MOSAIC: Mobile Surveillance for ARI and ILI in the Community

描述（由申请人提供）：急性呼吸道感染（ARI）包括流感样疾病（ILI）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，以及由于失去工作和上学时间而造成的间接费用。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与几十年前进行的基于人群的研究相比发生了变化，因此需要开展新的基于人群的研究来评估ARI/ILI的发病率和病因。同样，逆转录聚合酶链反应（RT-PCR）等现代诊断技术扩大了对病毒性ARI/ILIs的流行病学和病因学的更多了解的潜力；在以往的历史研究中，估计75%的ARI/ ili相关样本未发现病毒。具体目的：1)在具有代表性的以人群为基础的社区样本中确定ARI和ILI的发病率；(2)明确这些ARIs和ILIs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)评估本研究社区人群与寻求急性护理人群在ARI/ILI患病率和病因学方面的差异；(2)在研究的社区样本中确定流感疫苗接种对预防流感疾病的有效性。方法：对300户家庭进行至少一年的随访，每年保持约1000人的监测人口。家庭将通过随机抽样来确定，这些家庭目前已经参加了一项社区调查研究，该研究已经通过对曼哈顿北部华盛顿高地/因伍德地区的家庭进行随机分层抽样来招募。急性呼吸道感染/ILI监测将采用短信和电话随访方式，每周进行两次。将从患病家庭成员获取鼻咽拭子，并通过多重RT-PCR分析确定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。将本研究数据与医院数据进行比较，将评估社区人群和寻求急性护理的人群之间ARI/ILI患病率/病因学的差异。实验室数据将与我们的儿童/成人免疫登记相结合，通过病例对照分析确定季节性流感疫苗对实验室确诊流感的有效性。结果：主要结果为：(1)急性呼吸道感染/ILI的发病率和患病率；(2) ARI/ILI病因学；(3)与ARI/ILI发病和传播相关的因素。次要结局将包括：(1)社区人群和寻求急性护理的人群之间ARI/ILI患病率和病因的差异；(2)流感疫苗预防实验室确诊流感的有效性。如果成功，该项目将提供重要的新信息，帮助规划ARI/ILI干预措施，包括新疫苗、疫苗接种战略和病毒性病原体监测，包括未来的疫情。

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.