Vacinas inativadas de vírus inteiro (WIV) são amplamente utilizadas para o controle de influenza A em suínos (SIV) nos Estados Unidos e Europa e conferem proteção contra cepas homólogas à vacina reduzindo a doença clínica. Porém, a proteção da WIV pode ser limitada contra um desafio heterólogo. O aumento da doença respiratória associado à vacina (VAERD) foi descrito em suínos vacinados com uma WIV contendo uma cepa δ1-cluster-H1N2 e desafiado com uma cepa heteróloga contendo a mesma hemaglutinina, H1N1pdm09. Nesse contexto, os suínos apresentaram pneumonia severa com aumento das lesões pulmonares associado ao uso da WIV. No primeiro manuscrito foi avaliado se a formulação da WIV, o tempo entre o reforço vacinal e o desafio, e a idade de vacinação tinham impacto em VAERD. Suínos foram vacinados com duas vacinas bivalentes, WIV-δ1H1N2/H3N2 (MN08-TX98) ou WIV-δ1H1N2/H1N1pdm09 (MN08-CA09), administradas em duas doses com intervalo de três semanas, e desfiados com H1N1pdm09, três semanas após o reforço. Além disso, dois grupos foram vacinados com uma WIV-δ1H1N2 (MN08) e desafiados três ou seis semanas após o reforço. Em um estudo subsequente, dois grupos vacinados com uma WIV-δ1H1N2 com duas doses da vacina em diferentes idades: a primeira dose com 4 ou 9 semanas de idade e o reforço com 7 ou 12 semanas de idade. E um grupo vacinado com uma vacina viva atenuada de influenza (LAIV). Os animais foram desafiados com H1N1pdm09 às 15 semanas de idade. Com exceção dos grupos MN08-CA09, LAIV e controles, todos os grupos WIV apresentaram lesões pulmonares consistentes com VAERD. Nenhum grupo induziu anticorpos neutralizantes para o H1N1pdm09, exceto MN08-CA09. No entanto, grupos vacinados com a WIV-MN08 em diferentes idades induziram anticorpos IgG não-neutralizantes com reatividade cruzada com o H1N1pdm09 no soro e no pulmão, comparado com LAIV e controles. Esses dados sugerem que a idade da primeira dose da vacina, a formulação com a vacina bivalente MN08-TX98 e o desafio seis semanas após o reforço vacinal, não preveniram o desenvolvimento de VAERD. Em contraste, a vacinação com a LAIV demonstrou proteção até oito semanas após reforço. No segundo manuscrito foi avaliado o impacto dos adjuvantes na formulação da WIV no modelo de VAERD. Cinco grupos foram vacinados com WIV-δ1H1N2 formuladas com diferentes adjuvantes comerciais: óleo em água 1 (OW1), OW2, nano-emulsão (NE), gel polímero (GP) e partículas imuno-estimulantes aquosa (IMP). O protocolo vacinal/desafio foi utilizado com três semanas de intervalo entre as doses. Os grupos vacinados com WIV-OW apresentaram lesões macroscópicas nos pulmões consistentes com VAERD comparado com WIV-NE, WIV-GP e controles. Nenhum dos grupos induziu anticorpos neutralizantes contra o vírus do desafio (H1N1pdm09). Similarmente, os grupos WIV-OW, WIV-NE e WIV-GP induziram anticorpos não neutralizantes IgG de reatividade cruzada contra o H1N1pdm09 no soro e pulmão. Apesar dos anticorpos não neutralizantes com reatividade cruzada nos grupos WIV-NE e WIV-GP, não apresentaram lesões pulmonares tão severas como os grupos OW. Além disso, os adjuvantes tiveram um papel significativo na imunogenicidade da WIV e no desenvolvimento de VAERD. / Whole inactivated virus (WIV) vaccines reduce clinical disease against homologous influenza A virus (IAV) infection and are widely used in swine; however, WIV has been associated with vaccine-associated enhanced respiratory disease (VAERD) when challenged with heterologous IAV of the same hemagglutinin subtype. Here, we evaluated the impact of age at vaccination and timing between vaccination and challenge on development of VAERD using a model with a human-like 1δ cluster swine MN08 H1N2 as the vaccine component and pandemic H1N1 (H1N1pdm09) virus as the challenge strain. Pigs were vaccinated with bivalent WIV vaccine containing H1N2-MN08/H3N2-TX98 or H1N2-MN08/H1N1pdm09-CA09. All groups were challenged with H1N1pdm09 at 3 weeks post-boost (wpb). In addition, a monovalent WIV MN08 H1N2 group was challenged at 6 wpb to determine if time post-vaccination played a role on VAERD. In a follow up study, we compared the time of first WIV vaccination (4 or 9 weeks of age) and the boost three weeks later (7 or 12 weeks of age) to determine if age at first vaccination or if 8 weeks duration between vaccination and challenge impacted VAERD. A live-attenuated influenza virus (LAIV) vaccine administered at 4 and 7 weeks of age was also included. Pigs from study 2 were challenged with H1N1pdm09 at 15 weeks of age. All mismatched WIV groups had significantly higher macroscopic and microscopic lung lesions compared with LAIV, bivalent MN08-CA09 and non-vaccinated challenge controls. These data suggest that the age of first vaccination or length of time between booster dose and subsequent challenge do not alter the development VAERD in WIV vaccinated pigs. In the second paper, we evaluated the impact of adjuvant in WIV vaccine on VAERD-affected pigs. Pigs were vaccinated with WIV containing swine MN08/H1N2 that were formulated with five different commercially available adjuvants: OW1, OW2, nano-emulsion (NE), gel polymer (GP), and aqueous immunostimulating particulate (IMP). Pigs were vaccinated with 2 doses, 3 weeks apart, by the intramuscular (WIV-OW1, -OW2, -NE, and -GP) or intranasal (WIV-IMP) routes. Non-vaccinated and challenged pigs (NV/C) and non-vaccinated, non-challenged pigs (NV/NC) were included as controls. Following challenge with H1N1pdm09, WIV-OW1 and WIV-OW2 groups had significantly higher percentages of macroscopic lung lesions consistent with VAERD compared to the NV/C controls, and in contrast to WIV-NE, WIV-GP and WIV-IMP. Prior to challenge, WIV-OW, NE and GP groups had the hemagglutination inhibition antibody (HI) titers to the vaccine strain compared with controls. The WIV-IMP group had HI mean titers below the positive cut-off, with no response to any immune parameter measured, so it could not be implicated or excluded in the VAERD model. None of the groups had cross-reactive HI antibodies against the H1N1pdm09. WIV-OW groups had significantly higher levels of IgG antibody in serum against homologous and heterologous virus; however, the WIV-NE and WIV-GP groups also had serum IgG antibody against both viruses, so presence of total virus IgG alone did not explain the different VAERD outcomes. Adjuvant played a significant role in WIV immunogenicity and in VAERD; however the mechanism requires further investigation.

O vírus da influenza tipo A (VIA) é um importante agente em rebanhos suínos ao redor do mundo. Alguns subtipos do vírus podem ser transmitidos entre espécies diferentes, como aves, homem e suínos, proporcionando o aumento de mutações genômicas e de novas cepas circulantes. Os suínos são considerados hospedeiros de "mixagem", uma vez que possuem receptores para cepas de aves, de humanos e suínos. A doença clínica em suínos é caracterizada por quadro respiratório agudo e brando, com duração de 5 a 7 dias. Em rebanhos de reprodutores – como as Unidade Produtoras de Leitões (UPL) – um surto epidêmico de influenza pode levar o estabelecimento de uma infecção endêmica com duração de semanas a meses, sem produção de sinais clínicos evidentes. Protocolos de biosseguridade vêm sendo incorporados e padronizados pelas agroindústrias, visando prevenir a introdução de doenças infecciosas em rebanhos. Entretanto, existem lacunas no conhecimento dos fatores associados à biosseguridade em rebanhos de matrizes suínas brasileiras e sua relação com doenças infecciosas. Por essa razão, um estudo transversal foi realizado para estimar a soroprevalência do VIA em matrizes de UPL e explorar práticas de biosseguridade associadas à presença de anticorpos contra o vírus da influenza. Ao todo, foram amostradas 404 matrizes em 21 granjas. O diagnóstico sorológico foi realizado pelo ELISA (protocolo in house). Todas as amostras positivas pelo ELISA foram testadas usando a inibição de hemaglutinação (IH) para diagnosticar a presença de H1N1pdm2009, H1N2 e H3N2 como subtipos de vírus influenza. As informações sobre práticas de biosseguridade foram obtidas através da aplicação de um questionário. A associação entre o resultado do diagnóstico do ELISA de cada uma das matrizes amostradas e as práticas de biosseguridade da propriedade foi feitas através de um modelo de Regressão de Poisson Robusta, estimando a Razão de Prevalência (RP) como medida da associação. A prevalência estimada de anticorpos anti-VIA nas matrizes foi de 63,9% (IC 95%: 55% - 72%), sendo que todas as granjas tiveram resultados positivos. A frequência dos subtipos nas matrizes usando IH foi 51,9% para H1N1, 27,8% H1N2 e 0,6% H3N2. Coinfecções entre H1N1 e H1N2 foram observadas em 19 granjas. As práticas de biosseguridade associadas significativamente com a presença de anticorpos (p-valor <0,05) foram a "presença de tela anti-pássaros" (RP = 0,75) e "local de aclimatação para leitoas" (RP = 0,57) como fatores protetivos e "reposição externa de leitoas" (RP = 1,38) como associada a uma maior prevalência do vírus da influenza suína. Foi possível verificar que a soroprevalência do VIA nas matrizes comerciais da população estudada é alta, indicando que os animais são frequentemente expostos ao patógeno, e que algumas medidas de biosseguridade estão associadas com a ocorrência da doença, fornecendo subsídios técnicos sobre a importância dos protocolos de biosseguridade para a promoção da saúde do plantel. / Influenza A virus (IAV) is an important infectious agent in pig herds across the globe. Some subtypes of this virus can be transmitted between different species, such as birds, human and pig, increasing genomic mutations and evolving of new circulating strains. Pigs are considered "mixed vessel" for influenza A, since they have cell receptors for birds, humans and pigs strains. The clinical disease in pigs is characterized by an acute and mild respiratory disease, lasting from 5 to 7 days. In breeding herds such as sow farms, an epidemic outbreak of influenza can lead to the establishment of an endemic infection lasting weeks to months without clinical signs. Biosecurity procedures were incorporated and standardized by the agroindustry in order to prevent both the introduction and dissemination of infectious diseases. However, there are gaps in the knowledge about what biosecurity factors are associated with infectious diseases in Brazilian herds. For this reason, a cross-sectional study was carried out to estimate IAV seroprevalence in sows and assess which biosecurity practices are associated with the prevalence of influenza virus antibodies. Four hundred forty-four sows were sampled from 21 farms. Serological assays were performed using an ELISA test (in-house protocol). All ELISA positive samples were tested using the hemagglutination inhibition test (HI) to identify the presence of H1N1pdm2009, H1N2 and H3N2 subtypes. Information of biosecurity practices was obtained through the application of a questionnaire. Association between ELISA diagnostic result of each sampled sow and biosecurity practices was assessed using a robust Poisson regression and the Prevalence Ratio (PR) was used as the measure of association. The estimated prevalence of anti-IAV antibodies in sows was 63.9% (95% CI: 55% - 72%), and all farms had at least one seropositive sow s. The frequency of subtypes using HI was 51.9% for H1N1, 27.8% for H1N2 and 0.6% for H3N2. Co-infections with H1N1 and H1N2 were observed in 19 farms. Biosecurity practices such as "presence of bird-proof" (PR = 0.75), and "presence of an acclimatization unit" (PR = 0.57), protective ones, and "external replacement of gilts" (PR = 1.38), which was positively associated with the IAV prevalence, were statistically significant in the final model (p-value <0.05). It was possible to verify that IAV seroprevalence is high and some biosecurity procedures were associated with the serologic status, offering technical subsidies about the importance of the biosecurity for the herd heath.

Este estudo tem por objetivo analisar o conceito de vacinação contra influenza (VCI) em idosos. A análise do conceito, segundo Rodgers (2000) permite definir o conceito, identificar seus atributos essenciais, os eventos antecedentes, conseqüentes e fatores relacionados, bem como, os avanços e dificuldades na adesão dos idosos a essa vacina. Integrado a essa análise a revisão integrativa da literatura (Whittemore e Knafl, 2005), identifica o problema, adesão dos idosos à vacinação contra influenza, que orienta a coleta dos dados na literatura, cuja amostra é avaliada quanto à sua qualidade, e submetida à análise e apresentação dos resultados pertinentes ao conceito em questão. A busca nas bases de dados LILACS, PUBMED e Biblioteca Cochrane, originou 40 artigos que foram eleitos para este estudo. Os atributos da VCI em idosos são explicitados pela periodicidade anual e tipos de vírus que a compõe, que estão atrelados aos atributos dos idosos, evidenciados pela idade (grupo etário), sexo, raça e etnia, grupo de risco, suscetibilidade e vulnerabilidade à influenza e imunossenescência. Como eventos antecedentes à VCI constam: aumento da morbidade e moratalidade, surtos, epidemias ligados à influenza e probabilidade de ocorrer nova pandemia; presença de co-morbidades; percepção da severidade da influenza; fatores sócio-econômicos e demográficos; percepção da própria saúde; conhecimentos, crenças, atitudes frente à VCI; informações e experiência prévia com a VCI e/ou influenza; estado vacinal; intenção de vacinar; consulta médica recente; acesso ao serviço de saúde; e não recomendação dessa vacina pelo profissional da saúde. Dentre os eventos conseqüentes da VCI destacam-se o aumento das taxas de cobertura vacinal; ampliação das metas a alcançar na VCI; redução das taxas de morbidade e moratalidade em idosos; eficácia e efetividade da VCI e eventos adversos. Os fatores relacionados são referidos pelas campanhas anuais da VCI, recomendação da VCI (por profissionais da saúde, mídia e familiares e amigos), uso de protocolos, monitoramento do vírus influenza e conscientização profissional sobre a importância da recomendação da VCI. Destacam-se entre os elementos fortemente associados à adesão da VCI os idosos com mais de 65 anos, presença de co-morbidades (hipertensão e diabetes), informações corretas sobre a VCI, facilidade de acesso e uso dos serviços de saúde, consultas médicas recentes, VCI prévia, aumento da morbidade e mortalidade causada pela influenza e suas complicações. Entre as barreiras que comprometem a aceitação da VCI constam o medo dos eventos adversos e a não recomendação dessa vacina pelo profissional da saúde. Apesar das taxas de cobertura vacinal contra influenza estarem aumentando nos últimos anos, ainda estão aquém da meta preconizada pela OMS para 2010: vacinar 75% dos idosos. Acredita-se que investir em ações educativas para fortalecer a responsabilização dos profissionais e usuários dos serviços públicos de saúde, possa influenciar na adesão de idosos à VCI, e avançar em políticas públicas com estratégias destinadas à promoção da saúde e prevenção de doenças na população idosa, em franco crescimento no mundo atual. / This study aimed to analyze the concept of vaccination against influenza (VCI) in elderly people. Rodgers (2000) concept analysis permits to define the concept, identify its essential attributes, previous and consequent events, and the related factors, as well as the advances and difficulties in the adherence of elderly people to this vaccination. The integrative literature review (Whittemore and Knafl, 2005) identifies the problem, adherence of elderly people to vaccination against influenza, which orients data collection in literature. The sample was assessed regarding its quality and subject to analysis and presentation of results pertinent to the concept at issue. Searches in LILACS, PUBMED and Cochrane Library resulted in 40 articles elected to this study. The VCI attributes in elderly people are expressed by the annual periodicity and types of viruses that form it, which are related to the attributes of elderly people, evidenced by age (age group), gender, race and ethnic group, risk group, susceptibility and vulnerability to influenza and immunosenescence. Previous events to VCI were: increase in morbidity and mortality, outbreaks, epidemics related to influenza and probability of new pandemic; presence of co-morbidities; perception of influenzas severity; socioeconomic and demographic factors; perception of own health; knowledge, beliefs and attitudes regarding VCI; previous information and experience with VCI and/or influenza; immunization status; intention to vaccinate; recent medical appointment; access to health services; and non-recommendation of this vaccine by health professionals. Among the events resulting from VCI, the increase of immunization coverage rates; increase of goals targeted in VCI; reduction of morbidity and mortality rates in elderly people; efficacy and effectiveness of VCI and adverse events are highlighted. The related factors are referred by annual VCI campaigns, recommendation of VCI (by health professionals, media, relatives and friends), use of protocols, monitoring of the influenza virus and professional awareness about the importance and recommendation of VCI. Elements strongly associated to adherence to VCI are elderly people with more than 65 years of age, the presence of co-morbidities (hypertension and diabetes), correct information about VCI, access facility to health services, recent medical appointments, previous VCI, increase in morbidity and mortality caused by influenza and its complications. Among the barriers that compromise the acceptance of VCI are the fear of adverse events and the non-recommendation of the vaccine by health professionals. Despite the increase of immunization coverage rates against influenza in the last years, they are still below the target recommended by the WHO (World Health Organization) for 2010: to vaccinate 75% of the elderly. It is believed investing in educational actions to strengthen the responsibility of professionals and users of public health services can influence the adherence of elderly people to VCI. It can also permit advances in public policies with strategies targeting health promotion and the prevention of diseases in the elderly population, which is increasing worldwide.

Introdução- Em abril de 2009, novo subtipo viral foi identificado, Influenza A(H1N1)pdm09. Em 11 de junho de 2009, a Organização Mundial da Saude anunciou o início de uma pandemia de influenza. Objetivo- Investigar os fatores de risco para óbito por Influenza A(H1N1)pdm09 em pacientes e em gestantes hospitalizados com Doença Respiratória Aguda Grave-DRAG. Nas gestantes, foram analisados também os desfechos gestacionais e neonatais. Metodologia- Foram realizados dois estudos caso-controles, em pacientes e em gestantes hospitalizados com Influenza A(H1N1)pdm09 confirmada laboratorialmente e DRAG. Os casos evoluíram para óbito e os controles para cura. Os casos e controles foram selecionados no Sistema de Informação de Agravos de Notificação-SINANInfluenza- web, sendo sorteados dois controles no estudo dos pacientes, e quatro no das gestantes, pareados por semana epidemiológica da data de internação do caso. O primeiro estudo foi realizado nas regiões Metropolitanas de São Paulo e de Campinas, de 28 de junho a 29 de agosto de 2009. Nas gestantes, o estudo incluiu o Estado de São Paulo, de 09 de junho a 01 de dezembro de 2009. Foram realizadas avaliações dos prontuários hospitalares e entrevistas domiciliares, a partir de formulários padronizados. Foram empregados testes de Mann-Whitney-U ou quiquadrado para comparação das variáveis, e cálculos dos odds ratio brutos-ORb e seus intervalos de confiança-IC95 por cento , para avaliação dos fatores de risco. No primeiro estudo foi definido modelo de regressão logística múltipla para análise dos fatores associados ao óbito. Resultados- No primeiro estudo, foram investigados 193 casos e 386 controles, 73,6 por cento dos casos e 38,1 por cento dos controles tinham alguma condição de risco para complicações relacionadas à influenza. No modelo final, as seguintes variáveis foram fatores de risco para óbito: idade entre 18 a 59 anos, Odds Ratio Ajustado-ORa de 2,31, 95 por cento IC 1,31-4,10, (referência pacientes < 18 anos), presença de pelo menos uma condição de risco (ORa=1,99, 95 por cento IC 1,11-3,57), mais de uma condição de risco (ORa=6,05 95 por cento IC 2,76-13,28), obesidade (ORa=2,73, 95 por cento IC 1,28- 5,83), imunossupressão (ORa=3,43 95 por cento IC 1,28-9,19) e ter tido atendimento prévio à internação (ORa=3,35, 95 por cento IC 1,75-6,40). O tratamento antiviral, quando administrado nas primeiras 48 horas do início dos sintomas foi fator de proteção para óbito, (ORa=0,17, 95 por cento IC 0,08-0,37). Houve benefício também da administração do antiviral entre 48 a 72 horas, (ORa=0,30, 95 por cento IC 0,11-0,81). Em gestantes, foram investigados 48 casos e 185 controles. Foram fatores de risco para óbito: ter tido atendimento prévio à internação, (ORb de 8,03, 95 por cento IC 2,38-27,09) e terceiro trimestre de gestação, (ORb=4,45, 95 por cento IC 1,15-29,25). Tratamento antiviral foi fator de proteção, quando administrado até 48 horas do início dos sintomas (ORb=0,14, 95 por cento IC 0,05-0,37), e de 48 a 72 horas, (ORb=0,13, 95 por cento IC 0,02-0,68). Em relação aos desfechos gestacionais, houve maior proporção de perdas fetais e partos prematuros entre os casos, p=0,001. As gestantes que evoluíram para óbitos tiveram recém nascidos vivos com mais baixo peso e índices inferiores no Apgar do primeiro minuto, p=0,016, quando comparado aos controles que tiveram parto durante a internação, p<0,001. Conclusão: A identificação dos pacientes de maior risco e o tratamento precoce são fatores importantes para a redução da morbimortalidade por influenza. / Introduction - In April 2009, a new viral subtype was identified, influenza A (H1N1)pdm09. On June 11, the World Health Organization announced the beginning of the influenza pandemic. Objective - To investigate the risk factors for death from influenza A(H1N1)pdm09 in hospitalized patients and pregnant women with Severe Acute Respiratory Infections-SARI. In the pregnant women, the gestational and neonatal outcomes were analyzed. Methodology - Two case control studies were performed in hospitalized patients and pregnant women with laboratory confirmed influenza A (H1N1)pdm09 and SARI. The cases died and the controls recovered. The cases and controls were selected from the Information System for Notifiable Diseases-SINAN-Influenza-web. Two controls were randomly selected in the study of patients and four in the pregnant women, matched by epidemiological week of the date of admission of the case. The first study was conducted in the metropolitan regions of São Paulo and Campinas, from June 28th to August 29th, 2009. The study on pregnant women included the State of São Paulo, from June 09th to December 1th, 2009. Evaluations of the medical records and home interviews were conducted using standardized forms. The Mann-Whitney U test or the chi-square tests were performed to compare the variables, in addition to calculations of crude odds ratio- ORc and their 95 per cent confidence intervals for the assessment of the risk factors. In the first study a multiple logistic regression model was used to analyze factors associated with death. Results - In the first study, 193 cases and 386 controls were investigated, 73.6 per cent of cases and 38.1 per cent of controls presented some risk condition for developing influenza-related complications. In the final model, the following variables were risk factors for death: aged between 18 and 59 , Adjusted Odds Ratio-ORa of 2.31, CI95 per cent 1.31-4.10, (reference patients <18 years), the presence of at least one risk condition (ORa=1.99, CI95 per cent 1.11-3.57), more than one risk condition (ORa=6.05 CI95 per cent 2.76-13.28), obesity (ORa=2.73, CI95 per cent 1.28-5.83), immunosuppression (ORa=3.43 CI95 per cent 1.28-9.19) and being attended prior to hospitalization (ORa=3.35, CI95 per cent 1.75-6.40). Antiviral treatment, when administered during the first 48 hours of onset of symptoms, was a protective factor for death, (ORa=0.17, CI95 per cent 0.08-0.37). There were also benefits from antiviral administration between 48 and 72 hours, (ORa=0.30, CI95 per cent 0.11-0.81). In the pregnant women, 48 cases and 185 controls were investigated. The risk factors for death were: being attended prior to hospitalization, (ORc 8.03, CI95 per cent 2.38-27.09) and third trimester of pregnancy, (ORc=4.45, CI95 per cent 1.15-29.25). Antiviral treatment was a protective factor when administered within 48 hours of onset of symptoms (ORc=0.14, CI95 per cent 0.05-0.37) and between 48 and 72 hours, (ORc= 0.13, CI95 per cent 0.02-0.68). In relation to pregnancy outcomes, there was a higher proportion of fetal losses and premature births among cases, p=0.001. The pregnant women who died had live newborns with lower weight and lower Apgar scores in the first minute, p=0.016 compared to controls who gave birth during hospitalization, p<0.001. Conclusion: The identification of high-risk patients and early treatment are important factors in the reduction of morbidity and mortality from influenza.

Os vírus da influenza aviária têm provocado epidemias e pandemias através dos tempos, a pandemia mais devastadora que se tem notícia, a gripe espanhola em 1918, teve sua origem no vírus aviário do tipo A subtipo H1N1. Desde 2003 o vírus aviário do subtipo H5N1 infectou 442 pessoas e levou a morte 262. Além do aspecto de saúde os vírus da gripe aviária causam grande impacto econômico. O Brasil como maior exportador de frango do mundo tem muito a perder caso a gripe aviária chegue ao país. Devido às aves selvagens serem o reservatório natural influenza A, é que se faz necessário a execução do monitoramento. Apesar de existir programas de monitoramento contínuo de aves selvagens na Europa, EUA, Canadá, Japão entre outros, pouco foi feito no Brasil. Amostras coletadas de 671 aves foram testadas por meio das técnicas de GeneScan, PCR em tempo real e RT-PCR e Duplex Nested-PCR. / The avian influenza virus has caused epidemics and pandemics through the ages, the most devastating pandemic that we know, the Spanish flu in 1918, had its origin in the avian virus type A subtype H1N1. Since 2003 the avian virus subtype H5N1 has infected 442 people and led to death 262. Besides the health aspect of the avian influenza viruses cause major economic impact. Brazil as the largest exporter of chicken in the world has much to lose if bird flu reaches the country. Because wild birds are the natural reservoir of influenza A, is that it is necessary to implement the monitoring. Although programs exist for continuous monitoring of wild birds in Europe, USA, Canada, Japan and others, little has been done in Brazil. Samples collected from 671 birds were tested by GeneScan techniques, real-time PCR and RT-PCR and nested-PCR Duplex.

An effective antibody response is essential for immunity against influenza virus infection and is the primary goal for vaccine development. In this study, codon optimized and wild type DNA vaccines expressing hemagglutinin (HA) antigens of human flu viruses A/H1N1/NewCal/20/99 (H1 serotype) were compared to test the antigenic differences of the constructs in mammalian systems. Furthermore, to determine if a prime-boost immunization strategy was more effective in eliciting a greater immune response, a codon optimized HA vaccine was administered as a prime in conjunction with the trivalent inactivated vaccine (TIV), Fluzone, as a boost and immune responses were measured. We found that protein expression and antibody response levels of HA antigens were increased with the codon optimized construct when compared to the wild type HA gene construct. Prime-boost vaccination of NZW rabbits was able to elicit a greater immune response when compared to TIV alone as measured by enzyme-linked immunosorbent assay (ELISA), hemagglutinin inhibition (HI) and neutralizing antibody (NAb) assays. Together, these studies indicate that optimal HA DNA vaccine formulations should be codon optimized and can be used as part of a prime-boost vaccination strategy.

Lam, Ka Han. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 77-82). / Abstracts in English and Chinese. / Acknowledgement --- p.ii / Abstract --- p.iii / 摘要 --- p.v / Content --- p.vii / List of Abbreviations and Symbols --- p.xi / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Severity of influenza --- p.1 / Chapter 1.2 --- Introduction of influenza viruses --- p.3 / Chapter 1.2.1 --- Virion and genome structure --- p.4 / Chapter 1.2.2 --- The replication cycle of influenza viruses --- p.5 / Chapter 1.3 --- Influenza virus NP --- p.8 / Chapter 1.3.1 --- The importance of NP in RNP structure maintenance --- p.9 / Chapter 1.3.2 --- NP self oligomerization --- p.10 / Chapter 1.3.3 --- NP-RNA interaction --- p.12 / Chapter 1.3.4 --- NP and other interacting partners --- p.13 / Chapter 1.4 --- Aim of the project --- p.16 / Chapter Chapter 2 --- Materials and Methods / Chapter 2.1 --- Biological materials --- p.18 / Chapter 2.2 --- Construction of NP mutants --- p.19 / Chapter 2.3 --- Luciferase assay --- p.22 / Chapter 2.4 --- Western blot --- p.23 / Chapter 2.5 --- Protein expression and purification --- p.23 / Chapter 2.6 --- Circular dichroism spectroscopy --- p.24 / Chapter 2.7 --- Static Light scattering --- p.24 / Chapter 2.8 --- Surface plasmon resonance --- p.25 / Chapter 2.9 --- Co-immunoprecipitation (co-IP) --- p.26 / Chapter Chapter 3 --- Identification of residues crucial for NPB oligomerization and ribonucleoprotein activity / Chapter 3.1 --- Introduction --- p.27 / Chapter 3.2 --- Result --- p.31 / Chapter 3.2.1 --- NPB mutants showed deficiency in overall transcription and replication activity --- p.31 / Chapter 3.2.2 --- Expression and purification of NP mutants with low RNP activity --- p.37 / Chapter 3.2.2.1 --- Expression of MBP-tagged NP variants --- p.37 / Chapter 3.2.2.2 --- Purification of MBP-tagged NP variants --- p.38 / Chapter 3.2.3 --- Secondary structures of NP variants were comparable t o wild type NP --- p.41 / Chapter 3.2.4 --- NP variants with low RNP activity were abnormal in oligomerization in vitro --- p.42 / Chapter 3.2.5 --- NP variants with low RNP activity were impaired in homo-oligomer formation in vivo --- p.45 / Chapter 3.2.6 --- Discussion --- p.47 / Chapter Chapter 4 --- Identification of residues crucial for NP 一 RNA interaction and ribonucleoprotein activity / Chapter 4.1 --- Introduction --- p.56 / Chapter 4.2 --- Result --- p.58 / Chapter 4.2.1 --- NPB mutants showed deficiency in overall transcription and replication activity --- p.58 / Chapter 4.2.2 --- Expression and purification of NP variants with low RNP activity --- p.62 / Chapter 4.2.3 --- Secondary structures of NP variants were comparable t o wild type NP --- p.63 / Chapter 4.2.4 --- NP variants with low RNP activity were abnormal in RNA binding --- p.64 / Chapter 4.3 --- Discussion --- p.68 / Chapter Chapter 5 --- Conclusion and future prospect --- p.73 / Copyright --- p.76 / References --- p.77

A influenza é uma das doenças respiratórias agudas mais prevalentes e importante causa de absenteísmo e presenteísmo. Entretanto, a eficácia vacinal para influenza pode alcançar 80% quando há elevada correspondência entre cepas vacinais e circulantes. Por este motivo, a empresa há anos promove campanha de vacinação, contudo, sem estimar sua efetividade (eficácia na redução da carga da doença) e o impacto econômico (produtividade) para o aprimoramento de sua política de saúde ocupacional. Considerou-se que a efetividade da campanha seria determinada pela eficácia vacinal previamente demonstrada em estudos randomizados, pelo grau de acurácia diagnóstica ou de triagem dos casos, pelo nível de adesão do profissional de saúde ao registro no prontuário e do paciente ao informar a ocorrência dos sintomas e pela cobertura vacinal alcançada. Com os objetivos de avaliar a efetividade e impacto econômico da campanha de vacinação para influenza, optou-se por um desenho estudo observacional de coorte histórico com características de estudo de intervenção baseado em dados históricos da campanha de 2008 e informações individuais sobre a frequência de sintomas respiratórios e absenteísmo, idade, gênero, função (administrativa e operacional) e renda, comorbidades relevantes e tabagismo, obtidas mediante revisão de prontuário dos 12 meses subsequentes, comparadas entre os grupos de vacinados e não-vacinados (qui-quadrado e test t) e analisadas por regressão logística, e estimada a fração prevenível (proporção de episódios potenciais de influenza evitados pela vacinação). Foram analisados os prontuários de 2.425 trabalhadores (1.651 não-vacinados e 754 vacinados) correspondendo à cobertura de 31,1%. A prevalência de influenza observada foi de 10,4% e a vacinação foi efetiva entre os trabalhadores (RR=0,51; IC95% 39-67), quando considerados os sintomas de alta probabilidade de influenza. A fração prevenível foi 0,09 (9 casos evitados a cada 100 trabalhadores vacinados). A campanha de vacinação foi mais efetiva e provocou maior impacto econômico entre os trabalhadores em regime operacional. / Influenza is one of the most prevalent acute respiratory diseases and it is an important cause of absenteeism and presenteeism. However, the influenza vaccine efficacy can reach 80% when there is a high correspondence between vaccinal and circulating strains. For that reason, the company has promoved vaccination campaigns for several years, although without measuring its effectiveness (efficacy on reducing the diseases load) and the economic impact (productivity) to improve occupational health policy. The campaign effectiveness would be determined by the the vaccinal efficacy that had been shown previously in randomized studies, by the degree of diagnostic accuracy or screening of cases, by the levels on health records and by the patients information and vaccination coverage achieved. Aiming at assessing the effectiveness and the economic impact of the vaccination campaign, we opted for an observational historic cohort study design with features of study design based in historical data from the 2008 campaign and individual information on the frequency of respiratory symptoms and absenteeism, age, gender, function (administrative and operational) and income, relevant co morbidities and smoking, obtained through a revision of medical records of the following twelve months, compared to vaccinated and non-vaccinated group (Chi square and t-test) and analyzed by logistic regression, and estimated the preventable fraction (proportion of potential influenza episodes avoided by vaccination). Medical records of 2.425 workers were analyzed (1.651 non-vaccinated and 754 vaccinated) corresponding to 31,1% coverage. The prevalence of influenza observed was 10,4% and vaccination has been effective between workers (RR = 0,51; IC95% 39-67), when considering symptoms of high probability of influenza. The preventable fraction was 0,09 (9 avoided cases for every 100 workers vaccinated). The vaccination campaign was more effective and sparked greater economic impact among workers in the operating system.

INTRODUÇÃO: Indivíduos infectados pelo HIV apresentam maior risco de quadros graves de infecção por influenza sazonal e, portanto, devem receber doses anuais da vacina contra gripe. No entanto, a capacidade dos indivíduos responderem às vacinas com títulos apropriados de anticorpos depende de variáveis como tipo de antígeno vacinal, idade e grau de comprometimento imunológico no momento da imunização. OBJETIVOS: 1) Avaliar a imunogenicidade da vacina contra influenza sazonal em 37 pacientes infectados pelo HIV, em comparação com 29 indivíduos não infectados pelo HIV 2) Realizar a vigilância dos episódios de infecções respiratórias durante o período de acompanhamento após a vacinação. MÉTODOS: Ambos os grupos receberam a vacina contra o vírus da influenza sazonal recomendada para o hemisfério sul em 2008. A resposta de anticorpos contra os antígenos H1N1, H3N2 e B foi medida em amostras de sangue extraídas 1-2h antes da vacinação (T0), após 1 mês (T1) e após 6 meses (T6; apenas no Grupo HIV). A vigilância dos sintomas respiratórios foi realizada através de telefonemas semanais, durante 6 meses após a vacinação. Em indivíduos sintomáticos para infecções respiratórios foram coletadas amostras de lavado nasofaríngeo para pesquisa de vírus respiratórios por Imunofluorescência e PCR: influenza A e B, parainfluenza 1, 2 e 3, adenovírus, metapneumovírus, vírus sincicial respiratório, rinovírus e coronavírus. RESULTADOS: A idade mediana da população de estudo foi de 12 (10-18) anos. No momento T1, ambos os grupos mostraram aumento significativo nos TMGs para todos os antígenos. Contudo, o grupo controle apresentou valores mais elevados para os antígenos A/H1N1 e A/H3N2 (p = 0,002 e 0,001, respectivamente). Houve maior aumento na porcentagem de indivíduos não infectados pelo HIV com títulos protetores A/H1N1 (96,6%) em comparação aos infectados pelo HIV (67,6%). No T1 (p=0,004). A porcentagem de indivíduos do grupo controle com aumento de quatro vezes ou mais nos títulos de anticorpos para A/H1N1 e A/H3N2 foram mais elevadas que no grupo HIV (p = 0,03 e 0,01, respectivamente). Agentes virais foram detectados em 39/60 (65%) dos episódios de infecção respiratória no grupo HIV e em 17/32 (53,1%) no grupo controle. Os vírus diagnosticados no grupo HIV e grupo controle foram respectivamente: adenovirus (8,6%), metapneumovirus (1,2%), rinovirus (16,8%), coronavirus (14,0 %) e influenza B (0,1%).CONCLUSÕES: A vacina sazonal contra os vírus da influenza foram imunogenicas em ambos os grupos. Ocorreram diferença nas taxas de soroproteção entre os grupos somente para o antígeno H1, que foi mais elevadas no grupo controle. O grupo controle também mostrou valores mais altos nos TMGs para os antígenos H1 e H3 depois da imunização. Os rinovirus (27,7%) e coronavirus (22,5%) foram os agentes mais prevalentes identificados no grupo infectado pelo HIV. No grupo controle, os vírus mais freqüentes foram os rinovirus (24,2%) e adenovirus (21,2%) / INTRODUCTION: Individuals infected with HIV are at higher risk for severe cases of seasonal influenza infection and therefore should receive annual doses of influenza vaccine. However, the ability to respond to vaccines respond appropriate antibodies titres depends on variables such as vaccine antigen, age and degree of immune impairment at immunization. OBJECTIVES: 1)To evaluate the immunogenicity of a seasonal influenza vaccine in 37 HIV-infected patients (HIV Group), compared to 29 uninfected individuals (Control Group) 2) To carry out a clinical and virological surveillance of influenza in this population during a follow-up period of six months. METHODS: Both groups received the vaccine against seasonal influenza virus recommended for the southern hemisphere in 2008. The antibody response against the antigens H1N1, H3N2 and B were measured in blood samples drawn at vaccination (T0), after 30 days (T1) and after 6 months (T6; only for HIV Group). Antibody titres >1:40 were considered protective against influenza infection A surveillance of respiratory symptoms was performed weekly by telephone calls for a post-vaccination follow-up period of 6 months. Samples were collected (nasal wash) if respiratory symptoms. DFA and real time PCR was used to diagnose influenza A virus (FLU A) and B (FLU B), respiratory syncytial virus (RSV), parainfluenza virus types 1, 2 and 3 ( Paraflu 1, 2 or 3), adenovirus, coronavirus, rhinovirus, metapneumovirus and bocavirus. RESULTS: The median age of the study population was 12 (10-18) years. At T0, there were no significant differences in the antibody geometric mean titres (GMTs) against all vaccine antigens between groups. One month after vaccination (T1), both groups showed significant increases in the antibody GMTs for all antigens. However, healthy controls showed higher values for antigens A/H1N1 and A/H3N2 (p = 0.002 and 0.001, respectively). There was a higher increase in the percentage of HIVuninfected subjects with protective A/H1N1 antibodies (96.6%) comparing to HIVinfected vaccinees (67.6%) at T1 (p = 0.004). The percentage in subjects control group with a fourfold or greater increase of A/H1N1 and A/H3N2 antibody titres was higher than that found in HIV group (p = 0.03 and p = 0.01, respectively. Viral agents were identified in 39/60 (65%) episodes of respiratory infections in HIV-infected group and in 17/32 episodes (53.1%) from the control group (P=0.273). The virus diagnosed in HIV group and control group were, respectively: Adenovirus (8;6), Metapneumovirus(1;2) Rinovirus(16;8), Coronavirus(14 ;0); Influenza B(0;1). CONCLUSIONS: The seasonal influenza vaccine was immunogenic in both groups. There were differences in seroprotection rates between groups only for AgH1, which was higher in the control group. The control group also showed a greater increase in GMTs for H1 and H3 antigens after immunization. Viral agents were identified in respiratory symptoms during the follow-up: Rhinoviruses (27.7%) and coronavirus (22.5%) were the most prevalent agents identified in HIV-infected individuals. In the control group, the viruses most frequently found were rhinoviruses (24.2%) and adenovirus (21.2%)

Tse, Yuk Tin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 141-149). / Abstracts in English and Chinese. / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- The influenza virus --- p.1 / Chapter 1.1.1 --- Influenza NA and its inhibitors --- p.3 / Chapter 1.1.2 --- Follow-up on the use of NAIs --- p.9 / Chapter 1.2 --- Sources of NA for experimental studies --- p.11 / Chapter 1.2.1 --- Viral sources --- p.11 / Chapter 1.2.2 --- NA isolation --- p.12 / Chapter 1.2.3 --- Recombinant NA expressed in cell lines --- p.12 / Chapter 1.2.4 --- Glycosylation on NA functionality --- p.13 / Chapter 1.2.5 --- Recombinant NA expressed in yeast --- p.15 / Chapter 1.3 --- Research objectives --- p.16 / Chapter 2 --- Cloning of Influenza Neuraminidase and Expression in P. pastoris --- p.17 / Chapter 2.1 --- Background --- p.17 / Chapter 2.1.1 --- Full-length cloning of the A/HongKong/483/97(H5N 1) NA --- p.17 / Chapter 2.1.2 --- Identification of the H274 equivalent --- p.19 / Chapter 2.1.3 --- The experiment --- p.22 / Chapter 2.2 --- Materials and methods --- p.23 / Chapter 2.2.1 --- Preparation of chemically competent Escherichia coli --- p.23 / Chapter 2.2.1.1 --- Reagents --- p.23 / Chapter 2.2.1.2 --- Reagent setup --- p.23 / Chapter 2.2.1.3 --- Equipment --- p.23 / Chapter 2.2.1.4 --- Procedure --- p.23 / Chapter 2.2.2 --- Amplification of N1 NA and EGFP genes --- p.24 / Chapter 2.2.2.1 --- Reagents --- p.24 / Chapter 2.2.2.2 --- Reagent setup --- p.25 / Chapter 2.2.2.3 --- Equipment --- p.25 / Chapter 2.2.2.4 --- Procedure --- p.26 / Chapter 2.2.2.4.1 --- Amplification of the full-length N1 NA gene from cDNA --- p.26 / Chapter 2.2.2.4.2 --- Amplification of the EGFP gene --- p.26 / Chapter 2.2.3 --- TA cloning of PCR products --- p.27 / Chapter 2.2.3.1 --- Reagents --- p.27 / Chapter 2.2.3.2 --- Reagent setup --- p.27 / Chapter 2.2.3.3 --- Equipment --- p.28 / Chapter 2.2.3.4 --- Procedure --- p.28 / Chapter 2.2.3.4.1 --- TA cloning of PCR products --- p.28 / Chapter 2.2.3.4.2 --- Site-directed mutagenesis by overlapping PCR --- p.30 / Chapter 2.2.4 --- Construction of P. pastoris expression vectors --- p.31 / Chapter 2.2.4.1 --- Reagents --- p.31 / Chapter 2.2.4.2 --- Reagent setup --- p.31 / Chapter 2.2.4.3 --- Procedure --- p.32 / Chapter 2.2.4.3.1 --- Generation of N1 NA expression vectors --- p.32 / Chapter 2.2.4.3.2 --- Generation of EGFP expression vectors --- p.34 / Chapter 2.2.5 --- Transformation of P. pastoris --- p.37 / Chapter 2.2.5.1 --- Reagents --- p.37 / Chapter 2.2.5.2 --- Reagent setup --- p.37 / Chapter 2.2.5.3 --- Equipment --- p.38 / Chapter 2.2.5.4 --- Procedure --- p.38 / Chapter 2.2.5.4.1 --- Preparation and transformation of electrocompetent P. pastoris --- p.38 / Chapter 2.2.5.4.2 --- PCR analysis of P. pastoris transformants (colony PCR) --- p.39 / Chapter 2.2.6 --- Expression of N1 NA and EGFP in P. pastoris --- p.40 / Chapter 2.2.6.1 --- Reagents --- p.40 / Chapter 2.2.6.2 --- Reagent setup --- p.40 / Chapter 2.2.6.3 --- Procedure --- p.41 / Chapter 2.2.6.3.1 --- Small-scale protein expression in P. pastoris --- p.41 / Chapter 2.2.6.3.2 --- Sequence alignment --- p.42 / Chapter 2.2.6.3.3 --- Data processing --- p.42 / Chapter 2.3 --- Results and Discussion --- p.43 / Chapter 2.3.1 --- Cloning of NA and EGFP into the pPICZB expression vector --- p.43 / Chapter 2.3.2 --- Growth of P. pastoris transformants --- p.51 / Chapter 3 --- Physical Characterization of Influenza Neuraminidase Expressed in P. pastoris --- p.53 / Chapter 3.1 --- Background --- p.53 / Chapter 3.1.1 --- Structural significance of disulphide bonds in NA --- p.53 / Chapter 3.1.2 --- Localization of recombinant N1 NA in P. pastoris --- p.55 / Chapter 3.1.3 --- The experiment --- p.56 / Chapter 3.2 --- Materials and methods --- p.57 / Chapter 3.2.1 --- Differential centrifugation --- p.57 / Chapter 3.2.1.1 --- Reagents --- p.57 / Chapter 3.2.1.2 --- Reagent setup --- p.57 / Chapter 3.2.1.3 --- Equipment --- p.57 / Chapter 3.2.1.4 --- Procedures --- p.58 / Chapter 3.2.1.4.1 --- Cell harvesting and lysis --- p.58 / Chapter 3.2.1.4.2 --- Preparation of crude membrane --- p.58 / Chapter 3.2.1.4.3 --- Preparation of plasma membrane --- p.58 / Chapter 3.2.2 --- Sodium dodecyl sulphate polyaciylamide gel electrophoresis (SDS-PAGE)… --- p.59 / Chapter 3.2.2.1 --- Reagents --- p.59 / Chapter 3.2.2.2 --- Reagent setup --- p.60 / Chapter 3.2.2.3 --- Equipment --- p.61 / Chapter 3.2.2.4 --- Procedure --- p.61 / Chapter 3.2.3 --- Immunoblotting --- p.61 / Chapter 3.2.3.1 --- Reagents --- p.61 / Chapter 3.2.3.2 --- Reagent setup --- p.62 / Chapter 3.2.3.3 --- Equipment --- p.62 / Chapter 3.2.3.4 --- Procedure --- p.62 / Chapter 3.2.3.4.1 --- Electroblotting --- p.62 / Chapter 3.2.3.4.2 --- Blocking and probing --- p.63 / Chapter 3.2.3.4.3 --- Immunodetection --- p.63 / Chapter 3.2.3.4.4 --- Molecular weight determination --- p.63 / Chapter 3.2.4 --- Confocal microscopy --- p.64 / Chapter 3.2.4.1 --- Equipment --- p.64 / Chapter 3.2.4.2 --- Procedure --- p.64 / Chapter 3.2.4.2.1 --- Image acquisition --- p.64 / Chapter 3.2.4.2.2 --- Image processing --- p.65 / Chapter 3.3 --- Results --- p.66 / Chapter 3.3.1 --- Localization of recombinant N1 NA in P. pastoris sub-cellular fractions --- p.66 / Chapter 3.3.2 --- Molecular weight determination for the N1 NA expressed in P. pastoris --- p.69 / Chapter 3.3.3 --- Cellular localization of recombinant N1 NA in P. pastoris --- p.71 / Chapter 3.4 --- Discussion --- p.77 / Chapter 3.4.1 --- Molecular weight determination for N1 NA expressed in P. pastoris --- p.77 / Chapter 3.4.2 --- Disulphide bond formation in N1 NA expressed in P. pastoris --- p.78 / Chapter 3.4.3 --- Cell-surface association of recombinant N1 NA in P. pastoris --- p.79 / Chapter 3.5 --- Conclusion --- p.81 / Chapter 4 --- Functional Characterization of Influenza Neuraminidase Expressed in P. pastor --- p.is / Chapter 4.1 --- Background --- p.82 / Chapter 4.1.1 --- Fluorometric NA activity assay --- p.82 / Chapter 4.1.2 --- Colorimetric assay of NA activity --- p.84 / Chapter 4.1.3 --- The experiment --- p.85 / Chapter 4.2 --- Materials and methods --- p.86 / Chapter 4.2.1 --- Fluorometric assay of N1 NA expressed in P. pastoris --- p.86 / Chapter 4.2.1.1 --- Reagents --- p.86 / Chapter 4.2.1.2 --- Reagent setup --- p.86 / Chapter 4.2.1.3 --- Equipment --- p.86 / Chapter 4.2.1.4 --- Procedure --- p.87 / Chapter 4.2.1.4.1 --- Calibrating cell density with viable cell counts --- p.87 / Chapter 4.2.1.4.2 --- End-point measurement of NA activity --- p.87 / Chapter 4.2.1.4.2.1 --- Determination of expression yield --- p.89 / Chapter 4.2.1.4.2.2 --- End-point assay of NAI sensitivity --- p.89 / Chapter 4.2.1.4.3 --- Kinetic measurement of NA activity --- p.90 / Chapter 4.2.1.4.3.1 --- Derivation ofV0 --- p.92 / Chapter 4.2.1.4.3.2 --- Graphical determination of KM --- p.93 / Chapter 4.2.1.4.3.3 --- Graphical determination of KI --- p.94 / Chapter 4.2.2 --- Colorimetric assay of N1 NA expressed in P. pastoris --- p.96 / Chapter 4.2.2.1 --- Reagents --- p.96 / Chapter 4.2.2.2 --- Reagent setup --- p.96 / Chapter 4.2.2.3 --- Equipment --- p.96 / Chapter 4.2.2.4 --- Procedure --- p.96 / Chapter 4.3 --- Results --- p.98 / Chapter 4.3.1 --- CFU determination --- p.98 / Chapter 4.3.2 --- Fluorescent NA activity assay for N1 NA expressed in P. pastoris --- p.98 / Chapter 4.3.2.1 --- End-point measurement of NA activity --- p.98 / Chapter 4.3.2.1.1 --- Course of N1 NA expression in P. pastoris --- p.102 / Chapter 4.3.2.1.1.1 --- NA activity per unit cell mass --- p.102 / Chapter 4.3.2.1.1.2 --- Yield of NA --- p.102 / Chapter 4.3.2.1.2 --- End-point assay for NAI sensitivity --- p.105 / Chapter 4.3.2.2 --- Kinetic measurement of NA activity and NAI sensitivity --- p.107 / Chapter 4.3.2.2.1 --- Graphical determination of KM --- p.107 / Chapter 4.3.2.2.2 --- Graphical determination of KI --- p.107 / Chapter 4.3.2.3 --- Colorimetric NA activity assay --- p.111 / Chapter 4.4 --- Discussion --- p.114 / Chapter 4.4.1 --- Fluorescent NA activity assay of N1 NA expressed in P. pastoris --- p.115 / Chapter 4.4.1.1 --- End-point measurement of NA activity --- p.115 / Chapter 4.4.1.1.1 --- Time course of expression --- p.115 / Chapter 4.4.1.1.2 --- Effect of H275Y mutation on NA activity and NAI sensitivity --- p.117 / Chapter 4.4.1.1.3 --- Effect of C-terminal tags on NA activity and NAI sensitivity --- p.117 / Chapter 4.4.1.2 --- Kinetic measurement of NA activity --- p.118 / Chapter 4.4.1.2.1 --- Graphical determination of KM --- p.119 / Chapter 4.4.1.2.2 --- Graphical determination of KI --- p.120 / Chapter 4.4.1.3 --- Comparison of fluorometric NA activity assays for use with whole P pastoris cells --- p.122 / Chapter 4.4.2 --- Colorimetric NA activity assay --- p.124 / Chapter 4.5 --- Conclusion --- p.126 / Chapter 5 --- Conclusions and Discussions --- p.127 / Chapter 5.1 --- General conclusions --- p.127 / Chapter 5.2 --- Follow-up --- p.127 / Chapter 5.2.1 --- Studies of influenza NA with enhanced activity --- p.128 / Chapter 5.2.2 --- NAI screening using yeast-expressed NA --- p.132 / Appendix --- p.134 / References --- p.141