Integrated environmental and clinical surveillance for the prevention of acute respiratory infections (ARIs) in indoor environments and vulnerable communities (Stell-ARI): Protocol

PLoS One. 2024 Sep 30;19(9):e0309111. doi: 10.1371/journal.pone.0309111. eCollection 2024.

Abstract

The epidemiological relevance of viral acute respiratory infections (ARIs) has been dramatically highlighted by COVID-19. However, other viruses cannot be neglected, such as influenza virus, respiratory syncytial virus, human adenovirus. These viruses thrive in closed spaces, influenced by human and environmental factors. High-risk closed communities are the most vulnerable settings, where the real extent of viral ARIs is often difficult to evaluate, due to the natural disease progression and case identification complexities. During the COVID-19 pandemic, wastewater-based epidemiology has demonstrated its great potential for monitoring the circulation and evolution of the virus in the environment. The "Prevention of ARIs in indoor environments and vulnerable communities" study (Stell-ARI) addresses the urgent need for integrated surveillance and early detection of ARIs within enclosed and vulnerable communities such as long-term care facilities, prisons and primary schools. The rapid transmission of ARIs in such environments underscores the importance of comprehensive surveillance strategies to minimise the risk of outbreaks and safeguard community health, enabling proactive prevention and control strategies to protect the health of vulnerable populations. This study consists of designing and validating tools for integrated clinical and environmental-based surveillance for each setting, coupled with analytical methods for environmental matrices. The clinical surveillance involves specialized questionnaires and nasopharyngeal swabs for virus identification, while the environmental surveillance includes air and surface microbiological and chemical monitoring, and virological analysis of wastewater. Integrating this information and the collection of behavioural and environmental risk factors into predictive and risk assessment models will provide a useful tool for early warning, risk assessment and informed decision-making. The study aims to integrate clinical, behavioural, and environmental data to establish and validate a predictive model and risk assessment tool for the early warning and risk management of viral ARIs in closed and vulnerable communities prior to the onset of an outbreak.

MeSH terms

  • Acute Disease
  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Environmental Monitoring / methods
  • Humans
  • Respiratory Tract Infections* / diagnosis
  • Respiratory Tract Infections* / epidemiology
  • Respiratory Tract Infections* / prevention & control
  • Respiratory Tract Infections* / virology
  • SARS-CoV-2 / isolation & purification
  • Vulnerable Populations

Grants and funding

This project is funded by the National Government of Italy through the National Recovery and Resilience Plan (NRRP) 'Italy Tomorrow', which is part of the Next Generation EU (NGEU) programme. The NRRP aims to address the economic and social impacts of the SARS-CoV-2 pandemic crisis while addressing structural weaknesses in the Italian economy and promoting ecological and environmental transition. The Tuscany Health Ecosystem (THE), coordinated by the University of Florence, aligns with the NRRP's focus on 'Life Sciences', fostering growth in Tuscany's life sciences sector through collaboration between public and private entities to address innovation needs. THE comprises 10 Spokes, with our study falling under Spoke 2 (Preventive and Predictive Medicine), led by the University of Pisa's Department of Biology, in collaboration with other departments. In accordance with the NRRP, the Research and Innovation Programme "THE - Tuscany Health Ecosystem" has a 36-month eligibility period, commencing on 01/12/2022 and extending no later than 28/02/2026. Investment Line 1.5 allocates funding for the creation and/or strengthening of 12 Innovation Ecosystems (THE) across the national territory. This specific project falls under Spoke 2 (Preventive and Predictive Medicine), with project code I53C22000780001 with a budget of 1,308,657.86 €. The funders (The Italian Government) had no involvement in the study design, data collection and analysis, decision to publish, or manuscript preparation.