The Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) Research Center based at the Uniformed Services University of the Health Sciences (USU), conducts clinical research focused on military-relevant infectious diseases such as COVID-19. IDCRP was chartered under an interagency agreement between USU and the National Institute of Allergy and Infectious Diseases (NIAID) and through a cooperative agreement with The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF).
About EPICC
Following the 2014 Ebola outbreak and the 2015 Zika outbreak, researchers from IDCRP developed an adaptive protocol to study new emerging infectious diseases. This new protocol, known as EPICC (Epidemiology, Immunology and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential), was designed such that researchers could rapidly pivot to study quickly emerging infectious disease outbreaks that could impact the DoD population.
In early February 2020, IDCRP noted that the SARS-CoV-2 outbreak could give rise to a global pandemic. IDCRP quickly revised the EPICC protocol’s existing framework to support a study of the SARS-CoV-2 pathogen, as well as COVID-19, the disease associated with SARS CoV-2. EPICC opened for enrollment on March 20, 2020, just weeks after the first cases were detected in the United States.
IDCRP’s EPICC study is a longitudinal cohort study (a study that observes a large group of people over an extended period of time) of COVID-19 that enrolls those with COVID-19, COVID-like illness (CLI), asymptomatic individuals with a high risk of SARS-CoV-2 exposure, and COVID-19 vaccine recipients. The study’s goals are to characterize the epidemiology, immunology, and clinical characteristics of COVID-19; and examine outcomes of SARS- CoV-2 infections in Military Health System (MHS) beneficiaries. The study eventually expanded to ten enrolling military treatment facilities (MTFs), as well as virtual (online) enrollment across the MHS. Over 2,500 individuals have participated in EPICC across the ten enrolling MTFs, with an additional 5,000-plus online participants MHS-wide.
Over a one year follow-up study period, study participants complete a series of questionnaires to help researchers collect data on COVID-19 risk factors for COVID-19, previous testing, participants’ health conditions and medication use, and symptoms or treatments for participants diagnosed with COVID-19. MTF-enrolled participants provide serially collected blood specimens and swabs. Online participants may provide self-collected blood samples. These specimens have been analyzed by a network of immunology and virology EPICC laboratory partners to help EPICC researchers understand the host immune response to infection and vaccination and how this immune response might impact the potential risk of severe disease. Statisticians in the EPICC team are increasingly using artificial intelligence (‘machine learning’) methods to analyze complex data, and identify patterns and predictors of COVID-19 clinical outcomes.
EPICC has demonstrated major insights into COVID-19 in the MHS to date, including the role of obesity in severe COVID-19, the clinical and virological characteristics of COVID-19 in the vaccinated, the predictors of vaccine-induced immunity, and estimates of the durability of immunity from prior SARS-CoV-2 infections. Over the course of the pandemic, the EPICC study has adapted to new questions—for example, providing rapid information on immunity to new emerging variants such as the Omicron and related strains (e.g. BA.5); EPICC investigators are also examining how the risk of “Long COVID” may change as the SARS-CoV-2 virus evolves and how vaccination mitigates the risk of Long COVID. Recently, EPICC’s contributions to Long COVID research was highlighted in the Department of Health and Human Services National Research Plan on Long COVID.
The findings from EPICC have culminated in at least 12 journal publications, over 20 conference abstracts, and briefings to Department of Defense leadership, Military Treatment Facility stakeholders, the National Institutes for Health, and the U.S. Food and Drug Administration. EPICC is closing COVID-19 knowledge gaps by providing better insight into the progression of SARS-CoV-2 infection, including clinical, virologic, and immunologic determinants of severe disease and long-term post-COVID conditions. Ultimately, the EPICC study aims to improve clinical care for COVID-19 patients, and to advance development of treatment and prevention strategies to benefit both military and civilian populations.
Written by:
Dr Simon Pollett, MBBS, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
References:
https://epicc.usuhs.edu/ https://www.hjf.org/news/epicc-study-sars-cov-2-infection
https://www.covid.gov/assets/files/National-Research-Action-Plan-on-Long- COVID-08012022.pdf
https://pubmed.ncbi.nlm.nih.gov/35380448/ https://pubmed.ncbi.nlm.nih.gov/35873301/ https://pubmed.ncbi.nlm.nih.gov/35608504/ https://pubmed.ncbi.nlm.nih.gov/34909439/