Introduction The rapid expansion of the novel SARS-CoV-2 virus has raised serious public health concerns due to the possibility of misdiagnosis in regions where arboviral diseases are endemic. We performed the first study in northern Peru to describe the detection of SARSCoV-2 IgM antibodies in febrile patients with a suspected diagnosis of dengue and chikungunya fever. Materials and methods A consecutive cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through March 2021. Patients enrolled underwent serum sample collection for the molecular and serological detection of DENV and CHIKV. Also, serological detection of IgM antibodies against SARS-CoV-2 was performed. Results 464 patients were included during the study period, of which (40.51%) were positive for one pathogen, meanwhile (6.90%) presented co-infections between 2 or more pathogens. The majority of patients with monoinfections were positive for SARS-CoV-2 IgM with (73.40%), followed by DENV 18.09% and CHIKV (8.51%). The most frequent co-infection was DENV + SARS-CoV-2 with (65.63%), followed by DENV + CHIKV and DENV + CHIKV + SARSCoV-2, both with (12.50%). The presence of polyarthralgias in hands (43.75%, p<0.01) and feet (31.25%, p = 0.05) were more frequently reported in patients with CHIKV monoinfection. Also, conjunctivitis was more common in patients positive for SARS-CoV-2 IgM (11.45%, p<0.01). The rest of the symptoms were similar among all the study groups. Conclusion SARS-CoV-2 IgM antibodies were frequently detected in acute sera from febrile patients with a clinical suspicion of arboviral disease. The presence of polyarthralgias in hands and feet may be suggestive of CHIKV infection. These results reaffirm the need to consider SARS-CoV-2 infection as a main differential diagnosis of acute febrile illness in arboviruses endemic areas, as well as to consider co-infections between these pathogens. Copyright: / Revisión por pares

Over the past decade, and accelerated due to the COVID-19 pandemic, there has been increasing adoption of decentralized diagnostic testing, where the testing is brought closer to the patient. This trend has largely been fueled by the development of more accurate diagnostic tools and faster and more reliable data connectivity. Decentralized testing has been shown to greatly reduce turnaround times while increasing accessibility to users in remote regions. However, there are challenges that limit its widespread adoption. In this dissertation, we detail the development of tools and technologies to overcome these barriers and expedite the shift towards decentralized diagnostic testing. First, we demonstrate the ability to develop point-of-care (POC) diagnostic tests with performance that rivals that of traditional lab-based methods. We developed a rapid, multiplexed, microfluidic serological test for Lyme disease, a tick-borne disease caused by the Borrelia burgdorferi bacterium. The recommended testing, the standard 2-tiered (STT) approach, is not sensitive for early-stage infections, is labor-intensive, has long turnaround times, and requires the use of two immunoassays (enzyme-linked immunosorbent assay (ELISA) and the Western Blot). We developed a standalone multiplexed sandwich ELISA assay and adapted it to the mChip microfluidic platform. We validated the assay on a rigorously characterized panel of human serum samples and demonstrated that our approach outperforms the STT algorithm on sensitivity while matching its specificity. The form factor of this technology is amenable to use in physician’s offices and urgent care clinics. We also showed exploratory work towards adapting the mChip platform for diagnosis of Zika disease, a mosquito-borne disease caused by the Zika virus, and acute kidney injury, a syndrome characterized by loss of kidney excretory function. Next, we worked on increasing the adoption of rapid diagnostic tests for self- and partner-testing designed to be used in at-home settings. We developed a smartphone application to be used alongside the INSTI Multiplex test for detecting HIV and syphilis infections. The application was designed to provide users with i) instructions on running the test, ii) an automated deep-learning-based image interpretation algorithm to interpret the rapid test results from a smartphone image, iii) a way to save test results and display/share them, and iv) resources for follow-up care. We adopted a user-centered, iterative design process where we worked with a cohort of study participants composed of men who have sex with men and transgender women at high risk for contracting sexually transmitted infections. We then field tested the application with 48 participants over a duration of three months and found high acceptability for the application, both in terms of functionality and helpfulness. Finally, we sought to address a key limitation with deep-learning-based image classification techniques, specifically, the requirement for large numbers of annotated images for training. We developed a deep-learning image interpretation algorithm that could be quickly adapted to new rapid test kits using only a fraction of the images that would otherwise be needed for training the model. The interpretation algorithm followed a three-step, modular process. First, the rapid test kit and the membrane were extracted from the smartphone image. Second, the constituent zones were cropped from the extracted membrane. Finally, a classifier detected the presence or absence of a line in the individual zones. Fast adaptation was demonstrated by adapting a base model, trained using images of a single COVID-19 rapid test kit, to four different rapid test kits, each with different form factors, using few-shot domain adaptation. After training with 20 or fewer images, the classification accuracies of all the adapted models were > 95%. This approach can provide a digital health platform for improved pandemic preparedness and enable quality assurance and linkage to care for consumers operating new LFAs in widespread decentralized settings. Together, these methods provide a suite of tools that could expedite the shift towards decentralized, POC testing.

Molecular dating (or molecular clock) is a powerful technique that uses the mutation rate of biomolecules to estimate divergence times among organisms. In the last two decades, the theory behind the molecular clock has been intensively developed, and it is now possible to employ sophisticated evolutionary models on genome-scaled datasets in a Bayesian framework. The molecular clock has been successfully applied to virtually all types of organisms and molecules to estimate timing of speciation, timing of gene duplications, and generation times: this knowledge allows contextualizing past and present events in the light of (paleo)ecological scenarios. Molecular clock studies are routinely used in evolutionary and ecological studies, but their use in applied fields such as agricultural and medical entomology is still scarce in particular because of a paucity of genome data. Genome-scaled clocks have been successfully applied, for example, to various model organisms such as Anopheles and Drosophila, as well as to invasive mosquitoes Aedes aegypti and Aedes albopictus. Many other invasive pests are emerging worldwide aided by global trade, increased connectivity among countries, lack of prevention, and flawed invasive species management. Among them, there is Aedes koreicus and Aedes japonicus, two invasive mosquito species which are monitored for public health concerns because of their harboured human pathogenic viruses. For these, as well as for other insects of societal relevance, such as the parasitoid Trissolcus japonicus, there is a paucity of gene markers and no genome data for large scale molecular clock studies. Invasive pests are typically studied using microevolutionary approaches that tackle events at an intraspecific level: these approaches provide important information for the pest management, for example, by revealing invasion routes and insecticide resistances. Approaches that tackle the deep-time evolution of the pest, such as the molecular clock, are instead less used in pest science. Many important traits associated with invasiveness have evolved by speciation over a long time frame: the molecular clock can reveal the paleo-ecological conditions that favoured these traits helping a better understanding of pest biology. Molecular clock, when coupled with phylogenomics, can further identify genes and patterns that characterize the pest: this knowledge can be used to enhance management practices. Although this is a data-driven thesis, its major aim is to provide new results to demonstrate the utility of the molecular clock in pest science. This has been done by systematically apply the molecular clock to various neglected organisms of medical and agricultural relevance. To this aim, I generated new genome data and/or assembled the largest genome-scaled data to date. I studied the molecular clock in mosquitoes, focusing on the Aedini radiation (Chapter 2) and identified a strong incongruence between the mitochondrial and nuclear phylogeny for what concerns their molecular clock. This result highlighted the importance of employing genome scaled data for these species to exclude stochastic effects due to poor/inaccurate sampling in clock studies. To tackle the absence of data, I further assembled the whole mitogenome of emerging invasive species Aedes koreicus and Aedes japonicus with the aim of producing useful data for molecular typing and of inferring divergence estimates using whole mitogenomes (Chapter 3). Dated phylogenies point toward more recent diversification of Aedini and Culicini compared to estimates from previous works, addressing the issue of taxon sampling sensitivity in dated phylogeny. Although it is possible to perform molecular clock studies on single/few gene markers, the current trend is to couple this methodology with genome-scaled datasets to reduce the stochastic effect of using few genes. For this reason, I sequenced the draft genome of A. koreicus and A. japonicus (Chapter 4). The assemblies were extremely fragmented, highlighting the problem of sequencing large genomes using short reads. The assemblies provided, however enough information for genome skimming allowing extraction of BUSCO genes for downstream analyses, whole mitogenome assemblies (used in Chapter 3), and characterisation of the associated metagenome. These data need to be integrated by long reads; it provides, however a first framework to investigate the genome evolution of these species. I further sequenced and assembled the genome of Trissolcus japonicus, the parasitoid wasp of the invasive pest Halyomorpha halys. To elucidate its divergence, estimate and define an intraspecific typing system to differentiate strains for biocontrol strategies, I reconstructed the mitochondrial genomes of two populations: the mitogenomes were surprisingly identical, suggesting that they belong to the same de facto population. I further provide a detailed clock investigation of Zika, a virus harboured and transmitted by some Aedes species (Chapter 5). Using the largest set of genomes to date, I could set the origin of ZIKV in the middle age and its first diversification in the mid-19th century. From a methodological point of view, the clocking of this virus highlighted the importance of checking for recombination and for cell-passages to obtain correct divergence estimates. I finally show my contributions to molecular clock studies of three other invasive species (Chapter 6): I helped disentangle the divergence times of Bactrocera, a genus of invasive fruit files pest of agriculture; I contributed in performing a phylogenomics study of opsin genes in Diptera; I used chloroplast and nuclear genome data to reconstruct the divergences of the invasive reed Arundo. In the various Chapters of my thesis, I highlighted the limits and the problems of current molecular clock methodologies and identified the best practices for different types of organisms in order to develop a cross-discipline understanding of the molecular clock techniques. The various results presented in this thesis further demonstrate the utility of the molecular clock approach in pest studies.

A population survey was conducted on the mosquito species recorded in Denton, Texas for the years of 2005 to 2015. Data used in this project were obtained from an ongoing, long-term surveillance program led by the City of Denton and conducted through the University of North Texas. Research focused on the population dynamics and community structure of mosquitoes collected within urban areas of Denton, Texas in relation to certain environmental variables. A total of 80,837 female mosquitoes were captured and represented 38 species found under the following genera: Aedes, Anopheles, Coquillettidia, Culex, Culiseta, Mansonia, Orthopodomyia, Psorophora, Toxorhynchites, and Uranotaenia. Culex quinquefasciatus was the most abundant species followed by Aedes vexans. Seasonal patterns of the most abundant species revealed high variability throughout the study. Container breeders were most abundant in August and those that breed in floodwaters were most abundant in the months of May and September. Samples were tested for arbovirus presence through the Texas Department of State Health Services in Austin, Texas and multiple pools tested positive for West Nile virus throughout the study. Stepwise multiple regression and Spearman's rank correlation analyses were performed to examine the relationship between the mosquito community and environmental variables. Data revealed that temperature, precipitation, and dew point were the most important variables influencing the mosquito population in the City of Denton.

The rubella virus (RV) was the first virus shown to be teratogenic in humans. The wealth of data on the clinical symptoms associated with congenital rubella syndrome is in stark contrast to an incomplete understanding of the forces leading to the teratogenic alterations in humans. This applies not only to RV, but also to congenital viral infections in general and includes (1) the mode of vertical transmission, even at early gestation, (2) the possible involvement of inflammation as a consequence of an activated innate immune response, and (3) the underlying molecular and cellular alterations. With the progress made in the development of pluripotent stem cell-based models including organoids and embryoids, it is now possible to assess congenital virus infections on a mechanistic level. Moreover, antiviral treatment options can be validated, and newly emerging viruses with a potential impact on human embryonal development, such as that recently reflected by the Zika virus (ZIKV), can be characterized. Here, we discuss human cytomegalovirus (HCMV) and ZIKV in comparison to RV as viruses with well-known congenital pathologies and highlight their analysis on current models for the early phase of human development. This includes the implications of their genetic variability and, as such, virus strain-specific properties for their use as archetype models for congenital virus infections. In this review, we will discuss the use of induced pluripotent stem cells (iPSC) and derived organoid systems for the study of congenital virus infections with a focus on their prominent aetiologies, HCMV, ZIKV, and RV. Their assessment on these models will provide valuable information on how human development is impaired by virus infections; it will also add new insights into the normal progression of human development through the analysis of developmental pathways in the context of virus-induced alterations. These are exciting perspectives for both developmental biology and congenital virology.

No description available.

Zika (ZIKV), La Crosse (LACV), and Cache Valley (CVV) viruses are mosquito-vectored diseases that cause significant morbidity and mortality in humans and animals. Transmission of these viruses are dependent on numerous factors including vector competence and the effects of mosquito-virus interactions. We conducted vector competence studies of local Aedes and Culex mosquitoes for ZIKV and CVV, and found that all Aedes mosquitoes were competent for CVV and only Aedes albopictus and Aedes japonicus were competent for ZIKV. Vector competence for CVV was dose-dependent, where mosquitoes orally infected with high titers developed higher transmission rates. We also found that vector competence for ZIKV was limited by midgut and salivary gland barriers. Second, we looked at the effects of LACV and ZIKV infection on repellent response in Aedes mosquitoes and found that infected mosquitoes were refractory to low concentrations of DEET, picaridin, and PMD. Increasing concentrations of the repellents to ≥10% was able to increase percent protection (%p) against infected and uninfected mosquitoes. Lastly, we determined the effects of ZIKV and LACV infection on oxidative stress and glutathione-S-transferase (GST) activity in Aedes albopictus. Virus infection had no effect on oxidative stress, but GST activity was significantly different for mosquitoes 3-days post-exposure. We found that oxidative stress levels and GST activity had an inverse relationship for infected and uninfected mosquitoes, where oxidative stress decreased and GST activity increased over the 10-day test period. This indicates that GSTs may aid in controlling byproducts of oxidative stress. The results from this entire study identified competent vectors for emerging arboviruses and demonstrated the behavioral and physiological effects of virus infection in the mosquito vector. / Doctor of Philosophy / Zika (ZIKV), La Crosse (LACV), and Cache Valley (CVV) viruses are transmitted by mosquitoes and can make humans and animals very sick. There are many biological factors that determine if a mosquito can transmit a virus and these viruses can change the biology of a mosquito. We conducted laboratory studies to see if Aedes and Culex mosquitoes can transmit ZIKV and CVV. We found that all Aedes mosquitoes were able to transmit CVV and only the Asian tiger mosquito and Asian rock pool mosquito were able to transmit ZIKV. Mosquitoes infected with high amounts of CVV developed higher transmission rates. We also found that transmission of ZIKV was limited by barriers in the mosquito midgut and salivary glands. Second, we looked at the effects of LACV and ZIKV infection on how Aedes mosquitoes respond to repellents and found that infected mosquitoes were less sensitive to low concentrations of DEET, picaridin, and PMD. Increasing concentrations of the repellents to 10% or higher was able to provide adequate protection against infected and uninfected mosquitoes. Lastly, we determined the effects of ZIKV and LACV infection on oxidative stress and glutathione-S-transferase (GST) activity in the Asian tiger mosquito. Virus infection did not change oxidative stress, but GST activity was higher in infected mosquitoes tested after 3 days after infection. We found that oxidative stress decreased and GST activity increased over the 10-day test period. This indicates that GSTs may help control damaging products from oxidative stress. The results from this entire study identified what mosquitoes were able to transmit emerging mosquito-borne viruses and demonstrated the biological effects of virus infection in the mosquitoes.

<p>A significant development in mass spectrometry instrumentation and software in the past decade has led to its application in solving complex biological problems. One of the emerging areas is Chemical Proteomics that involves design and use of chemical reagents to probe protein functions in ‘a live cell’ environment. Another aspect of Chemical Proteomics is the identification of target proteins of a drug or small molecule. This is assisted by photoreactive groups, which on exposure to UV light, covalently link the target proteins that can be purified by affinity-based enrichment followed by mass-spectrometric identification. This phenomenon of Photoaffinity labeling (PAL) has been widely used in a broad range of applications. Herein, we have designed chemical tools to study Zika endocytosis and phosphoproteomics.</p> <p>Zika virus has attracted the interest of researchers globally, following its outbreak in 2016. While a significant development has been made in understanding the structure and pathogenesis, the actual mechanism of Zika entry into host cells is largely unknown. We designed a chemical probe to tag the live virus, leading to the identification of the virus receptors and other host factors involved in viral entry. We further validated neural cell adhesion molecule (NCAM1) as a host protein involved in early phase entry of Zika virus into Vero cells.</p> <p>The second aspect is the development of the DIGE (Difference Gel Electrophoresis) technology for phosphoproteomics. Phosphoproteins are known to be involved in various signaling pathways and implicated in multiple diseased states. We designed chemical reagents composed of titanium (IV) ion, diazirine and a fluorophore, to covalently label the phosphoproteins. Cyanine3 and cyanine5 fluorophores were employed to reveal the difference in phosphorylation between samples for the comparative proteomics. Thus far, we have successfully demonstrated the labeling of standard phosphoproteins in both simple and complex protein mixtures, and the future efforts are towards applying the technology to identify phosphoproteins in a cell lysate.</p>

Submitted by Jadson Francisco de Jesus SILVA (jadson@uefs.br) on 2018-07-20T21:53:39Z No. of bitstreams: 1 DISSERTA??O PAULO ROBERTO finalz?o 09 03.pdf: 3626215 bytes, checksum: a916a4a7fbf307b65ccad4330d1dd18c (MD5) / Made available in DSpace on 2018-07-20T21:53:39Z (GMT). No. of bitstreams: 1 DISSERTA??O PAULO ROBERTO finalz?o 09 03.pdf: 3626215 bytes, checksum: a916a4a7fbf307b65ccad4330d1dd18c (MD5) Previous issue date: 2018-02-22 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Study qualitative, exploratory, with the objective of understanding the experiences of families of children with microcephaly by Zika virus. For the production of empirical data we explore the narratives of relatives contained in videos posted on the YouTube Internet platform published between 10/01/2015 and 07/31/2016, as well as narratives obtained from an in-depth interview, of the story-theme design applied in 11 family members of children with microcephaly attended at the Association of Parents and Friends of the Exceptional in Feira de Santana, as well as field diary material. The data collection took place between September and November 2017. For the treatment of the data we adopted the thematic content analysis and the iconographic analysis. The results are organized in: Article 1 - Bad news: experiences and feelings of families regarding the diagnosis of microcephaly by Zika virus; A session entitled: Understanding the family dynamics of study participants; Article 2 - "Well run, very fast ...": experiences of care of mothers of children with microcephaly by Zika; Article 3 - Family organization to take care of the child with microcephaly by z?ka virus. Microcephaly is revealed in the prenatal period, through imaging tests, or during the immediate or late postpartum. Relatives live with feelings of sadness, despair, pain, fright, commotion, disorientation and terror. After diagnosis, family members seek to understand microcephaly through internet resources, and question God's permission and the relevance of scientific knowledge. Mothers experience day-to-day organizing and cleaning the home environment, caring for their children and the specific care of the child with microcephaly, regarding lullaby, since children cry frequently, requiring the mother to spend hours with the child in the lap; Give a shower; change diapers; to feed; play; and, stimulate. They learn to differentiate cognitive, psychomotor, auditory, and visual impairments; recognize progress in the development and new needs of children; identify episodes of seizure; consider patience and attention relevant to care; and, seek to learn about new thematic and unknown terms such as calcifications. Family members build a network of solidarity and unity for the benefit of the child, family relationships are strengthened, bringing together previously conflicting relationships. Caregivers include mothers, fathers, grandparents, sisters, cousins, aunts, friends and neighbors, with the mother being the protagonist who also coordinates and defines the roles played by other people. Family members practice care that has been organized in four dimensions: "Take care"; Encourage; Access Resources and Services. We recommend that family members and health workers attend to the restriction of social interaction, weakening marital relationships, jealousy behaviors on the part of siblings, worsening of grandparents' health conditions, and financial difficulties that may affect the family of children with microcephaly. / Estudo qualitativo, do tipo explorat?rio, com objetivo de compreender as experi?ncias de fam?lias de crian?as com microcefalia por Zika v?rus. Para produ??o de dados emp?ricos exploramos as narrativas de familiares contidas em v?deos postados na plataforma virtual da internet YouTube publicados entre 01/10/2015 e 31/07/2016, e tamb?m narrativas obtidas de entrevista em profundidade, do desenho est?ria-tema aplicados em 11 familiares de crian?as com microcefalia atendidos na Associa??o de Pais e Amigos dos Excepcionais em Feira de Santana, al?m de material do di?rio de campo. A coleta de dados ocorreu entre setembro a novembro de 2017. Para tratamento dos dados adotamos a an?lise de conte?do tem?tica e a an?lise iconogr?fica. Os resultados encontram-se organizados em: Artigo 1 ? M?s not?cias: experi?ncias e sentimentos de fam?lias face o diagn?stico de microcefalia por Zika v?rus; Uma se??o intitulada: Compreendendo a din?mica familiar dos participantes do estudo; Artigo 2 ? ?Bem corrido, muito corrido...?: experi?ncias de cuidado de m?es de crian?as com microcefalia por Zika; Artigo 3 ? Organiza??o familiar para cuidar da crian?a com microcefalia por z?ka v?rus. A microcefalia ? revelada no per?odo pr?-natal, atrav?s de exames de imagens, ou durante o p?s-parto imediato ou tardio. Os familiares convivem com sentimentos de tristeza, desespero, dor, susto, como??o, desorienta??o e terror. Ap?s o diagn?stico, os familiares buscam compreender a microcefalia atrav?s dos recursos da internet, e questionam a permiss?o de Deus e a relev?ncia do conhecimento cient?fico. As m?es experienciam o dia a dia organizando e limpando o ambiente dom?stico, exercendo os cuidados aos filhos e o cuidado espec?fico ? crian?a com microcefalia, referentes a: ninar, pois as crian?as choram com frequ?ncia, necessitando que a m?e passe horas com a crian?a no colo; dar banho; trocar fralda; alimentar; brincar; e, estimular. Elas aprendem a diferenciar as defici?ncias cognitivas, psicomotoras, auditivas e visuais; reconhecem os avan?os no desenvolvimento e as novas necessidades das crian?as; identificam epis?dios de convuls?o; consideram a paci?ncia e a aten??o relevantes para o cuidado; e, buscam apreender sobre novas tem?ticas e termos desconhecidos como calcifica??es. Os familiares constroem uma rede de solidariedade e uni?o em prol da crian?a, as rela??es familiares s?o fortalecidas, aproximando rela??es antes conflituosas. Participam do cuidado as m?es, pais, av?s, irm?s (os), primos (as), tias (os), amigas e vizinhas, havendo protagonismo da m?e que tamb?m coordena e define os papeis desempenhados pelas outras pessoas. Os familiares exercem cuidados que foram organizados em quatro dimens?es: Cuidar Integralmente; ?Tomar Conta?; Estimular; Acessar Recursos e Servi?os. Recomendamos que os familiares e trabalhadores da sa?de atentem para a restri??o do conv?vio social, enfraquecimento das rela??es conjugais, comportamentos que indiquem ci?mes por parte dos irm?os, agravamento das condi??es de sa?de das av?s e dificuldades financeiras que podem repercutir na fam?lia de crian?as com microcefalia.

O objetivo desta tese é entender o papel desempenhado por discursos e ferramentas transnacionais na atuação de atores políticos interessados nas políticas de saúde para as mulheres no Brasil entre 1983 e 2016. Buscamos entender a mobilização de discursos e dinâmicas transnacionais por diferentes atores políticos, sobretudo os movimentos de mulheres, representados por três redes de ativismo: a Rede Nacional Feminista de Saúde, Direitos Sexuais e Direitos Reprodutivos; a Rede pela Humanização do Parto e Nascimento e a Articulação de Mulheres Negras Brasileiras. Trata-se de uma pesquisa engajada cujos métodos de pesquisa foram: pesquisa documental; entrevistas semiestruturadas e observação participante. Analisamos três momentos em que debates e atores internacionais, nacionais e locais buscam determinar alterações nas políticas de saúde para as mulheres estabelecidas que atendam seus interesses. O primeiro caso que apresentamos é o processo de elaboração do PAISM, no início da década de 1980. Em larga medida, o PAISM é resultado da articulação de feministas dentro do Ministério da Saúde, constituindo a resposta à demanda da sociedade brasileira e internacional quanto à necessidade do estabelecimento de uma política populacional no Brasil, de acordo com os compromissos assumidos pelo país na Conferência de Bucareste, em 1974. O segundo caso é a criação do Programa Rede Cegonha, em 2011. A justificativa oficial para o lançamento do Programa é a dificuldade de alcance dos Objetivos de Desenvolvimento do Milênio no que tange à mortalidade materna. A reação ao Rede Cegonha por parte dos movimentos feministas e das mulheres negras é forte e quase imediata ao lançamento da nova política, caracterizada como uma política materno-infantil em contraponto ao paradigma de saúde da mulher vigente entre 1983 e 2010. O terceiro caso é a recente epidemia do vírus Zika e seus efeitos nos direitos reprodutivos das mulheres, sobretudo das mulheres negras no Brasil. Entre os resultados da pesquisa, destacamos que os discursos transnacionais sobre saúde são, caso não sejam acompanhadas da presença de grupos articulados de feministas ou grupos com objetivos específicos de defesa da saúde das mulheres de maneira ampla, em larga medida, utilizados para reduzir definições mais inclusivas de políticas. Além disso, destacamos os diferenciais de acesso a saúde entre as mulheres quando são usadas abordagens interseccionais de raça/cor. As mulheres negras no primeiro caso eram o público-alvo das ações de esterilização que levaram ao estabelecimento da Lei de Planejamento Familiar em 1996, que determinou a necessidade de separação entre parto e operação de laqueadura. No que tange à mortalidade materna, os diferencias de morte entre mulheres brancas e negras são enormes: caso a razão de mortalidade materna do país contasse apenas com as mulheres brancas, o Brasil teria sido capaz de alcançar uma das metas dos Objetivos do Milênio. No caso do Zika, o racismo ambiental tem afetado profundamentamente a vida das populações sem acesso a saneamento básico o que tem deixado essas populações vulneráveis diante de quaisquer epidemias. / The main objective of this thesis is to understand the role played by transnational discourses and tools in the performance of political actors interested in health policies for women in Brazil between 1983 and 2016. We seek to understand the mobilization of transnational discourses and dynamics by different political actors, especially women\'s movements, represented by three networks of activism: Rede Nacional Feminista de Saúde, Direitos Sexuais e Direitos Reprodutivos; Rede pela Humanização do Parto e Nascimento and Articulação de Mulheres Negras Brasileiras. It is an engaged research whose methods of research were: documental research; Semi-structured interviews and participant observation. We analyze three moments in which international, national and local debates and actors seek to determine changes in already established health policies for women. The first case we present is the PAISM elaboration process, in the early 1980s. Largely, the PAISM is a result of the articulation of feminists within the Ministry of Health, constituting the response to the demand of Brazilian and international society concerning the establishment of a population policy in Brazil, in accordance with the commitments made by the country at the Bucharest Conference in 1974. The second case is the creation of Programa Rede Cegonha in 2011. The official justification for launching the Program was aim to achieve the Millennium Development Goals with regard to maternal mortality. The reaction to Rede Cegonha by the feminist and black women\'s movements was strong and almost immediate to the launch of the new policy. It was considered a mother-child policy in opposition to the women\'s health paradigm in force between 1983 and 2010. The third case is the recent outbreak of the Zika virus and its effects on the reproductive rights of women, especially black women in Brazil. Among the results of the research, we emphasize that the transnational discourses on health, if not accompanied by the presence of articulated groups of feminists or groups with specific objectives in defending the health of women, are more commonly used to straighten the contents of policies. In addition, we highlight health access differentials among women when intersectional race/color approaches are used. Black women in the first case were the target audience for the sterilization actions that led to the establishment of the Family Planning Act in 1996, which determined the need for separation between delivery and sterilization. Regarding maternal mortality, the differences in death among white and black women are enormous: if Brazil\'s maternal mortality ratio was the same as the white women in the country, Brazil would have met one of the targets of the Millennium Development Goals. In the case of Zika, environmental racism has profoundly affected the lives of people without access to basic sanitation, which has left these populations vulnerable to any health outbreak.