Epidemiologic Studies of HMPXV Infection among PWID in the US-Mexico Border Region to Inform Prevention Responses

作为对NOT-OD-22-159的响应，该项目将利用持续的注射吸毒者队列(PWID) 在美墨边境地区研究猴痘病毒(HMPXV)的流行病学，为预防提供信息 诊断和治疗HMPXV和遏制传播的干预措施。尽管众所周知，PWID面临着 许多健康差距，包括艾滋病毒、丙型肝炎病毒和性传播感染(STI)的比率高于 在普通人群中，专家们担心HMPXV的持续爆发，这是最大的 自20世纪70年代S首次出现这种病毒以来，有记录的国际疫情很快就会不成比例地影响 经历无家可归(PEH)的人，其中包括高比例的PWID。我们的团队包括 流行病学家、预防干预者、分子病毒学家和传染病内科医生要解决的问题 这些目标：目标1.确定亚临床和症状性HMPXV的患病率及其相关性 圣地亚哥/提华纳(SD/TJ)边境地区PWID感染情况通报预防工作进展 干预措施。H1。住房不稳定(H1.1)、拉丁裔(H1.2)或感染艾滋病毒但未收到 ART(H1.3)将更有可能检测出HMPXV感染呈阳性。目标2.估计发病率 1年内PWID人群HMPXV感染的危险因素。H2.1最近报告的PWID 有与注射毒品有关的脓肿、性传播感染或开放性溃疡将更有可能感染HMPXV 在随访期间。H2.2。报告从事性工作的PWID和性伴侣数量较多的人 将更有可能在后续行动中收购HMPXV。目标3.确定与以下各项相关的网络功能 HMPXV在PWID之间的跨境传播。H3.1 SD和TJ之间的跨境毒品旅游(由 参与者及其网络联系人)将与HMPXV感染有关。H3.2。网络层面的风险因素 例如接触者总数和男男性接触者、性工作者、居住不稳定者或 有监禁史的人在控制HMPXV感染后将独立地与HMPXV感染有关 个人层面的风险因素。目的4：对人类免疫缺陷病毒(HMPXV)变异体进行系统发育分析 SD/TJ区包括突变签名(例如，APOBEC3)。H4.1循环中的HMPXV将有一个 起源(谱系B.1)，然后是局部扩散。我们将利用我们NIDA的两国基础设施- 资助PWID的两国队列，以及加州大学圣地亚哥分校一个新的大流行预防研究所的支持，以 对从任何可疑病变/水泡收集的拭子进行HMPXV聚合酶链式反应检测和测序 口腔和肛门拭子。血清学HMPXV检测将由疾控中心进行实物检测。调查结果将为潜在的 干预措施和政策，包括是否应建议将PWID和/或PEH作为常规 疫苗接种以及增加艾滋病毒/艾滋病检测、疫苗接种和治疗的后续干预措施 这些弱势群体应该是基于网络或场所的，遵循NIMHD的概念模型 结构性干预。

In response to NOT-OD-22-159, this project will leverage an ongoing cohort of people who inject drugs (PWID) in the U.S.-Mexico border region to study the epidemiology of monkeypox virus (HMPXV) to inform prevention interventions to diagnose and treat HMPXV and curtail transmission. Although it is well known that PWID face numerous health disparities including higher rates of HIV, HCV and sexually transmitted infections (STIs) than the general population, experts are concerned that the ongoing outbreak of HMPXV, which is the largest international outbreak recorded since this virus first emerged in the 1970’s, will soon disproportionately affect people experiencing homelessness (PEH), which includes a high proportion of PWID. Our team includes epidemiologists, prevention interventionists, molecular virologists and infectious disease physicians to address these aims: Aim 1. To determine the prevalence and correlates of subclinical and symptomatic HMPXV infection among PWID in the San Diego/Tijuana (SD/TJ) border region to inform the development of prevention interventions. H1. PWID who are unstably housed (H1.1), Latinx (H1.2) or living with HIV and not receiving ART (H1.3) will be significantly more likely to test positive for HMPXV infection. Aim 2. To estimate incidence and risk factors of HMPXV infection among PWID over a one-year period. H2.1 PWID who report recently having abscesses associated with injection drug use, STIs or open sores will be more likely to acquire HMPXV during follow-up. H2.2. PWID who report engaging in sex work and those with higher numbers of sex partners will be more likely to acquire HMPXV during follow-up. Aim 3. To determine network features associated with cross-border transmission of HMPXV among PWID. H3.1 Cross-border drug tourism between SD and TJ (by participants & their network contacts) will be associated with HMPXV infection. H3.2. Network-level risk factors such as total number of contacts and number of contacts who are MSM, sex workers, unstably housed, or have a history of incarceration will be independently associated with HMPXV infection after controlling for individual-level risk factors. Aim 4: To conduct phylogenomic characterization of circulating HMPXV variants in the SD/TJ region including mutation signatures (e.g., APOBEC3). H4.1 Circulating HMPXV will have a single origin (lineage B.1) followed by local dispersal. We will leverage the binational infrastructure of our NIDA- funded binational cohort of PWID, and support from a new pandemic preparedness institute at UCSD to conduct HMPXV PCR testing and sequencing on swabs collected from any suspect lesions/vesicles as well as oral and anal swabs. Serologic HMPXV testing will be done in-kind by the CDC. Findings will inform potential interventions and policies, including whether PWID and/or PEH should be recommended for routine vaccination and whether subsequent interventions to increase HMPXV testing, vaccination and treatment in this vulnerable population should be network or venue-based, following NIMHD’s conceptual model for structural interventions.