The global disease scape is constantly shifting, influenced by demographic transitions, altering the balance of the burden of infectious and non‐communicable diseases. The epidemiological transitions can be divided into three stages: the first, an increase in infectious disease burden as populations settled, then grew into towns and cities providing conditions for infectious agents to maintain spread; the second transition follows industrialisation, changes in lifestyle, diet and improved sanitation whereby infectious diseases are reduced and non‐communicable disease (NCD) prevalence increases; the third transition describes the re‐emergence of infectious diseases as the AIDS epidemic and other emerging and re‐emerging disease outbreaks lead to an increasing burden of infectious diseases, particularly in developing countries. Analysis of the disease‐scape has been carried out using WHO Global Burden of Disease data and correlation to demographic factors calculated using World Bank Development Indicators. The balance of chronic NCDs and infectious diseases can be represented numerically as the unit rate of infectious to non‐communicable diseases. The rate, which indicates at which end the continuum lies can then be correlated to these demographic development indicators to assess the factors which are influential to the continuum. As the balance of infectious and non‐communicable diseases around the world alters, the focus of the advocacy at the global health level has been examined to assess if the trends follow that of the shifting continuum. This has been carried out through an assessment of the WHO World Health Assembly (WHA) resolutions adopted annually between 1948 and 2013 on the subject of infectious and/or non-communicable diseases. The principle of International health stemmed from the need to contain the international spread of communicable diseases, so it is not surprising that in the first decade of the WHO, 88% of the resolutions adopted for infectious and non‐communicable disease were adopted for infectious diseases. In the latest ten years of the WHO, 72% of the Assembly resolutions for infectious and non‐communicable diseases were focused on infectious diseases; this indicates that while there has been a shift in the balance, the adopted resolutions still focus heavily on infectious diseases. An example of how advocacy can elevate diseases to a higher position on the global health agenda is that of the Neglected Tropical Diseases. Following the Millennium Development Goals, this group of seventeen diseases has been highlighted as being “neglected” in terms of funding, research and political will. A review of the campaign to highlight this shows how global health advocacy can elevate diseases to a prominent position on the global health agenda. With this in mind, the advocacy for a sub‐group of Neglected Zoonotic Diseases has been examined at the WHA level. The results highlight the sporadic nature of support to control these diseases, and that activism for control of some of the major zoonotic diseases remains lacking. Rabies is explored as an example of a disease for which there are recommendations and support at the global level for the control and elimination of the disease, but for which barriers to control exist locally in endemic countries. The advocacy for diseases at the global health level has the possibility to impact the priorities of health care within individual nations. However the advocacy at this level may take time to reflect the changes within the disease‐scape. The impact of such advocacy is also limited by local political will, availability of resources and local cultural implications. Therefore there is a need to ensure that efforts to control diseases are tailored to specific populations and that resources are made available to support the advocacy.

Introdução Giardia intestinalis é um dos principais protozoários flagelados causadores de diarreia em humanos e animais, sendo um micro-organismo re-emergente, responsável por vários surtos de veiculação hídrica em nível mundial, razão pela qual tem merecido atenção das autoridades de Saúde Pública, e deve ser avaliado e monitorado, principalmente devido ao seu impacto negativo na qualidade do abastecimento público, em particular através do esgoto. Através de técnicas de biologia molecular é possível caracterizar e genotipar cistos presentes no esgoto, e identificar a circulação dos agrupamentos A e B, patogênicos para o homem. Neste estudo foram avaliadas amostras de esgoto bruto de cidades cosmopolitas da América Latina, no Estado de São Paulo, e em Lima, Peru. Objetivos Detectar através da técnica de reação em cadeia pela polimerase (PCR) a presença de G. intestinalis e os agrupamentos A e B, de importância para a saúde humana, em amostras de esgoto bruto provenientes do Estado de São Paulo, Brasil e de Lima, no Peru. Material e Métodos Um total de 18 amostras de esgoto bruto provenientes de portos, aeroportos e estações rodoviárias, com alto trânsito de pessoas de cinco municípios do estado de São Paulo foram coletadas pela técnica de Moore. Adicionalmente, 10 amostras provenientes de dois bairros (urbano e semi-urbano) na entrada da ETE de Carapongo, Lima, no Peru foram coletadas e concentradas por centrifugação. O DNA genômico foi extraído utilizando kit comercial (QIAamp DNA Stool Mini Kit® - Qiagen, USA). A amplificação do gene gdh (glutamato desidrogenase) de Giardia, foi realizada por nested PCR como descrito por CACCIÓ et al., 2008, e G. intestinalis e seus agrupamentos A e B, por meio de reações de reamplificação por PCR (rePCR). Resultados No Estado de São Paulo 61,1 por cento (11/18) das amostras coletadas foram consideradas positivas para G. intestinalis, e na cidade de Lima 60 por cento (6/10) das amostras foram positivas para G. intestinalis. Os agrupamentos A e B foram obtidos em ambos os países. Conclusões Os achados indicam que na cidade de Lima e no estado de São Paulo, cistos de Giardia associados à giardíase humana estão circulando no esgoto bruto, de modo que a descarga dessa matriz em águas superficiais pode representar perigo para a saúde. Além disso, o diagnóstico proposto possibilita a caracterização molecular de Giardia presente em amostras de esgoto bruto sem a necessidade de sequenciamento ou clonagem, favorecendo as rotinas laboratoriais / Introduction Giardia intestinalis is on of the major flagellated protozoans that cause diarrhea in humans and animals, and a re-emerging microorganism, responsible for several waterborne outbreaks worldwide, therefore it has received attention from public health authorities, and should be evaluated and monitored mainly due to their negative impact on the quality of public supply, in particular through the sewage. Through molecular biology techniques it is possible to characterize and to genotype cysts present in wastewater, and to identify the circulation of Assemblages A and B, that are pathogenic to humans. In this study were evaluated samples of raw wastewater from cosmopolitan cities in Latin America, in the State of São Paulo and in Lima, Peru. Objectives Detect, through the technique of polymerase chain reaction (PCR), the presence of G. intestinalis and its Assemblages A and B, of importance to human health, in samples of raw wastewater from the State of São Paulo, Brazil and Lima, Peru. Material and Methods A total of 18 samples of raw wastewater from harbors, airports and bus stations, with high traffic of people from five municipalities of the state of São Paulo were collected by the technique of Moore. In addition, 10 samples from two districts (urban and semi-urban) at the entrance of the WWTP Carapongo, Lima, Peru, were collected and subjected to centrifugation. Genomic DNA was extracted by using a commercial kit (QIAamp DNA Stool Mini Kit ® - Qiagen, USA). The amplification of the Giardia gdh gene (glutamate dehydrogenase) was performed by nested PCR as described by Cacció et al., 2008 and G. intestinalis and its Assemblages A and B, through PCR reamplification reactions (rePCR). Results In the State of São Paulo 61.1 per cent (11/18) of the collected samples were positive for G. intestinalis, and in the city of Lima 60 per cent (6/10) of the samples were positive for G. intestinalis. Assemblages A and B were obtained in both countries. Conclusions The findings indicated that in the city of Lima and in the state of São Paulo, Giardia cysts associated with human giardiasis are circulating in raw wastewater, so that the discharge of this matrix in surface waters may pose a health hazard. Furthermore, the proposed diagnostic enables the molecular characterization of Giardia present in raw wastewater samples without the need of sequencing or cloning, favoring laboratory routines.

Introdução Giardia intestinalis é um dos principais protozoários flagelados causadores de diarreia em humanos e animais, sendo um micro-organismo re-emergente, responsável por vários surtos de veiculação hídrica em nível mundial, razão pela qual tem merecido atenção das autoridades de Saúde Pública, e deve ser avaliado e monitorado, principalmente devido ao seu impacto negativo na qualidade do abastecimento público, em particular através do esgoto. Através de técnicas de biologia molecular é possível caracterizar e genotipar cistos presentes no esgoto, e identificar a circulação dos agrupamentos A e B, patogênicos para o homem. Neste estudo foram avaliadas amostras de esgoto bruto de cidades cosmopolitas da América Latina, no Estado de São Paulo, e em Lima, Peru. Objetivos Detectar através da técnica de reação em cadeia pela polimerase (PCR) a presença de G. intestinalis e os agrupamentos A e B, de importância para a saúde humana, em amostras de esgoto bruto provenientes do Estado de São Paulo, Brasil e de Lima, no Peru. Material e Métodos Um total de 18 amostras de esgoto bruto provenientes de portos, aeroportos e estações rodoviárias, com alto trânsito de pessoas de cinco municípios do estado de São Paulo foram coletadas pela técnica de Moore. Adicionalmente, 10 amostras provenientes de dois bairros (urbano e semi-urbano) na entrada da ETE de Carapongo, Lima, no Peru foram coletadas e concentradas por centrifugação. O DNA genômico foi extraído utilizando kit comercial (QIAamp DNA Stool Mini Kit® - Qiagen, USA). A amplificação do gene gdh (glutamato desidrogenase) de Giardia, foi realizada por nested PCR como descrito por CACCIÓ et al., 2008, e G. intestinalis e seus agrupamentos A e B, por meio de reações de reamplificação por PCR (rePCR). Resultados No Estado de São Paulo 61,1 por cento (11/18) das amostras coletadas foram consideradas positivas para G. intestinalis, e na cidade de Lima 60 por cento (6/10) das amostras foram positivas para G. intestinalis. Os agrupamentos A e B foram obtidos em ambos os países. Conclusões Os achados indicam que na cidade de Lima e no estado de São Paulo, cistos de Giardia associados à giardíase humana estão circulando no esgoto bruto, de modo que a descarga dessa matriz em águas superficiais pode representar perigo para a saúde. Além disso, o diagnóstico proposto possibilita a caracterização molecular de Giardia presente em amostras de esgoto bruto sem a necessidade de sequenciamento ou clonagem, favorecendo as rotinas laboratoriais / Introduction Giardia intestinalis is on of the major flagellated protozoans that cause diarrhea in humans and animals, and a re-emerging microorganism, responsible for several waterborne outbreaks worldwide, therefore it has received attention from public health authorities, and should be evaluated and monitored mainly due to their negative impact on the quality of public supply, in particular through the sewage. Through molecular biology techniques it is possible to characterize and to genotype cysts present in wastewater, and to identify the circulation of Assemblages A and B, that are pathogenic to humans. In this study were evaluated samples of raw wastewater from cosmopolitan cities in Latin America, in the State of São Paulo and in Lima, Peru. Objectives Detect, through the technique of polymerase chain reaction (PCR), the presence of G. intestinalis and its Assemblages A and B, of importance to human health, in samples of raw wastewater from the State of São Paulo, Brazil and Lima, Peru. Material and Methods A total of 18 samples of raw wastewater from harbors, airports and bus stations, with high traffic of people from five municipalities of the state of São Paulo were collected by the technique of Moore. In addition, 10 samples from two districts (urban and semi-urban) at the entrance of the WWTP Carapongo, Lima, Peru, were collected and subjected to centrifugation. Genomic DNA was extracted by using a commercial kit (QIAamp DNA Stool Mini Kit ® - Qiagen, USA). The amplification of the Giardia gdh gene (glutamate dehydrogenase) was performed by nested PCR as described by Cacció et al., 2008 and G. intestinalis and its Assemblages A and B, through PCR reamplification reactions (rePCR). Results In the State of São Paulo 61.1 per cent (11/18) of the collected samples were positive for G. intestinalis, and in the city of Lima 60 per cent (6/10) of the samples were positive for G. intestinalis. Assemblages A and B were obtained in both countries. Conclusions The findings indicated that in the city of Lima and in the state of São Paulo, Giardia cysts associated with human giardiasis are circulating in raw wastewater, so that the discharge of this matrix in surface waters may pose a health hazard. Furthermore, the proposed diagnostic enables the molecular characterization of Giardia present in raw wastewater samples without the need of sequencing or cloning, favoring laboratory routines.

Les maladies émergentes représentent actuellement 65% de toutes les pathologies infectieuses récentes. Récemment, un nombre croissant de nouveaux virus a été associé à de petits mammifères terrestres, plus particulièrement à des rongeurs, désignant ce groupe comme étant l'une des possibles sources de dangereuses pathologies émergentes et ré-émergentes. Actuellement, la réaction en chaîne par polymérase (PCR) est l'outil principal utilisé pour la détection d'agents pathogènes dans la diagnostique de routine et dans la recherche. Or, plusieurs recherches ont montré que certaines substances inhibent la PCR, causant de faux résultats. Aussi, nous avons lancé un programme de capture de rongeurs pour le dépistage de virus connus et non identifiés. Au total 1441 rongeurs ont été capturés pendant des campagnes organisées en Europe et Afrique entre 2002 et 2011. Tout d'abord, nous avons examiné l'inhibition de la PCR et étudié les différentes techniques de traitement d'échantillons qui favorisent la réduction de la quantité d'inhibiteurs dans les échantillons de rongeurs. Parmi les techniques d'extraction évaluées, l'EZ1 virus mini kit et le réactif d'extraction RNAnow se sont avéré plus efficaces que le NucleoSpin virus kit ou le réactif d'extraction TRIzol. De même, l'utilisation des poumons et de reins était préférable à l'utilisation du foie et de la rate. Aucune différence significative n'a été observée entre le stockage à -80°C et le stockage dans le réactif RNAlater. Nous avons conduit le dépistage des virus, en utilisant les tests moléculaires et la culture cellulaire. Deux nouvelles souches de virus ont été isolées, séquencées et caractérisées. / Emerging diseases currently represent 65% of recent major disease outbreaks. Of them, 75% are associated with wildlife. Recently, an increasing number of newly discovered viruses have been associated with small terrestrial mammals, particularly with rodents, pointing at this group as one of the most dangerous potential sources of emerging or re-emerging diseases. To meet these challenges for public health, a proper surveillance becomes necessary, which passes by detection of pathogens in human and risky groups of animals, including field investigations. Yet this can be achieved only by using proper techniques of samples treatment and pathogen detection. Currently, polymerase chain reaction (PCR) is the main tool used for the detection of pathogens in routine diagnostic and research. Yet, several researches showed that some substances can inhibit PCR, causing false-negative results. Therefore, we initiated a screening program targeting rodents for the presence of known and unidentified viruses. A total of 1441 rodents were trapped during field campaigns organized in Europe and Africa, between 2002 and 2011. At first we investigated on PCR inhibitors and discussed techniques of treatment of samples allowing reducing the influence of inhibitors in rodent samples. Among the extraction techniques tested, EZ1 virus mini kit and RNAnow extraction reagent were more effective than NucleoSpin virus kit or TRIzol extraction reagent. Also, the use of lungs and kidneys was preferable to the use of liver and spleen, the quantity of inhibitors being higher in the last two organs. No significant difference was observed between storage at -80°C, or in RNAlater RNA stabilization reagent.