The effect of the 1918 influenza pandemic on seasonal influenza in the U.S.

描述(申请人提供)：1918-20年流感大流行是现代史上最大、最致命的流行病。它在大约六个月的时间里蔓延到整个世界，导致2000万到1亿人死亡。然而，尽管发生了如此毁灭性的事件，但关于流感疫情如何以及何时在世界各地的城市和国家传播的详细信息很少，特别是在美国。因为上一次流感大流行是在1968年，未来大流行的威胁迫在眉睫。因此，对于美国的公共卫生来说，重要的是不仅要了解1918年大流行的时间和空间过程，而且还要了解这一重大事件可能如何影响流感在非大流行季节的时间和传播。这些知识可以为针对未来大流行的有针对性的预防战略提供依据。这项拟议的研究试图使用历史来源的每周死亡数据和国家呼吸道和肠道病毒监测系统(NREVSS)的实验室监测数据来研究流感在大流行和非大流行季节在美国的时间和传播。这项研究的第一个目的是建立美国流感大流行和非大流行四个时期的时间和空间方面的模型：1918-20年大流行、1914-1917年流感季节、1920-1923年流感季节和1997-2007年流感季节。对于每个流感季节，将绘制每个城市的第一份流感死亡报告或实验室确认的一周，并根据这一日期序列构建传播媒介。还将通过确定每个城市每个季节的平均死亡时间或实验室确认时间来构建模型，然后构建线性趋势面，并将其绘制在单独的地图上。波浪行进的方向将在每张地图上用一个矢量标记。这项研究的第二个目的是比较1918年美国大流行的时间和空间发展与非大流行年份的发展。为了便于分析，美国将被分成九个地区，并将使用双比例分析来比较大流行年份和非大流行年份流感的空间和时间方面。这种方法将标准化历年流感的相对强度，从而分析美国流感的综合时空变异性。这些目标和方法的完成在备灾方面有广泛的应用，如大流行规划和生物恐怖主义。了解美国流感的时间和空间过程可能会严重限制未来大流行的影响，并使公共卫生专业人员能够更有效地利用干预措施。与公共卫生相关：我目前正在寻求Kirschstein-NRSA多样性奖学金，以便为在公共卫生领域长期而富有成效的职业生涯做好更好的准备。我希望成为联邦流行病学家，这样我就能最好地帮助国家的公共卫生和科学界改进传染病监测的方法。我相信Kirschstein-NRSA多样性奖学金将以我的研究生教育为基础，为我提供所需的培训和支持，以实现我的上述目标，并因此成为一名重要的未来流行病学家和科学研究人员。我希望Kirschstein-NRSA奖学金的培训将增加我对流行病学方法和分析的实际应用，并使我能够获得新的技术，如双比例分析和空间建模。这一奖学金将为我提供一个利用监测数据开发方法的机会，这些方法不仅将使我更好地了解流感在美国的传播过程，还可能改善美国的流感监测系统。我相信，从这个奖学金中获得的培训将使我成为一名更有才华的流行病学家，我相信我将成为Kirschstein-NRSA研究生研究员和校友以及整个公共卫生界的强大贡献成员。

DESCRIPTION (provided by applicant): The 1918-20 influenza pandemic was the largest, most lethal epidemic in modern: history. It spread over the entire world in about six months and killed between 20 and 100 million people. Yet, despite such a devastating event, there is little detailed information on how and when the influenza epidemic spread throughout cities and countries in the world, especially the U.S. Because the last influenza pandemic was in 1968, the threat of a future pandemic looms large. It is, therefore, important for public health in the U.S. to not only understand the timing and spatial course of the 1918 pandemic, but to also understand how this great event might have affected the timing and spread of Influenza in non-pandemic seasons. This knowledge could inform targeted prevention strategies for a future pandemic. The proposed research seeks to use weekly mortality data from historical sources and lab surveillance data from the National Respiratory and Enteric Viruses Surveillance System (NREVSS) to study the timing and spread of influenza through the U.S. during pandemic and non pandemic seasons. The first aim of this research is to develop models of the temporal and spatial aspects of influenza In the U.S. for four pandemic and non-pandemic periods: the 1918- 20 pandemic, 1914-1917 Influenza seasons, 1920-1923 influenza seasons, and 1997-2007 influenza seasons. For each influenza season, the week of the first report of influenza mortality or lab confirmation will be plotted for each city and spread vectors will be constructed from this sequence of dates. Models will also be constructed by determining the average time to death or lab confirmation for each city for each season and then constructing linear trend surfaces, which will be plotted on a separate map. The direction of the wave progression will be marked by a vector on each map. The second aim of this study is to compare the time and spatial progression of the 1918 pandemic in the U.S. with those of non-pandemic years. The U.S. will be divided into nine regions to allow for easier analysis and bi-proportionate analysis will be used to compare the spatial and temporal aspects of influenza in pandemic years with those in non-pandemic years. This method will allow the analysis of the combined space-time variability in influenza in the U.S. by standardizing the relative intensity of influenza throughout the years. The completion of these aims and these methods has broad application for disaster preparedness, such as pandemic planning and bioterrorism. Knowledge of the timing and spatial course of influenza in the U.S. could severely limit the impact of a future pandemic and allow public health professionals to more effectively utilize interventions. PUBLIC HEALTH RELEVANCE: I am currently pursuing the Kirschstein-NRSA Diversity Fellowship in order to be better prepared for a long and fruitful career in public health. I wish to become federal epidemiologist so that I can best help the nation's public health and scientific community refine the methods of infectious disease surveillance. I believe the Kirschstein-NRSA Diversity Fellowship will build upon my graduate education and provide me with the training and support I need to accomplish my above-stated goals and, consequently, become a significant future epidemiologist and scientific researcher. I expect that training from the Kirschstein-NRSA Fellowship will increase my practical application of epidemiologic methods and analysis and will allow me to gain new techniques, such as bi-proportionate analysis and spatial modeling. This fellowship will provide me with an opportunity to use surveillance data to develop methods that will not only better my understanding of the transmission process of Influenza In the U.S., but may also better the influenza surveillance system in the U.S. I believe the training from this fellowship will make me a more talented epidemiologist and I am confident that I would be a strong contributing member to the Kirschstein-NRSA graduate fellow and alumnus community as well as the overall public health community.