PROJECT SUMMARY This K01 award will support the career development of Dr. Jennifer Head, an Epidemiologist in the Division of Environmental Health Sciences at the University of California, Berkeley. The candidate’s goal is to become a leader in the development and application of mathematical and statistical approaches to understand the transmission dynamics of emerging infectious diseases. This application proposes linked career development and research activities to fill an important gap in understanding population immunity to coccidioidomycosis, an emerging infectious disease caused by inhalation of soil-dwelling Coccidioides spores. While CDC estimates nearly 150,000 cases of coccidioidomycosis go uncounted each year, direct methods for estimating population immunity for coccidioidomycosis are unavailable. Absent estimates of prior immunity for coccidioidomycosis, we are unable to identify populations experiencing higher rates of under-reporting, understand the role of low population immunity in the emergence of the disease in new regions, nor explain disparities in infection risk and case severity. This project aims to advance the candidate’s expertise and skills in computational methods for robustly estimating prior immunity in populations and incorporating population immunity into models examining key drivers of disease. The candidate will develop a quantitative Bayesian framework for estimating prior immunity to coccidioidomycosis by geographic region in California (Aim 1). The candidate will extend the framework to identify disparities in under-reporting by race and ethnicity, yielding a more accurate assessment of disparities in disease incidence (Aim 2). Estimates of population immunity will be integrated into a statistical framework capable of estimating key risk factors for infection in the presence of mobile immune and non- immune populations (Aim 3). Through partnership with California Department of Public Health, the work will leverage patient data on >94,000 geolocated cases reported since 2000. The 5-year training plan includes primary mentorship from three experienced and committed faculty mentors at UC Berkeley with expertise in biostatistics, infectious disease epidemiology and disease dynamics. Four additional mentors—top leaders in fungal biology, immunology, demography, and social epidemiology—will support the candidate. Leadership of the proposed research, along with a training plan involving coursework, and mentored grant writing and project management, will advance the candidate’s training objectives to: 1) build skills in assessing the role of population immunity in disease transmission; 2) develop expertise in measuring and integrating social factors into transmission models; 3) develop skills to overcome computational barriers when working with large datasets; and 4) strengthen collaborative partnerships and build leadership skills for directing transdisciplinary research projects. UC Berkeley’s commitment to early career scientists; leadership in epidemiology, biostatistics, and fungal biology; strong track record of research in infectious diseases; and close partnerships with public health agencies will provide the candidate an outstanding environment to advance her career goals.

PROJECT NARRATIVE The incidence of coccidioidomycosis in California has doubled since 2014; yet the true burden is not well understood and there are no approved tests for measuring prevalence of prior infection among the general population. This project develops new computational and statistical frameworks to estimate population immunity, identify disparities in disease burden and under-reporting, and understand the role of population immunity in disease transmission and emergence. The findings will have wide-ranging benefits for public health, including a better understanding of coccidioidomycosis under-reporting among vulnerable sub- populations, an ability to target resources more effectively, and support for unbiased estimation of risk factors for infection.