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O presente trabalho propõe o desenvolvimento e a caracterização de uma estratégia vacinal de caráter profilático contra o vírus da dengue (VD), baseada nas proteínas NS1 e domínio III da proteína E (EIII), empregando proteínas recombinantes em ensaios de imunização por via sub-cutânea em modelo murino. Estes antígenos foram obtidos pela clonagem e expressão de suas sequências de DNA codificadoras em sistema procarioto (E. coli). Além disso, formas atóxicas da toxina termo-lábil (LTG33D e LTK63) de E. coli enterotoxigência (ETEC) foram obtidas e incorporadas como adjuvantes às formulações vacinais. As respostas celulares e humorais anti-NS1 e anti-EIII foram monitoradas por ELISA para anticorpos e citocinas, ICS (do inglês intracellular citokine staining) e atividade citotóxica in vivo. Observamos que animais imunizados com a NS1 recombinante adicionada da LTG33D foram capazes de gerar respostas imunológicas com produção de anticorpos específicos e alta afinidade pelo antígeno. Em ensaios de desafio realizados para avaliar a proteção vacinal conferida à infecção por uma linhagem referência do o VD tipo 2 (NGC) observamos que essa formulação conferiu uma proteção de 50% aos animais imunizados. Paralelamente a esses resultados, demonstramos que a EIII não é um bom antígeno vacinal e que pode induzir anticorpos capazes de acentuar a infecção do VD. Descrevemos ainda a obtenção e a caracterização genética e patológica de um isolado clínico de VD tipo 2 naturalmente letal para camundongos Balb/C. A nova cepa viral (JHA1) demonstrou ser capaz de induzir perda de peso corporal, dano tecidual geral, e distúrbios hematológicos similares aos observados em humanos infectados pelo VD, podendo ser aplicada como modelo de infecção na avaliação de candidatos vacinais. Os resultados obtidos neste trabalho representam uma importante contribuição na área de desenvolvimento de estratégias vacinais contra a dengue e representam uma base importante para futuros estudos sobre a patologia da dengue. / The present study proposes the development and characterization of a strategy for prophylactic vaccination against dengue virus (VD) based on the NS1 protein and the domain III of the envelope glycoprotein (EIII), using recombinant proteins in subcutaneous immunization in a murine model. These antigens were obtained by cloning and expression of their DNA coding sequences in prokaryotic system (E. coli). In addition, the s non-toxic forms of the heat-labile toxin from enterotoxigenic E. coli (ETEC) (LTK63 and LTG33D) were obtained and incorporated as adjuvants to vaccine formulations. Anti-NS1 and anti-EIII cellular and humoral immune responses were monitored by antibody and cytokine ELISA, , intracellular citokine staining (ICS) and in vivo cytotoxic activity. We observed that animals immunized with the recombinant NS1 and LTG33D were capable to induce immune responses including specific antibodies with high affinity for the antigen. In challenge assays performed to evaluate the immunization protective efficacy such vaccine conferred protection of 50% against infection with a reference type 2 VD (VD2) strain(NGC). Alongside to these results, we demonstrated that EIII is not a good vaccine antigen and can induce the generation of antibodies that enhance DENV infection. We also described the isolation and the genetic and pathological characterization of a VD2 clinical isolate naturally lethal to immunocompetent Balb/c mice. The new strain was shown to cause weight loss, general tissue damage, and hematological disturbances similar to those observed in VDinfected humans, and therefore, may be applied as infection model to evaluate vaccine candidates. The results obtained in this study represent an important contribution to DENV vaccine development and established an important background for future studies of the dengue pathology.

Barnvaccination har varit en av de mest betydelsefulla åtgärderna för att främja folkhälsan och förebygga sjukdomsrelaterade dödsfall hos barn. Barnvaccinationstäckningen har emellertid minskat globalt med anledning av en ökad tveksamhet kring vaccinationer. Studiens syfte var att undersöka hur specialistsjuksköterskor främjar vårdnadshavares följsamhet till det allmänna barnvaccinationsprogrammet. Studien var empirisk med kvalitativ studiedesign. Semistrukturerade intervjuer genomfördes med elva specialistsjuksköterskor inom barnhälsovården och analyserades med kvalitativ innehållsanalys, i enlighet med   Lundman och Hällgren Granheim (2017).   I resultatet framkom lokala riktlinjer och nationella riktlinjer för att främja följsamhet till barnvaccinationsprogrammet. Att ge vårdnadshavare generell information om barnvaccinationer var den viktigaste åtgärden för att främja vaccinationstäckningen. Vid tveksamheter till barnvaccination var det avgörande för specialistsjuksköterskan att ha ett personcentrerat förhållningssätt mot vårdnadshavare. Att ge kunskap samt använda ett tvärprofessionellt samarbete var också betydelsefullt. Vidare forskning kan fokusera på vårdnadshavares perspektiv på barnvaccination för att få ytterligare vägledning i hur barnvaccinationstäckningen kan främjas. Det kan också vara betydelsefullt med ytterligare forskning kring hur specialistsjuksköterskor kan bemöta vårdnadshavare som avstår vaccination för sitt barn. / Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent death among children, caused by diseases. The global coverage of childhood immunization has however decreased globally due to an increased hesitancy towards immunizations. The aim of this study was to examine how specialist nurses promote legal guardians’ adherence to the national childhood immunization program. This study was empirical with a qualitative study design. Semi-structured interviews with eleven specialist nurses in pediatric primary care were conducted. The interviews were analyzed using a qualitative content analysis.    The results showed both local guidelines and national guidelines to promote adherence to the childhood immunizations program. The main nursing intervention to promote childhood immunization coverage was to give legal guardians general information about the program. If hesitation, it was essential to have a person-centered approach towards the legal guardian. Educating guardians and using a multidisciplinary approach was also beneficial. Further research suggests focusing on the guardians’ perspective regarding childhood immunization as it may generate further guidance in how to promote immunization coverage. It may also be beneficial to conduct further research on how specialist nurses can respond to guardians who decline immunization for their child.

Immunotherapy for Alzheimer\''s disease has emerged as a promising approach for clearing pathological tau protein conformers. To explore this kind of treatment we tested an active immunization with pseudo-phosphorylated tau fragments in P301L tangle model mice that develop neuronal tau aggregates as observed in frontotemporal dementia and Alzheimer’s disease. We found that an immunization reduces neurodegeneration in α-motor neurons in the spinal cord and slows progression of the tangle-related behavioral phenotype. Performance on behavioral assays correlated with tau pathology at the corresponding spinal cord level. Interestingly, a slowed progression of these tauopathy related characteristics were only seen in mice that received a specific immunization with pseudo-phosphorylated tau fragments, not in animals that received a non-specific activation of the immune system. An immunization witch pseudo-phosphorylated tau fragments may be a valuable therapeutic option in targeting one of the major hallmarks of Alzheimer’s disease and frontotemporal dementia.

The presented thesis deals with the issue of mothers' decision-making in relation to their child's vaccination against pneumococcal infections. An on-line survey of mothers was conducted (n = 180) in order to obtain data for the theoretical model based on the theory of planned behavior (TPB). A hierarchical logistic regression was then performed in order to analyze the model with the intention to vaccinate as the dependent variable. The results of the regression analyses were supplemented by results of correlation analyses and non-parametric tests. The theory proved itself as a strong predictive instrument and the results suggest that the attitude is the main predictor of the decision in this non-representative sample of mothers. The subjective norm, as the second construct of the TPB, contributes only in certain case and the perceived behavioral control was not found influential at all. The perception of thread of contraindications of the vaccine proves also influential next to the attitude. The beliefs that mothers hold about the vaccine were analyzed according to mothers intentions to vaccinate (n = 70) or not to (n = 110). These results support the idea that mothers, especially those who do not want to vaccinate their children against pneumococcal infections, decide particularly according to...

To improve U.S. residents' health, advocates are focusing their efforts on workplace health. Researchers have found that unionization is a positive influence on workers' participation in health promotion programs relating to smoking and obesity prevention. However, the effect of union membership on other health promotion initiatives, such as influenza vaccination compliance among health care workers, has not been examined. The purpose of this quantitative study was to address this knowledge gap between a union and a nonunion health care facility in the U.S. state of Pennsylvania. The health belief model was used to determine if different domains of influenza vaccination perception predicted vaccination behaviors among union and nonunion health care workers. A secondary analysis was performed on the 2013-2014 Influenza Vaccination Survey, which was completed by 2,480 health care workers. While a chi-square analysis showed that vaccination compliance was not statistically different between facilities, a binary logistic regression revealed a significant difference in predicted vaccination behaviors for each domain of influenza vaccination perceptions. Among union health care workers, perceived barriers yielded the highest positive predictability of vaccination compliance, whereas perceived benefits were positively associated with vaccination compliance among nonunion workers. These study findings affect social change by identifying vaccine compliance predictors among union and nonunion health care workers. By focusing on these predictors, health care facilities may be able to improve levels of vaccination compliance and achieve the Joint Commissions' vaccination goal of 90% compliance amongst all healthcare workers.

Background: The anti-vaccination movement has gained attention in the media over the last few years, which has revived the debate as to whether parents should vaccinate their children or not. Infections, whose incidence has previously been declining as a result of compliance to national immunization programmes, have made a resurgence and the protection of the society that comes with vaccinations is decreasing. Vaccines are one of the most cost-efficient measures available to health care to prevent spreading of diseases and decrease mortality at the population level. Aim: To study the factors that influence parents’ decisions not to vaccinate their children in accordance with national immunization programmes to increase the understanding of these decisions. Method: A scoping review of articles retrieved from the databases PubMed and CINAHL. A content analysis was used to interpret content and create context. The result was based on 23 articles. Results: Several reasons why parents don't vaccinate their children were uncovered. A fear of adverse effects and a lack of trust in health care, authorities and vaccines were prominent reasons for vaccination refusal. Where parents gathered information, how they defined health and culture or religion where other factors that influenced the decision not to vaccinate. Conclusion: The main findings indicate a lack of trust in authorities, health care or vaccines among parents. Gathering information from the internet and media have contributed to ignorance about and a fear of the effects of vaccines. Health care staff need to improve their person-centered care and adapt information about vaccines to the recipient. / Bakgrund: Antivaccinationsrörelsen har fått medial uppmärksamhet de senaste åren, vilket har aktualiserat debatten huruvida föräldrar ska vaccinera eller inte vaccinera sina barn. Infektioner, vars utbredning tidigare minskat till följd av följsamhet till vaccinationsprogram, har åter fått fäste och det samhällsskydd som följer vaccinationer har minskat. Vaccin är en kostnadseffektiv åtgärd inom hälso- och sjukvården för att förhindra smittspridning och minska mortaliteten på befolkningsnivå. Syfte: Undersöka faktorer som påverkar föräldrars beslut att inte vaccinera sina barn enligt nationella vaccinationsprogram för att öka förståelsen för dessa beslut. Metod: Scoping review baserad på artiklar hämtade ur databaserna PubMed och CINAHL. Innehållsanalys tillämpades för att förstå innehåll och skapa sammanhang. Resultatet baseras på 23 artiklar. Resultat: I resultatet framkom olika skäl till att föräldrar inte vaccinerar sina barn. Rädsla för biverkningar och bristande tillit till sjukvården, myndigheter och vaccin var framträdande orsaker till vaccinvägran. Var föräldrar inhämtade information, hur de definierade hälsa samt kultur och religion var andra faktorer som påverkade beslutet att inte vaccinera. Slutsats: Resultatets primära fynd baseras på någon form av bristande tillit till myndigheter, sjukvården eller vaccin hos föräldrarna. Internet och media som informationskälla har bidragit till felaktiga uppfattningar om och rädsla för vacciners effekt. Sjukvården måste bli bättre på personcentrerad vård och individanpassa information om vaccin.

Vaccines protect cats from serious diseases by inducing antibodies and cellular immune responses. Primary vaccinations and boosters are given according to vaccination guidelines provided by industry and veterinary organizations, based on minimal duration of immunity (DOI). For certain diseases, particularly feline panleukopenia, antibody titres correlate with protection. For feline calicivirus and feline herpesvirus, a similar correlation is absent, or less clear. In this review, the European Advisory Board on Cat Diseases (ABCD) presents current knowledge and expert opinion on the use of antibody testing in different situations. Antibody testing can be performed either in diagnostic laboratories, or in veterinary practice using point of care (POC) tests, and can be applied for several purposes, such as to provide evidence that a successful immune response was induced following vaccination. In adult cats, antibody test results can inform the appropriate re-vaccination interval. In shelters, antibody testing can support the control of FPV outbreaks by identifying potentially unprotected cats. Antibody testing has also been proposed to support decisions on optimal vaccination schedules for the individual kitten. However, such testing is still expensive and it is considered impractical to monitor the decline of maternally derived antibodies.

Research has indicated a strong interest in knowing who is being represented and how information is being represented in the communication about childhood immunization. This study uses a two-part analysis to look at source representation and framing in childhood immunization communication. A quantitative analysis of articles from the New York Times and USA Today were examined for their source representation, their use of fear appeals, through the Extended Parallel Processing Model (EPPM), and the use of frames, through the application of Prospect Theory. A qualitative semiotic analysis was conducted on 36 images that appeared on www.yahoo.com and www.google.com to find common themes for who is being represented and how information is being portrayed through the images. Results found a high prevalence of representation from the Center for Disease Control and Prevention, other governmental agencies and views from health/medical professionals in both the articles and images.

Bakgrund: Vaccination anses vara den mest effektiva åtgärd inom modern medicin för att förhindra spridning av sjukdomar. En bred vaccinationstäckning för barn och ungdomar sker när vaccinationer utförs i skolan. Trots dess nytta kan vaccination vara smärtsam för barn, vilket kan påverka deras välbefinnande och framtida smärttolerans. Skolsköterskor spelar en nyckelroll i att minimera vaccinationssmärta genom användning av olika strategier, särskilt avledningsstrategier. Syfte: Syftet med denna intervjustudie är att belysa vilka strategier skolsköterskan använder för att minimera vaccinationssmärta. Metod: Studien är en intervjustudie som utgick från en kvalitativ design med en induktiv ansats. Semistrukturerade intervjuer utfördes med 9 skolsköterskor. Data analyserades med innehållsanalys enligt Elo & Kyngäs. Resultat: Resultatet bildade fem kategorier och 13 subkategorier. Skolsköterskorna använde flera olika strategier för att minska vaccinationssmärtan hos eleverna. Resultatet delades in i kategorierna att ge tydlig information till elever kan minska smärta, att avleda är en viktig strategi, att skapa en trygg och tillitsfull situation för eleven vid vaccination, att öka elevens känsla av kontroll och emotionella stöd vid vaccination och att vara trygg i yrkesrollen skapar ökade möjligheter att eleven upplever mindre vaccinationssmärta. Under vaccinationsprocessen fokuserar skolsköterskorna på elevernas individuella behov genom att använda information och olika avledningsstrategier för att minimera smärta  Slutsats: De elevanpassade strategierna möjliggör för eleven att känna sig delaktig i sin vård. / Background: Vaccination is considered the most effective measure in modern medicine to prevent the spread of diseases. A wide vaccination coverage for children and adolescents occurs when vaccinations are performed in schools. Despite its benefits, vaccination can be painful for children, which can affect their well-being and future pain tolerance. School nurses play a key role in minimizing vaccination pain through the use of various strategies, especially distraction strategies. Aim: The aim of this interview study is to highlight the strategies used by school nurses to minimize vaccination pain.Method: The study is an interview study based on a qualitative design with an inductive approach. Semi-structured interviews were conducted with 9 school nurses. Data were analyzed using content analysis according to Elo & Kyngäs. Results: The results formed five categories and 13 subcategories. School nurses used several different strategies to reduce vaccination pain in students. The results were divided into the categories of providing clear information to students can reduce pain, diversion being an important strategy, creating a safe and trusting situation for the student during vaccination, increasing the student's sense of control and emotional support during vaccination, and being confident in the professional role creates increased opportunities for the student to experience less vaccination pain.  Conclusion: During the vaccination process, school nurses focus on students' individual needs by using information and various distraction strategies to minimize pain. These student-centered strategies enable the student to feel involved in their care.