Integrating Epidemiologic and Environmental Approaches to Understand and Predict Coccidioides Exposure and Coccidioidomycosis Emergence

整合流行病学和环境方法来了解和预测球孢子菌暴露和球孢子菌病的出现

• 批准号: 10116673
• 负责人: Justin V Remais
• 金额: $ 2.84万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-09 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10116673
• 关键词: Address; Air; Area; California; Cessation of life; Charge; Chronic; Climate; Coccidioides; Coccidioides immitis; Coccidioides posadasii; Coccidioidomycosis; Crossover Design; Data; Disease; Dose; Droughts; Dust; Economic Burden; Environment; Environmental Risk Factor; Environmental Wind; Epidemic; Epidemiology; Exposure to; Future; Heterogeneity; Hospitalization; Human; Incidence; Individual; Infection; Infection prevention; Inhalation; Knowledge; Laboratories; Lead; Lung infections; Measures; Meningitis; Methods; Modeling; Monitor; Pattern; Periodicity; Public Health; Records; Reproduction spores; Research; Resolution; Risk; Risk Factors; Sampling; Social Conditions; Soil; Source; Time; Variant; Vulnerable Populations; density; design; experience; fungus; high risk; infection rate; infection risk; novel; pathogen; pathogen exposure; prospective; remote sensing; response; sociodemographics; spatiotemporal; temporal measurement

Project Summary Coccidioidomycosis is an infection caused by inhalation of spores from the soil-dwelling fungi Coccidioides immitis or C. posadasii, and can lead to chronic lung infection, meningitis, or death. Southwestern states are currently experiencing among the highest incidence rates of coccidioidomycosis ever recorded. The disease has levied a substantial human and economic burden throughout the southwest, totaling an estimated $2.2 billion in charges in California alone for coccidioidomycosis-associated hospitalizations from 2000-2011. Critical gaps in understanding have hindered the public health response, including how dust, pathogen, and individual risk factors interact to determine disease incidence, as well as how environmental factors influence the distribution of the pathogen and dust. To address these gaps, this project investigates the impacts of dust exposure, environmental variability, and sociodemographic change on Coccidioides spp. proliferation, dispersion, and coccidioidomycosis infection rates in California. The research focuses on three main aims: 1) investigate the influence of climate variation and dust exposure on the spatiotemporal distribution of cocci incidence using >65,000 geolocated surveillance records from 2000 to 2018 and a case-crossover design; 2) identify environmental sources of C. immitis at high spatial and temporal resolution in disturbed and undisturbed soil, and determine how wind, rainfall, soil disturbance and other factors influence spore dispersion through longitudinal sampling of C. immitis in air and soil; and 3) predict changes in pathogen density over space and time and estimate the exposure-response relationship between pathogen density and risk of infection using a case-crossover approach with prospective surveillance for incident cases. In pursuit of these aims, the research will combine georeferenced coccidioidomycosis case data across California since 2000 at an unprecedented spatial resolution with fine-scale dust concentration estimates and environmental data from a combination of remote sensing, modeling and ground monitors. We will use novel field and laboratory methods to conduct longitudinal sampling of C. immitis in air and soil, determining how microenvironmental conditions and cyclical patterns of rainfall and drought determine pathogen source dynamics, and identifying conditions that support pathogen dispersion through the air. Through these activities, we will identify the specific dust conditions that pose the greatest risk for infection, estimate pathogen exposure and the dose-response relationship, and evaluate heterogeneity in this relationship across risk groups and regions. The results will elucidate drivers of the current epidemic, enhance understanding of the distribution and dispersion of Coccidioides spp. in the environment, and identify high risk regions and subpopulations. The knowledge gained will support decision- makers in targeting, designing and implementing protective measures for vulnerable populations.

项目摘要 球霉菌病是一种感染，是由吸入土壤栖息真菌孢子的孢子引起的感染 侵入性或C. posadasii，可导致慢性肺部感染，脑膜炎或死亡。西南州是 目前，有史以来记录的球菌病的发病率最高。疾病有 在西南部征收了巨大的人类和经济负担，总计22亿美元 仅在加利福尼亚州，从2000 - 2011年开始就在加利福尼亚州进行球菌相关的住院费用。关键的差距 理解阻碍了公共卫生的反应，包括灰尘，病原体和个人风险如何 因素相互作用以确定疾病发生率，以及环境因素如何影响分布 病原体和灰尘。为了解决这些差距，该项目调查了灰尘暴露的影响， 环境变异性和球球菌属的社会人口统计学变化。扩散，分散和 加利福尼亚州的球菌病感染率。研究重点是三个主要目的：1）调查 气候变化和灰尘暴露对使用球菌发病率的时空分布的影响 从2000年到2018年，> 65,000个地理监视记录和案例交叉设计； 2）识别 在受干扰和不受干扰的土壤中，在高空间和时间分辨率下的环境因素的环境来源， 并确定风，降雨，土壤干扰和其他因素如何影响孢子分散 空气和土壤中侵入性炎的纵向采样； 3）预测空间上病原体密度的变化和 时间并估计病原体密度与感染风险之间的暴露反应关系 案例交叉的方法与事件案件的前瞻性监视。为了追求这些目标，研究 自2000年以来，将结合加利福尼亚州的地球可去菌病术病例数据 与精细尘埃浓度估计的空间分辨率和来自结合的环境数据 遥感，建模和地面监视器。我们将使用新颖的领域和实验室方法进行执行 空气和土壤中侵入性炎的纵向采样，确定微环境条件和周期性如何 降雨和干旱的模式决定了病原体源动力学，并确定支持的条件 病原体通过空气分散。通过这些活动，我们将确定特定的灰尘条件 构成最大的感染风险，估计病原体暴露和剂量反应关系，以及 评估风险群体和地区之间这种关系中的异质性。结果将阐明 当前的流行病，增强了对球虫剂属的分布和分散的理解。在 环境，并确定高风险区域和亚群。获得的知识将支持决策 - 针对弱势群体的针对，设计和实施保护措施的制造商。