MERMAIDS - ARI [COVID-19] [UPH]
Research type
Research Study
Full title
Multi-centre EuRopean study of MAjor Infectious Disease Syndromes (MERMAIDS): Acute Respiratory Infections in Adults
IRAS ID
168492
Contact name
Heather House
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
2 years, 7 months, 28 days
Research summary
Summary of Research
The aim of this study is to find out why some people become much more ill than others when they have acute respiratory infections. More information about how different people respond to the agents that cause respiratory disease will allow us to better predict how bad the infection is likely to be and to develop treatments specific to that particular patient. This could reduce disease severity and the risk of complications and also reduce the need for hospital admission. People at general risk of developing severe disease are well known, such as the elderly, people with long term lung or heart disease or patients with a weak immune system. However, some respiratory infections can also cause severe disease in younger previously healthy people due to a combination of the virus itself and the person’s immune responses.\nThis study will recruit adults attending doctor’s surgeries and also those receiving hospital and community care with mild to severe acute respiratory infection. We will analyse blood samples to observe individual gene activity (the process by which the instructions in our genes are converted into a product, such as a protein) and compare samples from people with different risk factors. This will provide detailed information on how the body responds to infection and help us to understand the effects of different risk factors. [COVID-19 amendment - 18/05/2020]Summary of Results
Why was the research needed?
Respiratory infections such as colds, flu (influenza), pneumonia and COVID-19 affect millions of people around the world every year. Most cases are mild, but some people become very unwell. Whilst it is known that factors like pre-existing health conditions, such as diabetes or heart problems, may increase the risk of more severe illness, we still do not fully understand why some people become more unwell than others. By studying patients with mild, moderate and severe respiratory infections, the MERMAIDS-ARI study aimed to improve our understanding of these differences.What were the main questions of the study?
Our genes (genetic material or DNA) provide the biological instructions that tell our cells how to work. Some of these genes are involved in protecting us from infections and, like other genes, such as those for hair colour, different people have different versions of these genes. The different versions, and how they may be switched on or off during an infection, may influence how unwell we become. The main aim of the MERMAIDS-ARI study was to identify the roles of these genes in people with respiratory infections and how they may relate to the severity of their illness.
In addition, the MERMAIDS-ARI study aimed to describe the different causes of respiratory infections, as well as the patients’ course of infection and the treatment they received.Where and when did the study take place?
The MERMAIDS ARI study began in August 2015 and ended in July 2022. The study was Sponsored by the University of Oxford in the UK. Recruitment into the study took place in two phases:
- In the first phase (2016–2019), the study was open at 43 sites in 8 countries (Croatia, Germany, Ireland, Netherlands, Poland Romania, Spain and the UK).
- The second phase (2020-2022) of the study focussed on patients with COVID-19 and patients were recruited across 37 sites in 5 countries (UK, Netherlands, Romania, Germany, Croatia).What happened during the study?
Participants were recruited into the study from both primary care (GP surgeries) and hospitals. Study visits took place on the day of enrolment into the study, then 2 days and 28 later, with an additional visit on the day of discharge for Participants who were hospitalised.
During each study visit, data and samples were collected from the patient. At the time of enrolment, the information collected included the patient’s age, gender, health history and vaccination status, as well as their symptoms and vital signs such as heart rate and temperature. Later, information was also collected about their laboratory test results, any treatments given and the participants eventual outcome. For patients in hospital, this included details such as whether they needed to be admitted in the Intensive Care Unit or needed support with their breathing using a ventilator.
Samples, such as blood samples, and swabs taken from the back of the throat were collected from patients. The swabs were used to look for different viruses and bacteria that can cause respiratory infections, whilst the blood samples were used to look at the immune response to infection, and the patterns of switching ‘on’ or ‘off’ genes.What were the results of the study?
A total of 2,474 patients were enrolled in the study:
- In the first phase of the study (2016-2019), 1,526 patients were included, of which 515 were recruited from primary care and 1011 from hospitals. Just over half (around 52%) of patients included were female. The average age of patients recruited from primary care, with milder respiratory infections, was 44 years, whilst the average age of hospitalised patients was 60. Of the hospitalised patients, approximately 4% were admitted to a high dependency unit or intensive care and 1% died during the period of study follow-up.- In the second phase of the study (2020–2022), 949 patients were enrolled, of which 501 patients were hospitalised with COVID-19. 54% of hospitalised COVID-19 patients were male and the average age was 57. Just over 18% of hospitalised COVID-19 patients required admission to the intensive care unit and approximately 10% died during the 28-day study follow-up period.
The final analysis of the data and samples collected from these patients is still ongoing. When the analysis is complete, the full results of the study will be published in a scientific journal and will be made freely available to the public.How has this study helped patients and researchers?
The MERMAIDS-ARI study describes a cohort of patients with respiratory infections in the European region, both prior and during the COVID-19 pandemic, where COVID-19 patients were enrolled at the same time as patients with other respiratory infections. The combination of the data and the samples collected allow researchers to study how a person’s genes influences the severity of their respiratory infection. Where patients gave their consent, many of these samples have also been stored in a long-term research sample bank, so that they may be used for future related research. Current ongoing work using these samples includes investigating interactions between different viruses and bacteria in people who were found to have more than one type of infection.REC name
West Midlands - Black Country Research Ethics Committee
REC reference
15/WM/0254
Date of REC Opinion
27 Aug 2015
REC opinion
Further Information Favourable Opinion