Enhanced Surveillance for New Vaccine Preventable Diseases

项目总结/摘要 急性胃肠炎（AGE）和急性呼吸道疾病（ARI）是导致 全世界新生儿期后5岁以下儿童的死亡率。主要确立的主要病毒 AGE的病因是轮状病毒和诺如病毒以及呼吸道合胞病毒（RSV）和ARI的流感。我们 对AGE和ARI流行病学的理解由于季节性波动而不断变化， 新的或重新出现的病原体，以及轮状病毒和流感疫苗的使用。因此，监督工作是 必须更好地了解AGE和ARI疾病负担、致病病原体、结局和疫苗 冲击我们的范德比尔特研究团队在进行前瞻性、基于人群的 用实验室确认的肠道和呼吸道病毒进行AGE和ARI监测。对于这个项目，我们 我建议在田纳西州戴维森县进行前瞻性年龄和ARI监测，具体如下 核心组成部分的目的：1）确定年龄特异性AGE与特异性肠道疾病的相关率， 对实验室确诊的儿童胃肠炎病毒进行主动的、基于人群的监测 出现在急诊室和住院儿童中。2)确定年龄特异性关联 使用主动的、基于人群的实验室监测， 在急诊科就诊的儿童和住院患者中确诊的呼吸道病毒 孩子3)确定流感疫苗预防<18岁儿童住院的年度有效性（VE） 使用测试阴性研究设计，因实验室确认的流感而导致的年龄<5岁。 可选部分：作为补助金可选部分的一部分，我们计划建立一个出生队列， 250名儿童;婴儿将从出生到第二个生日、死亡或失访， 以先到者为准。我们将系统地收集样本（例如，呼吸道、粪便和血液），以了解 年龄和ARI病原体在幼儿期的自然史，并了解免疫学和 可能影响症状和无症状状态的流行病学因素。的具体目标， 可选的组成部分包括：1）建立一个预期的出生队列的儿童谁居住 田纳西州纳什维尔/戴维森县，研究病因学、社会人口学、环境和免疫学因素 与儿童ARI和AGE以及呼吸道和呼吸道感染的家庭传播动力学相关， 在生命的头两年里发生胃肠道感染。2)确定呼吸道疾病的自然史 出生队列中与有症状和无症状期相关的感染和宿主免疫应答 超过两年。3)确定胃肠道感染和宿主免疫反应的自然史 与出生队列中两年以上的有症状和无症状期相关。

PROJECT SUMMARY / ABSTRACT CORE Component: Acute gastroenteritis (AGE) and acute respiratory illness (ARI) are the leading causes of death worldwide in children <5 years old beyond the neonatal period. The primary established leading viral etiologies of AGE are rotavirus and norovirus and respiratory syncytial virus (RSV) and influenza for ARI. Our understanding of AGE and ARI epidemiology is constantly changing due to seasonal fluctuations, discovery of new or re-emerging pathogens, and use of rotavirus and influenza vaccines. Hence, surveillance efforts are imperative to better understand AGE and ARI disease burden, causative pathogens, outcomes, and vaccine impact. Our team of Vanderbilt investigators is highly experienced in conducting prospective, population-based AGE and ARI surveillance with laboratory-confirmed enteric and respiratory viruses. For this project, we propose to conduct prospective AGE and ARI surveillance in Davidson County, TN, with the following specific aims for the core component: 1) To determine age-specific association rates of AGE with specific enteric viruses using active, population-based surveillance for laboratory-confirmed gastroenteritis viruses in children presenting to the emergency department and in hospitalized children. 2) To determine age-specific association rates of ARI with specific respiratory viruses using active, population-based surveillance for laboratory- confirmed respiratory viruses in children presenting to the emergency department and in inpatient hospitalized children. 3) To determine annual influenza vaccine efficacy (VE) in preventing hospitalizations of children <18 years of age due to laboratory-confirmed influenza using a test-negative study design. OPTIONAL Component: As part of the optional component of the grant, we plan to establish a birth cohort of 250 children; infants will be followed from birth through their second birthday, death, or lost to follow-up, whichever comes first. We will systemically collect specimens (e.g., respiratory, stool, and blood) to understand the natural history of AGE and ARI pathogens during early childhood and to understand immunological and epidemiological factors that can affect symptomatic and asymptomatic status. The specific aims for the optional component include:1) To establish a prospective birth cohort of children who reside Nashville/Davidson County, TN to study etiologic, sociodemographic, environmental, and immunologic factors associated with childhood ARI and AGE and the dynamics of household transmission of respiratory and gastrointestinal infections during the first two years of life. 2) To determine the natural history of respiratory infections and host immune responses related to symptomatic and asymptomatic periods in the birth cohort over two years. 3) To determine the natural history of gastrointestinal infections and host immune responses related to symptomatic and asymptomatic periods in the birth cohort over two years.