The importance of modelling the spreading of infectious diseases as part of a public health strategy has been highlighted by the ongoing coronavirus pandemic. This includes identifying the geographical areas or travel routes most likely to contribute to the spreading of an outbreak. These areas and routes can then be monitored as part of an early warning system, be part of intervention strategies, e.g. lockdowns, aiming to mitigate the spreading of the disease or be a focus of vaccination campaigns.  This thesis focus on developing a network-based infection model between the municipalities of Sweden in order to identify the areas most likely to contribute to an epidemic. First, a human mobility model is constructed based on the well-known radiation model. Then a network-based SEIR compartmental model is employed to simulate epidemic outbreaks with various parameters. Finally, the adoption of the influence maximization problem known in network science to identify the municipalities having the largest impact on the spreading of infectious diseases.  The resulting super-spreading municipalities point towards confirmation of the known fact that central highly populated regions in highly populated areas carry a greater risk than their neighbours initially. However, once these areas are targeted, the other resulting nodes show a greater variety in geographical location than expected. Furthermore, a correlation can be seen between increased infections time and greater variety, although more empirical data is required to support this claim.   For further evaluation of the model, the mobility network was studied due to its central role in creating data for the model parameters. Commuting data in the Gothenburg region were compared to the estimations, showing an overall good accuracy with major deviations in few cases.

Over 80% of the newly emerging infectious diseases are caused by RNA viruses. Major global problems associated with the development of vaccines against the RNA virus are their high genetic and antigenic diversity. Hence, effective control of epidemics with newly emerging RNA viruses require improved vaccines which are either specific to the new strain or broadly effective even when new viral strains emerge. The main focus of this dissertation is to develop epidemic vaccines using these two approaches. Using a newly emerged swine enteric virus called porcine epidemic diarrhea virus (PEDV) as a model, our first goal was to develop a quick and easy method for rapid response vaccines with potential applicability to a range of RNA viruses. We hypothesized that the methods which can disrupt genomic RNA without impacting the structural integrity of the virus would result in attenuated vaccine with minimum replication in the host while inducing immune responses. As hypothesized, developed rapid response PEDV vaccine induced complete protection against the virulent challenge virus, while vaccine viral shedding was not detected in vaccinated pigs. To address the second problem of rapid viral evolution leading to vaccines becoming obsolete, we used swine influenza virus (SIV) as a model to develop and test a universal vaccine composed of peptides encoding conserved antigenic epitopes which are present in most influenza A viruses. Importantly, a novel amphiphilic invertible polymer (AIP) was used to address the well-recognized problem of poor antigenicity of peptides. We hypothesized that peptides encoding conserved epitopes when conjugated with an AIP will induce strong immune responses and protect against challenge virus. While the conserved epitopes were previously tested by others in mice, we were the first to test a combination of these epitopes in pigs. Pigs vaccinated with the peptide polymer vaccine mounted strong antibody responses against the epitopes indicating that the delivery system was effective. However, protection against replication of the challenge virus was delayed. In summary, the methods developed and tested in this body of work significantly contribute to the area of emergency response management in infectious disease outbreaks. / United States Department of Agriculture, National Institute of Food and Agriculture (USDA-NIFA) / North Dakota State Agricultural Products Utilization Committee (ND APUC) / North Dakota State Board of Agricultural Research (ND SABRE)

This master thesis is focused on decreasing levels of vaccination as a new health risk. In recent years it has become a new trend that we can observe in European countries. Low vaccination levels amongst population are one of the reasons for new epidemics or pandemics happening. When immunization rises above 95 % then a collective immunization comes into effect. Collective immunization lowers the chances of diseases spreading. For this reason, World health organization supports immunization and tries to make immunization affordable reachable for everyone everywhere. This these analyses measles which can be stopped by vaccinating the population. Therefore, the World health organization prepares strategic plans aimed at eradication of this disease. Each member state has a task to apply these plans in their specific environment. This thesis focuses on the Czech Republic and its implementation of strategic plans happening 2005-2010 and 2011-2020. This thesis is structured into 5 chapters focused on theory of international relations, hesitancy to vaccinate, strategic plans of World health organization and the Czech Republic.

The United States (U.S.) government has been attempting to combat the growing opioid epidemic ravaging the nation. The opioid epidemic has had a significant impact on public health and forensic science laboratories. Moreover, this epidemic has moderate to fatal health consequences for expectant mothers with substance use disorder and their child who may develop Neonatal Abstinence Syndrome (NAS), otherwise known as Neonatal Opioid Withdrawal Syndrome (NOWS). The objective of this thesis is to emphasize that further research is needed for the identification and quantification of opioids in human breast milk. This topic has public health implications such as discussing the information gaps as it relates to a highly vulnerable group, women, and infants, affected by the opioid epidemic. Furthermore, there are implications in forensic science connected to postmortem toxicology and pathology when determining the cause of death and contributing factors in pediatric cases. This emphasis on the need for greater research will be accomplished by highlighting the opioid epidemic, its impact and further understanding of the addictive drug class known as opioids. The history of the crisis, effects on society as well as pharmaceutical knowledge of opioids will assist in development of plans to suppress growth and provide care for the afflicted. Furthermore, this thesis will attempt to demonstrate the need for further research involving opioids will be of significant value for public health and forensic science. As the forensic laboratories and various medical facilities are at the forefront of the opioid epidemic, there is a need for more robust, validated, inexpensive, and fast drug detection methodologies. Increasing rates of new designer drugs, addiction, and opioid-related deaths has caused a backlog in the forensic laboratories due to the great number of cases. While, the higher instances of maternal substance use disorder (SUD)/ opioid use disorder (OUD) with parallel increases in cases of NAS incidences are a few of the issues that need to be managed by public health leaders. Additionally, this thesis will examine current methodologies for drug quantification of opioids in human breast milk. The valid methodologies developed as well as the findings by the few available studies allowed for the current recommendations related to the acceptability of mothers in MAT programs, using methadone and buprenorphine during pregnancy and postpartum, being able to breastfeed their infant. By examining these studies and the findings, standardization criteria for the development of study designs for new methodologies relating to drug determination in human breast milk could be developed. The establishment of standardization criteria and acknowledging information gaps in current knowledge will be significant as these findings could influence policies, guidelines and procedures relating to maternal SUD/OUD, NAS/NOWS, and pediatric death determination as well as postmortem toxicology.

The purpose of this essay is to examine the extent to which the cholera epidemics that prevailed in Sweden during the nineteenth century affected Döderhult parish during the period 1834-1866. The study aims first to examine the total number of cholera deaths in Döderhult parish. Additionally, it examines the individuals who died of cholera concerning gender, age and occupation. The essay also aims to examine whether Döderhult parish was more affected by the cholera epidemic than other nearby parishes were and if so, why? In accordance to this, the death rate of Döderhult parish is thus studied in comparison with Mönsterås parish and documented cholera deaths in Fliseryd parish during the period.  The results show that of the 68 people who died in Döderhult parish between 1834 and 1866, 35 were men and 33 were women. The examination of the deceaseds’ age showed that the most vulnerable groups in the parish were the children and the elderly. The results regarding the deceased’s occupation showed that most men, women and children belonged to the working class. Last but not least, the comparative examination between Döderhult parish and the nearby parishes showed that Döderhult parish was worse affected by the cholera epidemic due to factors such as potential trade agreements, overcrowding, lack of public health measures, the industries’ impact on population and the spread of infection through relocation from the town of Döderhultsvik to the parish.

With the growing popularity of integrating mobile networks and social networks, people now enjoy a freer and more efficient means of communication. Smarter mobile devices facilitate modern human life. In the information age, various new types of information have begun to appear. How to disseminate content to people in a swift and fair way has long been a question. Choosing the right strategy for content distribution is especially crucial for mobile social networks. In this thesis project we use epidemic models for content distribution in mobile social networks. Stochastic mobility models and an SIR epidemic model are set up in the evaluation. We analyze the impact of various parameters of mobility models and epidemic model on content distribution’s success rate and delivery delay. Also, we exploit the social relationships to facilitate content distribution and show the impact of social relationships on content distribution. Simulations have shown that increasing speed and node number in the mobility models will have positive impact on content distribution success rate as well as decreasing the delay. The infect time limit and infect count limit of the epidemic model are also important for swiftly distributing content while considering energy consumption and fairness for nodes. In the social relationship simulation, nodes’ meeting times during a period of time are calculated and a threshold based on a certain level of meeting times is used for categorizing the friendship relationships between nodes. The results show that it will be easier for a successful distribution to be achieved as the social relationship between nodes gets stronger. Also, the delay shows a decreasing trend until reaching the ideal distribution delay time. / Med den växande populariteten för att integrera mobila nätverk och sociala nätverk, människor njuta nu en friare och effektivare sätt att kommunicera.  Smartare mobila enheter underlättar moderna människans liv. I den information som ålder, har olika nya typer av information börjat visas. Hur sprida innehåll till människor påett snabbt och rättvist sätt har länge varit en fråga. Att välja rätt strategi för distribution av innehåll är särskilt viktigt för mobila sociala nätverk. I den här avhandlingen projekt använder vi epidemiska modeller för distribution av innehåll i mobila sociala nätverk. Stokastiska rörlighet modeller och en SIR-epidemi modell sätts upp i utvärderingen.  Vi analyserar effekterna av olika parametrar rörlighet modeller och epidemisk modell påinnehållsdistribution s framgång och leveransförsening. Dessutom utnyttjar vi de sociala relationerna för att underlätta distribution av innehåll och visa hur sociala relationer pådistribution av innehåll. Simuleringar har visat att ökad hastighet och nodnummer i rörlighet modellerna kommer att ha en positiv inverkan pådistribution av innehåll framgång samt att minska fördröjningen. Den infektera tid och infektera räkna gräns epidemin modellen är ocksåviktiga för att snabbt distribuera innehåll och samtidigt överväga energiförbrukning och rättvisa för noder. I den sociala relationen simulering är noder möte tid under en tidsperiod beräknas och en tröskel baserad påen viss nivåav mötestiden används för att kategorisera vänskap relationer mellan noder. Resultaten visade att det blir lättare för en lyckad spridning uppnås som den sociala relationen mellan noder blir starkare. Dessutom visar fördröjningen en nedåtgående trend tills den når fördröjningen av en ideal fördelning.

Titel: Upplevelser av aktivitetsbalans och dess påverkan på stress för studenter under pandemin covid-19. Syfte: Syftet med studien var att beskriva hur studenter på en svensk högskola upplever aktivitetsbalans och dess påverkan på stress under pandemin covid-19. Metod: En kvalitativ intervjustudie med 10 svenska informanter där materialet analyserades med en kvalitativ innehållsanalys. Resultat: I resultatet kom det fram 3 kategorier: Minskade möjligheter i att delta i aktiviteter påverkar aktivitetsbalansen, Strategier för att upprätthålla aktivitetsbalans och Relationen mellan aktivitetsbalans och stress. Resultatet visade upplevelserna av aktivitetsbalans och dess påverkan på stress hos informanterna. Slutsats: Fungerande rutiner och anpassade aktiviteter var av betydelse för upplevd aktivitetsbalans under pandemin covid-19. Upplevelsen av att pandemin påverkat aktivitetsbalans negativt var på grund av bristande rutiner och anpassningar i vardagen. Vid upplevd aktivitetsobalans sågs en verkan på stress men med tidigare erfarenhet av stresshantering kunde det undvikas. / Title: The experiences of occupational balance and its impact on stress for students during the covid-19 pandemic. Aim: The purpose of the study was to describe how students at a Swedish university experience occupational balance and its impact on stress during the pandemic covid-19. Method: A qualitative interview study was used with 10 Swedish participants and the material was analyzed with a qualitative content analysis. Result: The result revealed 3 categories: Reduced opportunities in participating in activities affect the occupational balance, Strategies for maintaining occupational balance and The relationship between occupational balance and stress. The results showed experiences of occupational balance and its impact on between informants Conclusion: Functioning routines and adapted activities were important for the perceived occupational balance during the covid-19 pandemic. The experience that the pandemic had a negative effect on the balance of activities was due to a lack of routines and adaptations in everyday life. In the case of perceived occupational imbalance, an effect on stress was seen, but with previous experience of stress management, it could be avoided.

Severe acute respiratory syndrome (SARS) is a severe pulmonary infection that has been identified in multiple outbreaks around the world after emerging from mainland China in early 2003, The syndrome is caused by SARS-associated coronavirus, a novel human infection. SARS-associated coronavirus is spread by multiple mechanisms, including direct contact and large-droplet aerosolization, and may be spread by droplet nuclei as well. Clinical disease is characterized by fever, dry cough, interstitial infiltrates, and variable progression to respiratory failure, No treatment has clearly been shown to be effective. Aggressive infection control measures to prevent viral spread are key to outbreak management.

Chlamydiae may exist at the site of infection in an alternative replicative form, called the aberrant body (AB). ABs are produced during a viable but non-infectious developmental state termed "persistence" or "chlamydial stress." As persistent/stressed chlamydiae: (i) may contribute to chronic inflammation observed in diseases like trachoma; and (ii) are more resistant to current anti-chlamydial drugs of choice, it is critical to better understand this developmental stage. We previously demonstrated that porcine epidemic diarrhea virus (PEDV) co-infection induced Chlamydia pecorum persistence/stress in culture. One critical characteristic of persistence/stress is that the chlamydiae remain viable and can reenter the normal developmental cycle when the stressor is removed. Thus, we hypothesized that PEDV-induced persistence would be reversible if viral replication was inhibited. Therefore, we performed time course experiments in which Vero cells were C. pecorum/PEDV infected in the presence of cycloheximide (CHX), which inhibits viral but not chlamydial protein synthesis. CHX-exposure inhibited PEDV replication, but did not inhibit induction of C. pecorum persistence at 24 h post-PEDV infection, as indicated by AB formation and reduced production of infectious EBs. Interestingly, production of infectious EBs resumed when CHX-exposed, co-infected cells were incubated 48-72 h post-PEDV co-infection. These data demonstrate that PEDV co-infection-induced chlamydial persistence/stress is reversible and suggest that this induction (i) does not require viral replication in host cells; and (ii) does not require de novo host or viral protein synthesis. These data also suggest that viral binding and/or entry may be required for this effect. Because the PEDV host cell receptor (CD13 or aminopeptidase N) stimulates cellular signaling pathways in the absence of PEDV infection, we suspect that PEDV co-infection might alter CD13 function and induce the chlamydiae to enter the persistent state.

In recent history, four influenza pandemics have occurred causing worldwide suffering. It is only a matter of time when a fifth pandemic will emerge. The willingness of the public to perform recommended precautionary actions is central for successful outbreak management, where the most important measure is vaccination. Trust in the health care system as well as personal perceptions of the threat of a pandemic can influence the publics willingness to perform precautionary actions. Aims: This study seeks to analyze how the public in two socioeconomically different areas of Stockholm perceive the threat of a possible future epidemic, their level of trust in the health system and what precautionary actions they are willing to perform. Methods: questioners with respondents from two socioeconomically different areas in Stockholm (Tensta and Danderyd) were gathered and have been statistically analyzed and interpreted using the health belief model and theories about trust. Results: The study showed that a higher level of perceived benefits of precautionary actions and a higher level of worriedness to get seriously ill if infected during an influenza epidemic were correlated with a higher level of willingness to follow precautionary actions. A significant association between unwillingness to vaccinate and perceived barriers to vaccination (that it can be harmful to the health) was also found. Trust in the health system was significantly lower in Tensta compared to Danderyd and higher trust in the health system was found to lead to higher perceived benefits of precautionary actions. Additionally, respondents with higher trust in information from the health care were generally more willing to vaccinate. Finally, no demographic determinants except age was shown to influence perceptions about precautionary actions and threat. Conclutions: Willingness to perform precautionary actions were influenced by worriedness, perceived benefits, perceived barriers, age and trust in the health care. Efforts might thus be needed to increase the trust in the health system in socioeconomically weak areas, as well as to increase the trust in influenza vaccination in general.