IP21-002 Enhanced Surveillance for New Vaccine Preventable Diseases

项目概要-强制性组成部分A 急性呼吸道疾病（ARI）和急性胃肠炎（AGE）是世界范围内死亡的主要原因， 年幼的孩子。已确定的AGE的主要病毒病因是轮状病毒和诺如病毒以及呼吸道合胞病毒 病毒（RSV）和流感病毒用于ARI。我们对ARI和AGE流行病学的理解不断地 由于时空波动而发生变化，发现新的或重新出现的病原体[例如肠道病毒D 68 （EV-D 68）和严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）]，以及使用轮状病毒和 流感疫苗。因此，监测工作是必要的，以确定ARI和AGE疾病负担， 致病病原体、结果和疫苗影响。美国流感的初级预防策略 美国规定所有6个月或以上的人都要接种疫苗。关于疫苗的数据很少 对实验室确认的儿童流感的有效性（VE）以及流感病毒和疫苗 抗原成分每年都在变化。因此，需要对虚拟价值进行永久评估，以监测 流感疫苗接种对疾病影响及提高规模、持久性和广度的信息策略 保护。儿童SARS-CoV-2疫苗是公共卫生的当务之急， 加快时间轴，以遏制COVID-19大流行。严谨、前瞻 SARS-CoV-2 VE的监测对于支持依赖疫苗作为一级预防至关重要。因此 该项目的第一个主要目标是进行基于人口的呼吸系统和 儿科住院和急诊环境中肠道病毒病原体和无症状 对照我们的范德比尔特研究团队在进行前瞻性、人群- 基于ARI和AGE的监测。我们建议进行急性呼吸道感染及年龄组别监察， 目的：1）进行前瞻性、主动监测，以确定住院患者的病因和负担， 急诊科（艾德）儿科人群中的急性病毒性呼吸道和肠道疾病。2)到 描述儿科感染的临床和流行病学因素（包括无症状儿童） 通过主动监视。3)评价疫苗的有效性和影响， 干预（例如，用抗病毒剂或其它治疗剂的免疫预防）， 在执行期间可用。该项目的第二个主要目标是开展 儿童急性弛缓性肌麻痹综合征监测和流行病学特征给定 EV-D 68感染与急性弛缓性肌炎（AFM）之间流行病学联系， 在连续多个季节对AFM进行严格、积极、纵向的监测; 定义AFM临床谱、风险因素、发病率和实验室参数;并记录当地 EV-D 68和其他ARI和AGE病原体的循环与AFM发生率的增加一致。这项工作 支持AFM的预防、诊断和治疗策略的发展。

PROJECT SUMMARY - Mandatory Component A Acute respiratory illness (ARI) and acute gastroenteritis (AGE) are the leading causes of death worldwide in young children. Established leading viral etiologies of AGE are rotavirus and norovirus and respiratory syncytial virus (RSV) and influenza virus for ARI. Our understanding of ARI and AGE epidemiology is constantly changing due to spatiotemporal fluctuations, discovery of new or re-emerging pathogens [e.g. enterovirus D68 (EV-D68) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], and use of rotavirus and influenza vaccines. Hence, surveillance efforts are imperative to define ARI and AGE disease burden, causative pathogens, outcomes, and vaccine impact. The primary influenza prevention strategy in the United States is vaccination for all individuals six months or older. There is a paucity of data regarding vaccine effectiveness (VE) against laboratory-confirmed influenza in children, and influenza viruses and vaccine antigenic components change annually. Therefore, perpetual assessments of VE are needed to monitor the impact of influenza vaccination on disease and inform strategies to improve magnitude, durability, and breadth of protection. Pediatric SARS-CoV-2 vaccines are an urgent public-health priority and likely will become available on an accelerated timeline in an effort to curb the COVID-19 pandemic. Rigorous, prospective surveillance of SARS-CoV-2 VE is crucial to support reliance on vaccines as primary prevention. Thus, the first main objective of this project is to conduct population-based active surveillance for respiratory and enteric viral pathogens in pediatric inpatient and emergency department settings and asymptomatic controls. Our team of Vanderbilt investigators is highly experienced in conducting prospective, population- based ARI and AGE surveillance. We propose to conduct ARI and AGE surveillance with the following specific aims: 1) To perform prospective, active surveillance to determine the etiology and burden of inpatient and emergency department (ED) acute viral respiratory and enteric diseases among the pediatric population. 2) To characterize the clinical and epidemiologic factors of pediatric infections (including in asymptomatic children) through active surveillance. 3) To evaluate vaccine effectiveness and impact of vaccines and other interventions (e.g., immunoprophylaxis with antiviral agents or other therapeutics) available or projected to become available during the period of performance. The second main objective of this project is to conduct surveillance and epidemiologic characterization of acute flaccid myelitis syndrome in children. Given the epidemiologic connection between EV-D68 infection and acute flaccid myelitis (AFM), it will be important to conduct rigorous, active, longitudinal surveillance for AFM across multiple consecutive seasons; carefully define AFM clinical spectrum, risk factors, incidence rates, and laboratory parameters; and document local circulation of EV-D68 and other ARI and AGE pathogens coincident with increased AFM occurrence. This work underpins development of preventive, diagnostic, and therapeutic strategies for AFM.