Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

Influenza Aviar impacta en la salud pública debido a que representa un potencial riesgo zoonótico. Además, es una amenaza para la industria avícola debido a que puede causar una elevada morbilidad y mortalidad en las aves afectando la economía y el comercio. El virus de Influenza Aviar ha sido aislado de una amplia variedad de especies aviares como por ejemplo los patos domésticos que pueden ser posibles portadores silenciosos del virus. El objetivo del presente estudio fue evaluar la presencia del virus de Influenza Aviar en patos domésticos de crianza familiar en las provincias de Huaral y Huaura. Se colectaron 600 muestras de hisopado cloacal de patos domésticos de traspatio sin distinción de sexo o edad, las cuales fueron analizadas mediante aislamiento viral en huevos embrionados de pollo SPF. La presencia del virus de la Influenza Aviar fue determinada por la actividad hemaglutinante del fluido alantoideo, y confirmada mediante un kit de diagnóstico rápido, que utiliza anticuerpos monoclonales. El 100% (600/600) de las muestras analizadas fueron negativas al virus de Influenza Aviar en este estudio con una prevalencia determinística de 0%. Se concluyó que las aves incluidas en el muestreo no se encuentran infectadas con el virus de Influenza Aviar.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

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

A key goal of modern evolutionary biology is the identification of genes or genome regions that have been targeted by natural selection. Methods for detecting natural selection utilise the information sampled in contemporary gene sequences and test for deviation from the null hypothesis of neutrality. One such method is the McDonald Kreitman test (MK test), which detects the the molecular 'footprint' left by natural selection by considering the frequency of observed mutations within the sampled population. In this thesis I investigate the applicability of the MK test to viral populations and develop several new methods based on the original MK test. In chapter 2, I use a combination of simulation and methodological improvements to show that the MK test can have low error when applied to analysis of RNA virus populations. Then, in chapter 3, I develop an extension of the MK test with the purpose of estimating rates of adaptive fixation for all genes of the human influenza A virus subtypes H1N1 and H3N2. My results are consistent with previous studies on selection in influenza virus populations, and provide a new perspective on the evolutionary dynamics of human influenza virus. In chapter 4 I develop a formal statistical framework based, on the MK test, for calculating the number of non neutral sites at any frequency range in the site frequency spectrum. In this framework, I introduce a new method for reconstructing the site frequency spectrum that incorporates sampling error and allows for the inclusion of prior knowledge. Using this new framework I show that the majority of nucleotide sites in hepatitis C virus sequences sampled during chronic infection represent deleterious mutations. Finally, in chapter 5 I use the generalised framework introduced in chapter 4 to develop a statistic for evaluating the deleterious mutation load of a population. I apply this test sequences that represent 96 RNA virus genes and show that my approach has comparable power to equivalent phylogenetic methods. In this thesis I have developed computationally efficient methods for analysis of genetic data from virus populations. It is my hope that these methods will become useful given the explosion in sequence data that has accompanied recent improvements in sequencing technology.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Orientador: Maria Rita Donalisio Cordeiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T11:53:53Z (GMT). No. of bitstreams: 1 Francisco_PriscilaMariaStolsesBergamo_D.pdf: 1732128 bytes, checksum: e40308a72ae69b30999c757a5f111ac4 (MD5) Previous issue date: 2006 / Resumo: O aumento da proporção de idosos no país associado à maior longevidade modificou o perfil de saúde da população com considerável aumento da demanda por prevenção e assistência à saúde nas faixas etárias mais avançadas. Neste contexto, destaca-se a importância relativa das doenças respiratórias nos idosos, com impacto econômico e social. O objetivo deste estudo foi investigar os fatores associados à vacinação contra influenza e doença pulmonar em idosos, com a utilização de diferentes técnicas de análise em estudos transversais de delineamento complexo. Os dados foram obtidos do "Inquérito de saúde de base populacional em municípios do Estado de São Paulo" (ISA-SP), cuja coleta foi realizada entre 2001 e 2002, e se referem a 1.958 registros de indivíduos de 60 anos e mais, analisados por meio de regressão logística e regressão de Poisson. Os resultados desta tese são apresentados em capítulos que se referem a três artigos publicados em revistas científicas. No primeiro artigo, "Fatores associados à vacinação contra influenza em idosos", os achados apontaram maior adesão à vacinação contra influenza entre os indivíduos com idade igualou superior a 70 anos (OR = 1,47; IC 95%: 1,09 -:- 1,99) e entre os hipertensos (OR = 1,39; IC 95%: 1,03 - 1,87), enquanto os idosos com nove anos ou mais de estudo referiram menor adesão à vacinação (OR = 0,64; IC 95%: 0,41 - 0,98). No segundo trabalho, "Vacinação contra influenza em idosos por área de residência: prevalência e fatores associados", pôde-se verificar diferenças no perfil do idoso quanto à referência de vacinação segundo subgrupos específicos e locais de residência. Nos municípios mais populosos apenas a menor escolaridade esteve associada à vacinação referida (RP = 1,26; IC 95%: 1,02-1,54), já na área composta pelos municípios menos populosos, idade mais avançada (RP = 1,15; IC 95%: 1,02-1,31), hipertensão arterial (RP = 1,21; IC 95%: 1,02-1,45), diabetes (RP = 1,16; IC 95%: 1,01-1,33) e doença crônica de pulmão (RP = 1,30; IC 95%: 1,03-1,64) referidas, estiveram associadas. No estudo, "Fatores associados à doença pulmonar em idosos", os resultados indicaram associação independente entre doença pulmonar referida e tabagismo (RP = 2,03; IC 95%: 1,39 - 2,97), uso de medicamentos (RP = 2,05; IC 95%: 1,11 - 3,79), auto-avaliação do estado de saúde atual como ruim ou muito ruim (RP = 1,89; IC 95%: 1,20 - 2,96) e depressão, ansiedade ou problemas emocionais (RP = 1,86; IC 95%: 1,11 - 3,10). Com o envelhecimento e a crescente importância das doenças respiratórias entre os idosos, os achados desse estudo apontam para a necessidade de ações que priorizem a manutenção da saúde do idoso, por meio de programas de promoção e prevenção que considerem as especificidades desse segmento / Abstract: The increase in the proportion of elder1y persons in Brazil, associated to increased longevity, has modified the health profile of the population, with a considerable increase in the demand for prevention and healthcare among the older age groups. In this context, the relative importance of respiratory diseases among the elder1y, along with its social and economic impact, is worthy of note. The aim of the present study was to investigate the factors associated with influenza vaccination and pulmonary disease in the elder1y population, using different analytical techniques in cross-sectional studies with complex design.The data were obtained from the Population-based survey of municipalities of the State of Sao Paulo (ISA-SP), whose data collection took place between 2001 and 2002 and inc1uded 1.958 records of subjects aged 60 years or older, and were analyzed using logistic regression and Poisson regression.The results of the present thesis are presented as chapters that refer to artic1es published in scientific journals. In the first article, "Factors associated with influenza vaccination among elderly persons", our findings indicate greater adherence to influenza vaccination among subjects aged 70 years or older (OR = 1.47; 95%CI: 1.09 - 1.99) and among subjects with hypertension (OR = 1.39; 95%CI: 1.03 - 1.87), whereas elder1y subjects with nine or more years of schooling reported lesser adherence to vaccination (OR = 0.64; 95%CI: 0.41- 0.98). In the second paper, "Influenza vaccination among elderly persons according to place of residence: prevalence and associated factors", we observed differences in subject profile in tenns of self-reported vaccination according to specific subgroups and places of residence. In more populous municipalities, only lesser schooling (PR = 1.26; 95%CI: 1.02-1.54) was associated with vaccination. Among the less densely populated municipalities, older age (pR = 1.15; 95%CI: 1.02-1.31) and 'reported hypertension .(PR = 1.21; 95%CI: 1.02-1.45), diabetes (pR = 1.16; 95%CI: 1.01-1.33), and chronic pulmonary disease (PR = 1.30; 95%CI: 1.03-1.64) were associated with the outcome. In the paper entitled "Factors associated with pulmonary disease among the elderly," our results indicate independent associations between self-reported pulmonary disease and smoking (pR = 2.03; 95%CI: 1.39 - 2.97), medication use (pR = 2.05; 95%CI: 1.11 - 3.79), self-perception of current health status as poor or very poor (RP = .1.89; 95%CI: 1.20 2.96), and depression, anxiety, or emotional disorders (pR = 1.86; 95%CI: 1.11 - 3.10).With the aging of the population, and the increasing importance of respiratory diseases among the elderly, the findings of the present study indicate a need for measures that prioritize the maintenance of health among this population, through promotion and prevention programs that take into account the specificities of this segment / Doutorado / Epidemiologia / Mestre em Saude Coletiva

Introduction: Epidemiological studies have indicated that 5-38% of influenza like illnesses (ILI) develop into severe disease due to, among others, factors such as; underlying chronic diseases, age, pregnancy, and viral mutations. There are suggestions that dual or multiple virus infections may affect disease severity. This study investigated the association between co-infection between influenza A viruses and other respiratory viruses and disease severity. Methodology: Datum for samples from North West England tested between January 2007 and June 2012 was analysed for patterns of co-infection between influenza A viruses and ten respiratory viruses. Risk of hospitalization to a general ward ICU or death in single versus mixed infections was assessed using multiple logistic regression models. Results: One or more viruses were identified in 37.8% (11,715/30,975) of samples, of which 10.4% (1,214) were mixed infections and 89.6% (10,501) were single infections. Among patients with influenza A(H1N1)pdm09, co-infections occurred in 4.7% (137⁄2,879) vs. 6.5% (59⁄902) in those with seasonal influenza A virus infection. In general, patients with mixed respiratory virus infections had a higher risk of admission to a general ward (OR: 1.43, 95% CI: 1.2 – 1.7, p = <0.0001) than those with a single infection. Co-infection between seasonal influenza A viruses and influenza B virus was associated with a significant increase in the risk of admission to ICU/ death (OR: 22.0, 95% CI: 2.21 – 219.8 p = 0.008). RSV/seasonal influenza A viruses co-infection also associated with increased risk but this was not statistically significant. For the pandemic influenza A(H1N1)pdm09 virus, RSV and AdV co-infection increased risk of hospitalization to a general ward, whereas Flu B increased risk of admission to ICU/ death, but none of these were statistically significant. Considering only single infections, RSV and hPIV1-3 increased risk of admission to a general ward (OR: 1.49, 95% CI: 1.28 – 1.73, p = <0.0001 and OR: 1.34, 95% CI: 1.003 – 1.8, p = 0.05) and admission to ICU/ death (OR: 1.5, 95% CI: 1.20 – 2.0, p = <0.0001 and OR: 1.60, 95% CI: 1.02 – 2.40, p = 0.04). Conclusion: Co-infection is a significant predictor of disease outcome; there is insufficient public health data on this subject as not all samples sent for investigation of respiratory virus infection are tested for all respiratory viruses. Integration of testing for respiratory viruses’ co-infections into routine clinical practice and R&D on integrated drugs and vaccines for influenza A&B, RSV, and AdV, and development of multi-target diagnostic tests is encouraged.