Outpatient VE for seasonal flu, pandemic flu and RSV in a large, diverse network

流感、呼吸道合胞病毒（RSV）和人偏肺病毒（HMPV）继续在 是主要的健康负担，每年造成数百万人患病， 住院和死亡在美国虽然旨在减少这一负担，流感 由于宿主因素、环境和环境因素，疫苗每年的有效性（VE）不同， 病毒和疫苗特性。来自美国流感VE网络的数据有助于CDC评估 疫苗政策，世卫组织选择疫苗株和临床医生使用抗病毒药物。 我们提出了一项测试阴性病例对照（TNCC）研究，以确定UPMC中的流感病毒VE， 为500个临床站点的不同人群提供服务。UPMC赢得奖项，成为最 UPMC优先为65岁以上的人使用高剂量疫苗 多年来，定期在其电子病历中记录疫苗接种状况，并有双向 与国家免疫登记处的接口。 我们的建议有一个强大的基础，目前参与美国流感VE网络， 多学科研究团队，随访调查完成率和入组率最高 数量超过要求。我们屡获殊荣的高通量实验室提供分析 流感病毒、RSV和HMPV。每个病毒季节定义都得到了超过14，000个临床 多重呼吸道病毒检测和持续的综合征监测。我们添加基于代理的 在匹兹堡超级计算机中心做模特我们是疾病预防控制中心住院VE网络网站， 从而比较门诊和住院患者的VE。 具体目标包括：1）使用TNCC方法，确定每年的流感和RSV（之后 许可证）VE对实验室确认，医疗护理，急性呼吸道感染 在3个年龄组的门诊患者中：6个月- 18岁，19-49岁，>50岁; 2)确定 相同年龄组中流感、RSV和hMPV的年度、基于人群的负担，使用 参与的初级保健站点作为源人群，进行敏感性分析， 关于疫苗接种方案影响的基于代理人的建模; 3）准备与 流感大流行，描述流行病学、抗病毒药物的有效性和/或大流行 疫苗，包括关于患者门户网站/电话登记的试点研究。

Influenza, respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) continue to be major health burdens, each year causing millions of illnesses and tens of thousands of hospitalizations & deaths in the U.S. Although designed to reduce this burden, influenza vaccine has variable effectiveness (VE) from year to year due to host factors, environment, and virus & vaccine characteristics. Data from the US Flu VE Network helps CDC to evaluate vaccine policy, WHO to select vaccine strains and clinicians to use antivirals. We propose a test-negative case-control (TNCC) study to determine influenza VE in UPMC, which serves diverse populations in 500 clinical sites. UPMC wins awards as one of the most wired health systems in the U.S. UPMC preferentially uses high-dose vaccine for persons >65 years, routinely records vaccination status in its electronic medical record and has a two-way interface with the state immunization registry. Our proposal has a strong foundation of current participation in the US Flu VE Network with a multidisciplinary research team with the highest follow-up survey completion rate and enrollment numbers exceeding requirements. Our award-winning, high-throughput lab proposes analyses of influenza, RSV and HMPV. Each virus season definition is supported by >14,000 clinical multiplex respiratory virus tests and ongoing syndromic surveillance. We add agent-based modeling at the Pittsburgh Supercomputer Center. We are a CDC inpatient VE network site, thus we can compare VE for outpatients and inpatients. Specific aims include: 1) Using TNCC methods, determine annual influenza and RSV (after licensure) VE against laboratory-confirmed, medically-attended, acute respiratory infections among outpatients in 3 age groups: 6 mos.-18 yrs., 19-49 yrs., and >50 yrs.; 2) Determine the annual, population-based burden of influenza, RSV and hMPV in the same age groups, using the participating primary care sites as the source population, conduct sensitivity analyses and agent-based modeling on the impact of vaccination options; 3) Prepare for studies related to an influenza pandemic, describing the epidemiology, effectiveness of antivirals and/or pandemic vaccines, including pilot studies on patient portal/phone enrollment.