MOSAIC: Mobile Surveillance for ARI and ILI in the Community

描述(申请人提供)：急性呼吸道感染(ARI)，包括流感样疾病(ILI)，可能导致严重的发病率和死亡率，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天数而造成的间接费用。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自几十年前进行了基于人群的研究以来，需要进行新的基于人群的研究，以评估ARI/ILI的发病率和病因。同样，逆转录聚合酶链式反应(RT-PCR)等现代诊断技术为更多地了解病毒性ARI/ILI的流行病学和病原学提供了可能；在先前的历史研究中，估计75%的ARI/ILI相关样本中没有发现病毒。具体目标：1)确定具有代表性的以人群为基础的社区样本中ARI和ILI的发病率；(2)确定ARI和ILI的病因；以及(3)评估与ARI/ILI的发病率和传播有关的个人和家庭因素。次要目标：(1)评估这项研究的社区人群和寻求急性护理的人群之间ARI/ILI的患病率和病因的差异；(2)在研究的社区样本中确定流感疫苗接种在预防流感疾病方面的有效性。方法：将对300户家庭进行至少一年的跟踪调查，保持每年约1000人的监测人口。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，目前正在参加一项基于社区的调查研究的现有家庭队列将被随机抽样，以确定家庭的身份。ARI/ILI监测将每周两次，使用短信和电话跟踪。鼻咽拭子将从患病的家庭成员中获得，并通过多重RT-PCR进行分析以鉴定ARI/ILI相关病毒。与ARI/ILI发病和传播有关的个人和家庭因素将使用一般估计方程回归模型进行评估。将这项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性护理的人群在ARI/ILI的患病率/病因学方面的差异。实验室数据将与我们的儿科/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认的流感的有效性。结果：主要结果将是(1)ARI/ILI的发生率和流行率；(2)ARI/ILI的病因；(3)与ARI/ILI的发生率和传播相关的因素。次要结果将包括(1)社区人群和寻求急性护理的人群之间ARI/ILI的患病率和病原学的差异；(2)流感疫苗在预防实验室确认的流感方面的有效性。如果成功，该项目可以提供重要的新信息，以帮助规划ARI/ILI干预措施，包括新疫苗、疫苗接种战略和病毒病原体监测，包括未来的暴发。

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.