Thesis (M. P. H.)--University of Hong Kong, 2007. / Also available in print.

Thesis (Ph.D.)--University of Western Australia, 2007.

Thesis (Ph.D.)--Aberdeen University, 2008. / Title from web page (viewed on June 11, 2009). Includes bibliographical references.

<b>Introduction:</b> Respiratory Syncytial Virus is the major viral cause of lower respiratory tract disease in young children worldwide, with the greatest burden of disease in infants aged 1-3 months. Consequently, vaccine development has centered on a vaccine to directly protect the infants in this age group. The fundamental problem is that these young infants are poor responders to candidate RSV vaccines. This thesis focuses on the use of mathematical models to explore the merits of vaccination. <b>Methods:</b> Following development and analysis of a simple non-age-structured ODE model, we elaborate this to a Realistic Age Structured model (RAS) capturing the key epidemiological characteristics of RSV and incorporating age-specific vaccination options. The compartmental ODE model was calibrated using agespecific and time series hospitalization data from a rural coastal Kenyan population. The determination of Who Acquires Infection From Whom (WAIFW) matrix was done using social contact data from 1) a synthetic mixing matrix generated from primarily household occupancy data and 2) a diary study that we conducted in the Kilifi Health and Demographic Surveillance System (KHDSS). The vaccine was assumed to elicit partial immunity equivalent to wild type infection and its impact was measured by the ratio of hospitalized RSV cases after to before introduction. of vaccination. Uncertainty and sensitivity analysis were undertaken using Latin Hypercube Sampling (LHS) and partial rank correlation respectively. Given the importance of households in the transmission of respiratory infections, an exploratory household model was developed to capture the transmission dynamics of RSV A and B in a population of households. <b>Results:</b> From the analytical work of the simple ODE model, we have demonstrated that the model has the potential to exhibit a backward bifurcation curve within realistic parameter ranges. Both the diary and the synthetic mixing matrices had similar characteristics i.e. strong assortative mixing in individuals less than 30 years old and strong mixing between children less than 5 years and adults between 20 and 50 years old. When the two matrices were jointly linearly regressed, their elements were well correlated with an R2 ~ 0.6. The RAS model was capable of capturing the age-specific disease and the temporal epidemic nature of RSV in the specified location. Introduction of routine universal vaccination at ages varying from the first month of life to the 10th year of life resulted in optimal long-term benefit at 7 months (for the diary contact model) and 5 months (for the synthetic contact model). The greatest benefit arose under the assumption of age-related mixing with the contact diary data with no great deal of effectiveness lost when the vaccine is delayed between 5 and 12 months of age from birth. Vaccination was also shown to change the temporal dynamics of RSV hospitalizations and also to increase the average age at primary infection. From the sensitivity analysis, we identified the duration of RSV specific maternal antibodies, duration of primary and tertiary infections as the most important parameters in explaining the imprecision observed in predicting both the age specific hospitalizations and the optimal month at vaccination. Results from the household model have demonstrated that the household epidemic profile may be different from the general population with strong interaction of the viruses in the household that do not necessarily reflect at the population level. <b>Conclusion:</b> The synthetic matrix method would be a preferable alternative route in estimating mixing patterns in populations with the required socio-demographic data. Retrospectively, the synthetic mixing data can be used to reconstruct contact patterns in the past and therefore beneficial in assessing the effect of demographic transition in disease transmission. Universal infant vaccination has the potential to significantly reduce the burden of RSV associated disease, even with delayed vaccination between 5 and 12 months. This age class represents the group that is being targeted by vaccines that are currently under development. More accurate data measuring the duration of RSV specific maternal antibodies and the duration of infections are required to reduce the uncertainty in the model predictions.

As infecções respiratórias agudas (IRA) são as doenças infecciosas mais frequentes em seres humanos e os vírus respiratórios são os agentes de maior ocorrência na etiologia das mesmas. Os coronavírus humanos (HCoVs) são reconhecidos como causa comum de infecções do trato respiratório superior e, menos comumente, do trato respiratório inferior. Dados da ocorrência do HCoV na população brasileira são escassos. O presente estudo tem por objetivo avaliar a ocorrência de HCoV em crianças acometidas por IRA atendidas no Hospital Universitário da Universidade de São Paulo , São Paulo-SP, entre o período de 1995 a 2008. Amostras em cDNA foram utilizadas em ensaio de PCR em Tempo Real para detecção dos 4 tipos de coronavírus. Amostras positivas foram utilizadas em ensaio de PCR convencional e posteriormente tipificadas por sequenciamento. Amostras negativas pelo método de PCR convencional foram tipificadas através de PCR em Tempo Real e Nested PCR específico para cada tipo de HCoV. Quatrocentos e dez amostras foram positivas pelo ensaio de PCR Real Time, sendo o coronavírus detectado em 8.94% das amostras. Duzentos e noventa e oito amostras foram tipificadas, sendo o tipo OC43 o de maior ocorrência, seguido pelos tipos NL63; HKU1 e 229E. / Acute respiratory infections (ARI) are the most common infectious diseases in humans and respiratory viruses are the most frequent agents in the etiology of the same. The human coronaviruses (HCoVs) are recognized as a common cause of upper respiratory tract infections and, less commonly, lower respiratory tract. Data from the occurrence of HCoV in the Brazilian population are scarce, despite the high incidence of respiratory infections during the winter. This study aims to evaluate the occurrence of HCoV in children affected by acute respiratory infections treated at University Hospital of São Paulo (USP), São Paulo-SP, between the periods 1995 to 2008. Samples of cDNA were screened by Real Time PCR for detection of the four types of coronavirus. Positive samples were used in standard PCR assay and subsequently typed by sequencing. Samples positive by Real Time but negative by standard PCR assay were typed by specific Nested PCR and Real-Time for each type of HCoV. Four hundred and ten samples were positive by Real Time PCR assay, and the occurrence of coronaviruses in our samples of 8.94%. Two hundred and ninety eight were typed, the type OC43 being the most frequent, followed by the recently discovered types, NL63 ; HKU1 and HCoV-229E.

M.Tech. (Homoeopathy) / The common cold is an acute viral infection of the respiratory tract, usually afebrile in nature. It is characterized by inflammation of the airways (Beers and Porter 2006). Influenza, commonly referred to as “flu”, is an acute and highly contagious viral infection of the respiratory tract. It is easily spread by sneezing and coughing (Balch, 2006). Conventional medication typically includes: aspirin, nasal decongestants, antihistamines, non-steroidal anti-inflammatory drugs and antiviral drugs, but these substances may produce unwanted side-effects. If a secondary bacterial infection develops, antibiotics are added (Beers, 2003). Linctagon® Forte Capsules are a self-help proprietary medication by Nativa containing Pelargonium sidoides, Quercetin, Bromelain and Zinc, and is used for the treatment of colds and influenza (Nativa, 2011), but further research is required for this product. The aim of this study was to determine the efficacy of Linctagon® Forte Capsules on the symptoms of colds and influenza of female resident students between the ages of eighteen and thirty five years at the University of Johannesburg. Efficacy was determined by means of a modified “Severity of Symptoms Questionnaire” and a modified “Quality of Life Questionnaire”. Thirty female participants, aged between 18 and 35 years, with symptoms of common cold and influenza, were recruited in this double-blind, placebo-controlled randomized study, according to the inclusion and exclusion criteria. Participants were recruited by means of advertising flyers and posters at the University of Johannesburg (UJ) campuses as well as the University of Johannesburg female residences. Participants that presented with any of the common cold or influenza symptoms were to immediately contact the researcher to set up an initial interview. The study was conducted over an eight day period with a total of three consultations. During the first consultation, the participants were requested to sign a “Participant Profile Form”, a “Participant Information and Consent Form” and undergo the relevant physical examinations. Participants were then given either the placebo capsules or the Linctagon® Forte Capsules and instructed to take one capsule three times daily. Participants were also requested to complete a modified “Severity of Symptoms Questionnaire” and a modified “Quality of Life Questionnaire” every evening for the duration of the study. All data collected during the study was statistically analysed using Chi Square as well as the Descriptive Analysis (Smith, 2011).

Best Practices: Antibiotic Stewardship and the Implementation of Evidence-Based Guidelines During Upper Respiratory Infections Among Rural, Primary Care Patients Sandra Kay Johnson, Doctor of Nursing Practice Candidate East Tennessee State University College of Nursing Abstract Antimicrobial resistance is a challenging clinical issue seen in the treatment of upper respiratory infections (URIs). Purpose/Aims: The purpose of this project is to implement an antibiotic stewardship (AS) program using antibiotic prescribing guidelines for URIs and clinic-wide patient education. The aim was to reduce antibiotic overuse. Processes: This quality improvement (QI) project was conducted at a rural clinic. Participants included the nurse practitioners and office staff. The target population included adult patients, ages 18 and up, who presented with upper respiratory symptoms. URI prescribing guidelines were used to compare antibiotic prescribing practices pre- and post-intervention. The initiative includes a provider education session and educational videos, posters, and scientific literature, which is available to those assessing the clinic. Educational materials were from the Centers for Disease Control and Prevention, the United States Department of Health and Human Services, and the National Center for Emerging Zoonotic Infectious Diseases. The Knowledge-to-Action framework was used to translate research into practice and data was collected through the administration of questionnaires and the review of EMRs. Results: Preliminary results suggest patient preferences, outside of guidelines, may influence prescribing behaviors. Limitations: The sample of providers was small and may not be characteristic of a larger group. Conclusions: This QI initiative was driven by the need to improve practice and educate patients regarding AS during upper respiratory-related illnesses. Preliminary evidence shows interventions such as patient education, implementation of guidelines, and identification of barriers and facilitators are all vital components of AS.

Background: Acute respiratory infections (ARIs) represent an important cause of morbidity and mortality in children, remaining a major public health concern, especially affecting children under 5 years old from low-income countries. Unfortunately, information regarding their epidemiology is still limited in Peru. Methods: A secondary data analysis was performed from a previous cross-sectional study conducted in children with a probable diagnosis of Pertussis from January 2010 to July 2012. All samples were analyzed via Polymerase Chain Reaction (PCR) for the following etiologies: Influenza-A, Influenza-B, RSV-A, RSV-B, Adenovirus, Parainfluenza 1 virus, Parainfluenza 2 virus, Parainfluenza 3 virus, Mycoplasma pneumoniae and Chlamydia pneumoniae. Results: A total of 288 patients were included. The most common pathogen isolated was Adenovirus (49%), followed by Bordetella pertussis (41%) from our previous investigation, the most prevelant microorganisms were Mycoplasma pneumonia (26%) and Influenza-B (19.8%). Coinfections were reported in 58% of samples and the most common association was found between B. pertussis and Adenovirus (12.2%). Conclusions: There was a high prevalence of Adenovirus, Mycoplasma pneumoniae and other etiologies in patients with a probable diagnosis of pertussis. Despite the presence of persistent cough lasting at least two weeks and other clinical characteristics highly suspicious of pertussis, secondary etiologies should be considered in children under 5 years-old in order to give a proper treatment. / Revisión por pares

Objective: This study aimed to determine the prevalence of A. baumannii in children aged less than 1 year admitted with a clinical diagnosis of whooping cough. Results: A total of 225 nasopharyngeal samples from children under 1 year old hospitalized with clinical diagnosis of whooping cough were studied from January 2010 to July 2012. The presence of A. baumannii was detected in 20.89% (47/225) of the nasopharyngeal swab samples. Among the 47 patients with A. baumannii: 5 were diagnosed with A. baumannii monoinfection, 17 co-infection with bacteria, 7 co-infection with virus and 18 co-infection with bacteria + virus. It was observed that 51.6% (116/225) were children between 29 days and 3 months old, this same group had the highest overall prevalence with 53.3%. The most common co-infecting pathogens were Bordetella pertussis in 55.3%, Adenovirus in 42.6% and Mycoplasma pneumoniae in 23.4%. / Revisión por pares

Thesis (D.P.H.)--University of Michigan.