MOSAIC: Mobile Surveillance for ARI and ILI in the Community

描述（由申请人提供）：包括流感样疾病（ILI）在内的急性呼吸道感染（ARI）可导致显著的发病率和死亡率，包括门诊和住院在内的直接医疗费用，以及因失去工作和上学而产生的间接费用。由于ARI/ILI的发病率和传播以及与ARI/ILI流行病学相关的因素自几十年前进行的基于人群的研究以来已经发生了变化，因此需要进行新的基于人群的研究来评估ARI/ILI的发病率和病因。同样，现代诊断技术，如逆转录聚合酶链反应（RT-PCR），扩大了对病毒性ARI/ILI的流行病学和病因学的更多了解的潜力;在以前的历史研究中，估计75%的ARI/ILI相关样本中没有发现病毒。具体目标：1）确定代表性人群社区样本中ARI和ILI的发病率;（2）确定这些阿里斯和ILI的病因;（3）评估与ARI/ILI发病率和传播相关的个人和家庭因素。次要目的：（1）评估本研究的社区人群和寻求紧急护理的人群之间ARI/ILI的患病率和病因学差异;（2）确定流感疫苗接种在本研究社区样本中预防流感疾病的有效性。研究方法：将对300户家庭进行至少一年的跟踪，每年保持约1000人的监测人群。通过对曼哈顿北部北方华盛顿高地/Inwood地区的家庭进行随机分层抽样，对目前参加基于社区的调查研究的现有家庭队列进行随机抽样，确定家庭。ARI/ILI监测将通过短信和电话随访每周进行两次。将从患病家庭成员中获得鼻咽拭子，并通过多重RT-PCR进行分析，以识别ARI/ILI相关病毒。将使用一般估计方程回归模型评估与ARI/ILI发病率和传播相关的个人和家庭因素。将本研究的数据与医院数据进行比较，将评估社区人群和寻求急诊护理的人群之间ARI/ILI患病率/病因的差异。实验室数据将与我们的儿童/成人免疫登记研究相结合，以使用病例对照分析确定季节性流感疫苗对实验室确认的流感的有效性。成果：主要结局为（1）ARI/ILI的发病率和患病率;（2）ARI/ILI的病因;（3）与ARI/ILI发病率和传播相关的因素。次要结局将包括（1）社区人群和寻求急诊护理人群之间ARI/ILI的患病率和病因差异;（2）流感疫苗预防实验室确诊流感的有效性。 如果成功，该项目可以提供重要的新信息，以帮助计划ARI/ILI干预措施，包括新疫苗，疫苗接种策略和病毒病原体的监测，包括未来的爆发。 公共卫生相关性：这项研究将提供有关社区样本中急性呼吸道疾病（ARI）和流感样疾病（ILI）的发病率、病因和相关因素的重要信息，希望最终能够更好地预防和控制。它还将允许直接比较社区与医院样本中病毒感染的病因，以及社区与紧急寻求治疗的人群中ILI的发病率，可能为病毒监测提供重要信息，包括 应对未来疫情的策略。此外，该项目将允许计算流感 在社区样本中对实验室确认的流感的疫苗有效性。

DESCRIPTION (provided by applicant): Acute respiratory infections (ARI) including influenza-like illness (ILI) can result in significant morbidity and mortality, direct medical expenses including outpatient visits and hospitalizations, and indirect costs due to lost work and school days. New population-based studies assessing the incidence and etiologies of ARI/ILI need to be conducted as ARI/ILI incidence and transmission as well as factors associated with ARI/ILI epidemiology have changed since previous population-based studies were conducted decades ago. Likewise, modern diagnostic techniques such as reverse transcription polymerase chain reaction (RT-PCR) expands the potential for greater knowledge regarding the epidemiology and etiology of viral ARI/ILIs; in previous historical studies in an estimated 75% of ARI/ILI-associate samples no virus was identified. Specific Aims: 1) Identify incidence of ARI and ILI in a representative population-based community sample; (2) Identify the etiology of these ARIs and ILIs; and (3) Assess individual and household factors associated with incidence and transmission of ARI/ILI. Secondary aims: (1) Assess differences in prevalence and etiology of ARI/ILI between this study's community population and those seeking acute care; and (2) Determine effectiveness of influenza vaccination on prevention of influenza illness in the study's community sample. Methods: Three hundred households will be followed for at least a year, maintaining a surveillance population of approximately 1000 individuals per year. Households will be identified by randomly sampling an existing cohort of households currently enrolled in a community-based survey study already recruited via a random, stratified sampling of households in the Washington Heights/Inwood area of Northern Manhattan. ARI/ILI surveillance will be conducted twice-weekly using text messaging with phone follow-up. Nasopharyngeal swabs will be obtained from ill household members and analyzed to identify ARI/ILI associated viruses via multiplex RT-PCR. Individual and household factors associated with ARI/ILI incidence and transmission will be assessed using general estimating equation regression models. Comparing this study's data with hospital data will assess differences in prevalence/etiology of ARI/ILI between community populations and those seeking acute care. Laboratory data will be combined with our pediatric/ adult immunization registry to determine seasonal influenza vaccine effectiveness against lab-confirmed influenza using a case-control analysis. Outcomes: The primary outcomes will be (1) incidence and prevalence of ARI/ILI; (2) etiologies of ARI/ILI; (3) factors associated with ARI/ILI incidence and transmission. Secondary outcomes will include (1) differences in the prevalence and etiology of ARI/ILI between community population and those seeking acute care; (2) influenza vaccine effectiveness in prevention of laboratory-confirmed influenza. If successful this project could provide important new information to help plan ARI/ILI interventions including new vaccines, vaccination strategies, and surveillance for viral pathogens, including future outbreaks. PUBLIC HEALTH RELEVANCE: This study will provide important information regarding the incidence, etiology and factors associated with acute respiratory illness (ARI) and influenza-like illness (ILI) in a community sample hopefully leading ultimately to better prevention and control. It will also allow a direct comparison between the etiology of viral infection in a community versus a hospital-based sample, as well as of ILI incidence in the community compared to those acutely seeking care, potentially providing important information for viral surveillance, including strategies for future outbreaks. Additionally, this project will allow the calculation of influenza vaccine effectiveness against laboratory-confirmed influenza in a community sample.