A Randomized Study of Exclusion Criteria in a University Population

描述(申请人提供)：流感大流行不定期发生，每一次都有不同的严重程度和受影响最大的人口群体的特点。一个不变的事实是，年轻人感染的比例不成比例；即使在1918年的大流行中，也有证据表明65岁及以上的人相对较少。在大流行和季节性流感中，大部分以社区为基础的传播发生在较年轻的个人中，部分原因是他们的易感性，但也因为他们的社会互动模式。在过去十年中，在规划流感大流行时，制定了社区缓解战略，建议采取各种措施来产生社会距离。许多分层干预措施涉及限制个人活动和/或隔离病例。在2009年的大流行中，此类措施从未得到正式建议，部分原因是早期难以评估严重程度。学校停课的时间各不相同，但许多都是为了应对当地事件，而不是像计划的那样提早关闭。因此，关于社会疏远的影响，有一些但没有足够的数据来为未来的大流行甚至季节性流感的爆发提出建议。大学是促进流感传播的地方，因为患者的年龄、他们彼此之间的密切接触以及疫苗接种率低。我们建议研究不同隔离期对大学宿舍流感传播的影响。具体地说，我们将随机选择大型大学宿舍(宿舍)执行三项隔离协议，这些协议将在已知流感传播期间实施。那些在随机住宿大厅出现流感样疾病的人将a)不被要求改变他们的行为b)同意在他们的房间里停留3天c)同意在他们的房间里停留6天。将在首次报告疾病时以及发病后第3天和第6天收集样本以进行病毒鉴定。这些样本将使用疾控中心推荐的探针和引子进行甲型和乙型流感以及其他呼吸道病原体的检测。将对结果进行分析，以量化脱落模式，并将在随机住宿大厅之间检查流感病例和呼吸道疾病病例的统计比较。需要检验的假设是，通过我们的研究和访问大学卫生服务机构，对居住大厅进行监测，对个人进行隔离将减少居住大厅内的传播。自愿隔离已被确定为减少流感传播的最有效方法之一。如果结果是肯定的，将确认这种干预措施的可接受性和效果的程度。它还将有助于确定应实行这种排除的天数。大学宿舍的环境可以很容易地识别变量并进行密切研究，这将为研究结果的概括性提供强大的信心。！！！ 公共卫生相关性：这项拟议的研究将评估密歇根大学校园宿舍不同隔离期对流感风险的影响。这项研究的结果将具有重要的公共卫生影响，包括确定可能导致学校爆发的疾病传播的关键时期。这些研究的结果可用于制定以社会距离为主要组成部分的具体国家缓解战略。

DESCRIPTION (provided by applicant): Influenza pandemics occur at irregular intervals and each has different characteristics in terms of severity and population groups most affected. One constant is that younger individuals are disproportionately infected; even in the great 1918 pandemic, there is evidence of relative sparing of those 65 years of age and older. Much of the community-based transmission in pandemic as well as seasonal influenza takes place in younger individuals, in part because of their susceptibility but also because of their social interaction patterns. During the last decade, in planning for an influenza pandemic, community mitigation strategies were developed which recommended various measures to produce social distancing. Many of the layered interventions involved restriction of individual activity and/or sequestration of cases. In the 2009 pandemic, such measures were never formally recommended, in part because of early difficulty in assessing severity. School closures were carried out for varying time periods, but many in reaction to local events rather than early as had been the planned approach. Thus, there are some, but not enough data on the effects of social distancing to make recommendations for future pandemics or even outbreaks of seasonal influenza. Universities are a place where transmission of influenza is facilitated because of the age of the individuals involved, their close contact with each other, and low vaccination coverage. We propose to study the effect of varying isolation periods on influenza transmission in University housing. Specifically, we will randomize large University residence halls (dormitories) to three sequestration protocols, which will be put into effect during periods of known influenza transmission. Those who develop influenza-like illnesses in randomized residence halls will a) not be asked to change their behaviors b) agree to remain in their rooms for 3 days c) agree to remain in their rooms for 6 days. Specimens will be collected for virus identification when the illness is first reported, as well as on day 3 and on day 6 from illness onset. The specimens will be run for type A and B influenza and other respiratory pathogens using CDC recommended probes and primers. Results will be analyzed to allow quantification of shedding patterns and statistical comparisons for influenza illness cases and respiratory illness cases will be examined between randomized residence halls. The hypothesis to be tested is that sequestration of individuals will reduce transmission within the residence hall via monitoring of residence halls through our study and visits to University Health Services. Voluntary isolation has been identified as one of the most efficient ways to reduce influenza transmission. The results, if positive, will confirm the acceptability and magnitude of effect that can be expected from such an intervention. It will also help in determining the number of days that such an exclusion should be practiced. The environment of a university dormitory, where variables can easily be identified and closely studied, will provide strong confidence in the generalizability of the findings. ! ! ! PUBLIC HEALTH RELEVANCE: The proposed study will assess the impact of varying isolation periods on risk of influenza in residence halls on the campus of University of Michigan. The findings from this study will have important public health implications, including identification of critical periods of illness transmission that may account for outbreaks in the school setting. The results of these studies may be used for setting specific national mitigation strategies where social distancing is a major component.