Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O estudo teve como objetivo construir e validar quanto ao conteÃdo e aparÃncia uma cartilha educativa para a prevenÃÃo da transmissÃo vertical do HIV. Tratou-se de uma pesquisa metodolÃgica. Para realizaÃÃo do estudo, seguiram-se as etapas: submissÃo do projeto ao comità de Ãtica em pesquisa; levantamento bibliogrÃfico; elaboraÃÃo da cartilha e validaÃÃo do material por juÃzes especialistas e representantes do pÃblico-alvo. Implementou-se, inicialmente, o levantamento bibliogrÃfico a partir de 15 publicaÃÃes do MinistÃrio da SaÃde do Brasil acerca dos cuidados que as mÃes devem ter para a prevenÃÃo da transmissÃo materno-infantil do HIV. A cartilha construÃda foi intitulada âComo prevenir a transmissÃo do HIV de mÃe para filho? Fique por dentro!â, abordando os cuidados para a prevenÃÃo da transmissÃo vertical desde o prÃ-natal, perpassando pelo parto e puerpÃrio. Na etapa de elaboraÃÃo da cartilha, foram elaborados os textos a partir das informaÃÃes levantadas na pesquisa bibliogrÃfica e consultada uma especialista em desenho para confeccionar as figuras. Para a validaÃÃo de aparÃncia e conteÃdo, foram selecionados nove juÃzes conforme critÃrios prÃ-estabelecidos e para a validaÃÃo de aparÃncia pelo pÃblico-alvo, foram selecionadas 30 mulheres, sendo 23 gestantes e 7 puÃrperas HIV positivas, captadas em duas maternidades pÃblicas da cidade de Fortaleza-Ce. O perÃodo de coleta de dados com juÃzes e mulheres se deu entre agosto e dezembro de 2013. Para a coleta de dados, foram utilizados dois instrumentos, um direcionado aos juÃzes e outro para o pÃblico-alvo. Quanto à validade de conteÃdo da cartilha, foi utilizado o Ãndice de Validade de ConteÃdo (IVC), com ponto de corte de 0,78. Quanto à validade de aparÃncia pelos juÃzes e pÃblico-alvo, foram considerados validados os itens que obtivessem nÃvel de concordÃncia mÃnimo de 75% nas respostas positivas. As sugestÃes e opiniÃes foram compiladas e apresentadas em quadros. A cartilha educativa em estudo foi a primeira a ser desenvolvida dentro da temÃtica e mostrou-se como um material validado, visto que apresentou bom IVC global de 0,87 e nÃvel de concordÃncia excelente entre juÃzes, variando de 91,1% a 100% e o pÃblico-alvo que oscilou de 93,3% a 100%. Diante das sugestÃes e contribuiÃÃes durante o processo de validaÃÃo, a cartilha passou por modificaÃÃes, ajustes e acrÃscimos a fim de tornÃ-la mais eficaz, de forma que a cartilha passou de 20 pÃginas para 28 em sua versÃo final. Acredita-se que o uso deste material com mulheres HIV positivas, desde o perÃodo prÃ-concepcional atà o pÃs-parto, facilitarà a prÃtica da enfermagem, tendo em vista que se constitui em uma tecnologia ilustrada capaz de favorecer o diÃlogo entre profissionais e mulheres, facilitar a aquisiÃÃo de conhecimentos e proporcionar o empoderamento das mulheres, gestantes e puÃrperas HIV positivas. / The study aimed to construct and validate the contents and appearance of an educational booklet for the prevention of vertical transmission of HIV. This was a methodological research. To conduct the study, we followed the steps: submission of the project to the research ethics committee; literature survey; development and validation of material by expert judges and representatives of the target audience. Initially it was implemented the bibliographic from 15 papers of the Ministry of Health of Brazil about the care that mothers should have for the prevention of mother to child transmission of HIV. The booklet developed was titled "How to prevent transmission of HIV from mother to child? Get inside!", addressing care for the prevention of vertical transmission in pre-natal, childbirth and postpartum. In the preparation of the primer stage, the texts were compiled from the information gathered in the literature and consulted one expert in design for making the figures. Nine judges were selected to validate appearance and content, according to pre-established criteria and to validate appearance by the target audience, 30 women were selected, with 23 pregnant and 7 postpartum HIV positive captured in two public hospitals in the city of Fortaleza - Ce. The period of data collection with judges and women occurred between August and December 2013. To collect data, two instruments, one directed to the judges and one for the target audience, were used. For the validity of the content of the booklet, we used the Content Validity Index ( CVI ), with a cutoff of 0.78. For the validity of appearance by the judges and audience were considered validated items that obtain a minimum level of agreement of 75 % for positive responses. The suggestions and opinions were collated and presented in tables. The educational booklet in the study was the first to be developed within the theme and showed up as a validated material, since it showed good overall CVI of 0.87 and excellent level of agreement between judges, ranging from 91.1% to 100% and between the audience that ranged from 93.3% to 100% . Given the suggestions and contributions during the validation process, the booklet has undergone modifications, adjustments and additions to make it more effective, so that the playbook went from 20 pages to 28 in the final version. It is believed that the use of this material with HIV positive women from pre-conception period to the postpartum facilitate nursing practice, because that is illustrated in a technology capable of promoting dialogue between professionals and women, facilitate the acquisition of knowledge and provide the empowerment of women, HIV positive pregnant women and postpartum women.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T13:47:09Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MargareteReginattoGiacomini.pdf: 2673689 bytes, checksum: 26438120dfcc7521140bab509eb60121 (MD5) / Made available in DSpace on 2018-08-22T13:47:09Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_MargareteReginattoGiacomini.pdf: 2673689 bytes, checksum: 26438120dfcc7521140bab509eb60121 (MD5) Previous issue date: 2017-06-26 / The objective of the present study was to delineate the epidemiological profile of pregnant women diagnosed with HIV/aids, syphilis and hepatitis B and C, notified in 2015, in a tertiary care regional referral service. As specific objectives: to present the epidemiological profile of the pregnant women notified in 2015 to the group responsible for the Maternal and Child Care Line of the hospital where the research was carried out, and to prepare a newsletter aiming at helping the visibility of the data to list the priorities of the team's actions. This is a cross-sectional retrospective study performed at a reference hospital in the central region of Rio Grande do Sul. Data collection took place in November and December 2016 and January 2017, through consultation in the system and notification forms of the Nucleus of Hospital Epidemiological Surveillance. From the survey, 179 cases of STI were identified in pregnant women in the year 2015. The age of women ranged from 15 to 41 years. The provenance of the pregnant women showed that many are coming from small municipalities of the central region of Rio Grande do Sul, considering that this hospital is a reference for this region. The product resulting from this work consisted of two articles of a newsletter, widely distributed and disseminated in the service in which the research was developed. As benefits, after the collection and analysis of the data, the results obtained were presented to the service, which allowed the knowledge of the situational diagnosis that could guide the planning of surveillance actions, prevention and control of the vertical transmission of STIs in municipalities of the 4th CRS, since HUSM is a reference in the hospital service for the region. / O presente trabalho teve por objetivo geral delinear o perfil epidemiológico das gestantes com diagnóstico de HIV/aids, sífilis e hepatites B e C, notificadas no ano de 2015, em um serviço de referência regional de atenção terciária. Como objetivos específicos: apresentar o perfil epidemiológico das gestantes notificadas no ano de 2015 ao grupo condutor da Linha de Cuidado Materno Infantil do hospital onde desenvolveu-se a pesquisa, e elaborar boletim informativo visando auxiliar a visibilidade dos dados para elencar prioridades de ações da equipe. Trata-se de um estudo transversal retrospectivo realizado em hospital de referência da região central do Rio Grande do Sul. A coleta de dados ocorreu de novembro e dezembro de 2016 e janeiro de 2017, por meio de consulta no sistema e fichas de notificação do Núcleo de Vigilância Epidemiológica Hospitalar. Do levantamento realizado, foram identificados 179 casos de IST em gestantes no ano de 2015. A idade das mulheres variou de 15 a 41 anos. A procedência das gestantes evidenciou que muitas são advindas de municípios de pequeno porte da região central do Rio Grande do Sul, tendo em vista que este hospital é referência para esta região. O produto resultante deste trabalho constou de dois artigos e boletim informativo, amplamente distribuído e divulgado no serviço no qual desenvolveu-se a pesquisa. Como benefícios, após o término da coleta e análise dos dados, os resultados obtidos foram apresentados ao serviço, o que permitiu o conhecimento do diagnóstico situacional que poderá balizar o planejamento de ações de vigilância, prevenção e controle da transmissão vertical das ISTs, nos municípios da 4ª CRS, visto que o HUSM é referência no serviço hospitalar para a região.

Made available in DSpace on 2014-07-29T15:30:43Z (GMT). No. of bitstreams: 1 Dissertacao Aline A Barbaresco.pdf: 3370221 bytes, checksum: 707471f496b902352a55ab3c490d78b1 (MD5) Previous issue date: 2009-11-05 / The infection caused by Toxoplasma gondii, Trypanosoma cruzi, Rubella virus, Cytomegalovirus (CMV) and Treponema pallidum, can reach the fetus via the placenta or transamniótica may cause different damage. The severity of the infection or even abortion, depend on the virulence of the strain of microorganism, the immune response of the mother and the period. The aim of this study was to analyze the results of serological, pathological and parasitological material for abortive infections with risk of vertical transmission, with emphasis on toxoplasmosis. They were invited to participate in the study, women who miscarried and complete or incomplete, attended at two public hospitals in Goiânia, Goiás, between the period June 2008 to June 2009. Were interviewed through a questionnaire and collected blood samples and abortive material. There were immunologic tests for toxoplasmosis, Chagas disease, rubella, cytomegalovirus and syphilis and pathology in cytogenetic. 55% of women were aged 20 to 30 years of age. The majority (68%) had gestational ages ranging from 7-14th weeks. 54.3% of women had completed high school or incomplete. Regarding the number of abortions, most women (69%) had only one abortion and minority (2.9%) were already in the fourth or fifth abortion. For the analysis of serology, infection with the risk of vertical transmission was more frequent with the CMV 97.1% positivity and then the rubella 95.2%. Toxoplasmosis has a percentage of 54.3%, Chagas disease by 1.9% and syphilis by 0.95%. The analysis of the biopsy showed that 63.1% showed inflammation and 34% absence of inflammation. Analysis of serological, pathological and parasitological of 105 women, 57 were seropositive for T. gondii. It was observed that 77.1% showed inflammation, detected in pathological examination. None has tested positive for Polymerase Chain Reaction (PCR) and inoculation in mice. This study demonstrated the high frequency of seropositive for CMV and rubella then toxoplasmosis, Chagas disease and syphilis in our country. The elucidation of the cause of miscarriage is still not routine in our country. These data showed that the prevalence of disease with risk of congenital transmission in patients with spontaneous abortion is important, more research is needed to elucidate the etiology of abortion. Women's health should receive more attention from our managers because primary care is the best and most efficient path to be followed in order to quality of life for mothers and their future children. / A infecção primária causada por Toxoplasma gondii, Trypanosoma cruzi, Rubella virus, Citomegalovirus (CMV) e Treponema pallidum, podem atingir o concepto por via transplacentária ou transamniótica podendo causar diferentes danos. A gravidade da infecção ou até mesmo o aborto, dependem da virulência da cepa do microrganismo, da resposta imune da mãe e do período. O objetivo deste estudo foi analisar os resultados sorológicos, anatomopatológicos e parasitológicos de material abortivo para infecções com risco de transmissão vertical, com ênfase na toxoplasmose. Foram convidadas para participar da pesquisa, mulheres que sofreram aborto espontâneo completo e/ou incompleto, atendidas em duas maternidades públicas em Goiânia-Goiás, entre o período de junho 2008 a junho de 2009. Foram entrevistadas, por meio de um questionário, e coletadas amostras de sangue e material abortivo. Realizaram-se testes imunológicos para toxoplasmose, doença de Chagas, rubéola, citomegalovírus e sífilis e o exame anatomopatológico nos restos ovulares. 55% das mulheres tinham entre 20 a 30 anos de idade. A maioria (68%) apresentou idade gestacional entre 7ª a 14ª semanas. 54,3% das mulheres tinham o ensino médio completo ou incompleto. Em relação ao número de aborto, a maioria das mulheres (69%) tiveram apenas um aborto e a minoria (2,9%) já estavam no quarto ou quinto aborto. Pela análise da sorologia, a infecção com risco de transmissão vertical mais frequente foi o CMV com 97,1% de positividade e em seguida a rubéola com 95,2%. A toxoplasmose teve um percentual de 54,3%, a doença de Chagas de 1,9% e a sífilis de 0,95%. A análise dos laudos de biópsia demonstrou que 63,1% apresentaram inflamação e 34% ausência de inflamação. Das análises sorológica, anatomopatológica e parasitológica das 105 mulheres, 57 foram soropositivas para T. gondii. Observou-se que 77,1% apresentaram inflamação, detectados no exame anatomopatológico. Nenhuma teve resultado positivo para a Reação em Cadeia da Polimerase (PCR) e para inoculação em camundongos. Este estudo demonstrou a alta frequência de soropositivas para CMV e rubéola em seguida de toxoplasmose, doença de Chagas e sífilis em nosso meio. A elucidação da causa dos abortos espontâneos ainda não é rotina em nosso país. Estes dados demonstraram que a prevalência de doenças com risco de transmissão congênita nas pacientes com abortamento espontâneo é importante, sendo necessário mais pesquisas visando esclarecer a etiologia do aborto. A saúde da mulher deve receber mais atenção de nossos gestores, pois a atenção primária é o melhor e o mais eficiente caminho a ser seguido visando uma qualidade de vida para mães e seus futuros filhos.

Made available in DSpace on 2016-08-18T18:54:00Z (GMT). No. of bitstreams: 1 Galvani Ascar Sauaia.pdf: 342362 bytes, checksum: 4e715a64f2a6730df087e3aeaa8aee27 (MD5) Previous issue date: 2011-04-27 / Introduction: The vertical transmission is considered the main way of HIV infection in children. The equivalent to 65% of ali cases occur during the labor and delivery, 35% remains occur in uterus and by breastfeeding. Nowadays, the rate of HIV vertical transmission is about 20%, however, lots of publications in literature shows a reduction for levels between zero and 2% with the introduction of antiretroviral therapy in pregnancy and delivery, elective cesarean section, AZT use for newborn and avoiding breastfeeding. Objectives: To evaluate the process of delivery assistance of the HIV-infected women and their newborns at the Maternity of the Hospital Universitário, Unidade Materno Infantil of the Universidade Federal do Maranhão in São Luís. The prevalence of vertical transmission and loss to follow or interruption of monitoring. Method: Retrospective study of 178 HIV-infected pregnant women, admitted in the HUMI UFMA for management of delivery from 2002 to 2008. Results: Among the HIV-infected women 40 (22.47%) had rapid HIV test, 47 (26.40%) Elisa test during prenatal assistance and the remains patients 91 (51.12%) had the diagnosis before pregnancy. About TARV, 125 (70.22%) had it during prenatal care, only AZT for 84 (67.20%) and, 174 (97.0%), the AZT during labor assistance or intrapartum. The remain equivalent to 04 (2.25%), did not receive any prophylactic care. About the serum Viral Lecture (VL) and CD4, just 18 (10,11%) did the procedure; 02 (11.11%) had VL below < 1000 copies and 18 (88,89%) had VL more than > 1000 copies/ml. About the percentage of women in labor, with amniorrexe and breastfeeding interruption was respectively 102 (57.30%); 23 (12.98); 175 (98.31%), considering the labor and the amniorrexe for more than 4 hours 73 (71.57%); 19 (82.61%). AII newborns and neonates received AZT - oral solution and no one was breastfed. About HIV-positive newborns and the follow up loss respectively 11 (6.18%); 65 (36.62%). The serum conversion appeared among RNS of women with labor that lasted more than 4 hours and those who had rapid test for diagnosis during labor e, 10 (90.91%). In attention to the way of delivering, Normal or cesarean section the percentages were equivalents around 50%. Conclusion: The level of assistance of HIV-infected pregnant women according to the "Nascer Maternidade Project" guidelines was ineffective in 7 years at the Hospital Maternity under study. Due to lack of organization, individual and social vulnerability of most of these population of HIV-infected women, had a negative influence over the actions or prophylactic measures for the control of vertical transmission at the maternity under study. / Introdução: A transmissão vertical, sem sombra de dúvidas, é a mais importante fonte de infecção do HIV em crianças, sendo que o equivalente a 65% dos casos ocorrem durante o trabalho de parto e no parto propriamente dito; os 35% restantes ocorrem intraútero e através do aleitamento materno. Atualmente, o percentual de TV do HIV, sem qualquer medida de prevenção, é de aproximadamente 20%. Contudo, estudos atuais publicados na literatura, mostram uma redução para taxas que variam de zero a 2% com a utilização de antirretrovirais durante todo o período gestatório e parto, operação cesariana eletiva, uso de AZT xarope para os recém-nascidos e a contraindicação do aleitamento materno. Objetivo: Avaliar o processo assistencial prestado a gestantes infectadas pelo vírus HIV e seus recém-nascidos atendidos no Hospital Universitário, Unidade Materno Infantil, da Universidade Federal do Maranhão, em São Luís - MA, a prevalência de transmissão vertical. Método: Estudo retrospectivo de 178 parturientes infectadas pelo vírus HIV, atendidas no HUMI/UFMA para assistência ao parto, no período de 2002 a 2008. Resultados: Dentre as parturientes, 40 (22,47%) realizaram teste rápido; 47 (26,40%), teste Elisa no pré-natal e as demais pacientes, 91 (51,12%), já tinham o diagnóstico antes de gestar. Quanto a TARV, 125 (70,22%) a utilizaram no pré-natal, sendo o uso exclusivo de AZT em 84 (67,20%) e 174 (97,0%) AZT no atendimento ao trabalho de parto. O restante, equivalente a 04 (2,25%), não fez qualquer medida profilática. Quanto à carga viral e CD4, apenas 18 (10,11%) realizaram o procedimento; 02 (11,11%) apresentaram carga viral inferior 1000 colônias e 18 (88,89%) apresentaram carga viral superior 1000 colônias. Sobre o percentual de gestantes em trabalho de parto, com ruptura das membranas das águas e inibição da lactação, foi obtido respectivamente 102 (57,30%), 23 (12,98%), 175 (98,31%), considerando o trabalho de parto e ruptura das membranas com mais de 4 horas 73 (71,57%), 19 (82,61%). Todos os RNs receberam AZT solução oral e nenhum deles foi amamentado. Para RNs com soroconversão e perda de seguimento, respectivamente, 11 (6,18%), 65 (36,62%). A soroconversão se fez presente em RNs de mulheres com duração do trabalho de parto acima de 4 horas e que realizaram teste de diagnóstico rápido 10 (90,91%). Quanto ao tipo de parto, Cesariana e Normal, apresentaram valores equitativos, em torno de 50% dos casos. Conclusão: O nível de assistência à gestante HIV positivo, em relação às metas do Projeto Nascer, nos sete anos desta avaliação, foi insatisfatório, onde os problemas de organização do serviço de saúde, somados à vulnerabilidade individual e social a que está submetida boa parte da população de mulheres portadoras do HIV, influenciou negativamente a execução das ações de controle da transmissão vertical do vírus na maternidade estudada.

Made available in DSpace on 2014-08-20T14:37:54Z (GMT). No. of bitstreams: 1 tese_nilton_azevedo_da_cunha_filho.pdf: 1341797 bytes, checksum: 3a24f48f5e86bbb452bd241d5e458c34 (MD5) Previous issue date: 2013-07-08 / Neospora caninum is causing great economic losses in cattle, due to abortion. It has been shown that the transmission of N. caninum is the primary route of infection in cattle, followed by horizontal transmission. Few studies demonstrate the outcome of this type of transmission in herd raised in pasture cattle. The first experiment aimed to evaluate the occurrence of vertical transmission of N. caninum in beef cattle and verify the relationship between seropositivity and abortion. Blood was collected from mothers in the pre-pregnancy and after, three more times in the gestation period, plus a sampling of calves at birth. The seroprevalence in the arrays found in the screening was 32.2% (29/90). The vertical transmission rate was 75.8% and all dams evaluated completed pregnancy, demonstrating that N. caninum is present on the property studied, with high transmission rates, but no apparent influence on the reproductive performance of dams. The second experiment aimed to demonstrate the importance of horizontal transmission in maintaining N. caninum in the same herd. Were accompanied by serological tests, 61 seronegative mothers during pregnancy thirds and their calves at birth (n = 61) and during the first year of life (n = 24). No seroconversion occurred in any of the dams. In calves, however, that seroconversion occurred, indicative of horizontal infection by N. caninum, 12.5% at the end of 12 months. This indicates that horizontal transmission interference occurred in this herd. The third experiment aimed to detect the presence of DNA of N. caninum in umbilical cord of calves positive of positive dams. Was collected the umbilical cord of 20 calves at birth for laboratory testing by PCR. The DNA of the parasite was confirmed by 1/20 (5.0%) umbilical cords. This is the first report of the detection of DNA from N. caninum in umbilical cord of calves by PCR. / Neospora caninum é causador de grandes perdas econômicas na bovinocultura, devidas ao aborto. Já foi demonstrado que a transmissão vertical de N. caninum é a principal rota de infecção entre bovinos, seguida pela transmissão horizontal. Poucos estudos demonstram qual o resultado desse tipo de transmissão em rebanho criado a campo. O experimento 1 teve o objetivo de avaliar a ocorrência de transmissão vertical de N. caninum em matrizes de criação extensiva de gado de corte e verificar a relação entre soropositividade e aborto. Foi coletado sangue das matrizes no período pré-gestacional e, após, em mais três momentos do período gestacional, além de uma coleta de seus bezerros ao nascer. A soroprevalência nas matrizes, constatada na triagem foi de 32,2% (29/90). O índice de transmissão vertical foi de 75,8% e todas as matrizes avaliadas levaram a gestação a termo, demonstrando que N. caninum está presente na propriedade estudada, com índices elevados de transmissão vertical, porém sem influência aparente no desempenho reprodutivo das matrizes. O experimento 2 objetivou demonstrar a importância da transmissão horizontal na manutenção de N. caninum nesse mesmo rebanho. Foram acompanhadas, através de exames sorológicos, 61 matrizes soronegativas durante os terços gestacionais e seus bezerros ao nascer (n=61) e durante o primeiro ano de vida (n=24). Não ocorreu soroconversão em nenhuma das matrizes. Nos bezerros, no entanto, ocorreu essa soroconversão, indicativa de infecção horizontal por N. caninum, em 12,5%, ao final dos 12 meses. Isso indica a interferência da transmissão horizontal nesse rebanho. O experimento 3 teve o objetivo de detectar a presença do DNA de N. caninum em cordão umbilical de bezerros soropositivos filhos de matrizes soropositivas. Coletou-se o cordão umbilical de 20 bezerros no momento do nascimento para os testes laboratoriais pela técnica de PCR. O DNA do parasito foi confirmado em 1/20 (5,0%) dos cordões umbilicais. Este é o primeiro relato da detecção de DNA de N. caninum em cordão umbilical de bezerros pela técnica de PCR.

Despite the advances made since the advent of germ theory, infectious diseases still wreak havoc on human societies, not only affecting us directly but impacting the crops and livestock upon which we rely. Infectious diseases also have dramatic effects on wildlife ecology. Therefore research into infectious diseases could not only directly lead to the improvement and saving of human lives, but aid in food security and the conservation of many wildlife species. Of vital importance in understanding the ecology of infectious diseases are the mechanisms by which they persist in host populations. One possible mechanism is vertical transmission: the transmission of a pathogen from a parent to its offspring as a result of the process of host reproduction. Another possible mechanism is inapparant infections, where an infected host does not display symptoms. Focusing on dengue fever and the Plodia interpunctella granulovirus laboratory system, this PhD thesis looks at the role these two mechanisms play on the persistence of two viral infections and their ecology. Regarding the Plodia interpunctella granulovirus (PiGV) low host food quality led to greater detection of vertically transmitted inapparant PiGV, but did not lead to its activation to an apparent form. Host inbreeding did not lead to vertically transmitted inapparant PiGV’s activation, nor had an effect on its vertical transmission. The vertical infection rate of PiGV was very low. I would therefore suggest that it may be better to use an insect virus system with a higher rate of vertical infection in future research into vertically transmitting inapparent infections. Regarding dengue virus I conclude that vertical transmission is not likely to play a role in the persistence of this virus. However modelling work found that inapparent infections could provide dengue viruses with a means of persistence and should be subject to further research.

No description available.

La Crosse virus (LACV) is a mosquito-borne arbovirus that is the main cause of pediatric encephalitis in the United States in children under 16. LACV is maintained in hardwood forests utilizing Aedes spp. mosquitoes, primarily Aedes triseriatus, and Sciuridae vertebrate host species, primarily the Eastern Chipmunk (Tamias striatus) or via transovarial transmission from mother mosquitoes to offspring. Historically, LACV comprised two genetically distinct lineages: lineage I in the Midwest and Appalachian regions and lineage II in the southern region. Lineage I LACV is a growing public health concern in Appalachia, where cases now outnumber those in the Midwest, which historically accounted for most LACV cases. The majority (53%) of LACV cases between 2003 and 2023 were reported from Appalachian states surrounding Virginia (North Carolina: 331, Tennessee: 213, West Virginia: 225, and Kentucky: 11), but Virginia only reported 25 cases. In chapter two, we explore the hypothesis that LACV is circulating in Virginia utilizing serosurveillance to indicate LACV circulation. Blood samples provided by wildlife rehabilitation centers throughout Virginia (n=527 comprising 9 vertebrate species) were screened for LACV antibodies using Plaque Reduction Neutralization tests (PRNTs). We identified an overall prevalence rate of 1.90% across five seropositive vertebrate species. In addition to known hosts of LACV, Eastern Gray Squirrel, Eastern Cottontail, and Groundhog, we identified the first reported seropositive Red Fox. We highlight that LACV is circulating in Virginia, although at a much lower rate than reported from other states, which may explain the reduced number of cases. In addition to lineage I and II LACV, a new lineage was identified in 2005 in the Northeast but has yet to cause human disease. In the face of an apparent entomological risk demonstrated by the continued isolation of lineage III from mosquitoes in this region, it is unclear why there is a lack of clinical cases. The prevailing hypotheses are (1) under-diagnosis in cases of human disease or lack of detection in humans, (2) reduced virulence in lineage III LACV, (3) low prevalence of lineage III in local mosquito and host animal populations, or (4) reduced vector competence in local mosquito populations. In chapter three, we explore the vector competence of Aedes albopictus and Aedes triseriatus from the range of lineage III (Connecticut) and from the historic LACV range (Virginia) to transmit LACV lineage III. Using oral feeding and intrathoracic inoculation, bodies, legs, saliva, and ovaries were harvested to indicate infection, dissemination, ability to transmit, and ability to vertically transmit, respectively. Although there were no apparent differences in horizontal or vertical transmission, we demonstrated that LACV lineage III can be transmitted both horizontally and vertically, highlighting the potential public health risk associated with lineage III. In chapter four, we explore the pathogenesis of lineage III. An immune-competent murine model, CD-1, and an immune-deficient murine model, IFNAR-/-, were used to determine the pathogenesis of lineage III. Interestingly, in the immune-deficient model, lineage III was able to cause significant morbidity and mortality, but not in the immune-competent model. LACV lineage I and II can overcome the host immune system through the interferon pathway, allowing viral replication. We hypothesize that lineage III cannot circumvent the interferon system as the other lineages can and, therefore, cannot replicate to cause clinical disease. Overall, although lineage III can be transmitted in vector mosquitoes, it may be unable to cause disease in humans because it cannot overcome the antiviral responses, but this needs to be explored further to determine the underlying mechanism. However, viruses can evolve quickly, and we still advocate for continued surveillance and investigation into lineage III LACV. / Doctor of Philosophy / La Crosse virus (LACV) is a mosquito-borne virus that can cause severe illness in children under 16 years of age through the bite of an infected mosquito. Infected children can develop severe neuroinvasive disease, including encephalitis, seizures, coma, and death. Following recovery, some children experience continued effects (neurological sequelae) of the infection, such as epilepsy, hemiparesis (weakness on one side of the body), and neurobehavioral issues. LACV is maintained in hardwood forests utilizing Aedes spp. mosquitoes, primarily Aedes triseriatus, and Sciuridae vertebrate host species, primarily the Eastern Chipmunk (Tamias striatus) or through transmission from mother to offspring in mosquitoes. Historically, the majority of LACV cases occurred in the Midwest, but recently, rising cases in the Appalachians are a growing concern. Cases in Appalachia now outnumber those in the Midwest and cause most cases in the US. Interestingly, the majority (53%) of LACV cases between 2003 and 2023 were reported from Appalachian states surrounding Virginia (North Carolina: 331, Tennessee: 213, West Virginia: 225, and Kentucky: 11), but Virginia only reported 25 cases. It is unclear why Virginia is not reporting as many LACV cases as other states, but it may simply be due to reduced circulation in the state. In chapter two, we investigate the circulation of LACV in Virginia by examining wildlife exposure to LACV. Blood samples from local wildlife rehabilitation centers (527 samples comprising 9 vertebrate species) were tested for the presence or absence of antibodies against LACV. We identified a seroprevalence rate of 1.9% in 5 vertebrate species. In addition to known vertebrate hosts of LACV (Eastern Gray Squirrel, Eastern Cottontail, and Groundhog), we identified the first known Red Fox exposed to LACV, potentially implicating it in the transmission cycle. In addition to the historic LACV lineages, a new lineage, lineage III, was isolated in the Northeast, and additional isolations have been made. However, there have not been any reported clinical cases attributed to lineage III. The prevailing hypotheses are (1) under-diagnosis in cases of human disease or lack of detection in humans, (2) reduced virulence in lineage III LACV, (3) low prevalence of lineage III in local mosquito and host animal populations, or (4) reduced vector competence in local mosquito populations. In chapter three, we explore the ability of vector mosquitoes to transmit LACV lineage III both through an infected bite and from mother to offspring. We were able to show that lineage III can be transmitted through an infected bite and from mother to offspring, and we highlight the potential of a public health risk for lineage III LACV. In chapter four, we explore the pathogenesis of LACV lineage III in an immune-competent and immune-deficient mouse model. Lineage III was able to cause severe disease similar to that in children in the immune-deficient model but not in the immune-competent model. Historic LACV lineages can overcome the host immune system through the antiviral interferon system, but our data indicate that lineage III may be unable to overcome this system and, thus, unable to cause clinical disease. Overall, although lineage III can be transmitted in vector mosquitoes, it may be unable to cause disease in humans because it cannot overcome the antiviral responses, but this needs to be explored further. However, viruses can evolve quickly, and we still advocate for continued surveillance and investigation into lineage III LACV.

ObjeEste estudo teve como objetivo primário avaliar a estratégia de incluir o parceiro na assistência pré-natal no município de Franca-Brasil. Constituíram os objetivos secundários: 1) Detectar a prevalência de parceiros com dosagens alteradas de colesterol total, HDL-colesterol, LDL-colesterol e triglicérides; 2) Detectar a prevalência de parceiros com dosagens alteradas de glicemia de jejum; 3) Detectar a prevalência de parceiros com HAS; 4) Detectar a prevalência da sífilis, HIV, hepatites B e C entre gestantes; 5) Verificar a taxa de DMG e de DM entre as gestantes; 6) Detectar a prevalência da sífilis, HIV, hepatites B e C entre os parceiros das gestantes; 7) Avaliar a motivação da equipe de saúde em acolher a Estratégia Pré-natal do Parceiro; 8) Avaliar a aceitação materna e do parceiro sobre a estratégia de inclusão do parceiro na assistência PN. Estudo quantitativo, utilizado o teste \"t\" de Student para comparações das variáveis paramétricas e o teste Qui-quadrado para as variáveis não paramétricas, considerando significativo o valor de p< 0,05 em quaisquer dos testes. Os resultados identificaram quatro parceiros com hipertensão arterial (3,4%) e 51 (43,2%) com intolerância à glicose, verificando-se que em quatro casos, a glicemia possibilitou diagnosticar diabetes mellitus. Constatou-se que a prevalência de dislipidemias dos parceiros foi de 84,4%. No tocante às sorologias identificou-se um casal (1,5%) com sorologia discordante para sífilis (gestante com sífilis) e outro casal, no qual o parceiro foi diagnosticado como portador da infecção pelo vírus da imunodeficiência humana (HIV), cujo diagnóstico só foi possível por sua participação no PNP. Foi possível identificar que 57 parceiros (48,3%) qualificaram as equipes de saúde com não motivadoras para a adoção da estratégia PNP. No entanto, 58 (49,1%) participaram por motivação própria. A percepção paterna sobre o PNP foi referida como positiva por 77,9% dos parceiros e 93 gestantes/mães (78,8%) consideraram importante e positiva a inclusão do parceiro no PN. Foi identificado que a inclusão do parceiro no PN foi importante no diagnóstico e tratamento precoces de doenças de transmissão vertical e crônicas e que é necessário incentivar a equipe de saúde a difundir os benefícios dessa participação no PN, contribuindo com a saúde da tríade mãe, filho e parceiro. / This study\'s primary objective was to analyze the strategy of including the male partner in prenatal care in the city of Franca, Brazil. The secondary objectives were: 1) To detect the prevalence of male partners with abnormal levels of total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; 2) To detect the prevalence of male partners with abnormal levels of fasting blood glucose; 3) To detect the prevalence of systemic hypertension among male partners; 4) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among pregnant women; 5) To find out the frequency of Gestational diabetes mellitus (GDM) and of Diabetes mellitus (DM) among pregnant women; 6) To detect the prevalence of syphilis, HIV, hepatitis B and hepatitis C among the pregnant women\'s male partners; 7) To gauge the health team\'s motivation to implement the strategy of male involvement in prenatal care; 8) To assess maternal acceptance and male partner acceptance of the strategy of including the male partner in prenatal care. This was a quantitative study, which used the Student\'s t-test to compare parametric variables and the Chi-squared test for the nonparametric variables and which considered a p-value < 0.05 as significant in both tests. The results identified 4 male partners with hypertension (3.4%) and 51 male partners (43.2%) with glucose intolerance, of which four had a diagnosis of Diabetes mellitus as a result of the blood glucose test. We found that the Anexos 100 prevalence of dyslipidemia among the male partners was 84.4%. Regarding serology tests, we identified a couple (1.5%) with discordant syphilis serology (pregnant woman with syphilis) and another couple in which the male partner was diagnosed with Human Immunodeficiency Virus (HIV) infection with such diagnosis only having been possible because of his participation in prenatal care. We could identify that 57 male partners (48.3%) classified the health teams as not encouraging of the male involvement in prenatal care. However, 58 male partners (49.1%) participated by selfmotivation. The fathers\' perception of their involvement in prenatal care was referred to as positive by 77.9% of the male partners and 93 pregnant women / mothers (78.8%) considered the inclusion of the male partner in prenatal care important and positive. We identified that the inclusion of the male partner in prenatal care was important in the early diagnosis and early treatment of vertical transmission diseases and chronic diseases as well as that it is crucial to encourage health teams to communicate the benefits of the inclusion of the male partner in prenatal care, thus contributing to the health of the father- mother-child triad.

O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal / The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.