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Fatores associados à gravidade da infecção por influenza A pandêmico (H1N1) 2009 em pacientes pediátricos hospitalizadosScotta, Marcelo Comerlato January 2012 (has links)
Introdução: A pandemia causada pelo vírus Influenza A(H1N1)pdm09 teve seu ápice entre julho e agosto de 2009 no sul do Brasil com maior incidência em crianças e adultos jovens. No período pós-pandêmico, houve um novo aumento na incidência de casos nos meses de inverno em 2011 e 2012 no Brasil, com padrão semelhante ao vírus Influenza sazonal. Como este agente persiste em circulação em nosso meio, objetivamos investigar os fatores de risco para evolução clínica desfavorável em pacientes pediátricos. Métodos: Foi realizado um estudo transversal através de revisão de prontuários de internação de pacientes com idade inferior a 14 anos e infecção por Influenza A (H1N1)pdm09 confirmada por RT-PCR durante a primeira onda pandêmica em seis hospitais terciários em Porto Alegre, Brasil. A necessidade de ventilação mecânica foi definida como desfecho e idade, doenças crônicas, codetecções de vírus ou bactérias, achados na radiografia de tórax e uso de Oseltamivir foram definidos como possíveis preditores. Resultados: Foram incluídos 120 pacientes. Na análise multivariável, a presença de doenças crônicas (Razão de prevalências: 2.613, 95% Intervalo de confiança: 1.267-5.386) e codetecção viral (Razão de prevalências: 2.43, 95% Intervalo de confiança: 1.203-4.905) foram estatisticamente associados a um pior desfecho (p<0,05). Conclusões: A presença de doenças crônicas como preditor reforça evidências prévias. Além disso, encontramos codetecção viral como um fator de risco. Estudos adicionais são necessários para confirmar esta associação. / Introduction: The pandemic caused by Influenza A(H1N1)pdm09 virus peaked between July and August 2009 in southern Brazil with the highest incidence in children and young adults. In the post-pandemic period, there was an increase in the incidence of cases in the winter months in 2011 and 2012 in Brazil, similar to seasonal Influenza virus. Since infections due to pandemic Influenza are still occurring, we aim to investigate risk factors for worse outcome in children. Methods: A cross-sectional study was performed reviewing charts of hospitalized patients younger than 14 years with RT-PCR positive for Influenza A (H1N1)pdm09 during the first pandemic wave in six tertiary centers in Porto Alegre, Brazil. We defined need of mechanical ventilation as severity outcome and age, chronic medical conditions, bacterial and viral co-detection, chest radiograph findings and use of Oseltamivir as possible predictors. Results: We included 120 patients. In a multivariable analysis, chronic medical conditions (PR: 2.613, 95% CI: 1.267-5.386) and viral co-detection (PR: 2.43, 95% CI: 1.203-4.905) were statistically associated with worse outcome (p<0,05). Conclusions: The presence of chronic medical conditions as predictor reinforces previous evidences. Furthermore, we found viral co-detection as a risk factor. Further studies are necessary to confirm this association.
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Pneumonia domiciliar associada a infecção pelo vírus p-H1N1 2009 em hospital terciário: frequência, características clínico-laboratoriais e aplicação de escores para predizer diagnóstico e prognóstico / Community-Acquired Pneumonia associated with p-H1N1 2009 infection in a tertiary hospital: frequency, clinical characteristics and applicability of scores to predict diagnosis and prognosisRodrigo Antonio Brandão Neto 17 December 2012 (has links)
Introdução: Em 13 de Setembro de 2009, a OMS reportou que existiam mais de 296.471 casos confirmados laboratorialmente de infecção pelo p-H1N1 2009. Ainda assim muitas questões permanecem, incluindo o papel de regras de probabilidade clínica e escores de gravidade de pneumonia adquirida na comunidade nestes pacientes. Nós descrevemos as características clínicas e epidemiológicas de pacientes internados por pneumonia adquirida na comunidade com ou sem infecção pelo p-H1N1. Objetivos: Verificar a incidência e características clínicas da pneumonia adquirida na comunidade associada com infecção pelo p-H1N1 2009, comparado as pneumonias adquiridas na comunidade sem infecção pelo p-H1N1 2009 e a aplicação de regras de probabilidade clínica e escores de gravidade de pneumonia. Métodos: Estudo observacional prospectivo avaliando pacientes consecutivos hospitalizados por pneumonia adquirida na comunidade por mais de 24 horas no HC-FMUSP. A infecção pelo p-H1N1 foi confirmada utilizando ensaios realtime PCR (RT-PCR). Os dados coletados incluíam variáveis clínicas e laboratoriais e 3 escores de gravidade de pneumonia: PSI (Pneumonia Severity Index), CURB-65 e o SMART-COP. Resultados: De 12 de julho a 17 de agosto de 2009, um total de 118 pacientes com pneumonia foram hospitalizados e RT-PCR realizado em 105 pacientes, infecção pelo p-H1N1 foi identificada em 53 pacientes. Comparado com os 52 pacientes sem infecção pelo p-H1N1, o grupo p-H1N1 apresentou significativamente mais coriza [razão de chances (RC): 6,09;intervalo de confiança 95% (IC95%): 1,72-21,52) e infiltrado bilateral (RC: 11,08; IC95%: 3,48-35,2).Um modelo clínico baseado em nossos resultados, incluindo infiltrado bilateral, febre, coriza e idade menor que 65 anos, foi capaz de predizer infecção pelo p-H1N1 2009 com sensibilidade de 90,6% e acurácia de 82% e com uma área sobre a curva (AUC) de 0,82. Nós também verificamos que, em pacientes com infecção pelo p-H1N1 2009, apenas 9,52% com escore SMART-COP entre 0-2 foram admitidos em UTI ou evoluíram para óbito intra-hospitalar comparado a 36,84% dos pacientes com escore PSI 1-2 e 51% dos pacientes com escore CURB-65 de 0-1. O prognóstico da pneumonia foi similar nos grupos com ou sem infecção pelo p-H1N1 2009. Conclusões: A pneumonia associada com infecção pelo p-H1N1 2009 possui apresentação clínica diferente de pacientes sem infecção pelo p-H1N1, entretanto, possuem prognóstico similar. Escores tradicionais de gravidade de pneumonia como PSI e CURB-65 tiveram desempenho ruim em pacientes com infecção pelo p-H1N1 e o escore SMART-COP foi o melhor preditor de internação em UTI em pacientes com pneumonia e infecção pelo p-H1N1. / Introduction: As of September 13, 2009, the WHO had reported over 296.471 laboratory-confirmed cases of p-H1N1 2009. However many questions remain unanswered, including the role of clinical prediction rules and community-acquired pneumonia severity scores. We describe clinical and epidemiologic characteristics of patients hospitalized for pneumonia at our tertiary hospital with laboratory-confirmed and laboratory-excluded H1N1 infection. Objectives: Verify the incidence and clinical characteristics of community-acquired-pneumonia associated with p-H1N1 2009 infection compared with community-acquired pneumonia without p-H1N1 infection and the applicability of clinical prediction rules and pneumonia severity scores. Methods: We prospectively reviewed medical chart in daily basis to collect data on that patients. H1N1 infection was confirmed in specimens using a real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) assay. The data collected included clinical and laboratorial variables and three pneumonia severity scores: Pneumonia Severity Index, CURB-65 and the SMART-COP rule. Results: From 12 of July through August 17, 2009, a total of 118 cases of pneumonia were hospitalized, and RT-PCR was performed in 105, indentifying p-H1N1 infection in 53 patients. Compared with the 52 patients without p-H1N1 infection , the p-H1N1 group presented significantly more often with rhinorrhoea (OR 6,09 IC 95 1,72-21,52) and bilateral infiltrates ( OR 11,08 IC 95 3,48-35,2), a clinical model based on our results and using bilateral infiltrates, fever, rhinorrhoea and age less than 65 years was capable of predict p-H1N1 infection with 90,6% sensitivity, 82% accuracy and area under the ROC curve (AUC) being 0.82. We also find that in the patients with pneumonia and p-H1N1 infection, only 9.52% of those with SMART-COP score of 0-2 presented ICU admission/in-hospital mortality, compared with 36.84% of those with PSI score of 1-2 and 51% of those with CURB-65 score of 0-1. The prognosis of pneumonia was similar in the patients with and without p-H1N1 2009 infection. Conclusions: Pneumonia associated with p-H1N1 2009 has different clinical presentation than in pneumonia patients without p-H1N1 infection, but the prognosis is similar. Traditional pneumonia severity scores like PSI and CURB-65 performed poorly in patients with p-H1N1 infection and the SMART-COP rule was the best predictor of ICU admission in pneumonia patients with p-H1N1 infection.
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BIOPOLÍTICA, GRIPE A (H1N1) E MÍDIA: O QUE PODE UM PORCO? / BIOPOLITICS, INFLUENZA A (H1N1) AND MEDIA: WHAT CAN A PIG?Corrêa, Guilherme 23 March 2012 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to analyze how biopolitics encompasses the dis-media courses in a
newspaper circulating in the central region of Rio Grande do Sul on Influenza A (H1N1),
seeking to make visible how the institutional and discursive practices and are cross the subjects.
As specific objectives, we aim to identify, in the symbolic forms of the newspaper, the
ways in which population health can become the target of a power over life, and recognize the
different elements disciplinary power bodies emphasized the symbolic forms and check discursive
elements present in symbolic forms that may be contributing to make living biotechnologies.
Initially a theoretical review of the main references on Sovereignty, Biopower, Discipline,
and Biopolitics Biotechnologies. Following were recovered information about the
development of epidemiology as a science is responsible for monitoring the health of populations
especially in large cities, through different paradigms regarding the disease and its possible
triggering factors, culminating in the development of modern epidemiology . Still follows
a genealogy research concerning the influenza virus and its spread across the globe for
about 2000 years, emphasizing the H1N1 viral strain. The following parts deal with smallpox
vaccination in 1904 and vaccination of Pandemic Influenza A (H1N1) in 2009, the means of
mass communication. In the final part presents the analysis of the reports, noting biopolitics in
general and its consequences regarding the disciplining of bodies, production of knowledgepower,
a standard society, pharmaceuticals and medicalization. From a genealogical perspective
of historic, aimed at understanding the conditions that enable the emergence and permanence
of discursive practices, we analyzed a total of 291 articles published during the month
of July 2009, a period considered critical due to the number of deaths registers resulting from
the pandemic of influenza A (H1N1). As a result of research, can be observed the influence of
mass media and the symbolic elites have on the subject due to the constructions of symbolic
material transmitted by the media, which ultimately have an effect not only on the bodies of
the subjects, but the dynamics of populations. / A presente pesquisa teve como objetivo analisar como a biopolítica perpassa os discursos
midiáticos de um jornal de circulação na região central do estado do Rio Grande do Sul
sobre Gripe A (H1N1), buscando tornar visível como as práticas institucionais e discursivas
atravessam e constituem os sujeitos. Como objetivos específicos, visamos identificar, nas
formas simbólicas do jornal, os modos pelos quais a saúde da população pode se tornar alvo
de um poder sobre a vida; reconhecer os diferentes elementos de disciplinararização dos corpos
ressaltados nas formas simbólicas e averiguar elementos discursivos presentes nas formas
simbólicas que podem estar contribuindo para se fazer viver as biotecnologias. Inicialmente
foi realizada uma revisão teórica sobre as principais referências sobre Soberania, Biopoder,
Disciplina, Biopolítica e Biotecnologias. Após, foram resgatadas informações sobre o desenvolvimento
da epidemiologia enquanto ciência responsável por monitorar a saúde das populações
especialmente nas grandes cidades, passando pelos diferentes paradigmas referentes às
doenças e seus possíveis fatores desencadeantes, até culminar no desenvolvimento da epidemiologia
contemporânea. Segue ainda uma genealogia das pesquisas referentes ao vírus Influenza
e sua propagação pelo globo durante aproximadamente 2000 anos, dando ênfase a cepa
viral A H1N1. As partes seguintes tratam da vacinação da varíola em 1904 e da vacinação da
Pandemia de gripe A (H1N1) no ano de 2009; dos meios de comunicação de massa. Na parte
final apresenta-se a análise das reportagens, atentando para a biopolítica de forma geral e seus
desdobramentos referentes à disciplinarização dos corpos, produção de saber-poder, normalização
da sociedade, indústria farmacêutica e medicalização. Sob uma ótica da genealogia histórica,
que visa o entendimento das condições que possibilitam o surgimento e permanências
de práticas discursivas, foram analisadas um total de 291 reportagens veiculadas durante o
mês de julho de 2009, período este considerado crítico devido ao número de mortes registradas
decorrentes da pandemia da gripe A (H1N1). Como resultado da pesquisa, pode-se observar
a influência que as mídias de massa e as elites simbólicas exercem sobre os sujeitos devido
às construções de material simbólico transmitidos pelos meios de comunicação, que acabam
por surtir efeito não só nos corpos dos sujeitos, mas nas dinâmicas das populações.
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Etude de la pandémie grippale A/H1N1 2009 en France et en Bolivie / Study of the the pandemic Flu 2009 in France and in BoliviaDelangue, Julie 17 December 2013 (has links)
Par le passé les virus influenza A ont montré leur capacité d’émergence dans la population humaine. En 2009, l’apparition d’un nouveau variant réassortant a provoqué une pandémie. Ces travaux avaient pour objectifs d’étudier la propagation de la pandémie en France et Bolivie. Premièrement en Franve avec l’étude sérologique d’une population hospitalière et la surveillance hebdomadaire mise en place grâce au programme SéroGrippeHebdo. La séroprévalence prépandémique était de plus de 20% (au1/80) chez les plus de 60ans et de moins de 10% dans les autres groupes. Il a été possible de calculer un taux d’attaque d’environ 12% au sein de la population française métropolitaine. Mais aussi d’observer la perte d’anticorps rapide après le pic d’infection. Les taux de séroconversions les plus importants étaient chez les 0-24 ans (23.4%). La deuxième partie de ce travail s’est déroulée à Santa Cruz de la Sierra, en Bolivie. Le programme CoPanFlu international en association avec le CENETROP a permis l’étude de la sérologie sur une cohorte de foyers en 2010. Par ailleurs, nous avons caractérisé les pathogènes respiratoires de 2010 à 2012 à Santa Cruz. La grippe représente entre 40 et 58% des cas chaque années, suivie des rhinovirus, des coronavirus et des VRS. L’épidémiologie moléculaire des virus influenza a mis au jour un cluster de circulation sud américain pour les virus H1N1(2009).Les sérologies pré-pandémiques montrent une séroprévalence de 23% pour les ≥60ans. Après la pandémie la distribution par tranche d’âge est différente entre les villes de haute altitude et les autres.Enfin une estimation de la séroconversion montre que les jeunes adultes entre 20-39 sont les plus touchés. / Influenza viruses A have shown their ability to emerge in the human population and in 2009, the appearance of a new variant has caused a pandemia. The objective of this work was to study the pandemia’s spread in France and in Bolivia.In France, first, with the serological study of a hospital population and the weekly supervision established with SeroGrippeHebdo. The prepandemic seroprevalence was more than 20%(au1/80) for the >sixty years, and less than 10% in the others groups. It was possible to reckon an attack rate for about 12% in the metropolitan French population, and to observe a quick loss of antibody after the infection rate. Most important seroconversion rates concerned the 0-24 years(23.4%).The second part of this work took place in Santa Cruz de la Sierra, in Bolivia, developing country in the tropical zone of South America. The international CoPanFlu in partnership with the CENETROP, has enabled to study serology among a cohort of families in 2010. Moreover, we have characterized etiologies of respiratory pathogenesis from 2010 to 2012, in Santa Cruz. Flu represented about 40 to 58% of the cases each year, followed by rhinoviruses, coronaviruses and SRV. The molecular epidemiology of influenza viruses has shown a South American circulation cluster for the H1N1 viruses(2009). The prepandemic serologies in Santa Cruz show a seroprevalence of 23% for the ≥60. After the pandemia, the distribution by age is different for the towns at high altitude and others. Finally, an estimation of the sero-conversion showed that young adults between 20 and 39 were more affected in Bolivia.
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Analyse d'un grand jeu de données en épidémiologie : problématiques et perspectives méthodologiques / Analysis of a large dataset in epidemiology : issues and methodological perspectivesMansiaux, Yohann 30 October 2014 (has links)
L'augmentation de la taille des jeux de données est une problématique croissante en épidémiologie. La cohorte CoPanFlu-France (1450 sujets), proposant une étude du risque d'infection par la grippe H1N1pdm comme une combinaison de facteurs très divers en est un exemple. Les méthodes statistiques usuelles (e.g. les régressions) pour explorer des associations sont limitées dans ce contexte. Nous comparons l'apport de méthodes exploratoires data-driven à celui de méthodes hypothesis-driven.Une première approche data-driven a été utilisée, évaluant la capacité à détecter des facteurs de l'infection de deux méthodes de data mining, les forêts aléatoires et les arbres de régression boostés, de la méthodologie " régressions univariées/régression multivariée" et de la régression logistique LASSO, effectuant une sélection des variables importantes. Une approche par simulation a permis d'évaluer les taux de vrais et de faux positifs de ces méthodes. Nous avons ensuite réalisé une étude causale hypothesis-driven du risque d'infection, avec un modèle d'équations structurelles (SEM) à variables latentes, pour étudier des facteurs très divers, leur impact relatif sur l'infection ainsi que leurs relations éventuelles. Cette thèse montre la nécessité de considérer de nouvelles approches statistiques pour l'analyse des grands jeux de données en épidémiologie. Le data mining et le LASSO sont des alternatives crédibles aux outils conventionnels pour la recherche d'associations. Les SEM permettent l'intégration de variables décrivant différentes dimensions et la modélisation explicite de leurs relations, et sont dès lors d'un intérêt majeur dans une étude multidisciplinaire comme CoPanFlu. / The increasing size of datasets is a growing issue in epidemiology. The CoPanFlu-France cohort(1450 subjects), intended to study H1N1 pandemic influenza infection risk as a combination of biolo-gical, environmental, socio-demographic and behavioral factors, and in which hundreds of covariatesare collected for each patient, is a good example. The statistical methods usually employed to exploreassociations have many limits in this context. We compare the contribution of data-driven exploratorymethods, assuming the absence of a priori hypotheses, to hypothesis-driven methods, requiring thedevelopment of preliminary hypotheses.Firstly a data-driven study is presented, assessing the ability to detect influenza infection determi-nants of two data mining methods, the random forests (RF) and the boosted regression trees (BRT), ofthe conventional logistic regression framework (Univariate Followed by Multivariate Logistic Regres-sion - UFMLR) and of the Least Absolute Shrinkage and Selection Operator (LASSO), with penaltyin multivariate logistic regression to achieve a sparse selection of covariates. A simulation approachwas used to estimate the True (TPR) and False (FPR) Positive Rates associated with these methods.Between three and twenty-four determinants of infection were identified, the pre-epidemic antibodytiter being the unique covariate selected with all methods. The mean TPR were the highest for RF(85%) and BRT (80%), followed by the LASSO (up to 78%), while the UFMLR methodology wasinefficient (below 50%). A slight increase of alpha risk (mean FPR up to 9%) was observed for logisticregression-based models, LASSO included, while the mean FPR was 4% for the data-mining methods.Secondly, we propose a hypothesis-driven causal analysis of the infection risk, with a structural-equation model (SEM). We exploited the SEM specificity of modeling latent variables to study verydiverse factors, their relative impact on the infection, as well as their eventual relationships. Only thelatent variables describing host susceptibility (modeled by the pre-epidemic antibody titer) and com-pliance with preventive behaviors were directly associated with infection. The behavioral factors des-cribing risk perception and preventive measures perception positively influenced compliance with pre-ventive behaviors. The intensity (number and duration) of social contacts was not associated with theinfection.This thesis shows the necessity of considering novel statistical approaches for the analysis of largedatasets in epidemiology. Data mining and LASSO are credible alternatives to the tools generally usedto explore associations with a high number of variables. SEM allows the integration of variables des-cribing diverse dimensions and the explicit modeling of their relationships ; these models are thereforeof major interest in a multidisciplinary study as CoPanFlu.
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Ensaio molecular para vigilância epidemiológica de gripe com ênfase no diagnóstico de Influenza A H1N1Dias, Ronaldo Ferreira January 2011 (has links)
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Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil. / O uso de métodos moleculares tem sido apontado como uma das principais
ferramentas para o diagnóstico de doenças infecciosas. Dentre as técnicas
disponíveis, a PCR em tempo real tem sido uma das mais amplamente utilizadas. A
partir dos achados das inúmeras pesquisas desenvolvidas em virtude da epidemia
de Influenza A H1N1 em 2009, tal metodologia foi preconizada pelo CDC como
sendo a mais eficiente para a confirmação desta patologia na população. A rápida
disseminação da epidemia de 2009, em território Brasileiro, evidenciou a
necessidade de adoção de uma alternativa de teste em âmbito nacional, cujos
custos fossem mais compatíveis com os recursos de que dispõe o Sistema Único de
Saúde (SUS). Esta dissertação buscou estabelecer um protótipo de produto para a
Vigilância epidemiológica de Influenza A H1N1 a partir de uma plataforma de PCR
em Tempo Real, visando contribuir para o estabelecimento de uma rede de
vigilância epidemiológica baseada em ensaios moleculares, com a definição de uma
matriz de extração semiautomatizada e um equipamento para a realização de PCR
em Tempo Real. Este trabalho foi desenvolvido por meio da comparação de
matrizes de extração e de equipamentos de PCR em tempo real dos principais
fornecedores internacionais. A empresa que obteve a melhor avaliação segundo os
critérios descritos foi a Biotools®, por ter apresentado uma proposta competitiva
quanto aos custos das plataformas e insumos necessários, além de um atraente
pacote de transferência de tecnologia. Após a definição dos equipamentos e
insumos, foi iniciada a aferição de um protótipo de modelo nacionalizado de
diagnóstico. Em paralelo, buscou-se ainda a melhoria do desempenho do modelo
brasileiro, com a avaliação de diferentes composições da mistura de reação, tendo
sido também testadas regiões genômicas diferentes daquelas do padrão de
referência para o diagnóstico, além da possibilidade do uso de sondas purificadas.
Com base nos resultados obtidos, observou-se que a extração semiautomatizada e
aquela realizada pelo método manual apresentam um padrão semelhante de
eficiência. Também foi comprovada a capacidade de extração do equipamento,
inclusive em diluições de amostra pura até uma concentração de 1024 vezes, além
da eficiência da purificação de sondas pela técnica de HPLC (High-performance
liquid chromatography). Ficou evidenciada a equivalência da reação de PCR em
tempo real desenvolvida pelo consórcio IBMP/Bio-Manguinhos quando comparada à
reação de PCR em tempo real desenvolvida pelo CDC-EUA, considerado padrão de
referência para o diagnóstico molecular de influenza A H1N1. Concomitantemente, o
modelo de equipamentos da Biotools(Labturbo/Liongene) oferece, como vantagens,
a possibilidade de eliminar a etapa manual de extração indicada pelo protocolo do
CDC, e de agregar ao processo a realização de uma extração semiautomatizada, o
que facilita a execução do protocolo e amplia o quantitativo de amostras que podem
ser examinadas a cada ciclo de trabalho. / Nowadays, molecular tools appear as the main alternatives for diagnosis of
infectious diseases. Among the available techniques, Real Time PCR (RT-PCR) has
been widely used, coupled to extraction matrices. In view of the findings obtained
from several researches conducted due to the Influenza A H1N1 epidemic, this
technique is considered by the CDC as the most efficient method to confirm this
pathology in an affected population. The rapid expansion of the 2009 epidemic in
Brazil evidenced the need of a nationalized alternative diagnostic option, without
requiring materials from international (foreign) suppliers, and that could be costeffective
to Brazilian National Health System (SUS). The present work aimed at the
establishment of a product prototype that could meet such requirements. The choice
of an instrument setting based on the Real Time PCR (RT-PCR) platform contributes
to an epidemiological surveillance network of molecular assays, and enhances Bio-
Manguinhos participation in this field.Other factors that were taken into account
concern the economic viability of such instruments, as well as the respective
installation and validation protocols and clearance by the National Sanitary
Surveillance Agency (ANVISA). According to the aforesaid criteria, the best ranked
supplier was BioTools Company, which presented a competitive proposal for cost of
platform and consumables, as well as an attractive technology transfer proposal.
Different formulations of the reaction mixture were evaluated in order to improve the
test performance. It was found that the Real Time PCR (RT-PCR) assay developed
by the IBMP/Bio-Manguinhos consortium presented a better efficacy than that of the
CDC-USA, which is the reference standard for Influenza A H1N1 molecular
diagnosis. Furthermore, BioTools instruments, which were chosen for the tests, have
the advantage of eliminating the manual extraction step in the CDC protocol and
include a semi-automated extraction, which facilitates the performance and increases
the amount of samples processed (throughput of samples).
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Étude sur les déterminants psychosociaux de la vaccination contre le virus A(H1N1) auprès des parents d’enfants qui fréquentent des services de garde éducatifs de MontréalLanglois, Mathieu 12 1900 (has links)
Introduction En juin 2009, l’Organisation Mondiale de la Santé (OMS) a déclaré l’état de pandémie pour le nouveau virus influenza A(H1N1). Malgré les recommandations des autorités de santé publique, lors de la mise en place de la campagne de vaccination de masse au Québec contre ce virus pandémique, certains groupes de la population ont été plus enclins à être vaccinés que d’autres groupes. Ceci souligne l’importance des déterminants psychosociaux du comportement humain, sujet qui a donné cadre à notre étude. Objectifs Le but de cette étude a été de documenter les attitudes, les connaissances et les influences sociales des parents dont les enfants fréquentent des services de garde éducatifs (SGE) vis-à-vis la vaccination contre la pandémie ainsi que la couverture vaccinale. Méthodologie Un questionnaire auto-administré et anonyme basé sur la théorie des comportements interpersonnels de Triandis a été distribué aux parents d’enfants âgés de 0-59 mois de neuf centres de la petite enfance sur l’île de Montréal. Résultats Le taux de réponse de l’enquête a été de 32,0% (N=185). Le taux de vaccination des enfants s’est retrouvé à 83,4%; ceci représente une couverture plus élevée que la moyenne régionale et nationale. Toutefois, à une question sur l’intention des parents face à une autre pandémie, seuls 46% des parents feraient vacciner leur enfant. Les facteurs les plus significatifs associés à la vaccination de leur enfant ont été les croyances personnelles positives, de bonnes habitudes vaccinales et l’influence des média, tous mesurés par plusieurs indicateurs (RC respectifs de 7,7, 3,1 et 4,2, p<0,05). Conclusion Pour la grippe A(H1N1), plusieurs facteurs contextuels ont joué en faveur des taux de vaccination acceptables chez les enfants. Toutefois, la mise en place d’une campagne de la vaccination par les instances gouvernementales et de santé publique en utilisant divers média pourraient contribuer à un taux de vaccination encore plus élevé en cas d’épidémie ou de pandémie. / Background In June 2009, the World Health Organization (WHO) declared the 2009 A(H1N1) swine flu a pandemic. Despite the recommandations from public health authorities when setting up the mass immunization campaign in Quebec against the influenza A(H1N1), some population groups were more likely to be vaccinated than others. This underlines the importance of psychosocial determinants of human behaviour, which gave a framework for our study. Objectives The aim of this study was to document the attitudes, knowledge and social influences of parents whose children attend early childhood centers (ECC) regarding the vaccination against the pandemic and its coverage. Methods A self-administered and anonymous questionnaire based on the theory of reasoned action of Triandis was distributed to parents of children aged 0-59 months in nine childcare centers on the island of Montreal. Results The response rate of the survey was 32.0% (N=185). The vaccination uptake for children was 84%; this represents a higher coverage than the average regional and national levels. However, only 46% of the parents said that they would vaccinate their child again if a new flu pandemic was being declared by the World Health Organization. The most significant factors associated with vaccination uptake were positive personal beliefs, getting seasonal flu vaccines and the influence of media, all measured by several indicators (respective odds ratio 7,7, 3,1 and 4,2, p<0,05). Conclusion Several contextual factors played in favour of acceptable vaccination rates among children. However, the establishment of a campaign of vaccination by government authorities and public health agencies while using various media to spread information could contribute to higher vaccination rates in a future case of epidemic or pandemic.
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Étude du réassortiment génétique des virus influenza d’origines et de sous-types différents / Genetic reassortment of influenza viruses with different origins or subtypesBouscambert-Duchamp, Maude 14 June 2010 (has links)
Dans le contexte de la menace pandémique liée au virus influenza A(H5N1), un projet «GRIPPE AVIAIRE ET GRIPPE PANDÉMIQUE » a émergé au sein de LyonBioPôle avec comme objectif le développement d’outils de caractérisation des virus influenza pour la production de vaccins. Pour étudier le réassortiment génétique entre virus influenza, nous avons développé 3 systèmes de génétique inverse : virus humain A(H3N2) et aviaires A(H5N2) et A(H5N1) et produit des virus réassortants de composition déterminée. Leurs capacités réplicatives ont été évaluées par cinétiques de croissance virale sur MDCK avec quantification de la production virale par qRT-PCR temps réel. L’émergence du virus influenza A(H1N1)2009 pose deux questions sur l’acquisition par réassortiment génétique, d’une résistance à l’oseltamivir d’une part ou de facteurs de virulence d’autre part. Nous avons donc développé un protocole de co-infection virale de cellules MDCK pour étudier les constellations de gènes des réassortants entre différents virus: A(H1N1)2009-A(H1N1) H275Y et A(H1N1)2009-A(H5N1). Nous montrons par deux approches différentes, génétique inverse et co-infections virales, que le réassortiment génétique entre souches aviaires et humaines et surtout aviaires et porcines est possible, en privilégiant certaines constellations. Nous rapportons que le virus pandémique peut acquérir la NA H275Y des virus A(H1N1) Brisbane-like résistants à l’oseltamivir sans que ses capacités de réplication ne soient altérées. De même nous montrons que son réassortiment avec un virus hautement pathogène A(H5N1) est possible. Ces observations renforcent la nécessité de promouvoir la vaccination afin de limiter les risques de co-infection virale chez un même individu. / In the context of A(H5N1) pandemics threat, an « avian flu and flu pandemics » project was proposed by LyonBioPole to develop influenza viruses characterization tools for vaccine production. To study genetic reassortment between influenza viruses, 3 reverse genetic systems of A(H3N2) human virus and A(H5N2) and A(H5N1) avian viruses were developed and reassortant viruses were produced. Their replicative capacities were evaluated using growth kinetics on MDCK cells with viral production quantification by real-time qRT-PCR. The A(H1N1)2009 emergence raises two questions about the acquisition by genetic reassortment of oseltamivir resistance and/or pathogenicity determinants. A co-infection protocol on MDCK cells was developed to study gene constellations of reassortant viruses like A(H1N1)2009-A(H1N1) H275Y and A(H1N1)2009-A(H5N1). We report here that genetic reassortment is possible between avian, human and swine strains using reverse genetic and viral co-infection and that some specific constellations emerged. We also report, that pandemic A(H1N1)2009 can acquire the H275Y mutated NA from seasonal oseltamivir resistant A(H1N1) viruses without any modifications on replicative capacities. This genetic reassortment is also possible with A(H5N1) viruses. These observations strenght the importance of vaccination against all these influenza strains to reduce the risk of one-individual viral co-infection.
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Imunização contra influenza pandêmica em síndrome antifosfolípide primária: gatilho para trombose e produção de autoanticorpos? / Pandemic influenza immunization in primary antiphospholipid syndrome: a trigger to thrombosis and autoantibody production?Hisano, Danielle Martins de Medeiros 12 February 2016 (has links)
Os pacientes com doenças reumáticas crônicas exibem um risco aumentado de contrair infecções. Consequentemente, sua vacinação é indispensável. Há relatos da produção de anticorpos antifosfolípides e tromboses após infecções e vacinação nesta população, exceto em síndrome antifosfolípide (SAF) primária. O objetivo principal deste estudo foi avaliar a curto e longo prazos um painel de anticorpos antifosfolípides após a vacinação contra influenza A/H1N1 (sem adjuvante) em SAF primária e controles saudáveis. Quarenta e cinco pacientes com SAF primária e 33 controles saudáveis foram imunizados e prospectivamente avaliados antes da vacinação e 3 semanas e 6 meses após a vacinação. Os anticorpos antifosfolípides foram determinados por ensaio imunoenzimático (ELISA) e incluíram os anticorpos IgG e IgM a seguir: anticardiolipina (aCL), anti-beta2glicoproteína I (anti-beta2GPI), anti-anexina V, anti-fosfatidilserina e anti-protrombina. O anticorpo anti-Sm foi igualmente determinado por ELISA e o anti-DNA dupla hélice, por imunofluorescência indireta. Avaliamos clinicamente à ocorrência de tromboses arterial e venosa. A frequência pré-vacinação de pelo menos um anticorpo antifosfolípide foi significativamente maior nos pacientes com SAF primária comparados aos controles (58% vs 24%, p = 0,0052). A frequência global de anticorpos antifosfolípides pré-vacinação e 03 semanas e 06 meses após a vacinação permaneceu inalterada tanto em pacientes (p = 0,89) como em controles (p = 0,83). A frequência de cada anticorpo específico nos dois grupos permaneceu estável nas três avaliações (p > 0,05). A frequência de cada anticorpo mantevese invariável nos pacientes tratados com cloroquina (p > 0,05). Em 3 semanas, 2 pacientes com SAF primária deselvolveram um anticorpo antifosfolípide novo porém transitório (aCL IgG e IgM), enquanto que em 6 meses novos anticorpos foram observados em 6 pacientes e nenhum apresentou altos títulos. Anti-Sm e anti-DNA dupla hélice foram negativos e nenhuma nova trombose arterial ou venosa foi observada durante o estudo. Este foi o primeiro estudo a demonstrar que a vacina contra influenza pandêmica em pacientes com SAF primária não induz tromboses e uma produção significante de anticorpos antifosfolípides a curto e longo prazos. (ClinicalTrials.gov, #NCT01151644). / Chronic rheumatic disease patients exhibit an increased risk for infections. Therefore, vaccination is imperative. Antiphospholipid antibodies (aPL) and thrombosis triggering after infections and vaccination in this population were reported, except for primary antiphospholipd syndrome (PAPS). Study\'s main objective was short and long-term evaluation of a panel of antiphospholipid autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in primary antiphospholipid syndrome patients and healthy controls. Forty-five PAPS and 33 healthy controls were immunized with A/H1N1 pandemic influenza vaccine. They were prospectively assessed at pre-vaccination, 3 weeks and 6 months after vaccination. aPL autoantibodies were determined by an enzyme-linked immunosorbent assay (ELISA) and included IgG/IgM: anticardiolipin (aCL), anti-beta2GPI; anti-annexin V, anti-phosphatidyl serine and antiprothrombin antibodies. Anti-Sm was determined by ELISA and anti-dsDNA by indirect immunfluorescence. Arterial and venous thrombosis were also clinically assessed. Pre-vaccination frequency of at least one aPL antibody was significantly higher in PAPS patients versus controls (58% vs. 24%, p=0.0052). The overall frequencies of aPL antibody at pre-vaccination, 3 weeks and 6 months after immunization remained unchanged in patients (p=0.89) and controls (p=0.83). The frequency of each antibody specificity for patients and controls remained stable in the three evaluated period (p > 0.05). The frequency of each antibody kept invariable in PAPS patients under chloroquine treatment (p > 0.05). At 3 weeks, 2 PAPS patients developed a new but transient aPL antibody (aCL IgG and IgM), whereas at 6 months new aPL antibodies were observed in 6 PAPS patients and none had high titer. Anti-Sm and anti-dsDNA autoantibodies were uniformly negative and no new arterial or venous thrombosis were observed throughout the study. This was the first study to demonstrate that pandemic influenza vaccine in PAPS patients does not trigger short and long-term thrombosis or a significant production of aPL related antibodies. (ClinicalTrials.gov, #NCT01151644)
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Avaliação da resposta clínica e humoral dos pacientes portadores de ICV submetidos à vacinação com antígenos protéicos e polissacarídicos / Clinical and laboratory evaluation of patients with common variable immunodeficiency before and after immunization with polysaccharide and protein antigensMarinho, Ana Karolina Barreto Berselli 14 March 2013 (has links)
Estudos recentes têm apresentado resultados in vitro satisfatórios em pacientes com Imunodeficiência Comum Variável (ICV) que receberam vacinas contra tétano, influenza e meningococo. No entanto, existem poucos ensaios clínicos que avaliem a resposta clínica e laboratorial após a exposição a antígenos específicos. O presente estudo tem como objetivo avaliar a resposta clínica à imunização contra antígenos protéicos e polissacarídicos (influenza, H1N1 e pneumococo) em pacientes com diagnóstico de ICV seguidos no ambulatório de Imunodeficiências Primárias do Serviço de Imunologia Clínica e Alergia do HC-FMUSP. O diagnóstico dos pacientes foi estabelecido de acordo com os critérios da OMS / PAGID / ESID. Um grupo de 37 pacientes foi vacinado contra a influenza A (H2N3), gripe H1N1 e pneumococo e outro grupo com 16 pacientes, não foi vacinado. A avaliação clínica foi realizada através da aplicação de um score com avaliação dos seguintes parâmetros clínicos: pneumonia, sinusite, otite média, infecções de vias aéreas superiores (IVAS), amigdalites, diarréia, bronquiectasias, hospitalizações, uso de antibióticos, uso de antibióticos profiláticos, sepse e meningite. O score foi aplicado durante os 12 meses que precederam a vacinação e 12 meses posteriores à administração das vacinas. O mesmo score foi aplicado ao grupo controle, com os pacientes que não foram vacinados. A determinação da IgG contra os sorotipos do pneumococo foi feita por ELISA. A determinação da IgG específica H1N1 foi feita por hemaglutinação indireta, enquanto que a dosagem da IgG específica para influenza, por ELISA, utilizando o kit comercial RIDASCREEN ® Influenza. O grupo de pacientes vacinados incluiu 37 pacientes (51% mulheres), com idade entre 20 e 78 anos (mediana= 33 anos). Observou-se uma mediana de 7 anos de atraso no diagnóstico de ICV. A mediana de idade do grupo de pacientes (n=16, 37,5% mulheres) que não receberam a vacina foi de 41 anos e a mediana de atraso no diagnóstico foi de 8 anos. Observamos que as infecções de vias aéreas superiores (IVAS), sinusites e pneumonias foram as manifestações mais freqüentes no grupo controle. IVAS seguida por pneumonia e sinusite foram as manifestações infecciosas mais freqüentes em mulheres (80%, 78% e 55%, respectivamente). Entretanto, em homens observamos IVAS seguido por sinusite e pneumonia (78%, 65% e 35%, respectivamente). Observou-se redução significativa no score relativo ao número de infecções respiratórias superiores, sinusites e pneumonias um ano após a administração das vacinas (p <0,001). Os dados foram comparados com pacientes ICV não vacinados e neste grupo não houve diferença entre os scores dos dois períodos de 12 meses . Após a vacinação, observou-se uma tendência a aumento no título de anticorpos específicos para a H2N3, mas sem resultado significativo. Em relação aos resultados obtidos com as sorologias para o H1N1 e o pneumococo, não se observou resposta após a vacinação. Concluindo, houve redução do número de infecções, principalmente das IVAS, sinusites e pneumonias em pacientes com ICV após a vacinação contra a influenza, H1N1 e pneumococo. Embora não tenhamos encontrado correlação entre a redução do número de infecções e os títulos de anticorpos específicos para as vacinas testadas, a melhora clínica observada nos pacientes com ICV reforça o benefício da vacinação / Recent studies have shown satisfactory in vitro results in patients with CVID who received immunization against tetanus, influenza and meningococcus. However, there are only a few studies that evaluate the clinical and laboratory response after exposure to specific antigens in these patients. This study aims to evaluate the clinical response to immunization with protein and polysaccharide antigens (influenza, H1N1 and pneumococcus) in CVID patients followed at the Primary Immunodeficiency outpatient clinic of the Division of Clinical Immunology and Allergy, Hospital das Clínicas, FMUSP. CVID patients were diagnosed according the WHO/PAGID/ ESID criteria. Thirty-seven patients were immunized against influenza (H2N3), H1N1 and pneumococcal polysaccharide vaccine while another group with 16 CVID patients were not vaccinated. Clinical evaluation was performed through a score with assessment of the following parameters: pneumonia, sinusitis, otitis media, upper respiratory infections (URI), tonsillitis, diarrhea, bronchiectasis, hospitalizations, use of antibiotic therapy, and use of prophylactic antibiotics, sepsis and meningitis. The score was applied during the 12 months prior to immunization and one year after the administration of vaccines. The same score was applied to the group of CVID patients who weren´t immunized. Determination of IgG antibodies to pneumococcal serotypes was made by ELISA. H1N1-specific IgG was detected by indirect hemagglutination while the determination of influenzaspecific IgG was performed by ELISA, using the RIDASCREEN ® Influenza kit. The group of patients who were vaccinated included 37 patients (51% women), aged 20 to 78 years (mean 33 years). This group presented a median delay in the diagnosis of 7 years. The control group consisted of 16 patients (37.5% females) who were not immunized. Their median age was 41 years and the median delay in the diagnosis was 8 years. URI followed by pneumonia and sinusitis were the most frequent infections in women (80%, 78% and 55% respectively). However in men, URI followed by sinusitis and pneumonia were the most frequent (78%, 65% and 35% respectively). We observed a significant reduction in the score of URI, sinusitis and pneumonias in the year post administration of the vaccines (p <0.001). Conversely, there was no difference in the infections pre and post supposed vaccination scores in the group of CVID patients who were not immunized. There was no significant change in specific antibody titers to influenza and pneumococcus after vaccination. Regarding H1N1, there was no statistically significant production of antibodies to H1N1, although we observed a slight non-durable increase in antibody titers. In conclusion, there was a reduction in the number of infections, mainly sinusitis, URIs and pneumonias in patients with CVID vaccinated against influenza, H1N1 and pneumococcus. While we found no correlation between the reduction in the number of infections and specific antibody titers for the vaccines administered, the clinical improvement observed in CVID patients reinforces the benefit of vaccination
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