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: 10582097
• 负责人: Justin V Remais
• 金额: $ 2.95万
• 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/10582097
• 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; Persons; Public Health; Rain; 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; risk prediction; 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.

项目概要 球孢子菌病是一种由吸入土壤真菌球孢子菌孢子引起的感染 immitis 或 C. posadasii，并可导致慢性肺部感染、脑膜炎或死亡。西南部各州是 目前球孢子菌病的发病率是有记录以来最高的。该病有 对整个西南地区造成了巨大的人力和经济负担，估计总额达 22 亿美元 仅在加州，2000 年至 2011 年期间与球孢子菌病相关的住院费用就被收取。关键差距 理解阻碍了公共卫生应对措施，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的发病率，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， 环境变异性和球孢子菌属的社会人口变化。扩散、扩散和 加利福尼亚州球孢子菌感染率。该研究主要关注三个目标：1）调查 气候变化和粉尘暴露对球菌发病率时空分布的影响 > 2000年至2018年65,000条地理定位监测记录和病例交叉设计； 2）识别 受干扰和未受干扰土壤中高空间和时间分辨率的 C. immitis 环境来源， 并确定风、降雨、土壤扰动和其他因素如何影响孢子传播 对空气和土壤中的 C. immitis 进行纵向采样； 3）预测空间内病原体密度的变化 时间并估计病原体密度和感染风险之间的暴露-反应关系 病例交叉方法，对事件病例进行前瞻性监测。为了实现这些目标，研究 将以前所未有的速度整合自 2000 年以来加州各地的地理参考球孢子菌病病例数据 空间分辨率与精细粉尘浓度估计和环境数据相结合 遥感、建模和地面监测。我们将使用新颖的现场和实验室方法来进行 对空气和土壤中的 C. immitis 进行纵向采样，确定微环境条件和周期性 降雨和干旱模式决定病原体源动态，并确定支持的条件 病原体通过空气传播。通过这些活动，我们将确定具体的粉尘条件， 造成最大的感染风险，估计病原体暴露和剂量反应关系，以及 评估不同风险群体和地区之间这种关系的异质性。结果将阐明驱动因素 加强对球孢子菌分布和扩散的了解。在 环境，并确定高风险区域和亚人群。获得的知识将支持决策 - 制定者针对弱势群体制定和实施保护措施。