O tratamento das infecções do trato respiratório inferior – em especial as pneumonias adquiridas na comunidade – fundamenta-se em critérios clínico-radiológicos, de acordo com consensos e publicações sobre o assunto. A valorização diagnóstica do exame bacteriológico do escarro nessas infecções tem se mostrado controversa, esbarrando em diversos obstáculos, entre eles o fato de o material transitar pela orofaringe e boca, sofrendo a contaminação por microorganismos residentes nessas estruturas. No presente estudo procurou-se verificar se era possível identificar a flora bacteriana envolvida em infecções bronco-pulmonares de indivíduos adultos, diferenciando-a daquela presente nas estruturas supra-glóticas, particularmente na boca, examinando-se simultaneamente o escarro “dessalivado”, cuidadosamente obtido e processado, e a saliva. Nos períodos 1995-1997 e 2005-2007 foram estudados 164 pacientes adultos, 80 homens e 84 mulheres, com idades entre 22 e 92 anos (média de 57 anos), todos com escarro purulento, e evidências clínicas e radiográficas de infecção do trato respiratório inferior. Casos de tuberculose e de micose foram excluídos. De cada um desses 164 indivíduos, amostras de escarro foram cuidadosamente colhidas em frascos esterilizados. Com uma alça de platina, recolhia-se um grumo do material purulento, o qual, após ser arrastado pela margem de uma lâmina ou parede do frasco, onde o excesso de saliva ficava retido (“dessalivação” do material), ele era distendido no centro da mesma lâmina e corado (gram), e também cultivado em meio apropriado (ágarsangue). Com outra alça de platina buscava-se, no mesmo frasco, o material não purulento (saliva) que ficava em torno do grumo, o qual era distendido em outra lâmina, e também corado pelo método de gram, e cultivado no mesmo tipo de meio usado para a cultura do material purulento. Os germes identificados e a celularidade encontrada ao exame direto (gram), tanto do grumo de pus (escarro) como da saliva, e os resultados das culturas de ambos os materiais eram registrados. As lâminas foram inicialmente examinadas por algum dos diferentes microbiologistas do Serviço, e finalmente por um único deles (referência). Ao exame direto, os tipos de germes encontrados no escarro (grumo purulento) mostraram-se significativamente diferentes dos que foram vistos na saliva (p < 0,001). No grumo purulento observou-se, em geral, um único ou predominante tipo de bactéria, enquanto que na saliva, contendo células epiteliais, uma flora mista foi mais vezes identificada. A mesma diferenciação, entretanto, não foi observada nas culturas, mais freqüentemente crescendo um mesmo tipo de bactéria em ambos os materiais (Streptococcus sp.), comumente presente em orofaringe e boca. A presença de macrófagos e ausência de células epiteliais foram verificadas quase que exclusivamente no escarro (p < 0,0001), enquanto que polimorfonucleares foram igualmente observados em ambos os materiais. Em conclusão, em indivíduos com infecções pulmonares diversas, o exame direto do escarro adequadamente obtido e processado, “dessalivado”, corado pelo método de gram, e mostrando a presença de macrófagos, pareceu discriminar – de modo superior à cultura – os germes provenientes do trato respiratório inferior. / The treatment of the lower respiratory tract infections – in special community acquired pneumonias – is today based in clinical and radiographic criteria, according to guidelines and publications about the subject. The diagnostic value of the sputum examination in these infections have been considered controversial. Among the several obstacles for its natural acceptance is the fact of the material to transit through pharynx and mouth suffering contamination by resident microorganisms of these structures. The aim of this study was to verify the possibility to identify the bacteriological flora involved in adult pulmonary infections, and differentiate it from those of the upper structures, particularly the mouth, through the simultaneous examination of a valid sample of sputum and saliva. In two periods (1995-1997; 2005-2007), 164 adult patients – 80 males, 84 females; age 22 to 92 years (mean 57) – all with purulent sputum and clinical-radiographic features of a lower respiratory tract infection. Cases of tuberculosis and mycosis were excluded. In sterilized bottles sputum samples were carefully obtained from every of the 164 individuals. With a platinum wire, a bit of purulent portion of the material was token and dragged by the inner surface of the bottle or over the glass slide, until the excess of saliva was reduced (“de-salivation”). The material was then distended on the center of the slide and stained (gram) for microscopic examination, and also cultivated in an appropriate media. From the same sample, saliva near the purulent material was token, fixed, stained (gram), and cultivated. The germs and cell types found at the direct examination and the culture results of both materials (sputum and saliva) were registered. The smears were at first examined by one of different microbiologists of the service, and finally by one of them (reference) in each period of the study. At the bacterioscopy, the germs found in the sputum smears were significantly different of those found in saliva (p < 0.001). There were either one or a predominant type of bacteria in the sputum, whereas in saliva (containing epitelial cells) a mixed flora was often observed. In the cultures, however, the results were others, growing more frequently a type of microorganism in both materials, often Streptococcus sp, germ commonly present in mouth and pharynx. Presence of macrophages and absence of epitelial cells were found almost exclusively in the sputum (p < 0.0001), whereas the inverse were observed in saliva. Polymorphonuclear cells were identified in both materials of all patients. In conclusion, individuals with different pulmonary infections, the direct examination of the properly collected and processed (“dessalived”) purulent sputum , stained by gram method, and with presence of macrophages, seemed indicate – better than the culture – the germs from the lower respiratory tract.

O tratamento das infecções do trato respiratório inferior – em especial as pneumonias adquiridas na comunidade – fundamenta-se em critérios clínico-radiológicos, de acordo com consensos e publicações sobre o assunto. A valorização diagnóstica do exame bacteriológico do escarro nessas infecções tem se mostrado controversa, esbarrando em diversos obstáculos, entre eles o fato de o material transitar pela orofaringe e boca, sofrendo a contaminação por microorganismos residentes nessas estruturas. No presente estudo procurou-se verificar se era possível identificar a flora bacteriana envolvida em infecções bronco-pulmonares de indivíduos adultos, diferenciando-a daquela presente nas estruturas supra-glóticas, particularmente na boca, examinando-se simultaneamente o escarro “dessalivado”, cuidadosamente obtido e processado, e a saliva. Nos períodos 1995-1997 e 2005-2007 foram estudados 164 pacientes adultos, 80 homens e 84 mulheres, com idades entre 22 e 92 anos (média de 57 anos), todos com escarro purulento, e evidências clínicas e radiográficas de infecção do trato respiratório inferior. Casos de tuberculose e de micose foram excluídos. De cada um desses 164 indivíduos, amostras de escarro foram cuidadosamente colhidas em frascos esterilizados. Com uma alça de platina, recolhia-se um grumo do material purulento, o qual, após ser arrastado pela margem de uma lâmina ou parede do frasco, onde o excesso de saliva ficava retido (“dessalivação” do material), ele era distendido no centro da mesma lâmina e corado (gram), e também cultivado em meio apropriado (ágarsangue). Com outra alça de platina buscava-se, no mesmo frasco, o material não purulento (saliva) que ficava em torno do grumo, o qual era distendido em outra lâmina, e também corado pelo método de gram, e cultivado no mesmo tipo de meio usado para a cultura do material purulento. Os germes identificados e a celularidade encontrada ao exame direto (gram), tanto do grumo de pus (escarro) como da saliva, e os resultados das culturas de ambos os materiais eram registrados. As lâminas foram inicialmente examinadas por algum dos diferentes microbiologistas do Serviço, e finalmente por um único deles (referência). Ao exame direto, os tipos de germes encontrados no escarro (grumo purulento) mostraram-se significativamente diferentes dos que foram vistos na saliva (p < 0,001). No grumo purulento observou-se, em geral, um único ou predominante tipo de bactéria, enquanto que na saliva, contendo células epiteliais, uma flora mista foi mais vezes identificada. A mesma diferenciação, entretanto, não foi observada nas culturas, mais freqüentemente crescendo um mesmo tipo de bactéria em ambos os materiais (Streptococcus sp.), comumente presente em orofaringe e boca. A presença de macrófagos e ausência de células epiteliais foram verificadas quase que exclusivamente no escarro (p < 0,0001), enquanto que polimorfonucleares foram igualmente observados em ambos os materiais. Em conclusão, em indivíduos com infecções pulmonares diversas, o exame direto do escarro adequadamente obtido e processado, “dessalivado”, corado pelo método de gram, e mostrando a presença de macrófagos, pareceu discriminar – de modo superior à cultura – os germes provenientes do trato respiratório inferior. / The treatment of the lower respiratory tract infections – in special community acquired pneumonias – is today based in clinical and radiographic criteria, according to guidelines and publications about the subject. The diagnostic value of the sputum examination in these infections have been considered controversial. Among the several obstacles for its natural acceptance is the fact of the material to transit through pharynx and mouth suffering contamination by resident microorganisms of these structures. The aim of this study was to verify the possibility to identify the bacteriological flora involved in adult pulmonary infections, and differentiate it from those of the upper structures, particularly the mouth, through the simultaneous examination of a valid sample of sputum and saliva. In two periods (1995-1997; 2005-2007), 164 adult patients – 80 males, 84 females; age 22 to 92 years (mean 57) – all with purulent sputum and clinical-radiographic features of a lower respiratory tract infection. Cases of tuberculosis and mycosis were excluded. In sterilized bottles sputum samples were carefully obtained from every of the 164 individuals. With a platinum wire, a bit of purulent portion of the material was token and dragged by the inner surface of the bottle or over the glass slide, until the excess of saliva was reduced (“de-salivation”). The material was then distended on the center of the slide and stained (gram) for microscopic examination, and also cultivated in an appropriate media. From the same sample, saliva near the purulent material was token, fixed, stained (gram), and cultivated. The germs and cell types found at the direct examination and the culture results of both materials (sputum and saliva) were registered. The smears were at first examined by one of different microbiologists of the service, and finally by one of them (reference) in each period of the study. At the bacterioscopy, the germs found in the sputum smears were significantly different of those found in saliva (p < 0.001). There were either one or a predominant type of bacteria in the sputum, whereas in saliva (containing epitelial cells) a mixed flora was often observed. In the cultures, however, the results were others, growing more frequently a type of microorganism in both materials, often Streptococcus sp, germ commonly present in mouth and pharynx. Presence of macrophages and absence of epitelial cells were found almost exclusively in the sputum (p < 0.0001), whereas the inverse were observed in saliva. Polymorphonuclear cells were identified in both materials of all patients. In conclusion, individuals with different pulmonary infections, the direct examination of the properly collected and processed (“dessalived”) purulent sputum , stained by gram method, and with presence of macrophages, seemed indicate – better than the culture – the germs from the lower respiratory tract.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O vÃrus influenza à o Ãnico com a habilidade de causar epidemias anuais recorrentes em curto espaÃo de tempo, atingindo todas as faixas etÃrias, ocorrendo com maior gravidade em crianÃas e idosos. Este estudo teve como objetivo conhecer os aspectos demogrÃficos e o padrÃo de sazonalidade das infecÃÃes respiratÃrias agudas (IRAs) causadas pelo vÃrus influenza em crianÃas atendidas no Hospital Infantil Albert Sabin, na cidade de Fortaleza â CearÃ, no perÃodo de janeiro de 2001 a julho de 2004. Foram coletadas 1950 amostras de aspirado de nasofaringe de crianÃas com sintomas de infecÃÃo respiratÃria aguda. Todas as amostras foram analisadas por reaÃÃo de imunofluorescÃncia indireta. A reaÃÃo de em cadeia da polimerase com transcriÃÃo reversa foi utilizada em 47 amostras positivas por imunofluorescÃncia indireta dos anos de 2003 e 2004 para anÃlise da variantes virais (H1 e H3 ) e influenza B. Um total de 156 amostras foram positivas para os vÃrus influenza A ou B, representando uma prevalÃncia de 8%. Entre as infecÃÃes causadas por vÃrus, aquelas causadas pelos vÃrus influenza A e B representaram 24,1%. O vÃrus influenza apresentou um padrÃo de ocorrÃncia anual regular, com surtos epidÃmicos durante o primeiro semestre de cada ano, correlacionados aos perÃodos chuvosos. Os picos dos perÃodos epidÃmicos de influenza antecederam ou ocorreram concomitantemente Ãs campanhas nacionais de vacinaÃÃo. Os vÃrus influenza A e B co-circularam em todos os anos de estudo, havendo uma predominÃncia significativa do vÃrus influenza A (91%) em relaÃÃo ao vÃrus influenza B (9%). Em relaÃÃo ao setor de atendimento das crianÃas com infecÃÃes por vÃrus influenza observouse a maioria delas foi atendida em ambulatÃrios (48,7%) e emergÃncia (39,7%). Dezoito crianÃas infectadas pelo vÃrus influenza foram atendidas nas enfermarias (11,5%). Com relaÃÃo à idade das crianÃas com influenza observou-se que essas infecÃÃes predominaram em crianÃas atà dos dois anos de idade (55%). InfecÃÃes de vias aÃreas inferiores predominaram em crianÃas atà dois anos de idade. Cerca de 65,4% das infecÃÃes pelo vÃrus influenza foram diagnosticadas como infecÃÃes de vias aÃreas superiores. InfecÃÃes de vias aÃreas inferiores predominaram em crianÃas atà dois anos de idade (68,5%). Nos anos de 2003 e 2004 foram identificadas as variantes virais A/H3 e B do vÃrus influenza, com predominÃncia da primeira (78,7%) / The influenza virus is unique with it is ability to cause recurring annual epidemics in a short time interval, affecting all ages, with larger gravity in children and elderly people. The aim of this study is to describe demographic features and the pattern of the seasonality of acute respiratory infections caused by influenza virus in children attended at Albert Sabin Children Hospital, in Fortaleza â CearÃ, over the period of January period 2001 at July 2004. A total of 1950 samples of nasopharyngeal aspirates were collected from chidren with symptoms of acute respiratory infection. All samples were analyzed by indirect imunofluorescense assay (IFA). Forty seven Influenza A or B positive samples by IFA, in 2003 and 2004, were submitted to polimerase chain reaction with reverse transcription (RTPCR) for analysis of viral variant H1 and H3 and influenza b. A total of 156 samples were influenza A or influenza B positive, representing a prevalence rate of 8%. Among the viral infections, those caused by influenza viruses represented 24,1%. The influenza virus showed a pattern of regular annual occurrence, observed during the first semester of each year, correlated to the rainy periods. The peak of the epidemic periods of influenza preceded or occurred concomitantly to the national campaigns of vaccination. Influenza virus A and B cocirculated in all years of the study, with a significant predominance of the virus influenza A (91%) over influenza B (9%). Regarding to the medical care setting, the majority of the children with influenza infection were attended in ambulatories (48,7%) and emergency (39.7%). Eighteen children with influenza were attended in wards (11,5%). Regarding to the age of the children with influenza these infections predominated in children until two years of age. About 65,4% of the influenza infections were diagnosed as upper respiratory tract infections. Lower respiratory tract infection predominated in children until two years of age. In 2003 and 2004 were identified the variants A/H3 and B, with predominance of the first (78,7%)

As infecções respiratórias agudas são responsáveis por elevados índices de morbimortalidade. Desde sua descoberta em 2005, foi relatada presença de bocavírus humano (HBoV) com prevalência variando de 1,5% a 19%. Durante o período de estudo foram detectadas 153 amostras positivas para HBoV (14%) de 1113 amostras coletadas, sendo sete HBoV positivos na unidade neonatal. O HBoV ocupou a terceira posição em frequência de vírus respiratórios detectados. As crianças positivas para HBoV eram mais velhas, utilizaram mais antibióticos e apresentaram o diagnóstico de pneumonia com maior frequência (independente da presença de outros vírus coinfectantes) do que as crianças negativas. O HBoV circulou ao longo de todos os meses, com maior prevalência entre maio a agosto. Houve uma elevada taxa de codetecção (84%) com os demais 20 vírus respiratórios pesquisados. A análise filogenética encontrou apenas HBoV1. Esse achado contribui para a consolidação do HBoV1 como causador de doença respiratória aguda. / It is well established that respiratory viruses are an important cause of hospitalizations in young children worldwide. Since its discovery in 2005, many authors have reported detection of human bocavirus (HBoV) in children with respiratory infection with prevalence varying from 1.5% to 19%. During the study period we detected HBoV in 153 samples (14%) from 1113-screened samples; seven were from the neonatal unit. HBoV was the third most frequently detected virus. Children infected with HBoV were significantly older, used more antibiotics and had pneumonia more frequently diagnosed (irrespective of presence of other virus coinfection than those negative for HBoV. Seasonality of HBoV was characterized by year-round circulation with peaks in months of May through August. There was a high rate of co-detection (84%) with the other 20 respiratory viruses. Phylogenetic analysis revealed only HBoV1. This finding contributes to consolidate HBoV1 as cause of acute respiratory infection in children.

Abstract Respiratory syncytial virus (RSV) is one of the most common pathogens for early childhood respiratory tract infections. Most children are infected by RSV, approximately 1% of infants require hospital care. RSV infections are often accompanied by otitis media (OM). Surfactant proteins A and D (SP-A and SP-D) are involved in lung function and innate immunity. The proteins are capable of recognizing surface patterns in pathogens and function as a defense before the acquired immunity is developed. The Toll-like receptor (TLR) family is associated to several pathogens. The role of the TLR-family is to recognize pathogens and activate the immune defense. The aim of the thesis was to investigate the genetic association of RSV and OM infections in infants. A candidate gene approach was used study SP-A, SP-D and TLR4 in severe RSV bronchiolitis. Association between SP-A and OM was also studied. A case-control study setup was used for all studies. 1700 samples were collected for the studies. The results revealed genetic association between SP-A gene variation and severe RSV infections. SP-A allele 1A3 was overrepresented in RSV infants, the allele 1A was present more often in the control population. SP-D allele Met11 and genotype Met/Met were predisposing to severe RSV infections. The TLR4 gene did not show direct association with severe RSV. However, we showed for the first time difference in association in two separate epidemics. In the OM study, an association was shown between SP-A gene variations and otitis media in children. The present results have brought new information about innate defense and the genetic variations and associations involved. The results will help understand the mechanisms of innate defense and predisposition to infections. The results also present possibilities to investigate and develop new treatment strategies.

Abstract Acute rhinosinusitis is estimated to be one of the most common diseases in childhood. Still, the diagnostics and clinical relevance of this disease are controversial. Bacterial rhinosinusitis cannot be differentiated from mere rhinitis on clinical grounds alone. Abnormal radiologic findings have been found to be common in child and adult volunteers without sinus symptoms and in adults during viral upper respiratory infection. In children, the results of the few placebo-controlled studies on the benefit of antimicrobial treatment of clinically diagnosed acute rhinosinusitis are controversial. Bacteriologic cultures obtained from the middle meatus by rigid nasal endoscopy have been introduced as a way to determine the bacteriology of the maxillary sinus in adults, but they have not been studied in children with acute symptoms. In this thesis, incidental paranasal abnormalitites were found to be common in healthy school children examined by magnetic resonance imaging (MRI). Some of these abnormalities resolved during a follow-up period of 6 months, but new abnormalities appeared in some children. MRI abnormalities of the paranasal sinuses were found to be much more common in children with acute upper respiratory infections, and most of these abnormalities resolve spontaneously. Children with acute rhinosinusitis confirmed clinically and by imaging did not benefit from cefuroxime treatment as compared to placebo. Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) in the nasal middle meatus during acute upper respiratory infection predicted longer duration of the symptoms and signs of common cold. Based on these findings, imaging methods should not be used in the diagnostics of acute rhinosinusitis in children. Similarily, incidental imaging findings of abnormalities in the paranasal sinuses or in children with symptoms of acute rhinosinusitis are not an indication for antimicrobial treatment. Because middle meatal pathogenic bacteria were found to predict prolonged symptoms of upper respiratory infection, a randomized controlled trial is needed to evaluate the clinical value of middle meatal culture in identifying the children who would benefit from antimicrobial treatment during acute respiratory infection.

Influenza is an important respiratory pathogen that infects several million people each year. Currently available flu vaccines have to be updated regularly in order to be effective as the virus changes its composition by antigenic drift and shift. Most of the antibody response generated by these vaccines is strain specific as it is directed against the head domain (HA1) of HA. The HA2 subunit of hemagglutinin is highly conserved and immunogens designed from this subunit are likely to provide protection against multiple strains of the virus. However, expression of HA2 alone in the absence of HA1 resulted in a protein that took up the low pH conformation of HA. Our goal was to design immunogens from HA2 that would fold into the neutral pH form. Sequence analysis of a large number of HA protein sequences was carried out to identify conserved and exposed regions on HA. Several peptide and protein constructs were designed from the stem region of HA. These proteins were expressed in bacteria and purified proteins were used to immunize mice. Immunized mice were challenged with a lethal dose of virus to test for efficacy of the immunogen. Using this approach, stem domain constructs of HA were successfully designed and shown to take up the neutral pH form. These immunogens were also shown to be capable of providing broad range protection. Residues involved in the low pH induced conformational change of HA were identified from studies on HA2 derived peptides.

Orientador: Maria Rita Donalisio Cordeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T22:14:31Z (GMT). No. of bitstreams: 1 Ramalheira_RaquelMariaFerreira_M.pdf: 783396 bytes, checksum: 4c4dede3c21fce6bd0892ad98627ec66 (MD5) Previous issue date: 2006 / Resumo: Surtos de infecções respiratórias, particularmente pelo vírus influenza são comuns em instituições asilares, sendo a vacina a maneira mais eficaz de prevenção. Os objetivos desse trabalho foram: estudar a incidência de síndrome gripal no período de 15 meses e analisar a ocorrência de eventos adversos após vacinação contra influenza nos idosos de instituição asilar de Campinas, SP. Foram visitados semanalmente os indivíduos institucionalizados, SUS dependentes (N=154), moradores do Lar dos Velhinhos de Campinas para detecção de casos de síndrome gripal (SG) de junho de 2004 a agosto de 2005. Foram incluídos na pesquisa os indivíduos com condições de compreender e responder as perguntas e que consentiram em participar. Após a campanha vacinal contra influenza em abril de 2004, os idosos vacinados somente contra a influenza (cobertura de 95%) foram investigados no 5o dia após a aplicação do imunobiológico para detecção de sintomas sugestivos de eventos adversos, com nexo temporal com a vacina. Foram investigadas em modelo logístico múltiplo, co-variáveis possivelmente associadas à ocorrência de SG e de eventos adversos (variáveis dependentes). Dentre os 154 identificados acompanhados, 50 (32,5 por 100 moradores) apresentaram sintomas gripais. Foram encontrados 76 episódios de SG cuja distribuição temporal concentrou-se nos meses de junho de 2004 e 2005. A incidência de pelo menos um evento adverso foi de 14,3 por 100 vacinados. Entre as queixas pós-vacinais referidas, 12 (57,1%) foram de sintomas locais, sendo a dor no local da aplicação o evento de maior freqüência tanto nas mulheres (53,3%) quanto nos homens (50,0%). A ocorrência de eventos adversos bem como de quadro de SG não se associaram a nenhuma co-variável testada nos modelos logísticos. Embora com altas coberturas, houve indícios de circulação de vírus de tropismo respiratório na instituição. Ressalta-se a importância de manter altas as coberturas vacinais contra influenza nos moradores e funcionários, além de incrementar medidas de prevenção de doenças de transmissão por secreções. A baixa reatogenicidade da vacina pode facilitar a adesão às campanhas. A vigilância etiológica da SG poderá dar mais subsídios para a compreensão da dinâmica de circulação de patógenos em populações de risco / Abstract: Respiratory infection, particularly influenza outbreaks are common in institutionalized individuals. Vaccination is the most efficient prevent measure. The aim of this work were: to study respiratory infection incidence in institutionalized elderly subjects in 15 months period and to analyze the occurrence of adverse effects after influenza vaccination in a nursing home in Campinas, São Paulo State. SUS dependent elderly people (N= 154) living in Lar dos Velhinhos de Campinas were visited weekly to detect flu like syndrome from June 2004 to August 2005. It was included individuals with ability to understand and to answer research questions and those who accept to participated. After influenza vaccination campaign of April 2004 (coverage 95%) individuals were investigated in the 5-day to discover vaccine side events. A multiple logistic models were applied to investigate association between co variables and flu like syndrome and adverse events (dependent variables). Among the 154 subjects, it was identified 50 (32.5%) individuals witch present flu like symptoms during study period. Temporal trend of the 76 episodes showed concentration in June 2004 and 2005. Incidence of at least one side effect was 14.3 per 100 vaccinated residents. Local symptoms were referred by 12 (57.1%) individuals, whereas the most frequent complain was local pain in women (53.3%) and men (50%). Neither side effects nor flu like syndrome were associated with co variables in the logistic models. Despite high influenza coverage levels it was detected respiratory virus circulation in the nursing home. It is reinforced the importance of influenza vaccination of residents and staff, and also improvement of routine measures to prevent secretion transmission disease. The safety and low reatogenity of influenza vaccine may help campaign adhesion. Etiologic surveillance of flu like syndrome could improve understanding of the pathogens circulation among risk population / Mestrado / Epidemiologia / Mestre em Saude Coletiva

The close proximity of the United States to the Mexican border poses a concern for communicable diseases because of the high flow of population movement. The purpose of this retrospective, quantitative study was to identify risks associated with respiratory diseases using an analysis of archived data from the Severe Acute Respiratory Illness (SARI) surveillance program. Based on the epidemiologic triangle theory, demographic and etiologic factors were analyzed to examine any associations with SARI in this population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336 (42.1%) testing positive for respiratory pathogens. Chi square analysis determined that age (X2 (4, N = 786) = 255.361, p < 0.001), clinic location (X2 (3, N = 780) = 290.841, p < 0.001), and race/ethnicity (X2 (4, N = 762) = 1456.701, p < 0.001) showed significant associations with SARI in the population. The logistic regression model showed that the youngest age group (0-4) had the highest risk of developing SARI compared to other age groups (5-24 OR = 0.521, 95% CI [0.311-0.871]; 25-49 OR = 0.377, 95% CI [0.224-0.636]; 50-64 OR = 0.211, 95% CI [0.118-0.376]; >65 OR = 0.225, 95% CI [0.143-0.356]. African Americans were also at higher risk of developing SARI compared to Hispanic Americans (OR = 3.997, 95% CI [1.272-12.558]. This study promotes positive social change by informing efforts to increase vaccination and health literacy, improve the accessibility and availability of preventive health care in low socioeconomic communities, and promote healthy lifestyles among at-risk groups. These steps will improve the overall health of the communities along the U.S.-Mexico border region.

Introduction and Rationale: Household Air Pollution (HAP) refers to the pollution of air in the indoor environment, from the combustion of solid fuels such as biomass and coal. The World Health Organization (WHO) estimates that 2.6 billion people today are exposed to HAP daily. Women and children tend to be at a higher risk of exposure due to their increased time spent indoors. This can result in a range of adverse cardio-respiratory outcomes such as asthma, Acute Lower Respiratory Infection (ALRI) and Chronic Obstructive Pulmonary Disease (COPD). This thesis document investigates the association between HAP and the adverse respiratory outcomes, namely lung function, ALRI and asthma in children. Methodology: Systematic Reviews were conducted to synthesize the effect of HAP on lung function, ALRI, and asthma. The lung function outcome was synthesized in a narrative manner, while the pooled estimates for the ALRI and asthma outcomes were synthesized by meta-analysis. Results: Exposure to HAP is associated with decreased lung function growth, and an increased risk of the incidence of ALRI in children. No association was noted between HAP exposure and the incidence of asthma in children. Conclusion: The effect of HAP on childhood growth of lung function and the incidence of ALRI provides evidence justifying the universal transition to cleaner fuels and technologies, such as electricity and natural gas. / Thesis / Master of Science (MSc) / Household Air Pollution (HAP) refers to the pollution of indoor air caused by the combustion of solid fuels, such as biomass, for the purposes of heating and cooking. According to the World Health Organization (WHO), 2.6 billion people are exposed to HAP daily. Women and children are especially at high risk of exposure, due to the time spent indoors. This places them at a higher risk of adverse respiratory outcomes, such as Acute Lower Respiratory Tract Infection (ALRI), asthma, Chronic Obstructive Pulmonary Disease (COPD) and reduced lung function. This thesis document investigates the association between HAP and the adverse respiratory outcomes, namely lung function, ALRI and asthma in children. It was found that HAP is associated with a decrease in childhood lung function growth, and an increased risk of the incidence of ALRI. However, there was no clear association between the incidence of asthma and HAP. The results of the systematic reviews justify a transition from the use of solid fuels to clean fuels and technologies.