DISCOVAR:Disparities in Immune Response to SARS-CoV-2 in ARkansas

项目摘要 严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）是一种新型冠状病毒， 2019冠状病毒病（COVID-19），并负责目前的大流行，共有1440万人 2019冠状病毒病（COVID-19）确诊病例在200多个国家和地区， 截至2020年7月19日，604，000人死亡。其中，383万例和14.3万例死亡发生在美国， 美国。大多数长期的公共卫生和临床方法，以遏制大流行是基于 推测感染SARS-CoV-2可赋予至少1年的抗再次感染免疫力。然而，在这方面， 对SARS-CoV-2的免疫反应的了解非常有限， 缺乏预防再感染或持续时间。最令人担忧的是，种族/族裔少数群体承担着 SARS-CoV-2感染的发病率、发病率和死亡率负担不成比例。到目前为止， 对这种差异的解释被认为是结构性的种族主义和歧视， 健康状况，以及获得医疗保健的机会延迟或有限。然而，免疫反应的差异， SARS-CoV-2也可能在这种差异中发挥作用。免疫反应中的种族/民族差异是很好的 对于其他病毒性疾病和疫苗，有记录，但对SARS-CoV-2的免疫反应知之甚少 种族/少数民族。为了解决这一关键的知识缺口，我们将评估和表征免疫系统， 阿肯色州少数民族对SARS-CoV-2感染的反应。为了实现这一目标，我们建议 一项基于人群的、观察性前瞻性队列研究，包括男性和女性， 种族和地理多样性，所有非制度化的成年人居住在代表性的样本， 阿肯色州通过实时逆转录酶聚合酶链反应（RT-PCR）检测COVID-19， 二零二零年十一月及二零二一年四月。这450人的队列将从全州的COVID-19测试中抽样 数据库，并随访至测试后48个月。我们的第一个目标是确定血清学反应， 阿肯色州经RT-PCR证实的阳性成人中按种族/民族划分的SARS-CoV-2感染随时间的变化在这 我们将评估NH黑人和西班牙裔成人与NH白色成人相比的血清学反应。 我们的第二个目标是确定SARS-CoV-2感染的血清学应答随时间的持久性， RT-PCR确认的阳性成年阿肯色州人中的种族/民族。在目标3中，我们将确定心理社会如何 和行为因素，如慢性压力、抑郁、焦虑、社会支持、吸烟、饮酒， 和久坐不动的生活方式，随着时间的推移影响SARS-CoV-2的血清学反应的种族/民族。我们 我希望我们的研究结果能为少数民族患者的临床管理和预后提供信息。 COVID-19和疫苗开发。我们的研究结果也将对长期的公共卫生产生重大影响。 遏制流行病的公共卫生政策。

PROJECT SUMMARY Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is the causative agent of coronavirus disease 2019 (COVID-19) and is responsible for the current pandemic, with 14.4 million total confirmed cases of coronavirus disease 2019 (COVID-19) in over 200 countries and territories and more than 604,000 deaths as of July 19, 2020. Of these, 3.83 million cases and 143,000 deaths occurred in the United States (US). Most long-term public health and clinical approaches to pandemic containment are based on the presumption that infection with SARS-CoV-2 confers immunity against reinfection for at least 1 year. However, understanding of immune responses to SARS-CoV-2 is extremely limited and evidence of conferred immunity against reinfection or its duration are lacking. Most concerning is that racial/ethnic minorities bear a disproportionate burden of the incidence, morbidity, and mortality from SARS-CoV-2 infection. To date, explanations for this disparity are postulated as structural racism and discrimination, higher rates of pre-existing health conditions, and delayed or limited access to healthcare. However, differences in immune response to SARS-CoV-2 may also play a part in this disparity. Racial/ethnic differences in the immune response are well documented for other viral diseases and vaccines, but little is known about immune response to SARS-CoV-2 in racial/ethnic minorities. To address this critical gap in knowledge, we will assess and characterize the immune response to SARS-CoV-2 infection in racial/ethnic minorities in Arkansas. To achieve this objective we propose a population-based, observational prospective cohort study comprised of men and women that is a racially, ethnically, and geographically diverse, representative sample of all noninstitutionalized adults residing in Arkansas tested by real-time, reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 between November 2020 and April 2021. The 450-person cohort will be sampled from the statewide COVID-19 test database and followed up to 48 months posttesting. Our first aim is to determine the serological responses to SARS-CoV-2 infection over time by race/ethnicity among RT-PCR confirmed, positive adults in Arkansas. In this aim we will assess serological response among NH black and Hispanic adults in comparison to NH white adults. Our second aim is to determine the durability of the serological response to SARS-CoV-2 infection over time by race/ethnicity among RT-PCR confirmed positive adult Arkansans. In Aim 3 we will determine how psychosocial and behavioral factors such as, chronic stress, depression, anxiety, social support, tobacco use, alcohol intake, and sedentary lifestyle, influence the serological response over time to SARS-CoV-2 by race/ethnicity. We expect that our results will inform clinical management and prognosis of racial/ethnic minority patients with COVID-19 and vaccine development. Our findings will also have a significant public health impact for long-term public health policies for pandemic containment.