿壁虱的侵袭？2)氯氰菊酯及其代谢物被吸收的水平是多少，它们是否具有潜在的毒性？3)为什么我们之前研究中的LLPI服装在一年后失效？为了回答这些问题，我们建议在东北莱姆流行地区对200名户外工作者进行为期两年的双盲随机对照试验。来自国家公园管理局、罗德岛州环境管理部和国家电网的户外工作人员将被随机分配到处理组或对照组。所有研究对象将填写每周的壁虱日志，收集附壁的壁虱，以便以后进行物种鉴定和病原体检测，并提交每年的血清样本，以测试是否接触壁虱传播的病原体。随机选择的一组受试者也将被要求在随访期间的几个时间点提交尿样进行氯氰菊酯代谢物分析。其他人将被要求在第一年和第二年的现场测试结束时提交穿着的衣服进行滴答击倒测试和氯氰菊酯含量分析。这个项目 具体涉及NIOSH校外研究的以下优先目标：目标2：减少由于保护其自身安全和健康的选择受到限制而更容易受伤或患病的工人的有害健康和安全后果；目标7：通过减少急慢性疾病的职业原因或促成因素，改善林业工人的健康和福祉。这项研究将针对农业、林业和渔业部门以及跨部门的个人防护技术，评估氯氰菊酯浸渍长效衣物在林业、公用事业工人和公园护林员中预防扁虱叮咬和壁虱传播疾病的保护效果和毒理风险。这项研究的结果可能有助于保护数十万接触壁虱和壁虱传播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.