Thesis (M.S.)--University of Wisconsin--Madison, 1950. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [56]-65).

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2015 / The purpose of the study was to explore and describe the experience of a nurse in a private sector hospital after contracting a highly pathogenic novel haemorrhagic fever from a patient and to explore the context of the environment in which she was cared for. Patients with complications from severe acute febrile diseases are admitted to intensive care units. During 2008, two patients with an unidentified disease were airlifted from Zambia and admitted to a private sector hospital in Johannesburg, South Africa. Four of five patients died in the outbreak before a diagnosis of Lujo virus was confirmed. Countries to the North and West of South Africa are known to be endemic areas of Viral Haemorrhagic Fevers (VHF). This puts South Africa at risk for imported VHF and future outbreaks. The sole survivor was able to share useful advice for future implementation from experiences during the period of her illness. Unique challenges of the management and environment of this outbreak may assist in future outbreaks. A bounded single case study design using mixed multiple qualitative approaches including phenomenology was used to underpin and guide the study of the participant’s experience. The participant’s reflection was subjected to in-depth analysis using Colaizzi’s framework. Triangulation using the reflection of the contents of the “Outbreak diary” – a journal kept by members of the managing team and clinical nursing records was undertaken. Emerging themes were grouped into four main themes: Initial contact with the source; Admission is inevitable; Moments of care and Always involved, which have been discussed in depth. The information gleaned from these themes can be applied to practice in future. The safety of patients and staff in an outbreak depends on attention to detail. History taking was identified as crucial for appropriate infection prevention methods to be put in place. Contact tracing and monitoring is key to containing an outbreak. The definition of contacts is based on the risk profile. Successful management requires coordination by a team of multi-skilled senior persons who have the authority to make decisions. As with all critically ill patients, the participant experienced many emotions. The lack of ability to control situations and care appeared to be important. Feelings of guilt still remain. A different meaning of kindness was exposed. Infection prevention and isolation is part of routine nursing practice and should be applied if there is an index of suspicion of a contagious disease. Care of patients with VHF is not routinely taught however maintaining basic principles may prevent spread and thus further cases. Support of and communication with all staff in the hospital is important for commitment. The setting in this study was a hospital in the private sector. The revelations of this case study can be used in future research to develop guidelines for use by the outbreak management team. They are intended to improve the management and emotional support of the health care workers as well as the victims and can be applied to outbreaks of any nature.

Thesis (Ph. D.)--University of Virginia, 2001. / Includes bibliographical references (leaf 239). Also available online through Digital Dissertations.

Thesis (M.P.H.)--University of Michigan, 1947.

Thesis (Ph. D.)--University of Virginia, 1998. / Includes bibliographical references (p. 163-177). Also available online through Digital Dissertations.

Thesis (M.P.H.)--University of Michigan, 1947.

O Vírus de Influenza aviária pertence à família Orthomyxoviridae. Nos últimos anos vários subtipos da gripe aviária de baixa patogenicidade têm causado surtos e epidemia em humanos e aves domésticas. As aves selvagens e migratórias participam da manutenção e transmissão interespécie dos 16 subtipos de hemaglutinina e 9 subtipos de Neuraminidase na natureza. Nosso estudo teve como objetivo subtipar as amostras positivas através de teste sorológico de inibição da hemaglutinação (HI) e técnica de Biologia Molecular. Foram positivas as amostras das espécies: Elaenia mesoleuca (2), Sporophila lineola (1) Sporophila caerulescen (1), Vireo olivaceus (3), Columbina talpacoti (3), Paroaria dominicana (2), foram coletadas das reservas experimentais de campo localizadas no estado de São Paulo-Brasil,durante os anos de 1997 e 1998. Tais amostras foram identificadas por teste preconizado HI(de acordo com WHO) usando 20 soros imunes anti-influenza do tipo A e um do tipo B e análise de RT-PCR com sequenciamento do gene Hemaglutinina e Neuraminidase. O teste HI demonstrou que 12 amostras apresentou estreita afinidade com com soros imune A/HongKong/1/68 (H3N2), A/Equine/Miami/63 (H3N8) and A/Duck/Ukraine/63 (H3N8). As análises de sequenciamento do gene hemaglutinina e Neuraminidase desses isolados revelaram uma alta homologia com os do subtipos H3N2. As análise filogenética e variabilidade genética em comparação com as seqüências de Genbank representando diversos países, mostraram que nossas amostras apresentou estreita homologia com os vírus do subtipos que circularam em Victoria (1990), Siena (1991) e Beijim (1989). A análise de amino ácido indicou que há mutações não sinônimas no gene da Hemaglutinina exclusiva de nossas amostras e as mutações da Neuraminidase são sinônimos, quando comparadas com amostras de AIV de outros paises. Nossas Amostras quando análisadas a NA, não apresentaram mutações nos aminoácidos y285t e r297n que conferem resistencia aos inibidores da Neuminidase. / Avian Influenza virus belongs to Orthomyxoviridae family. The last years several low pathogenic avian influenza subtypes have caused outbreaks and epidemic in human and poultry. The wild and migrating birds may be participating of maintenance and interspecies transmission of the sixteen subtypes of the Hemagglutinina and nine Neuraminidase in nature. Our study was aimed to subtype the positive samples for influenza A isolated from migrating and wild birds by molecular technique and Haemagglutination inhibition test (HI). The samples from species Elaenia mesoleuca (2), Sporophila lineola (1) Sporophila caerulescens (1), Vireo olivaceus (3), Columbina talpacoti (3), Paroaria dominicana (2), were collected in reserves and experimental field stations located in the São Paulo State - Brazil, during the years 1997 and 1998. The samples were identified by HI test (according WHO) using the 20 antibody patterns anti-influenza A type and one for the influenza type B and RT-PCR and Sequence analysis of Hemaglutinina and Neuraminidase gene. The HI test demonstrated that 12 samples presented an antigenic close relationship with A/HongKong/1/68 (H3N2), A/ Equine/Miami /63 (H3N8) and A/Duck/ Ukraine/ 63 (H3N8) antiserum.The sequencing analyses of Hemaglutinin and Neuraminidase gene of these 12 isolates revealed a high homology with H3N2. Phylogenetic analysis and genetic variability compared with genbank sequence representing several countries, showed that our current samples submitted close homology to that circulated in Victoria (1990), Siena (1991) and Beijim (1989). Amino acid analysis compared our samples with representative genbank samples all of mutation are synonymous.

O Vírus de Influenza aviária pertence à família Orthomyxoviridae. Nos últimos anos vários subtipos da gripe aviária de baixa patogenicidade têm causado surtos e epidemia em humanos e aves domésticas. As aves selvagens e migratórias participam da manutenção e transmissão interespécie dos 16 subtipos de hemaglutinina e 9 subtipos de Neuraminidase na natureza. Nosso estudo teve como objetivo subtipar as amostras positivas através de teste sorológico de inibição da hemaglutinação (HI) e técnica de Biologia Molecular. Foram positivas as amostras das espécies: Elaenia mesoleuca (2), Sporophila lineola (1) Sporophila caerulescen (1), Vireo olivaceus (3), Columbina talpacoti (3), Paroaria dominicana (2), foram coletadas das reservas experimentais de campo localizadas no estado de São Paulo-Brasil,durante os anos de 1997 e 1998. Tais amostras foram identificadas por teste preconizado HI(de acordo com WHO) usando 20 soros imunes anti-influenza do tipo A e um do tipo B e análise de RT-PCR com sequenciamento do gene Hemaglutinina e Neuraminidase. O teste HI demonstrou que 12 amostras apresentou estreita afinidade com com soros imune A/HongKong/1/68 (H3N2), A/Equine/Miami/63 (H3N8) and A/Duck/Ukraine/63 (H3N8). As análises de sequenciamento do gene hemaglutinina e Neuraminidase desses isolados revelaram uma alta homologia com os do subtipos H3N2. As análise filogenética e variabilidade genética em comparação com as seqüências de Genbank representando diversos países, mostraram que nossas amostras apresentou estreita homologia com os vírus do subtipos que circularam em Victoria (1990), Siena (1991) e Beijim (1989). A análise de amino ácido indicou que há mutações não sinônimas no gene da Hemaglutinina exclusiva de nossas amostras e as mutações da Neuraminidase são sinônimos, quando comparadas com amostras de AIV de outros paises. Nossas Amostras quando análisadas a NA, não apresentaram mutações nos aminoácidos y285t e r297n que conferem resistencia aos inibidores da Neuminidase. / Avian Influenza virus belongs to Orthomyxoviridae family. The last years several low pathogenic avian influenza subtypes have caused outbreaks and epidemic in human and poultry. The wild and migrating birds may be participating of maintenance and interspecies transmission of the sixteen subtypes of the Hemagglutinina and nine Neuraminidase in nature. Our study was aimed to subtype the positive samples for influenza A isolated from migrating and wild birds by molecular technique and Haemagglutination inhibition test (HI). The samples from species Elaenia mesoleuca (2), Sporophila lineola (1) Sporophila caerulescens (1), Vireo olivaceus (3), Columbina talpacoti (3), Paroaria dominicana (2), were collected in reserves and experimental field stations located in the São Paulo State - Brazil, during the years 1997 and 1998. The samples were identified by HI test (according WHO) using the 20 antibody patterns anti-influenza A type and one for the influenza type B and RT-PCR and Sequence analysis of Hemaglutinina and Neuraminidase gene. The HI test demonstrated that 12 samples presented an antigenic close relationship with A/HongKong/1/68 (H3N2), A/ Equine/Miami /63 (H3N8) and A/Duck/ Ukraine/ 63 (H3N8) antiserum.The sequencing analyses of Hemaglutinin and Neuraminidase gene of these 12 isolates revealed a high homology with H3N2. Phylogenetic analysis and genetic variability compared with genbank sequence representing several countries, showed that our current samples submitted close homology to that circulated in Victoria (1990), Siena (1991) and Beijim (1989). Amino acid analysis compared our samples with representative genbank samples all of mutation are synonymous.

Os vírus Influenza A infectam um largo espectro de hospedeiros e causam epidemias anuais. São vírus com alta variabilidade genética e RNA segmentado, que podem sofrer rearranjos entre os genes de diferentes vírus. Em 2006, foram analisadas 521 amostras de crianças menores de 5 anos atendidas no HU-USP e 25 foram positivas para Influenza A, sendo H3N2 o mais prevalente (68%). Cinco genes de 18 amostras foram seqüenciados e obtivemos 13 sequencias de HA, 12 da NP, 12 de NA, 14 da M e 10 da NS. Verificou-se a presença de várias mutações, especialmente na HA e NA, que favoreceram a substituição da cepa vacinal naquele ano. Todas as amostras H3N2 apresentaram sítios de resistências aos inibidores da M2. Diferentes linhagens circularam no mesmo ano, tanto de H1 como de H3, favorecendo rearranjos entre elas. Foram verificados, também rearranjos envolvendo os genes da HA e NP, indicando o complexo mecanismo de evolução desses vírus e enfatizando a necessidade de monitoramento da circulação e caracterização de seus genes. / Influenza A virus infects a wide range of hosts and cause annual outbreaks. RNA segmented virus has high genetic variability and may have rearrangements between the genes of different viruses. In 2006, 521 samples of children younger than 5 years were analyzed and 25 tested positive for Influenza A virus, of which the subtype H3N2 is the most prevalent (68%). Five genes of 18 samples were sequenced and 13 sequences of HA, 12 of NP, 14 of M and 10 of NS obtained were. The presence of this several mutations, especially in the HA and NA genes probably helped the replacement of the vaccine strain in that year. All H3N2 subtype samples showed points of resistance to M2 inhibitors. The phylogenetic analysis revealed the circulation of different lineages in the same year, for both H1 and H3, and the presence of two rearrangements involving the HA and NP genes. These results indicate the influence of rearrangements in the evolution of the virus and emphasize the need for monitoring of circulation and characterization of genes.

Os vírus Influenza A infectam um largo espectro de hospedeiros e causam epidemias anuais. São vírus com alta variabilidade genética e RNA segmentado, que podem sofrer rearranjos entre os genes de diferentes vírus. Em 2006, foram analisadas 521 amostras de crianças menores de 5 anos atendidas no HU-USP e 25 foram positivas para Influenza A, sendo H3N2 o mais prevalente (68%). Cinco genes de 18 amostras foram seqüenciados e obtivemos 13 sequencias de HA, 12 da NP, 12 de NA, 14 da M e 10 da NS. Verificou-se a presença de várias mutações, especialmente na HA e NA, que favoreceram a substituição da cepa vacinal naquele ano. Todas as amostras H3N2 apresentaram sítios de resistências aos inibidores da M2. Diferentes linhagens circularam no mesmo ano, tanto de H1 como de H3, favorecendo rearranjos entre elas. Foram verificados, também rearranjos envolvendo os genes da HA e NP, indicando o complexo mecanismo de evolução desses vírus e enfatizando a necessidade de monitoramento da circulação e caracterização de seus genes. / Influenza A virus infects a wide range of hosts and cause annual outbreaks. RNA segmented virus has high genetic variability and may have rearrangements between the genes of different viruses. In 2006, 521 samples of children younger than 5 years were analyzed and 25 tested positive for Influenza A virus, of which the subtype H3N2 is the most prevalent (68%). Five genes of 18 samples were sequenced and 13 sequences of HA, 12 of NP, 14 of M and 10 of NS obtained were. The presence of this several mutations, especially in the HA and NA genes probably helped the replacement of the vaccine strain in that year. All H3N2 subtype samples showed points of resistance to M2 inhibitors. The phylogenetic analysis revealed the circulation of different lineages in the same year, for both H1 and H3, and the presence of two rearrangements involving the HA and NP genes. These results indicate the influence of rearrangements in the evolution of the virus and emphasize the need for monitoring of circulation and characterization of genes.