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Thesis (PhD) - Faculty of Life and Social Sciences, Swinburne University of Technology, 2007. / Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Life and Social Sciences, Swinburne University of Technology - 2007. Typescript. "September 2007". Includes bibliographical references (p. 173-204).

No description available.

Objectives This study focuses on the evaluation of the use of vaccine in the prevention of severe acute gastroenteritis in the community in the literature. The objectives of this project report include an in depth review of the effectiveness and cost effectiveness of rotavirus vaccination for severe acute gastroenteritis in low and middle income countries (developing countries). Methods Publications were identified using computerized bibliographic searches in PubMed (for the period from October 1994 to July 2012). The keywords “effective*”, “vaccin*”, “rotavirus” , “Randomized controlled trial” were used to search for relevant information. Also the keywords “轮状病毒”, “疫苗” , “随机对照试验” were used to search for relevant information in China Journals Full-text Database(中国期刊全文数据库). Selection criteria: SSRandomized controlled trials (RCT) in children (<5 years old) comparing rotavirus RV1/RV5/LLR vaccines for use with (1) placebo, (2) no intervention, or (3) another RV1/RV5/LLR vaccine. Once the identified articles had been screened by the inclusion and exclusion criteria, the content of each was evaluated in relation to the two research questions. International guidelines: CONSORT (for RCT) was also followed in the quality assessment process. Results In our review, there were 9 studies included and 2 of them were graded A(i.e. good quality), 5 graded B(i.e. medium quality) and 2 graded C(i.e. poor quality). For the two Grade A studies, vaccine effectiveness was estimated to be 39.3% and 48.3%. For 5 Grade B studies, vaccine effectiveness was estimated to be 19.2% to 63.9%. For 2 Grade C studies, vaccine effectiveness was estimated to be 10.6% and 74.3%. There is a smaller range in vaccine effectiveness in grade A studies. In contrast, there is a greater range in vaccine effectiveness in grade B and C studies. Many low and middle income countries may not have enough training in conducting RCT. However, the Grade A studies showed that rotavirus vaccine is effective. Our review also showed that authors from most of the low income countries suggested that rotavirus vaccine is cost effective to very cost effective, while those from middle income countries suggested that the cost of the vaccine is the key factor. Conclusion This review showed evidence of effectiveness of rotavirus vaccine and cost-effectiveness in low and middle income countries (developing countries). China has a huge population and similar situation with other developing countries, hence it is useful to conduct a study on cost-effectiveness on universal vaccination in the near future. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xxii, 276 p .; also includes graphics Includes bibliographical references. Available online via OhioLINK's ETD Center

Thesis(Ph.D.)--Case Western Reserve University, 2010 / Title from PDF (viewed on 2010-01-28) Department of Epidemiology and Biostatistics Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center

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

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

Thesis (PhD)--Montana State University--Bozeman, 2008. / Typescript. Chairperson, Graduate Committee: Michele Hardy. Includes bibliographical references (leaves 141-173).

Orientador: Maria Silvia Viccari Gatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-11T09:06:47Z (GMT). No. of bitstreams: 1 Martini_IzabelJulien_M.pdf: 1690786 bytes, checksum: ad68ca07a7cffdeef9fcdd571b9ae911 (MD5) Previous issue date: 2007 / Resumo: Gastroenterites e diarréias, doenças comuns em humanos, são responsáveis por altas taxas de morbidade e mortalidade em todo o mundo. Os rotavírus são um dos principais agentes dessas doenças, acometendo principalmente crianças com idade inferior a três anos. Esses vírus pertencem à família Reoviridae, gênero Rotavirus, não envelopados e de simetria icosaédrica. Seu genoma é composto por 11 segmentos de RNA dupla fita que podem separar os rotavírus em sete grupos (RV-A a RV-G), dada a migração desses segmentos em eletroforese em gel de poliacrilamida (EGPA). Os RV-A estão mais frequentemente associados a infecções no homem e em outros animais. Os rotavírus apresentam três camadas protéicas concêntricas, com o capsídeo externo contendo a proteína VP4 e a glicoproteína VP7, indutoras de anticorpos neutralizantes. Variações nas seqüências de nucleotídeos dos segmentos genômicos que codificam para essas proteínas diferenciam os rotavírus em genotipos G (VP7) e [P] (VP4). A distribuição desses genótipos é variável nos diferentes países e a utilização da técnica de semi-nested RT-PCR permite a caracterização dos genotipos circulantes, o que é importante para a definição de estratégias vacinais contra esses vírus. O uso de diferentes vacinas contra a rotavirose vem sendo implementado, inclusive no Brasil. Nesse trabalho o objetivo foi caracterizar os genotipos de rotavírus associados a surtos de diarréia em humanos, ocorridos na cidade de Campinas, SP, Brasil, nos anos de 2003 e 2004. Das 328 amostras de fezes estudadas, 98 foram positivas para rotavírus em EGPA, sendo 96 delas RV-A e duas RV-C. Todas as amostras positivas em EGPA para RV-A e outras 96 amostras negativas nesse teste foram submetidas à genotipagem G (G1 a G6 e G8 a G10) e P (P[4] e P[8]). Com os resultados obtidos concluiu-se que a técnica de seminested RT-PCR foi mais sensível na detecção de rotavírus (73,9%) que a EGPA (50,0%) (?2=67,06, valor-p= 0,000 e Kappa= 0,52).Os genotipos de rotavírus mais freqüentes nas amostras coletadas no ano de 2003 (n=38) foram: G1P[8] (38,4%), G3P[8] (15,4%), G5P[8], G9P[8] (7,8%) e G2P[4] (3,9%). Para as amostras enviadas em 2004 (n=290) os genotipos mais freqüentes foram: G3P[8] (18,7%), G9P[8] (13,9%), G1P[8] (8,4%), G5P[8] (6,0%) e G4P[8] (5,4%). A proporção de identificação do genotipo G1P[8] no ano de 2004 foi significativamente maior no ano de 2004 (Z= 3,07; valor-p=0,002). O genotipo emergente G9 foi identificado em 13,5% (n= 26) das amostras estudadas. Infecções mistas com os genotipos G1 e G2, G1 e G8, G2 e G3, G3 e G5 e G5 e G8 foram identificadas em oito amostras de fezes (4,1%). Nas regiões Sul e Sudoeste de Campinas, consideradas como menos favorecidas socio-economicamente, foi verificada maior variabilidade de genotipos circulantes nos dois anos de análise. Os dados obtidos poderão contribuir para a verificação da eficácia da vacina em uso no Brasil contra a rotavirose / Abstract: Gastroenteritis and diarrhea are a important cause of morbidity and mortality worldwide. Rotavirus is the most important etiologic agent of these disorders in infants and young children. These viruses, which form a genus of the Reoviridae family, are icosahedral, non-enveloped and their genome consists of 11 segments of double stranded RNA. When submitted to electrophoresis in polyacrylamide gels the RNAds of rotaviruses classify these viruses into seven groups (RV¿A to RV-G). Group A rotaviruses have been established as the most common cause of severe infections in human and other animals worldwide. The genome of rotaviruses is surrounded by three concentric protein layers. The outer capsid consists of VP4 and VP7 that carry neutralization and protective antigens and allow classification into P and G genotypes, respectively. The VP7 serotype is designated as G serotype (VP7 is a glycoprotein), whereas the VP4 serotype is designated as [P], from protease-sensitive. Many studies have been showed fluctuations in the distribution of rotavirus G-P combinations in many countries, using the seminested RT-PCR. These data, in relation of the circulation of different rotavirus genotypes, are important to establish rotavirus vaccine programs. Since a universal immunization of infants with rotavirus vaccine was introduced in Brazil, it becomes important to characterize rotavirus genotypes associated with diarrhea in humans from Campinas, SP, Brazil, in the years of 2003 and 2004. From 328 faecal samples, 98 were positive to rotavirus in polyacrylamide gel electrophoresis (PAGE), being 96 of them belonging to group A and two to RV-C. All the positive samples in PAGE for RV-A and another 96 negative samples to this test were submitted to semi-nested RT-PCR for G (G1 to G6 and G8 to G10) and P (P[4] and P[8]) genotypes determination. The results obtained showed that that semi-nested RT-PCR was more sensitive to the detection of rotavirus (73.9%) than the PAGE (50.0%) (?2=67.06, p= 0,000 and Kappa= 0,52). In 2003, in 38 faecal samples analyzed were identified as the genotypes G1P[8] (38.4%), G3P[8] (15.4%), G5P[8] (7.8%), G9P[8] (7.8%) and G2P 4] (3.9%). For the samples sent in 2004 (n=290), the genotypes G3P[8] (18.7%), G9P[8] (13.9%), G1P[8] (8.4%), G5P[8] (6.0%) and G4P[8] (5.4%) were identified. The genotype G1P[8] was identified in a higher proportion in 2004 than in 2003 (Z=3.07; p=0.002). The emergent genotype G9 was detected in 13.5% of the samples studied. Mixed infections, with G1 and G2, G1 and G8, G2 and G3, G3 and G5 and G5 and G8 were identified in eight faecal samples (4.1%). In the regions of South and Southwestern of Campinas, both of them considered as less socio-economically favored, a high variability of genotypes circulating in the two years of the study was verified. With these data will be able to contribute to the verification of the effectiveness of vaccines in use in Brazil against rotaviruses / Mestrado / Microbiologia / Mestre em Genética e Biologia Molecular