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

美墨边境地区吸毒者 HMPXV 感染的流行病学研究，为预防措施提供信息

基本信息

批准号：
10674322
负责人：
STEFFANIE A. STRATHDEE
金额：
$ 38万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10674322
关键词：
2019-nCoV Abscess Address Adult Affect Africa Animals Anus Behavior Blood specimen California Centers for Disease Control and Prevention (U.S.)Central America Communicable Diseases Contact Tracing Country Crowding Detection Development Diagnosis Disease Outbreaks Epidemic Epidemiologist Epidemiology Equipment Evolution Face Funding General Population HIV HIV Infections Health system Hepatitis A Virus Hepatitis C virus Homelessness Human Immunosuppression Imprisonment Incidence Individual Infection Infrastructure Injecting drug user Injections Institutes International Intervention Interviewer Investigation Latin America Latinx Leisures Lesion Letters Location Masks Mediating Mexico Migrant Molecular Monkeypox virus Mutation National Institute of Drug Abuse National Institute on Minority Health and Health Disparities Oral Participant Persons Pharmaceutical Preparations Physicians Policies Population Prevalence Prevention Primary Prevention Recording of previous events Reporting Risk Factors Rocky Mountain Spotted Fever Rodent Scientist Secondary Prevention Serology Serology test Sexual Partners Sexually Transmitted Diseases Shigella South America Structural Models Substance Use Disorder Surveys Swab Syphilis Testing Tuberculosis Ulcer Vaccination Variant Vesicle Virus Vulnerable Populations Work base cohort cost epidemiology study experience follow-up health disparity high risk housing instability injection drug use male men who have sex with men pandemic disease pandemic preparedness pathogen preventive intervention public health emergency response sex substance use transmission process

项目摘要

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.

为了响应 NOT-OD-22-159，该项目将利用一批持续注射吸毒者 (PWID) 在美国-墨西哥边境地区研究猴痘病毒（HMPXV）的流行病学，为预防提供信息尽管众所周知，吸毒者面临着诊断和治疗 HMPXV 并减少传播的干预措施。存在许多健康差异，包括艾滋病毒、丙型肝炎病毒和性传播感染 (STI) 的发病率高于专家们对 HMPXV 的持续爆发表示担忧，该病毒是最大规模的自该病毒于 1970 年代首次出现以来，该病毒已在国际范围内暴发，很快将造成不成比例的影响无家可归者 (PEH)，其中很大一部分是吸毒者。我们的团队包括。流行病学家、预防干预专家、分子病毒学家和传染病医生来解决这些目标：目标 1. 确定亚临床和有症状 HMPXV 的患病率和相关性圣地亚哥/蒂华纳 (SD/TJ) 边境地区注射吸毒者感染情况，为预防工作的开展提供信息 H1. 居住不稳定的注射吸毒者 (H1.1)、拉丁裔 (H1.2) 或感染艾滋病毒且未接受治疗的人。 ART (H1.3) 检测 HMPXV 感染呈阳性的可能性显着增加目标 2. 估计发病率。最近报告的 H2.1 吸毒者一年内 HMPXV 感染的危险因素。患有与注射吸毒相关的脓肿、性传播感染或开放性疮口更有可能感染 HMPXV H2.2 期间报告从事性工作的吸毒者以及性伴侣数量较多的吸毒者。在后续目标 3 中更有可能获得 HMPXV。确定与相关的网络特征。注射吸毒者中 HMPXV 的跨境传播 H3.1 SD 和 TJ 之间的跨境毒品旅游（由 H3.2. 网络层面的风险因素例如接触者总数以及属于 MSM、性工作者、居住不稳定的接触者数量，或者在控制了以下因素后，有监禁史将与 HMPXV 感染独立相关目标 4：对循环中的 HMPXV 变异进行系统发育表征。包括突变特征（例如，H4.1 循环 HMPXV）的 SD/TJ 区域将具有单个。我们将利用 NIDA 的跨国基础设施。资助了两国注射吸毒者队列，并得到了加州大学圣地亚哥分校新的流行病防备研究所的支持，对从任何可疑病变/囊泡收集的拭子以及口腔和肛门拭子血清学 HMPXV 检测将由 CDC 进行实物检测，结果将告知潜在的情况。干预措施和政策，包括是否应建议将吸毒者和/或 PEH 纳入常规疫苗接种以及后续干预措施是否增加 HMPXV 检测、疫苗接种和治疗这个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。