INTRODUÇÃO: Os Centros de Referência para Imunobiológicos Especiais (CRIEs) são unidades de vacinação públicas e gratuitas que disponibilizam vacinas e imunoglobulinas não disponíveis na rotina do Programa Nacional de Imunizações (PNI), para indivíduos que necessitam de imunobiológicos específicos, mediante prescrição médica. Também realizam atendimento de pessoas com eventos adversos pós-vacinação (EAPV). É um subprograma do PNI, criado em 1993. OBJETIVO: Avaliar a implantação dos CRIEs quanto ao cumprimento de diretrizes e regulamentações formais. MÉTODOS: Foi realizada uma avaliação de programa do tipo pesquisa avaliativa e para isso, desenvolvido um questionário on-line, contendo 170 questões, envolvendo as dimensões \"estrutura\", \"recursos humanos\" e \"atividades desenvolvidas\". Os responsáveis pelos 42 CRIEs existentes em 2011 participaram do estudo. A fim de agrupar serviços com características semelhantes, foi aplicado o método de agrupamento para dados binários, utilizando a Distância Euclidiana Quadrática (pelo método do vizinho mais distante - complete linkage). RESULTADOS: Foi evidenciada uma grande diversidade entre os serviços nas três dimensões analisadas. Treze CRIEs (31%) estavam localizados em instituição universitária; 29 (69%) possuíam o mínimo de salas preconizado; 29 (69%) relataram insuficiência de equipamentos para armazenamento de imunobiológicos; 22 (52%) não realizavam manutenção preventiva da rede de frio; 30 (71%) possuíam gerador elétrico; 24 (57%) tinham fonte de oxigênio. O número de funcionários variou de três a 21; quatro serviços não tinham enfermeiros e nove não tinham médicos; 23 (55%) possuíam médico em período maior ou igual à metade do expediente; 27 (64%) tinham recursos humanos treinados para atender emergências. O número de doses de imunobiológicos administrados aumentou 66% de 2006 a 2010. Trinta e cinco serviços (83%) funcionavam 40 horas semanais ou mais. Acerca do atendimento de EAPV, 28 (67%) CRIEs contavam com retaguarda laboratorial, 36 (86%) com retaguarda hospitalar e 36 (86%) com retaguarda de especialistas. A análise estatística resultou em cinco \"perfis\" de serviços, denominados de acordo com suas características. 1) \"Melhor estrutura\": 12 CRIEs com a maior porcentagem de serviços com o mínimo de salas preconizado, câmaras de vacinas, manutenção preventiva da rede de frio e fonte de oxigênio. 2) \"Dispensador de imunobiológicos\": 6 CRIEs que mais dispensavam do que aplicavam imunógenos; nenhum serviço tinha médico mais da metade do expediente; nenhum serviço possuía câmaras de vacinas. 3) \"Implantação incipiente\": 5 CRIEs com estrutura mais precária, com baixos índices de câmaras de vacinas, manutenção preventiva e fonte de oxigênio; nenhum possuía computador. 4) \"Sala de vacinas\": 13 CRIEs, todos faziam imunização de rotina e a maioria participava de campanhas de vacinação. 5) \"Ensino e pesquisa\": 6 serviços, todos inseridos em hospitais de ensino, desenvolviam pesquisas e recebiam estagiários. Quase todos possuíam médicos em mais da metade do expediente e tinham manutenção preventiva da rede de frio. CONCLUSÃO: Diante da variabilidade de situações, a avaliação de implantação dos CRIEs foi avaliada por perfil: \"melhor estrutura\" e \"ensino e pesquisa\" foram considerados implantados; \"dispensador de imunobiológicos\" e \"sala de vacinas\", parcialmente implantados; \"implantação incipiente\", não implantados / INTRODUCTION: The Reference Centers for Special Immunobiologicals (Centros de Referência para Imunobiológicos Especiais, CRIEs) are public vaccination clinics that provide vaccines and immunoglobulins not routinely available in the National Immunization Program (NIP) to persons with special needs, free of charge, by medical prescription. These centers also provide medical assistance for persons with adverse events following immunization (AEFI). The CRIEs were established in 1993, by the Brazilian NIP. OBJECTIVE: To evaluate the implementation of CRIEs on its compliance to formal policies and regulations. METHODS: This is a program evaluation, type \"evaluative research\". We developed an on-line questionnaire, with 170 questions, involving the dimensions: \"structure\", \"human resources\" and \"developed activities\". The persons in charge of the 42 CRIEs in activity in 2011 were invited to participate in this study. A statistical analysis was performed to group services with similar characteristics, applying the binary data\'s grouping method, by using the Quadratic Euclidean Distance (by the method of the farthest neighbor - complete linkage). RESULTS: A great diversity was observed among services, in the three dimensions. Thirteen (31%) CRIEs were in university premises; 29 (69%) had the minimum recommended spaces; 29 (69%) reported insufficiency of equipment for immunobiologicals storage; 22 (52%) did not conduct preventive maintenance of the cold chain; 30 (71%) had power generator; 24 (57%) had oxygen supply. The number of professionals varied from three to 21; four services did not have nurses and nine did not have doctors; 23 (55%) had doctors for at least half of working hours; 27 (64%) had human resources trained in emergency. The number of administered doses of immunobiologicals increased 66% from 2006 to 2010. Thirtyfive (83%) CRIEs were open at least 40 hours/week. Regarding care to AEFI, 28 (67%) CRIEs had laboratory support, 36 (86%) had hospital reference, and 36 (86%) had reference experts. The statistical analysis showed five service profiles, nominated according to their characteristics. 1) \"Best structure\": 12 CRIEs with the best index of the minimal recommended spaces, vaccine storage chambers, preventive maintenance of the cold chain and oxygen supply. 2) \"Distribution centers\": 6 CRIEs that, mainly, delivered immunobiologicals to be administered in other services; none with a physician for at least half of the opening hours; none with vaccine storage chamber. 3) \"Incipient implementation\": 5 CRIEs with an overall poorer infrastructure; only some had vaccine storage chambers, preventive maintenance of the cold chain and oxygen supply; none of them had computer. 4) \"Vaccination Room\": These 13 CRIEs administered routine immunization; most of them participated in immunization campaigns. 5) \"Teaching and research\": 6 CRIEs in teaching hospitals, performed research and received trainees; almost all of them had physicians for at least half of the working hours and preventive maintenance of the cold chain. CONCLUSION. Considering the services\' diversity, the implementation of CRIES was evaluated according to the different profiles: \"Best structure\" and \"Teaching and research\" were considered implemented; \"Distribution centers\" and \"Vaccination Rooms\", partially implemented; and \"Incipient implementation\", not implemented

Made available in DSpace on 2014-07-29T15:04:41Z (GMT). No. of bitstreams: 1 Santos, Silvana.pdf: 1374305 bytes, checksum: 77f10539cefd889f796d4266c623b502 (MD5) Previous issue date: 2005-12-22 / This is a descriptive study carried out in Higher Education Institutions (HEI) at the State of Goiás Andergraduating students from the last term/grade of courses in the health field took part in this study We aimed at characterizing the exposure to biohazards among andergraduating students from courses in the health area within the State of Goiás; identifying the vaccinal profile of the andergraduating students; characterizing HEI performance on orienting students towards vaccination against immune-preventable diseases of major importance to health professionals (HP) and verifying on students who vaccinated against Hepatitis B the procedure of anti-HBs exam and its outcome A sample test was carried out and with the support of the software Epi-info version 2004 we scored n=651 corresponding to 54% of the population with reliability interval of 95% The research ethic-legal aspects were observed Data was collected by questionnaires validated by three jurors Its application ocurred in a classroom setting Database was structured and processed in the program Epi-info version 2004 and data was presented in figures tables and analysed through descriptive statistics 777 (68,5%) graduating students enrolled on the last grade in 2005 participated in this study Aged between 20 and 55 years mean 34,7 years of age and 83,6% between 20 and 30 years of age Females are predominant with 73,8% 25,4% of graduating students had already been exposed to biological material 64,2% were exposed to sharp instruments together with contact with bloody skin and/or body fluids Among those who were involved in accidents only 35,2% reported them Students showed greater adherence to anti-hepatitis B vaccine referied by 84,9% and only 34,0% took the anti-Hbs tests 73,0% of them called themselves respondents and 10,0% of them did not know about it There was also 46,8% adherence to vaccine against diphtheria and tetanus and 25,8% of adherence to anti-yellow-fever vaccine 92,0% of students affirmed having been oriented about immunization 94,8% recognize anti-hepatitis B as recommendable vaccine to HP 77,3% for anti-diphtheria and tetanus and 48,3 % of accounts suggest anti-yellow-fever vaccine Data sources for the graduating students about recommended vaccine to HP were curricular discipline with 32,3% followed by the college direction with 13,6% of accounts Although HEI in the State of Goiás have been addressing this issue they do so in a fragmented and little consistent way We consider it critical for HEI to set urgently a policy of vaccine establishment before clinical practice as well as to reflect about prevention, and control of infection aiming at interdisciplinarity and above all the quality of teaching which will be reflected on the health professionals profile / Estudo descritivo realizado em Instituições de Ensino Superior (IES) do Estado de Goiás Fizeram parte do estudo graduandos do último ano/semestre dos cursos da área de saúde Objetivou caracterizar a exposição a material biológico entre os graduandos de cursos da área de saúde no Estado de Goiás; Identificar o perfil vacinal destes graduandos; caracterizar a atuação das IES na orientação do graduando quanto à vacinação às doenças imunopreveníveis de importância para os profissionais da área de saúde (PAS) e verificar nos graduandos vacinados contra hepatite B a realização e a resposta do exame anti-Hbs Realizamos o teste piloto e com auxílio do software Epi-info versão 2004 calculamos um n=651, o que corresponde a 54,0 % da população com intervalo de confiabilidade de 95% Foram observados os aspectos ético-legais da pesquisa Os dados foram obtidos por meio de questionário que foi validado por três juízes A aplicação do instrumento foi em sala de aula O banco de dados foi estruturado e processado no programa Epi-info versão 2004 e os dados apresentados em figuras e tabelas e analisados por meio de estatística descritiva Participaram do estudo 777 (68,5%) dos graduandos matriculados no último ano em 2005 Idade entre 20 e 55 anos média de 34,7 anos moda 23 anos e 83,6% entre 20 a 30 anos O sexo feminino é o predominante com 73,8% Já haviam sido expostos a material biológico 25,4% dos graduandos quanto ao tipo de acidente 64,2% afirmaram terem se acidentado tanto com perfurocortantes quanto com exposição de pele e mucosas Dentre os que se envolveram em acidentes somente 35,2% os notificaram Os graduandos apresentaram maior adesão às vacinas anti-hepatite B que foi referida por 84,9% e apenas 34,0% realizaram o teste anti-HBs; destes 73,0% referiram ser respondedores e 10,0% não sabiam Houve também adesão às vacinas anti-difteria e tétano por 46,8% e anti-amarílica por 25,8% dos graduandos Afirmaram terem sido orientados sobre imunização 92,0% dos estudantes Reconhecem como vacinas recomendadas aos PAS: a anti- hepatite B em 94,8% a anti-difteria e tétano em 77,3% e anti-amarílica em 48,3% das citações As fontes de informação aos graduandos sobre as vacinas recomendadas aos PAS foram: disciplina curricular com 32,3% seguida pela direção da faculdade com 13,6% das citações Embora as IES no Estado de Goiás estejam abordando esta temática a fazem de forma fragmentada e pouco consistente Consideramos imprescindível que as IES estabeleçam com urgência uma política de instituição das vacinas antecedendo a prática clínica e repensem o ensino sobre a prevenção e controle de infecção visando a interdisciplinaridade e principalmente a qualidade do ensino o que refletirá no perfil dos profissionais da área de saúde

A utilização do serviço de saúde, que inclui a cobertura do gasto com medicamentos e a vacinação, são fatores importantes no controle do diabetes mellitus. O estudo teve como objetivos estimar a prevalência de diabetes mellitus no município de São Paulo e descrever a utilização de serviços de saúde, incluindo a vacinação, utilização, gasto e cobertura do gasto com medicamentos na população adulta do município de São Paulo em 2003 que refere ser portadora da doença. Os dados foram coletados pelo Inquérito Multicêntrico de Saúde de São Paulo (ISA-Capital), estudo transversal realizado por meio de entrevistas domiciliares de base populacional. Foram estudadas as características sociodemográficas e de condições de vida e saúde, a presença de outras doenças, o controle do diabetes, a utilização dos serviços de saúde, a vacinação pelo serviço público, a utilização, cobertura e gastos com medicamentos na população de ambos os sexos, maior de 20 anos e que refere ser portadora de diabetes. Foram realizadas análises descritivas e também estimativas de prevalências e calculadas as razões de prevalência para diabetes autorreferida por meio da regressão de Poisson. A prevalência de diabetes autorreferida na população foi 5,0%, sendo maior na população com 60 anos ou mais, que exerce atividade remunerada e com avaliação negativa da saúde. Foi estimada alta prevalência de indivíduos que referem hipertensão arterial, depressão e outras doenças crônicas na população estudada. A maioria da população relatou utilizar regularmente o serviço de saúde para controle do diabetes. A utilização de medicamentos, de grande importância no controle da doença, esteve associada a não exercer atividade remunerada. A vacinação foi realizada principalmente por intermédio do serviço público. Na cobertura do gasto com medicamentos essenciais houve participação significativa do setor privado e foi maior na população com avaliação negativa da saúde. Sabendo-se da importância de informações para o delineamento do serviço de saúde, e da necessidade de maior aplicação dos dados epidemiológicos nas políticas públicas, a investigação dos fatores envolvidos na utilização dos serviços de saúde, como foi realizada no presente estudo, pode contribuir para pesquisadores e profissionais na formulação de políticas, visando ao acesso universal ao serviço de saúde, que inclui cobertura vacinal e a equidade no acesso a medicamentos / Health Services Accessibility, Immunization and Access to medicines are important factors in diabetes mellitus control. The aim of this study is to estimate the prevalence of diabetes mellitus in São Paulo city and to describe the use of health services, Immunization and use of medicines in adult population of São Paulo in 2003 who reported diabetes mellitus. Data were collected by the Multicenter Survey of Health of São Paulo (ISACapital), population-based study. We studied sociodemographic characteristics and health conditions, presence of other chronic diseases, diabetes control, use of health services, Immunization, utilization, coverage, and spending with medicines in the population who reported diabetes in both sexes, older than 20 years of age. Descriptive analysis and prevalence estimates and prevalence ratios for diabetes were calculated by Poisson regression. Prevalence of diabetes was 5.0%, higher in the population aged 60 or older, who wasnt working and with negative evaluation of health. High prevalence of individuals with high blood pressure, depression and other chronic diseases was estimated in the study population. The use of medicine, very important in diabetes mellitus control, was associated with individuals above 60 years of age and who werent working. Immunization was mainly provided by public health service. In essential medicines coverage there was a large participation of the private sector and was higher in the population with negative evaluation of health. The information is very important for the design of the health service and the necessary application of epidemiological data on Public Health. The investigation of factors in the use of Health Services, as was done in this study, may contribute to policies aimed at universal access to health services, including immunization coverage and equity in access to medicines

Toxinas termo-lábeis expressas por Escherichia coli enterotoxigênica (LT-I, LT-IIa e LT-IIb) são adjuvantes sistêmicos e de mucosa. Essas proteínas apresentam reduzida identidade (<14%) em suas subunidades B e ligação a receptores distintos, o que pode resultar em propriedades biológicas diferenciais. O objetivo do trabalho foi avaliar a resposta imune induzida pela toxina LT-IIa e seu pentâmero B (LT-IIaB) administradas pelas vias transcutânea e intradérmica. Inicialmente as proteínas foram expressas em E. coli, purificadas e avaliadas quanto à funcionalidade in vitro. Numa segunda etapa, as propriedades imunomoduladoras de LT-IIa e LT-IIaB, imunogenicidade e atividade adjuvante, foram avaliadas em modelo murino. A resposta imune (humoral e celular) induzida contra ovalbumina (OVA), aplicada como antígeno, foi determinada. Os resultados demonstram que as atividades adjuvantes induzidas por LT-IIa e LT-IIaB variam de acordo com a via de inoculação e que as holotoxinas LT-I e LT-IIa induzem graus de inflamação e ativação de resposta imune distintos em camundongos. / Heat-labile toxins expressed by enterotoxigenic Escherichia coli (LT-I, LT-IIa and LT-IIb) are potent systemic and mucosal adjuvants. These proteins have low identity (<14%) in their B subunits and bind to different receptors, which may result in differential biological properties. The objective of this work was to evaluate the immune response induced by LT-IIa toxin and its pentameric B subunit (LT-IIaB) delivered by transcutaneous and intradermic routes. Initially the proteins of interest were expressed in recombinant E. coli strains, purified and tested for functionality in vitro. In a second moment, the immunomodulatory properties of LT-IIa and LT-IIaB, immunogenicity and adjuvant activity, were evaluated in mouse model. The humoral and cellular immune responses induced against ovalbumin (OVA) used as antigen were determined. The results show that the adjuvant activity of LT-IIa and its B pentamer depends on the route of inoculation and that LT-I and LT-IIa differ both on induction of inflammation and activation of immune responses in mice.

Utilistions d'anticorps monoclonaux est une partie prometteuse de la thérapie du cancer. À ce jour, il existe plus de 30 anticorps monoclonaux approuvés pour la thérapie contre le cancer. Plus de 350 anticorps se situent également dans différentes phases du développement clinique. La mésothéline est l'une des cibles les plus prometteuses pour l'immunothérapie. La mésothéline est présente à des niveaux relativement faibles dans les cellules mésothéliales de la plèvre, du péritonéum et du péricarde normaux, mais est fortement exprimée dans un certain nombre de cancers différents, y compris les mésothéliomes, le cancer de l'estomac, les carcinomes à cellules squameuses, le cancer de la prostate, le cancer du pancréas, le cancer du poumon et le cancer de l'ovaire. La mésothéline est une glycoprotéine liée au glycosylphosphatidylinositol (GPI) synthétisée sous la forme d'un précurseur de 69 kDa et transformée de façon protéolytique en une forme sécrétée à 30 kDa (anciennement appelée Facteur de potentialisation des mégacaryocytes (MPF)) et une forme liée à la membrane de 40 kDa. Par ailleurs, il peut être clivé par une protéase et peut produire une forme de mésothéline soluble. Il a été déjà montré que cette forme soluble de mésothéline agit comme un ligand et neutralise les anticorps thérapeutiques ciblant la mésothéline. Par conséquent, les anticorps ne pouvaient pas atteindre les cellules cancéreuses et reste inefficaces. Dans notre travail, nous avons décidé de développer un anticorps discriminant spécifique à la forme associée à la membrane pour surmonter l'antagonisme produit par les formes solubles de mésothéline. Pour ce but, nous avons utilisé une nouvelle méthode d'immunisation de souris, que nous avons d'abord toléré la souris avec une mésothéline soluble et ensuite ré-immunisée avec des cellules exprimant la mésothéline. En utilisant la technologie de phage display, nous avons obtenu près de 150 clones de ciblant mésothéline dans 34 familles de VH-CDR3 parmi lesquelles nous avons identifié seulement 2 familles qui se lient à la mésothéline membranaire avec une affinité élevée et ne reconnaissent aucune autre forme soluble de mésothéline. Ici, nous proposons qu'ils puissent être des bons candidats pour être utilisés pour la thérapie contre le cancer de qui permet de passer à travers la barrière de mésothéline soluble. Pour démontrer leur efficacité pour une utilisation thérapeutique, nous avons construit une CAR avec le sc-Fv d'un anticorps discriminant de la forme membranaire. / Antibody based immune treatment is a promising component of cancer therapy. To date there are more than 30 approved monoclonal antibodies for cancer therapy. More than 350 antibodies are also in different phases of clinical development. Mesothelin is one of the most promising targets for immunotherapy. It is present at relatively low levels in mesothelial cells of the pleura, peritoneum and pericardium of healthy individuals, but is highly expressed in a number of different cancers, including mesotheliomas, stomach cancers, squamous cell carcinomas, as well as prostate, pancreatic, lung, and ovarian cancers. Mesothelin is a glycosylphosphatidylinositol (GPI)-linked glycoprotein synthesized as a 69 kDa precursor and proteolytically processed into a 30 kDa NH2-terminal secreted form (formerly referred to as Megakaryocyte Potentiating Factor (MPF)) and a 40 kDa membrane-bound form. Besides that it can be cleaved by a protease leading to the production of a soluble, shedded, form of mesothelin. It has already been shown that this soluble form of mesothelin acts as a ligand and neutralizes the mesothelin targeting therapeutic antibodies. Therefore antibodies could not reach cancer cells and remained inefficient. In our work we decided to develop discriminating antibodies specific to a membrane associated form so as to overcome the antagonism produced by soluble forms of mesothelin. To this aim we used a novel method of mouse immunization, in which we first tolerized the mouse with soluble mesothelin before immunization with mesothelin expressing cells. By using phage display technology we obtained nearly 150 mesothelin recognizing clones in 34 VH-CDR3 families, among which we identified only 2 families that bind membrane mesothelin with high affinity and do not recognize any other soluble form of mesothelin. Here we suggest that this Fab can be effective candidates to be used for mesothelin expressing cancer therapy being allowed to pass through the soluble mesothelin barrier. To show their efficacy for therapeutic use we constructed a CAR with the sc-Fv of a membrane-form discriminating antibody

Apart from isolated programs in private and public health care sectors, South Africa has no existing systematic public infant hearing screening program at community level. As a result, early identification of hearing loss is certainly not being attained for the majority of infants in South Africa with far-reaching effects for individuals, families and society at large. Screening programs at primary health care immunization clinics have been proposed as an alternative to hospital-based programs in South Africa. The objective of this study was to evaluate the first systematic community-based infant hearing screening program in a developing South African community in the Western Cape. A combined descriptive and exploratory research methodology was followed incorporating aspects of a program evaluation design. The study was of a quantitative nature and the required data were collected by means of a questionnaire and OAE testing conducted by clinic nurses on subjects. A community-based universal infant hearing screening program initiated at eight primary health care clinics in the Cape Metropolitan area was evaluated over a 19-month research period. During this time 6227 infants who were candidates for screening attended their 6, 10 or 14-week immunization visit at the relevant clinic. Clinic nurses were trained as screening personnel. A two-stage distortion product otoacoustic emissions screening protocol was utilized. The target disorder for this study was bilateral permanent congenital and early onset hearing loss and infants referring the first screen were scheduled for a 4-week follow-up visit at the clinic. Diagnostic audiological and medical evaluations were scheduled at referral hospitals when indicated. The study evaluated the efficacy of the program based on coverage, referral and follow-up rates and diagnostic outcomes according to guidelines specified by the Health Professions Council of South Africa 2007 Position Statement. Overall coverage rate across the eight clinics was 32.4% with 2018 infants (aged 0- 14 weeks) screened. The mean age of the sample at first stage screen was 3.9 weeks of age and 13.5 weeks of age for first hospital visit. Overall first stage screen referral rate was 9.5% with 62 subjects (3%) referred for diagnostic services at hospital level after a follow-up screen. The average follow-up rate for rescreens at clinic level was 85.1% and for initial diagnostic assessments at hospital level it was 91.8%. Although minimal hearing loss was not the primary focus of the screening program the outcomes did include those subjects with fluctuating conductive hearing loss and permanent unilateral hearing loss. Prevalence rates were 4.5/1000 with significant hearing loss, including sensorineural (1.5/1000) and conductive (3/1000) losses, and 12.9/1000 for subjects with middle ear effusion.<p-> The community-based infant hearing screening program was valuable in attaining high follow-up return rates but reaching sufficient coverage may require dedicated screening personnel as opposed to existing nursing personnel. Furthermore, consideration of an alternative community-based platform such as midwife obstetric units may improve coverage and referral rates and prevalence of permanent congenital and early onset hearing loss. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / Speech-Language Pathology and Audiology / Unrestricted

Cette thèse examine l’apport du travail statistique à la normalisation de la vaccination en France, des années 1950 au milieu des années 1990, une période au cours de laquelle la vaccination a fait l’objet de peu de controverses. Au moyen d’opérations statistiques de rationalisation, de régulation et de justification, l’épidémiologie (entendue comme un ensemble de pratiques plutôt qu’une discipline universitaire autonome) a largement contribué à maintenir cet état de fait – un processus que je qualifie de routinisation. L’enquête est construite sur des archives issues de diverses institutions, nationales et internationales, ainsi que sur une série d’entretiens avec les principaux acteurs du domaine. Elle éclaire le rôle d’un groupe d’épidémiologistes associés au Centre international de l’enfance (1949-1999), qui mit en œuvre un programme de rationalisation et de simplification de la vaccination. Dans cette période coloniale et postcoloniale, l’Afrique subsaharienne était un de leurs terrains de prédilection : ils y réalisèrent de nombreux essais, simultanément à leurs activités métropolitaines. L’implication de l’OMS dans le domaine de la vaccination a conforté la dimension internationale de cette routinisation : les épidémiologistes français se sont appropriés des opérations statistiques popularisées par Genève. À la fin de la période considérée, la controverse de la vaccination contre l’hépatite B a perturbé cette routinisation et mis en évidence un écart croissant entre les logiques de l’épidémiologie et l’expérience des individus vaccinés. Cette recherche éclaire d’une lumière nouvelle la façon dont l’intervention de santé publique la plus courante a été normalisée et gouvernée par des nombres. / This dissertation studies the entanglement between statistical production and the normalization of immunization practices in France from the 1950s to the mid-1990s, a period during which immunization remained largely uncontroversial. By rationalizing, regulating, and justifying immunization, epidemiology (understood as a collection of practices, rather than a discrete academic discipline) has contributed greatly to this normalization – a process I term “routinization.” This research project is based on archival findings, both in France and internationally, as well as a series of interviews with significant actors in the field. It is primarily focused on a group of epidemiologists affiliated with the Centre international de l’enfance (French International Children’s Center, 1949-1999), whose mission was to rationalize and simplify immunization for children. Throughout the institution’s history, which overlaps with the late colonial period and the process of de-colonization, there is a significant engagement with Francophone Africa: numerous trials were carried out simultaneously in Sub-Saharan Africa and the Paris region. The transnational nature of this activity is also due, in part, to the involvement of the World Health Organization in matters of immunization – French epidemiologists appropriated calculations popularized on a global scale. At the end of the period in question, the Hepatitis B vaccine controversy disrupted the routinization process and shed light on the rising gap between the discourse and practice of epidemiology and the experience of vaccinated individuals. This study offers new insights into the role of numbers in the maintenance and governance of the most common public health intervention.

This thesis makes use of biopolitical theory to examine the governmental and organizational response to the covid-19-infodemic. It aims to answer the puzzling research question as to why the infodemic – whose inherent problem is an overabundance of information – is responded to and met with even greater amounts of information by governments and health organizations, and what implications these measures may have on the population. The analysis finds that the question can partly be answered by derivation to previous research within the field of crisis communication: the most efficient way to respond to mis- and disinformation is to respond with correct information and with counter arguments. To answer the question in full an analysis of the subject of security is conducted where what can be interpreted from the material, following a modified version of Carol Lee Bacchi’s “What’s the Problem Represented to be?” method, is that the human judgement can be understood as the subject of security. The idea is that by securing the human judgment through improving people’s health literacy, people can be taught to act in a manner which is coherent with the state’s biopolitical goals, i.e. to secure the survival of the population. The analysis also shows that while these measures are made in an effort to secure the population, the measures themselves risk becoming a threat to the very population it is supposed to protect.

研究の目的 : 多変量解析とGISを用いて、乳幼児を対象とする日本の予防接種率の地域差の実態を把握し、その要因を検討する。研究の背景 : 公衆衛生上の課題である予防接種率の地域差の特定と改善を目的として、多様な地域スケールからその要因を分析する研究が行われている。しかしながら、日本における既往研究では個人を対象とした研究が多く、接種率の地域差の検討や関連要因を用いた生態学的研究もほとんど行われてこなかった。研究手法 : 日本の1737の市区町村における7種類19回の予防接種を対象として、重回帰分析と市区町村―都道府県間の階層を用いたマルチレベル分析を行った。被説明変数には推計した2013年から2018年までの予防接種率を、説明変数には9つの個人要因と4つの環境要因を用いた。これらの変数の作成には国勢調査などの政府統計を用いた。予防接種率の分布図と予測モデルの残差プロットを用いて、地理的な関連要因を探索した。結果 : 一人当たり課税所得と乳幼児健診受診率は市区町村レベルで、世帯の児童数は都道府県レベルで全般的に有意な関連を示した。その他の変数は予防接種の種類や接種時期(回数)によって関連の有無が異なった。接種率は西日本で低く、大都市圏で高い傾向がみられた。残差は内陸部と接種率の偏差が大きい地域に多く見られた。考察 : 市区町村の所得格差と都道府県の世帯あたり児童数の差が、地域の接種率の格差に関連すると示唆された。また、人口減少と高齢化が進む小規模地域には接種率に関連する固有の因子が存在する可能性がある。結論 : 接種率の向上には、その地域の社会経済的状況や人口構造、地域の文脈、予防接種の種類、それらの要因の影響するスケールを踏まえた施策が求められる。 / Objective: Examining geographical variation and the factors of infant immunization coverage in Japan. Background: Incomplete vaccination coverage is one of the largest public health threats. Many interdisciplinary studies have investigated factors that might increase immunization rates or cause Vaccine Hesitancy. However, most studies in Japan have focused on individuals and few studies have considered regional disparities of vaccination coverage. Methods: We conducted a multiple regression analysis and a multilevel analysis (municipality-prefecture hierarchy) for 19 vaccinations in 1737 municipalities in Japan, during 2013-2018. The dependent variable was the estimated vaccination rate, and nine individual factors and four environmental factors were used as explanatory variables. Data were collected from publicly available sources. We used distribution maps of vaccination rates and residuals of the predictive models to explore geographical factors. Results: In general, per capita taxable income and infant health checkup rate showed generally significant positive associations at the municipal level, and the number of children in the household negative association at the prefectural level. Other factors showed various associations depending on the type and the timing of vaccines. Vaccination rates were likely to be lower in western Japan and higher in metropolitan areas. Residuals were found mostly in inland areas and areas with large deviations in vaccination rates. Discussion: These results suggested that vaccination rates were associated with regional differences in municipal income inequality and in the number of children per household in prefectures. Smaller villages with declining and aging populations might have unique factors. Conclusions: To increase vaccination coverage among infants, it requires to consider the effect size at various spatial scales, in addition to compositional and contextual effects as the socioeconomic status, demographic structure, the local contexts, and the type of vaccination. / 京都大学 / 修士 / 修士(文学) / Kyoto University / TFtmp

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