Introdução: O enfermeiro é responsável em atuar no controle da contaminação do ambiente, visando a prevenção de transmissão de infecções relacionadas à assistência à saúde. Surtos de gastroenterite causados por norovirus (NoV) em locais fechados são caracterizados pela persistência do vírus no ambiente, aerolização das partículas virais e baixa dose infectante, mesmo em indivíduos saudáveis. Portanto, há necessidade de definição de um protocolo seguro para limpeza e desinfecção do piso contaminado com vômito e fezes, considerando a possibilidade de dispersão de aerossóis a partir do piso. Objetivo: Avaliar a presença residual de partículas de NoV-GII no ar e no piso quando implementados diferentes protocolos de descontaminação do piso, após contaminação intencional. Método: Trata-se de um estudo experimental laboratorial. Dois tipos de piso, vinil e granito (matérias primas frequentemente utilizadas nos pisos dos serviços de saúde), foram contaminados intencionalmente com fezes humanas positivas 10% para NoV-GII, dissolvidas em 500ml de solução tampão salino-fosfato. Os pisos foram submetidos a três tipos de tratamento: limpeza padronizada com fricção manual, água e detergente neutro; limpeza seguida de desinfecção com hipoclorito de sódio 1% por 10 minutos; limpeza seguida de desinfecção com dispositivo portátil de luz ultravioleta por cinco minutos (SURFACE-UV®). Amostras foram obtidas do piso, por meio do swab, e do ar, por meio de um coletador de ar (Coriolis® - Bertin Technologies, França), nos seguintes momentos: antes e após a contaminação intencional; após a limpeza e após os métodos de desinfecção. Para detecção de NoV-GII nas amostras, utilizou-se a técnica 4.6.2. Reação em Cadeia pela Polimerase quantitativa precedida de Transcrição Reversa (RT-qPCR), pelo método TaqMan®. Resultados: Não foram encontradas diferenças estatisticamente significantes entre os tipos de piso após os protocolos de descontaminação, tanto para o residual de NoV-GII no piso, quanto no ar. Os valores médios de Cycle Threshold (Ct) após limpeza seguida de desinfecção foram maiores (38,75 40,00) comparados aos de após limpeza (35,67 38,66), comprovando a maior eficácia desse protocolo (p<0,001). Em algumas amostras, a limpeza isolada foi capaz de reduzir a contaminação por NoV do piso até níveis indetectáveis. Quando houve residual de NoV-GII após a limpeza do piso, o protocolo cuja desinfecção foi realizada com hipoclorito de sódio foi mais eficaz do que a luz ultravioleta (p<0,001), sendo que os valores de Ct de todas as amostras foram acima de 40. Em 27 das 36 (75%) amostras de ar coletas após a limpeza do piso, foram detectadas partículas de NoV, com diferenças estatisticamente significantes entre as segundas e terceiras amostras, coletadas a 150cm do piso. Foram identificadas que, em média, 17 cópias de RNA viral/L estavam presentes no ar após a limpeza, com redução gradual após a desinfecção. Conclusões: Quando vômito e fezes com NoV-GII contaminam o piso, há aerolização desse vírus já no ato da limpeza. Essas partículas podem ser inaladas ou depositarem em superfícies frequentemente tocadas pelas mãos, estabelecendo o ciclo de transmissão oro-fecal. As partículas virais residuais no piso após a limpeza, indiscutivelmente devem ser eliminadas, evitando assim a reaerolização do NoV a partir dessa fonte. Nesse sentido, a limpeza seguida de desinfecção com hipoclorito de sódio a 1% por 10 minutos mostra superioridade como protocolo de descontaminação do piso, quando comparado ao protocolo com limpeza seguida de desinfecção com luz ultravioleta por 5 minutos de exposição. / Introduction: Nurses are responsible for controlling contamination of the environment, working to prevent the transmission of health-care-associated infections. Gastroenteritis outbreaks caused by Norovirus (NoV) in closed settings are characterized as the result of persistence of the virus in the environment, aerosolization of viral particles, and small infectious dose, even in healthy individuals. Therefore, a safe protocol to decontaminate the floor after vomit or feces have spilled must be defined, considering that subsequent aerosol dispersal may occur. Objective: To assess the presence of residual NoV-GII particles in the air and on the floor after different decontamination protocols are conducted on a deliberately contaminated floor. Method: This is an experimental laboratory study. Two types of floor, vinyl and granite (materials which are often used in the flooring of healthcare facilities), were intentionally contaminated with 10% NoV-GII-positive human feces dissolved in 500ml of a saline-phosphate buffer solution. The floors received three types of treatment: standard cleaning, with manual friction, water, and neutral detergent; cleaning followed by a ten- minute disinfection procedure using 1% sodium hypochlorite; and cleaning followed by a five- minute disinfection procedure using a portable ultraviolet light device (SURFACE-UV®). Swab samples were taken from the floor, and air samples were obtained using an air sampler (Coriolis® - Bertin Technologies, France) at the following moments: before and after the intentional contamination, after cleaning, and after disinfection. The TaqMan® method for real-time Reverse Transcription-Polymerase Chain Reaction was used to detect NoV-GII in the samples. Results: No statistically significant difference between the two types of floor was found for residual NoV-GII, either in the air or on the floor, after the decontamination protocols. The average Cycle Threshold (Ct) values found after cleaning followed by disinfection were higher (38.75 - 40.00) than those recorded after cleaning (35.67 - 38.66), thus attesting to the greater effectiveness of the latter protocol (p<0.001). In some samples, cleaning alone was enough to reduce floor contamination by NoV to undetectable levels. When residual NoV-GII was found after cleaning the floor, the disinfection protocol that involved using sodium hypochlorite proved more effective than UV-light exposure (p<0.001), and Ct values were higher than 40 for all samples. NoV particles were detected in 27 of the 36 (75%) air samples obtained after cleaning the floor, and significant statistical differences were found between the second and third samples, collected 150cm from the floor. An average of 17 copies of viral RNA/L were identified in the air after cleaning, gradually decreasing after disinfection. Conclusions: When NoV-GII-infected vomit or feces contaminate the floor, the virus is aerosolized even during cleaning. These particles may then be inhaled or settle on frequently touched surfaces, establishing the fecal-oral transmission cycle. Residual viral particles on the floor must undoubtedly be eliminated, thereby preventing NoV aerosolization from this source. Along these lines, cleaning followed by disinfection by 1% sodium hypochlorite for ten minutes proved to be a superior floor decontamination protocol when compared with cleaning followed by disinfection by UV-light exposure for five minutes.

Diante da necessidade de responder algumas indagações relacionadas a epidemiologia da Estomatite Vesicular, principalmente aquelas que dizem respeito a ocorrência de surtos em locais onde existem coleções d\'água, foi desenvolvido um modelo de transmissão do VSA utilizando a água como via de transmissão, a tilápia nilótica, inoculada intraperitonealmente, como fonte de infecção e o cobaio como hospedeiro susceptível. O objetivo da utilização deste modelo biológico de transmissão do Vírus da Estomatite Vesicular foi de avaliar o papel desempenhado pelos peixes no ciclo epidemiológico, propor um modelo de ciclo epidemiológico do VSA, destacando o papel da água como via de transmissão e padronizar uma técnica de RT-PCR para a detecção do VSA, em amostra de tecidos. Através do modelo desenvolvido, fica demonstrado que estes peixes eliminaram partículas virais na água, decorridos 13 dias pós-inoculação e que esta última se caracteriza como via de transmissão, possibilitando a infecção dos hospedeiros susceptíveis (cobaios) através de inoculações experimentais em coxim plantar. A tilápia nilótica pode ser considerada como uma fonte de infecção, por ser capaz de eliminar um agente infeccioso no meio ambiente e através de uma via de transmissão este agente alcançou o hospedeiro susceptível; os peixes podem ser inseridos no ciclo epidemiológico da Estomatite Vesicular como fonte de infecção, sendo capazes de eliminar na água partículas virais infectantes, destacando o papel da água como via de transmissão; fica padronizada uma técnica de RT-PCR dirigida ao gene codificador da proteína RNA-polimerase, útil para a detecção direta do Vírus da Estomatite Vesicular Alagoas e Indiana em amostras de tecidos. / A model of transmission of Vesicular Stomatitis was developed to Vesicular Stomatitis Alagoas (VSA) serotype employing water as a way of transmission, the Nile tilapia intraperitoneal inoculated as a source of infection and guinea pigs as susceptible hosts aiming to answer many questions concerning Vesicular Estomatitis epidemiology, as the risk of disease on farms with dose relationship with riverine areas and the role of fishes in the epidemiological cycle of the disease. Furthermore, a RT-PCR assay was developed to detect VSA in tissue samples. According to the experimental transmission, fishes eliminated virus into the water after 13 days pos-infection and a model to VSA epidemiological cycle is proposed in which water was characterized as a way of transmission, carrying the virus to the susceptible host through experimental inoculation and the Nile tilapia should be thought as a source of infection, once it was able to eliminate the infective agent into the environment. A useful tool to the diagnosis of both Indiana and Alagoas serotypes was developed.

Introdução: A infecção aguda pelo Toxoplasma gondii em gestantes pode determinar infecção fetal através de passagem transplacentária. As crianças afetadas podem desenvolver coriorretinite e déficit neurológico, na ausência de tratamento adequado. Objetivos: Estimar a prevalência de toxoplasmose aguda em gestantes atendidas na maternidade do Hospital Nossa Senhora da Conceição, avaliando possíveis diferenças nas freqüências ao longo do período estudado; medir a incidência de toxoplasmose congênita (TC) e estimar a taxa de transmissão vertical em crianças nascidas neste hospital; avaliar a acurácia de testes diagnósticos em TC, aplicados no momento do nascimento, na população de crianças estudadas. Métodos: Inicialmente um estudo transversal foi desenvolvido para identificar as pacientes que apresentaram critérios de infecção aguda na gestação, atendidas na maternidade no momento do parto, entre outubro de 1998 e dezembro de 2005. Novas tecnologias foram introduzidas para detecção diagnóstica ao longo deste período. Entre outubro de 1998 e dezembro de 2001 (período 1), utilizou-se o método microparticle enzyme immunoassay – MEIA e entre janeiro de 2002 e dezembro de 2005 (período 2) foi utilizada a técnica de captura de IgM e o teste de avidez de IgG com o método enzyme linked fluorescent assay – ELFA (VIDAS). Os recém-nascidos identificados a partir deste estudo inicial foram incluídos em um estudo de coorte histórico, com tempo de acompanhamento aproximado de doze meses, para estabelecer o diagnóstico definitivo de toxoplasmose congênita, obtido em dois momentos: (1) logo após o nascimento; (2) aos 12 meses, aproximadamente. Para a definição de caso da infecção aguda na gestação e de toxoplasmose congênita foi utilizado o sistema de classificação elaborado por Lebech et al., com adaptações (quadro 1). Aqueles casos classificados como improváveis foram excluídos do cálculo da prevalência de toxoplasmose aguda em gestantes e de incidência de TC. Para avaliar a acurácia de testes diagnósticos em TC realizados no momento do nascimento utilizou-se, como padrão ouro para o diagnóstico definitivo, a concentração de anticorpos IgG em torno de 12 meses de vida. Um bebê infectado deve ter concentrações iguais ou mais elevadas de IgG nesta idade quando comparadas às encontradas no nascimento. Houve comparação independente e cega dos métodos diagnósticos avaliados em relação ao padrão ouro. A dosagem de anticorpos IgG e IgM em recém-nascidos foi processada com o método microparticle enzyme immunoassay (MEIA). Análise: Para comparar proporções foi utilizado o teste qui-quadrado com correção de Yates, teste exato de Fisher, quando necessário, e Teste t de Student para comparação entre médias de duas amostras independentes com distribuição simétrica. Na avaliação do desempenho de testes diagnósticos foram obtidos resultados de sensibilidade, especificidade, razões de verossimilhança (RV) positiva e negativa dos testes diagnósticos – hemograma, exame do líquor, ecografia transfontanelar, exame de fundo de olho (EFO) e a detecção de anticorpos IgM para toxoplasmose (MEIA) e do DNA do toxoplasma com reação em cadeia da polimerase – método Nested (RCP-Nested) séricos. Resultados: Em uma população de 41.112 gestantes, a prevalência de toxoplasmose aguda foi de 4,8 para cada 1.000 gestantes (IC95%: 4,2 a 5,6). Houve redução significativa na prevalência de toxoplasmose aguda nas gestantes deste hospital a partir do ano 2002 (P=0,008). O diagnóstico de toxoplasmose congênita foi definitivo em 37 crianças entre 40.727 nascidos vivos no período estudado, atingindo uma incidência de 0,9 para cada 1.000 nascimentos (IC95%: 0,6 a 1,3). Logo após o nascimento, entre os 200 recém-nascidos expostos ao T. gondii, resultado de 199 gestantes infectadas, 25 bebês apresentaram critérios diagnósticos de toxoplasmose congênita, atingindo taxa de transmissão vertical de 12,5% (IC 95%: 8,2% - 17,9%). Após o seguimento foram detectados mais 12 casos, aumentando esta taxa para 18,5% (IC 95%: 13,4% – 24,6%). Para avaliar a acurácia de testes diagnósticos aplicados no momento do nascimento, foram identificadas 31 crianças com TC, de acordo com o padrão ouro, entre 136 expostas ao protozoário intra-útero e que completaram seguimento até os 12 meses de vida. Os testes que apresentaram melhor desempenho isoladamente na predição do diagnóstico, foram detecção de anticorpos IgM específicos, EFO e RCPNested atingindo razões de verossimilhança positivas de 119,3 (IC95%: 7,40 – 1923,92), 49,9 (IC95%: 3,0 – 838,2) e 24,8 (IC95%: 3,22 – 190,35), respectivamente. A RV negativa para IgM foi 0,4 (IC95%: 0,3 – 0,6), mas para o EFO e RCP-Nested foi apenas 0,7 (IC95%: 0,6 – 0,9). Conclusão: A prevalência de toxoplasmose aguda em gestantes incluídas neste estudo foi inferior à encontrada na França e na Bélgica, mas foi mais elevada quando comparada às descritas na Suécia, Noruega, Dinamarca e Nova Iorque. A prevalência estimada neste estudo foi similar a de outros locais do Brasil, como Mato Grosso do Sul, mas inferior à obtida no Distrito Federal. Esta variabilidade nas estimativas pode estar relacionada com os diferentes métodos diagnósticos utilizados no rastreamento, ou ainda, com os diferentes fatores de risco envolvidos na transmissão da doença. Em nosso estudo, esta freqüência diminuiu a partir do ano de 2002, o que não pode ser atribuível à introdução do teste de avidez de IgG, uma vez que a média de idade gestacional na realização deste exame foi tardia. Entretanto, existe a possibilidade de que o teste de captura de IgM com o método ELFA tenha contribuído para diminuir os casos falso-positivos de IgM, o que poderá ser confirmado com futuros estudos. Estes resultados apontam que a introdução de novas tecnologias no laboratório deve ser acompanhada de esforços para melhorar as condições de acesso precoce das gestantes ao pré-natal de referência, com o objetivo de não perder a oportunidade para melhor discriminar as gestantes sem doença e evitar procedimentos invasivos, desnecessários e onerosos. A incidência de toxoplasmose congênita e a taxa de transmissão vertical foram elevadas. Estas freqüências podem estar subestimadas devido às perdas no seguimento. Para avaliar o efeito das perdas na validade do estudo, foram comparadas as características da população de gestantes e de recém-nascidos do grupo de bebês com seguimento completo em relação ao grupo que não retornou para o seguimento. Estas características foram semelhantes nos dois grupos, portanto, consideramos que o percentual de perdas, embora elevado, não prejudicou a validade do estudo. A identificação de 12 casos adicionais de TC com o seguimento dos bebês reforça a necessidade de monitoramento sorológico durante o primeiro ano de vida, mesmo sem evidência de infecção congênita ao nascimento. Na avaliação dos testes diagnósticos aplicados ao nascimento, a detecção de anticorpos IgM específicos no sangue do neonato, o EFO e o RCP-Nested sérico demonstraram melhor desempenho para identificar os bebês com TC. Entretanto, para afastar este diagnóstico, apenas o resultado não reagente de anticorpos IgM específicos apresentou maior utilidade, mas com efeito de pequena magnitude. / Introduction: The acute infection by Toxoplasma gondii in pregnant women may cause fetal infection by means of the transplacental transfer. Affected children may develop chorioretinitis and neurological deficit in the absence of a proper treatment. Objectives: To estimate the prevalence of acute toxoplasmosis in pregnant women cared for at the maternity ward of Hospital Nossa Senhora da Conceição, evaluating possible differences in frequencies along the period of study; to measure the incidence of congenital toxoplasmosis (CT), and estimate the rate of vertical transmission in children who were born in this hospital; to evaluate the accuracy of diagnostic tests in CT, applied at the moment of the birth, in the population of studied children. Methods: Initially a cross-sectional study was developed to identify the patients who presented criteria of acute infection in the pregnancy, cared for at the maternity ward at the moment of the labor, between October 1998 and December 2005. New technologies have been introduced for diagnostic detection along this period. Between October 1998 and December 2001 (period 1) the microparticle enzyme immunoassay – MEIA was used, while between January 2002 and December 2005 (period 2) the IgM capture technique and the IgG avidity test with the enzyme linked fluorescent assay – ELFA (VIDAS) method were used. Those newborns (NB) identified at this initial study were included in a historical cohort study, with an approximate follow-up time of twelve months, to establish the definitive diagnosis of congenital toxoplasmosis, obtained in two moments: (1) soon after birth; (2) at 12 months, approximately. For the definition of cases of acute infection in pregnancy and congenital toxoplasmosis, the classification system elaborated by Lebech et al. was used with adaptations (Picture 1). Those cases that were classified as unlikely were excluded from the prevalence calculation of acute toxoplasmosis in pregnant women and from the incidence of CT. In order to evaluate the accuracy of diagnostic tests in CT accomplished at the moment of birth, the concentration of IgG antibodies around 12 months of age was used as a gold standard for the ultimate diagnosis. An infected baby must have equal or higher concentrations of IgG at this age when compared to the ones found at birth. An independent and blind comparison of the diagnostic methods evaluated in relation to the gold standard was performed. The dosage of IgG and IgM antibodies in newborns was processed with the microparticle enzyme immunoassay (MEIA) method. Analysis: In order to compare proportions, a chi square test with Yates correction, an exact Fisher test when necessary, and a Student's t-test for comparison between means of two independent samples with symmetrical distribution were used. In the performance evaluation of diagnostic tests, results of sensitivity, specificity, positive and negative likelihood ratio (LR) of the diagnostic tests – hemogram, liquor test, transfontanellar ultrasonography brain scan, ophthalmoscopy, and detection of IgM antibodies for toxoplasmosis (MEIA) and the DNA of the toxoplasm with polymerase chain reaction – method Nested (PCR-Nested) serum were obtained. Results: In a population of 41,112 pregnant women, the prevalence of acute toxoplasmosis was 4.8 per 1,000 pregnant women (CI95%: 4.2 to 5.6). There was a significant decrease in the prevalence of acute toxoplasmosis in pregnant women of this hospital from 2002 on (P=0.008). The diagnosis of congenital toxoplasmosis was definitive in 37 children among 40,727 live births in the studied period, reaching an incidence of 0.9 per 1,000 births (CI95%: 0.6 to 1.3). Soon after the birth, among the 200 newborns exposed to the T. gondii, resulting from 199 pregnant women, 25 babies showed diagnostic criteria of congenital toxoplasmosis, reaching a vertical transmission rate of 12.5% (CI 95%: 8.2% - 17.9%). After the follow-up, another 12 cases were detected, increasing this rate to 18.5% (CI 95%: 13.4% – 24.6%). In order to evaluate the accuracy of diagnostic tests applied at the moment of birth, 31 children with CT were identified according to the gold standard, among 164 ones who were exposed to protozoan intra-uterus and who completed their follow-up until 12 months of age. The tests that showed better performance when isolate in the prediction of the diagnosis were the detection of specific IgM antibodies, ophthalmoscopy, and PCR-Nested reaching positive RV of 119.3 (CI95%: 7.40 – 1923.92), 49.9 (CI95%: 3.0 – 838.2), and 24.8 (CI95%: 3.22 – 190.35), respectively. The negative RV for IgM was 0.4 (CI95%: 0.3 – 0.6), but for ophthalmoscopy and PCR-Nested it was 0.7 (CI95%: 0.6 – 0.9) only. Conclusion: The prevalence of acute toxoplasmosis in pregnent women included in this study was lower than the one found in France and Belgium, but was higher when compared to the ones described in Sweden, Norway, Denmark, and New York. The estimated prevalence in this study was similar to the one from other locations in Brazil, such as Mato Grosso do Sul, but lower to the one obtained in Brasília. This variability in the estimates may be related to the different methods for diagnosis used in the screening or even to the different risk factors involved in the transmission of the disease. In our study, this frequency decreased from 2002 on, and this cannot be attributed to the introduction of the IgG avidity test, since the means of gestational age at the accomplishment of this test was late. However, there is a possibility that the IgM capture test with the ELFA method has contributed to decrease the frequency of false-positive cases of IgM, what can be confirmed with future studies. These results signal that the introduction of new technologies in the laboratory must be accompanied by efforts to improve conditions for an early access of pregnant women to the reference prenatal care, aiming to prevent the loss of opportunities of better discriminating pregnant women that are not sick and avoiding unnecessary and expensive invasive procedures. The incidence of congenital toxoplasmosis and the rate of vertical transmission were elevated. These frequencies may be underestimated due to the losses in the follow-up. In order to evaluate the effect of losses in the study validity, characteristics of the population of pregnant women and newborns belonging to the group of babies with full follow-up in relation to the group that did not return for the follow-up were compared. These characteristics were similar in the two groups, therefore we consider that the percentual of losses, even though high, did not endanger the validity of the study. The identification of twelve additional cases of congenital toxoplasmosis with the follow-up of the babies reinforces the need of a serological monitoring during the first year of life, even without any evidence of congenital infection at birth. In the evaluation of diagnostic tests applied at birth the detection of specific IgM antibodies in the blood of the newborn, the ophthalmoscopy, and the serum PCR-Nested showed a better performance to identify babies with CT. However, in order to discard this diagnosis, only the non-reagent IgM specific antibodies result showed higher utility, with a small magnitude effect though.

Orientador: Helaine Maria Besteli Pires Milanez / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T07:08:24Z (GMT). No. of bitstreams: 1 Delicio_AdrianeMaira.pdf: 1826833 bytes, checksum: bc3f2dce3447c00fccb97f45337d0f78 (MD5) Previous issue date: 2009 / Resumo: Objetivo: avaliar a transmissão vertical (TV) do HIV e fatores associados em gestantes soropositivas acompanhadas em um serviço universitário brasileiro (CAISM/UNICAMP) entre 2000 e 2009. Sujeitos e Métodos: coorte histórica de 452 gestações e seus recém-nascidos. Os dados foram coletados dos prontuários e registrados em fichas específicas. Crianças sem seguimento foram convocadas para definição diagnóstica. Análise dos dados: análise descritiva através de distribuição percentual e de médias; teste de X², exato de Fisher, t de Student, Mann-Whitney e ANOVA, razão de risco e intervalo de confiança. Resultados: A TV foi de 3,6%. A idade média das gestantes foi 27 anos; principal categoria de exposição foi a sexual (86,5%); 55% já apresentava o diagnóstico prévio à gravidez. Sessenta e dois por cento não estavam em uso de TARV ao engravidar. CD4 médio inicial foi de 474 células/ml e 70.3% apresentaram carga viral indetectável no terceiro trimestre. Como TARV, 55% usaram esquemas com IP e 35% com nevirapina. Monoterapia com AZT foi utilizada em 5,5%. Idade gestacional média no parto foi de 37,2 semanas e em 92% a via foi cesárea; 97,2% receberam AZT endovenoso. Os fatores associados à TV foram: baixa contagem de CD4, elevada carga viral, tempo reduzido de TARV, presença de alterações gestacionais (anemia, RCF, oligoâmnio), coinfecções durante o pré-natal (CMV e toxoplasmose) e presença de trabalho de parto. Uso de TARV potente, parto por cesárea e uso do AZT pelo RN foram fatores protetores. Má adesão ao tratamento esteve presente em 13 dos 15 casos infectados; em sete houve presença de coinfecção neonatal (CMV e toxoplasmose). Conclusão: Fatores de risco para TV foram comprometimento do estado imunológico da gestante, menor tempo de terapia, coinfecções (CMV e toxoplasmose) e presença de trabalho de parto. O uso de TARV potente e a realização de cesárea foram fatores protetores para a TV do HIV. / Abstract: Objectives: to evaluate mother-to-child transmission (MTCT) rates and related factors in HIV-infected pregnant women from CAISM/UNICAMP between 2000 and 2009. Subjects and methods: cohort of 452 HIV-infected pregnant women and their newborns. Data was collected from recorded files and undiagnosed children were enrolled for investigation. Statistical analysis: qui-square test, Fisher exact test, Student t test, Mann-Whitney test, ANOVA, risk ratio and confidence intervals. Results: MTCT occurred in 3.6%. The study population displayed a mean age of 27 years; 86.5% were found to have acquired HIV through sexual contact; 55% were aware of the diagnosis prior to the pregnancy; 62% were not using HAART. Mean CD4 cell-count was 474 cells/ml and 70.3% had undetectable viral loads in the third trimester. HAART included nevirapine in 35% of cases and protease inhibitors in 55%; Zidovudine monotherapy was used in 5.5%. Mean gestational age at delivery was 37.2 weeks and in 92% by caesarian section; 97.2% received intravenous zidovudine. Implicated factors related to MTCT were: low CD4 cell counts, elevated viral loads, maternal aids, shorter periods receiving HAART, maternal concurring illnesses (anemia, IUGR, oligodydramnium), coinfections (CMV and toxoplasmosis) and the occurrence of labor. Use of HAART for longer periods, caesarian delivery and oral zidovudine for the newborns were associated with a decreased risk. Poor adhesion to treatment was present in 13 of the 15 cases of transmission; in 7, co-infections were diagnosed (CMV and toxoplasmosis). Conclusion: Use of HAART and caesarian delivery are protective factors in mother-to-child transmission of HIV. Maternal coinfecctions and maternal concurring illnesses were risk factors for MTCT. / Universidade Estadual de Campi / Ciencias Biomedicas / Mestre em Tocoginecologia

Durante o repasto sanguíneo, fêmeas do mosquito Aedes aegypti inoculam saliva na pele de seu hospedeiro vertebrado, modulando suas funções imunológicas e facilitando a transmissão de doenças. Alguns componentes presentes na saliva de Ae. aegypti já foram descritos e caracterizados como alérgenos. No presente estudo, desenvolvemos um modelo de inflamação alérgica em camundongos expostos naturalmente às picadas de mosquitos Ae. aegypti. Nossos dados revelam que a sensibilização e posterior desafio com componentes salivares desse mosquito induz inflamação pulmonar com aumento no número de eosinófilos, células T CD4+, CD19+ e citocinas IL-4 e IL5 no lavado broncoalveolar, produção de muco e colágeno no pulmão, anticorpos IgE total e IgG1 e IgG2a específicos no soro, porém, sem alterações no padrão respiratório e reatividade das vias aéreas. Em conjunto, os resultados gerados neste trabalho confirmam o desenvolvimento de uma resposta alérgica diferente dos modelos clássicos dessa área com a presença de elementos que sugerem tanto um perfil Th1 quanto Th2 de resposta. / During blood feeding, Aedes aegypti female mosquitoes inoculate saliva into the skin of their vertebrate hosts, modulating their immune functions and facilitating disease transmission. Some components presents in the saliva of Ae. aegypti have been described and characterized as allergens. In this study, we developed a model of allergic inflammation in mice naturally exposed to Ae. aegypti mosquito bites. Our data show that the sensitization and subsequent challenged with this mosquito salivary components induces lung inflammation with increased numbers of eosinophils, T CD4+ and CD19+ cells and IL-4 and IL-5 in bronchoalveolar lavage, mucus and collagen production in lung, total IgE and specific IgG1 and IgG2a antibodies in serum, but no changes in breathing pattern and in the airways reactivity. Together, the results generated in the present study confirm the development of an allergic response that is different from classic models of this area with the presence of components which suggest both Th1 and Th2 responses.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2016. / IntroductionMale circumcision refers to the surgical removal of all or parts of the prepuce of the penis. This procedure is undertaken for religious, cultural, social, hygiene or medical reasons (Maibvise and Mavundla 2013: 139). The number of people living with Human Immunodeficiency Virus (HIV) rose from approximately 8 million in the year 1990 to 33 million infections now. Sub-Saharan Africa is the region in the world most affected by HIV/AIDS with 22.4 million people living with the virus in the year ending 2008 (Naidoo et al. 2012: 2). The use of male and female condoms remains a challenge despite decades of promotion. There is evidence that medical male circumcision (MMC) is effective in preventing HIV sexual transmission. Medical male circumcision is a drive that was initiated by the National Department of Health as a strategy to curb HIV infection in South Africa in 2010. Aim of the Study The purpose of the study was to investigate and describe knowledge, attitudes and perceptions of males with regard to medical male circumcision. Methodology A quantitative descriptive survey research method was used to describe the knowledge, attitudes and perceptions of males attending the community health care centers (CHCs) in eThekwini district regarding medical male circumcision. Results Displayed posters motivated 71.4% (n = 329) to have circumcisions. While 65.1% (n = 300) respondents had knowledge about circumcision and HIV, 27.8% (n = 280) perceived that circumcision would interfere with their sexual function and reproduction. A total of 38.8% (n = 179) of respondents indicated that it is good for children to be circumcised. There is a significant positive correlation between age and knowledge (r = 0.135, p = .004). Higher age is correlated with more knowledge. Conclusion This study found that knowledge plays a major role in changing attitudes and perceptions. The more knowledgeable an individual is, the more the chance is of them having a positive attitude towards MMC which could also influence a positive perception of MMC. In order to strengthen male circumcision as an HIV prevention strategy, it is imperative to provide the population that reflected low knowledge and negative attitude with information, education and counselling services. This may help them to change their attitudes and acquire a positive perception of MMC. / M

No description available.

Infectious disease is a ubiquitous aspect of life on earth; however, parasites and pathogens are not distributed equally among individual hosts. Due to its ability to shape the way that individuals interact with other potential hosts and the environment, behavior is one of the most salient ways through which host biology varies in the context of disease. Variation in animal behavior can impact both transmission and the extent of a host's pathogen acquisition, and thus can have important consequences for infectious disease dynamics. Additionally, in this world of rapid urbanization where landscapes and wildlife resources are being altered, it is important to understand the ways in which human activity impact wildlife behavior, and in turn, disease dynamics. Here, we used both observational and experimental studies in field and laboratory settings to investigate the relationships among host behavior and physiology, anthropogenic food sources, and disease transmission in a natural host-pathogen system. First, we examined the relationship between house finch (Haemorhous mexicanus) stress physiology, exploratory behaviors, and social behaviors in the wild. We provided evidence that more exploratory house finches interact with more individuals in the wild, and have higher baseline concentrations of circulating stress hormones. Next, we found evidence that the amount of time spent on bird feeders drives both the acquisition and transmission of the bacterial pathogen Mycoplasma gallisepticum (Mg), indicating that variation in host foraging behavior has important transmission consequences in this system. Lastly, we found that the density of bird feeders available to house finches predicts the extent of Mg transmission in captivity. Taken together, these results highlight the important role that behavioral heterogeneity can play in the acquisition and spread of pathogens, as well as the potential impacts of human behavior on wildlife disease dynamics. Future work should seek to identify specific physiological mechanisms driving Mg acquisition and transmission as they relate to variation in host behavior, and the ways in which bird feeders impact disease-relevant behaviors in the wild. / Ph. D.

Anthropogenic resource provisioning of wildlife has increasingly been hypothesized to alter pathogen spread. Although bird feeding is the most widespread form of intentional wildlife provisioning, we know relatively little about how the degree of anthropogenic feeding at a site impacts wild birds in ways relevant to disease transmission. We manipulated the density of bird feeders (low versus high) available at otherwise similar sites and tracked the local abundance, body condition (scaled-mass index), feeding behavior, and movement across the landscape in wild house finches (Haemorhous mexicanus), a feeder-dependent species subject to outbreaks of a contagious pathogen commonly spread at feeders. The local abundance of house finches was significantly higher at sites with high feeder density but, surprisingly, finches at high-density feeder sites had poorer body condition than those at low-density sites. Behaviorally, birds at high-density feeder sites had longer average feeding bouts and spent more time per day on feeders than birds at low-density feeder sites. Further, birds first recorded at low-density feeder sites were more likely to move to a neighboring high-density feeder site than vice versa. Overall, because local abundance and time spent on feeders have been linked with the risk of disease outbreaks in this species, effects of bird feeder density on both traits may, in turn, influence disease dynamics in house finches. Our results suggest that heterogeneity in the density of bird feeders can have diverse effects on wild birds, with potential consequences for disease transmission. / Master of Science / Feeding wildlife has increasingly been thought to change the spread of disease. Although bird feeding is the most widespread form of intentional wildlife feeding, we know relatively little about how much human feeding impacts wild birds in ways that affect disease transmission. We changed the density of bird feeders (low versus high) available at otherwise similar areas and tracked the local abundance, body condition, feeding behavior, and movement across the landscape in wild house finches (Haemorhous mexicanus), a feeder-dependent species subject to outbreaks of a infectious disease commonly spread at feeders. The local abundance of house finches was significantly higher at sites with high feeder density but, surprisingly, finches at high-density feeder sites had poorer body condition than those at low-density sites. Behaviorally, birds at high-density feeder sites had longer average bouts on feeders and spent more time per day on feeders than birds at low-density feeder sites. Further, birds first recorded at low-density feeder sites were more likely to move to a neighboring high-density feeder site than vice versa. Overall, because local abundance and time spent on feeders have been linked with the risk of disease outbreaks in this species, effects of bird feeder density on both traits may, in turn, increase disease spread in house finches. Our results suggest that variation in the density of bird feeders can have diverse effects on wild birds, with potential consequences for disease transmission.

Essay #1 – Factors influencing the risk of falls in the construction industry: a review of the evidence Falls are a significant public health risk and a leading cause of nonfatal and fatal injuries among construction workers worldwide. A more comprehensive understanding of casual factors leading to fall incidents is essential to prevent falls in the construction industry. However, an extensive overview of causal factors is missing from the literature. In this paper, 536 articles on factors contributing to the risk of falls were retrieved. One hundred twenty-one (121) studies met the criteria for relevance and quality to be coded, and were synthesized to provide an overview. In lieu of the homogeneity needed across studies to conduct a structured meta-analysis, a literature synthesis method based on macro-variables was advanced. This method provides a flexible approach to aggregating previous findings and assessing agreement across those studies. Factors commonly associated with falls included working surfaces and platforms, workers’ safety behaviors and attitudes, and construction structure and facilities. Significant differences across qualitative and quantitative studies were found in terms of focus, and areas with limited agreement in previous research were identified. Findings contribute to research on the causes of falls in construction, developing engineering controls, informing policy and intervention design to reduce the risk of falls, and improving research synthesis methods. Essay #2 – Review of quantitative studies of interventions for responding to infectious disease outbreaks We reviewed the modeling and retrospective literature on responding to outbreaks of infectious diseases in humans and animals. Unlike routine immunization and control efforts, outbreak response activities require rapid reactive actions to address an urgent or emergent situation. We focused our review on characterizing the types of diseases analyzed, the interventions used, and the models employed. Out of the 211 studies identified, we find that the majority focus on a few diseases (influenza, foot and mouth disease, smallpox, measles, and hepatitis). We identified 34 distinct interventions explored in these studies that fall under the general categories of vaccination, prophylaxis, quarantine/isolation, contact restriction, exposure reduction, killing/slaughtering, and surveillance. A large number of studies (141) use simulation/analytical models to analyze outbreak response strategies. We identify key factors contributing to the effectiveness of different interventions that target high-risk individuals, trace infected contacts, or use a ring to delineate geographical boundaries for an intervention. Essay #3 – Development of an individual-based model for polioviruses: implications of the selection of network type and outcome metrics We developed an individual-based (IB) model to explore the stochastic attributes of state transitions, the heterogeneity of the individual interactions, and the impact of different network structure choices on the poliovirus transmission process in the context of understanding the dynamics of outbreaks. We used a previously published differential equation-based model to develop the IB model and inputs. To explore the impact of different types of networks, we implemented a total of 26 variations of six different network structures in the IB model. We found that the choice of network structure plays a critical role in the model estimates of cases and the dynamics of outbreaks. This study provides insights about the potential use of an IB model to support policy analyses related to managing the risks of polioviruses and shows the importance of assumptions about network structure. / Ph. D.