Prospective Studies of Avian Influenza Transmission in Asia

禽流感在亚洲传播的前瞻性研究 H5 N1禽流感疫情在亚洲肆虐了多个物种，现在威胁到美国， States.国家应对计划要求积极的人间病例识别、抗病毒药物的使用、隔离和 可能是隔离流行病计划所依赖的数学模型缺乏基本的 传播率和病毒传染性等客观数据。由于亚洲的人类疾病检测是 根据临床经验，对H5 N1亚型病毒的亚临床感染或危险因素知之甚少 感染在这项拟议的研究中，我们的长期果阿是从流行病学角度描述临床和 亚临床H5 N1传播，以便公共卫生官员可以设计适当的H5 N1监测 和控制措施。 在这项工作中，我们将进行一项为期三年的前瞻性对照研究，研究H5 N1在900名 职业性接触家禽的成年人（家禽饲养者，家禽业工人，肉类加工工人， 开放家禽市场的工人），以及300名年龄组和性别匹配的非暴露对照，生活在三个 亚洲H5 N1流行地区：印度尼西亚丹格朗、印度尼西亚巴厘和柬埔寨干丹省。的 研究将涉及对研究参与者中流感样疾病的积极主动监测（ 鼻咽拭子和血清采样），每年对参与者进行系列血清学随访，并通过 家庭访视，对暴露于发生流感的研究受试者的家庭成员进行的类似研究 感染将使用中和血清学技术、RT-PCR和病毒培养来确定 流感感染的结果。我们的目标是确定以前的证据的血清阳性率 H5 N1流感感染，估计H5 N1流感感染的年发病率，估计 二次H5 N1流感感染率，并确定H5 N1流感感染的危险因素。基于 根据初步数据，我们的主要假设是，H5 N1型流感感染将在这些国家中频繁发生， 我们将能够估计H5 N1感染的流行率和发病率，我们将 能够识别感染H5 N1病毒风险最高的人。 我们特别适合进行这项工作，因为我们在这两方面都有丰富的经验 流行病学和实验室研究的流感传播，我们有特殊的 国家和地方公共卫生官员在实地开展合作。本研究具有创新性， 没有在这些人中进行禽流感感染的前瞻性研究， 在H5 N1流行地点职业性接触家禽。

Prospective Studies of Avian Influenza Transmission in Asia 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.