Core_plus Option_A_C_Influenza Surveillance and Vaccine Effectiveness in a Large

描述（由申请人提供）：流感造成重大的公共卫生负担，最近H1N1大流行期间为预防和治疗疾病所做的巨大努力证明了这一点。预防流感的主要方法是接种疫苗；然而，流感疫苗的有效性取决于宿主因素和疫苗特性，包括个体免疫反应以及任一年份疫苗毒株与流行毒株之间的匹配。因此，疫苗有效性（VE）每年都不相同，特别是在老年人中，这是一个国际争议的主题。我们提出一项年龄匹配的病例对照研究流感疫苗的有效性在UPMC-卫生系统。采用病例对照方法，我们建议计算流感疫苗对6个月-18岁、19-49岁和50岁以上三个年龄组门诊患者实验室确诊流感病毒感染的有效性。我们将利用现有的综合征监测来确定流感样疾病（ILI）何时在社区开始；招募、同意和登记接受医疗护理的急性呼吸道疾病门诊患者；用逆转录聚合酶链反应（RT-PCR）检测以确定病例和对照；主要使用UPMC电子健康记录（EHR）和电子全州疫苗登记（PA-SIIS）确定疫苗接种状态；使用电子病历（如Charleson共发病评分）和调查方法量化潜在的混杂因素和效果调整因素；确定已经;并对潜在的未测量混杂因素的影响进行敏感性分析。此外，我们将确定当地的流行病学、负担和流感疾病的病程，并使用匹兹堡超级计算中心基于代理的建模来估计实验室确诊流感的基于人群的发病率。拟议的研究是基于我们正在进行的流感综合征监测、使用全系统电子病历的先进生物医学信息学、提高疫苗接种率的广泛研究、多种呼吸道病毒检测的临床背景和基于agent的建模以产生疾病负担和成本的人群估计的坚实基础，并涉及一个良好发表的研究小组。

DESCRIPTION (provided by applicant): Influenza causes a major public health burden, as evidenced by the tremendous efforts required to prevent and treat disease during the recent H1N1 pandemic. The primary influenza prevention method is vaccination; however, the effectiveness of influenza vaccine varies depending upon host factors and vaccine characteristics that include individual immune response and the match between the vaccine strains and circulating strains in any given year. Therefore, vaccine effectiveness (VE) varies annually, particularly among elderly persons, and is a subject of international controversy. We propose an age-matched case-control study of the effectiveness of influenza vaccine in the UPMC- Health System. Using case-control methods, we propose to calculate the effectiveness of influenza vaccines against laboratory-confirmed influenza virus infections among outpatients in three age groups: 6 months-18 yrs, 19-49 yrs, and 50+yrs. We will use existing syndromic surveillance to identify when influenza-like illness (ILI) begins in the community; recruit, consent and enroll outpatients with for medically-attended acute respiratory illness (MAARI); test with reverse transcriptase-polymerase chain reaction (RT-PCR) to identify cases and controls; determine vaccination status using primarily the UPMC electronic health record (EHR) and the electronic statewide vaccine registry (PA-SIIS); quantify potential confounders and effect modifiers using the EHR (e.g., Charleson co-morbidity score) and survey methodology; determine VE; and conduct sensitivity analyses about the impact of potential unmeasured confounders. Additionally we will determine the local epidemiology, burden and course of influenza illness and estimate the population-based attack rate for laboratory-confirmed influenza, using agent-based modeling at the Pittsburgh Supercomputing Center. The proposed study is based on a strong foundation of our ongoing syndromic surveillance of influenza, advanced biomedical informatics using system-wide electronic medical record, broadly-based research to increase vaccination rates, clinical context of multiplex respiratory virus testing, and agent-based modeling to produce population estimates of disease burden and cost and involves a well-published team of investigators. Optional Objective A Overall Priority Score: 20 Optional Objective C Overall Priority Score: 1