76 Abstract Topical issues of the regulation of international air carriage The object of this presented thesis is to inform readers about the phenomenon of the international air carriage. This rapidly growing transport industry is bringing attention mainly because of its thorough practical usability. The first part of the thesis is dedicated to the specification of the basic concepts, these will be found in the rest of the thesis all through. To comprehend the actual topical issues it is essential for the reader to familiarize with the historical development of the air carriage. Especially in the 20th century the air carriage went through a swift progress that lead to a recent modern aerial transportation for long distances as we know these days. The second part draws attention into the basic legal sources of the air carriage concentrating not only on the international and European level but also on the Czech laws. Transport customs are not omitted, neither is practice of the courts that has a growing importance. Author of this paper engages in particular rights of the passengers in the air transportation and subsequent liability of the carrier in the third part of the thesis. Recently travelling through the air has become a very commonly used method of transport. From this reason it is necessary to point...

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-27T13:46:56Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Yves Mauro Fernandes Ternes - 2014.pdf: 5561765 bytes, checksum: 46838b1cfdd58678c8db3a46e445ce06 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-28T11:32:01Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Yves Mauro Fernandes Ternes - 2014.pdf: 5561765 bytes, checksum: 46838b1cfdd58678c8db3a46e445ce06 (MD5) / Made available in DSpace on 2015-01-28T11:32:01Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Yves Mauro Fernandes Ternes - 2014.pdf: 5561765 bytes, checksum: 46838b1cfdd58678c8db3a46e445ce06 (MD5) Previous issue date: 2014-04-28 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Fundação de Apoio à Pesquisa - FUNAPE / 10-valent conjugate pneumococcal vaccine (PCV10) was introduced in the routine immunization at Goiania in June, 2010. The aims of this study were: (i) to evaluate the direct effect of PCV10 in preventing vaccine types nasopharyngeal/NP pneumococcal carriage in younger children according to different schedules; (ii) to investigate possible genetic changes that could interfere in the pneumococcal capsular typing. Methods: A cross-sectional population-based household survey was conducted in Goiania, Brazil, from December/2010-February/2011, targeting children aged 7-18 months. To evaluate PPCV10 effectiveness/VE, NP swabs, clinical and demographic data, and vaccination dates were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type (VT) carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by positivity in culture after of NP secretions in enrichment broth and isolates serotyping was performed by Quellung reaction. The nontypeable isolates were processed by conventional multiplex PCR (cmPCR). Rate ratio/RR was calculated as the ratio between the prevalence of VTs carriage in children vaccinated with different schedules (exposed) and not vaccinated to PCV10 (non-exposed). Adjusted RR was estimated using Poisson regression. VE on VT carriage was calculated as 1-RR*100. Results: The prevalence of pneumococcal carriage in a total of 1,287 children was 41.0% (95%CI: 38.4%-43.7%). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Serotypes 6B (11.6%), 6A (9,8%), 23F (7.8%), 14 (6.8%), 19F (6.6%), and 19A (6,3%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction on pneumococcal VT carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2%-57.1%; p=0.030) and 44.0% (95%CI: 14.2%-63.5%; p=0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p=0.905). We identified 13 samples with a genetic variation that underestimated the capsular typing for 19F by cmPCR. Conclusion: PCV10 was associated with high protection against vaccine-type carriage for children vaccinated before the second year of life, for 2p+0 and 3p+0 schedules. The identification of genetic variations (19Fv) allowed adapt the molecular technique (cmPCR) for capsular typing samples from Latin America. The continuous evaluation of carriage serotype is mandatory to evaluate the long-term effectiveness and impact of pneumococcal vaccine on serotypes reduction. / A vacina pneumocócica conjugada 10-valente (PCV10) foi introduzida no calendário básico de imunização em Goiânia em junho de 2010. Este estudo teve como objetivos: (i) Avaliar o efeito direto da PCV10 na redução de sorotipos vacinais de Streptococcus pneumoniae (pneumococo) na nasofaringe (NP) de crianças, de acordo com diferentes esquemas vacinais; (ii) investigar possíveis alterações genéticas que possam interferir na tipagem capsular dos pneumococos isolados. Métodos: Um estudo de corte transversal aninhado a um inquérito domiciliar de base populacional foi conduzido em Goiânia, de dezembro/2010 a fevereiro/2011, em crianças de 7-18 meses. Para avaliar a efetividade da PCV10 (VE), swabs de NP, dados clínicos e demográficos e datas da administração da vacina foram obtidos de 1.287 crianças durante as visitas domiciliares. As variáveis de desfecho e de exposição foram portador (colonização) por tipos vacinais (VTs) da PCV10 e esquemas vacinais (3p+0, 2p+0 e dose única – catch-up), respectivamente. A colonização pelo pneumococo foi definida pela positividade à cultura das secreções de NP em caldo enriquecido, e a sorotipagem dos isolados foi realizada pela reação de Quellung. Os isolados não tipáveis foram submetidos à PCR multiplex convencional (cmPCR). A razão de prevalência (rate ratio/RR) foi calculada como a razão entre a prevalência de VTs em crianças vacinadas com diferentes esquemas vacinais (expostas) e não vacinadas pela PCV10 (não expostas). A RR ajustada foi estimada utilizando a regressão de Poisson. A VE no estado de portador por VTs foi calculada como (1-RR) x 100. Resultados: A prevalência de portador pelo pneumococo no total de 1.287 crianças foi 41,0% (IC95%; 38,4-43,7). Os sorotipos presentes na PCV10 e PCV13 foram 35,2% e 53,0%, respectivamente. Os sorotipos mais frequentes foram 6B (11,6%), 6A (9,8%), 23F (7,8%), 14 (6,8%), 19F (6,6%) e 19A (6,3%). Após ajustar pelas variáveis de confusão, crianças que receberam os esquemas 2p+0 ou 3p+0 apresentaram uma redução significativa dos VTs, com VE igual a 35,9% (IC95%: 4,2-57,1; p=0,030) e 44,0% (IC95%: 14,2-63,5; p=0,008), respectivamente, quando comparado com crianças não vacinadas. Crianças que receberam dose única catch-up não apresentaram VE significante (p=0.905). Foram identificadas 13 amostras que apresentaram uma variação gênica que subestimava a tipagem capsular do 19F pela técnica cmPCR. Conclusões: a PCV10 foi associada a uma proteção significativa contra colonização nasofaringeana de VTs crianças menores de um ano, quando utilizados os esquemas vacinais 3p+0 ou 2p+0. A identificação de variações genéticas do sorogrupo 19 (19Fv) permitiu adequar a técnica de cmPCR para tipagem de amostras da América Latina. O monitoramento contínuo de sorotipos no portador é fundamental na avaliação da efetividade a longo prazo e o impacto da vacinação na redução dos sorotipos vacinais.

Made available in DSpace on 2014-07-29T15:30:37Z (GMT). No. of bitstreams: 1 Camila Xavier de Carvalho_dissertacao.pdf: 504724 bytes, checksum: a41997b1490987005878aa95bc646e53 (MD5) Previous issue date: 2010-03-19 / Haemophilus influenzae (Hi) causes infection in children, and is presented in two ways: with six encapsulated serotypes a-f and non-encapsulated or nontypeable (NTHi). Capsulated strains are responsible for a variety of invasive diseases, with meningitis being the most frequent. Nontypeable strains are responsible for respiratory tract infections and acute otitis media in children under 24 months. Children who attend day care centers have increased risk of developing otitis media when colonized with NTHi. Our goal was to describe the prevalence of colonization by Hi and risk factors associated with carrier status in children attending day care centers. Nasopharyngeal swabs collected from 1192 healthy children under five years of age who attended one of 62 daycare centers in Goiânia - Goiás, Brazil were analyzed. The samples were placed on chocolate agar plates and incubated in an atmosphere containing 5% CO2 at 37 ° C overnight. Hi were identified according with colony morphology in culture, Gram staining, and their requirement for V (hemin) and X (NAD) factors. Capsular typing and the presence of the genes TEM1 and ROB1 for resistance to β-lactams were evaluated by PCR. Differences between proportions and means were tested using Chi-square and Student's t test, respectively. Estimates of relative risk (odds ratio) were evaluated by univariate and multivariate logistic regression, p values less than 5% were considered statistically significant. The prevalence of colonization among the 1192 children was 32.1% and 23.3% for HiNT and 8.8% for encapsulated strains. The prevalence of strains carrying the gene TEM1 was 38.4%. Among HiNT strains the prevalence of TEM1 gene was 43.2%. Previous hospitalization of children in the last 6 months was independently associated with the risk carrier by H. influenzae typeable. The data described in this study will aid investigation on the impact of the 10-valent pneumococcal vaccine (PHiD-CV) introduction. / Haemophilus influenzae (Hi) é uma das espécies de bactéria que causa infecção em crianças, e se apresenta sob duas formas: capsulados com seis sorotipos de a-f e não capsulados ou não tipáveis (HiNT). Cepas capsuladas são responsáveis por uma variedade de doenças invasivas, sendo a meningite a mais freqüente. As cepas não capsuladas ou não tipáveis são responsáveis por infecções do trato respiratório e otite média aguda em menores de 24 meses. As crianças que frequentam creches têm risco aumentado de desenvolverem otite média quando colonizadas por HiNT. Nosso objetivo foi descrever a prevalência de colonização por Hi e fatores de risco associados ao estado de portador em crianças atendidas em creches. Foram analisados swabs de nasofaringe coletados de 1192 crianças saudáveis menores de cinco anos de idade que frequentavam uma das 62 creches de Goiânia - Goiás, Brasil. As amostras foram semeadas em placas de ágar chocolate e incubadas em atmosfera contendo 5% de CO2 a 37°C durante a noite. Os Hi foram identifiados de acordo com a morfologia da colônia em meio de cultura, coloração de Gram e a exigência dos fatores V (hemina) e X (NAD). A tipagem capsular assim como a presença dos genes TEM1 e ROB1 para resistência a β-lactâmicos foi avaliada pela PCR. Diferenças de proporção e de média foram avaliadas pelo teste do Chi-quadrado e teste t de student, respectivamente. Estimativas de risco relativo (odds ratio) foram avaliadas por regressão logística uni e multivariada, valores de p menores que 5%, foram considerados estatisticamente significantes. A prevalência de colonização entre as 1192 crianças foi de 32,1% sendo 23,3% para HiNT e 8,8% para cepas capsuladas. A prevalência de cepas portadoras do gene TEM1 foi de 38,4%. Dentre os HiNT a prevalência de cepas portadoras do gene TEM1 foi de 43,2%. Internação prévia da criança nos últimos 6 meses esteve independentemente associado ao risco de portador por H. influenzae tipável. Os dados obtidos neste estudo poderão subsidiar o impacto da introdução da vacina pneumocócica decavalente PHiD-CV.

Abstract The purpose of this study was to develop sensitive and specific laboratory diagnostic methods for the demonstration of pneumococcal surface antigens or pneumococcus-specific antibodies in clinical samples. The work took account of epidemiological aspects of both pneumococcal disease and nasopharyngeal carriage of pneumococcus. We first compared the sensitivity of pneumococcal culture and antigen detection methods in nasopharyngeal samples in a developing country setting and then investigated the possibility of improving the sensitivity of the antigen detection by introducing an enrichment step in the procedure. — Further investigations were designed to determine the validity of pneumolysin-specific immune complex bound antibody assay as a tool for diagnosing pneumococcal ALRI in a developing country setting. Finally, we developed an enzyme immunoassay for the detection of pneumococcal capsular polysaccharide antigens, using type-specific antibodies produced in-house in rabbits through immunisation with an in-house-produced pneumococcal whole cell vaccine. The method was tested in nasopharyngeal and middle ear fluid samples. The first results indicated that antigen detection might be more sensitive than culture in demonstrating pneumococci in URT, particularly in children with prior antimicrobial therapy. Antigen detection is a feasible method for studies on pneumococci in developing countries. For type-specific demonstration of S. pneumoniae, detection of pneumococcal antigen after an enrichment step proved a sensitive method that can be applied for epidemiologic study purposes, e.g., in vaccine trials, in areas without ready access to a good microbiology laboratory. Determination of IC-bound pneumolysin IgG antibodies appears to be a useful method for species-specific diagnosis of pneumococcal infections. The results indicating pneumococcal aetiology in ALRI patients in this study compare well with the best results obtained by the use of lung aspirates. Increasing the number of serial samples improves the sensitivity of the assay, but even two samples provide more positive findings than other methods currently in routine use. Criteria of positivity need to be confirmed in subsequent larger studies with both healthy controls and patients with confirmed pneumococcal disease. It is also important to control the findings in patients with pneumonia of non-pneumococcal origin. The novel enzyme immunoassay was shown to work well with enrichment culture samples, with an almost 100% sensitivity compared with the culture. Middle ear fluid samples were too diluted for the enzyme immunoassay method used, and only 74% sensitivity compared with culture was achieved. Provided that adequate samples can be obtained, the method will be a useful complement to the current laboratory methods used to diagnose pneumococcal disease. With the existence of a broad spectrum of microbiological and immunological methods, it is imperative to seek international consensus for standard methods to demonstrate pneumococcus. Otherwise it is very difficult to compare results from different clinical studies. A WHO Working Group recently proposed a standard method for detecting upper respiratory carriage of pneumococcus, but a lot of work remains to be done in other areas of research on pneumococcal infections.

La colonisation nasale à Staphylococcus aureus est un important facteur de risque d’infection par cette bactérie chez l’homme. Le rôle de la colonisation extra-nasale dans la physiopathologie des infections liées à la souche de colonisation est incertain. Contrairement aux porteurs intermittents et aux non porteurs, les porteurs persistants ont un risque accru d’infection à S. aureus notamment chez les patients dialysés. Nous avons développé et proposé une nouvelle stratégie applicable aux soins courants pour prédire rapidement le statut de portage nasal persistant de S. aureus dans l’optique de faire bénéficier les porteurs les plus à risque d’infection à S. aureus de mesures de prévention ciblées. Nous avons montré, à travers l’étude des réservoirs pharyngé et digestif, qu’il existe une grande diversité génétique des souches de S. aureus isolées des muqueuses. Enfin, différentes hypothèses ont été investiguées pour déterminer les facteurs microbiologiques associés à la persistance du portage nasal de S. aureus. Ces résultats préliminaires suggèrent que les souches isolées de colonisation nasale persistante et intermittente ont des caractéristiques très similaires / Staphylococcus aureus nasal carriage is a major risk factor of infection with this bacterium in humans. The role of S. aureus extra-nasal carriage in endogenous infections remain elusive. By contrast to intermittent carriers and noncarriers, persistent carriers have a higher risk of S. aureus infection, especially in dialysis patients. We have developed and validated an algorithm to predict the nasal carriage state in clinical practice for proposing decolonization to carriers having the highest risk of S. aureus infection. We found a high diversity between S. aureus strains colonizing the nose, the throat and the rectum, suggesting that extra-nasal carriage could be an additional risk factor of S. aureus infection. Finally, we studied several bacterial determinants of persistent nasal carriage. Our preliminary results suggest that S. aureus isolated in persistent and intermittent carriers harboured similar features

L’uniformisation internationale du droit de transport de marchandises par mer est caractérisée par certains défauts. Par exemple, les Règles de La Haye-Visby ne s’appliquent qu’au transport maritime, ainsi les opérations avant et après le transport par mer sont exclues de leur champ d’application. Le droit international privé déterminera la loi applicable à ces opérations, mais les règles de conflit de lois sont générales et il existe quelques règles spéciales relatives au transport de marchandises par mer. Afin de guider le choix entre les règles de conflit de lois générales et spéciales, la nature particulière des contrats maritimes doit être prise en compte. La thèse tente de déterminer les défauts de l’uniformisation internationale du droit de transport de marchandises par mer, étudie l’application des règles de conflit de lois aux contrats maritimes et tente également de démontrer comment la nature particulière des contrats maritimes influence le choix et l’interprétation des règles de conflit de lois générales. La thèse prend en compte le droit de contrats internationaux et le droit international privé de France et de Panama. / The international uniformity of the carriage of goods by sea law is characterized by certain deficiencies. For instance, the Hague-Visby Rules are applicable only to the maritime leg, so the operations before and after the maritime leg are not under regulation. Here private international law will determine the law to regulate these operations, but the conflict of laws is generalized and there are very few special rules related to the carriage of goods by sea. To guide the choice between the general and special conflict of law rules, the specific characteristics of maritime contracts have to be taken into account. This research tries to determine the deficiencies in the international uniformity of the carriage of goods by sea law, studies the application of the conflict of law rules to maritime contracts and to show how the specific characteristics of maritime contracts influence the choice and the interpretation of the general conflict of law rules. The research takes into account contract and private international law in France and Panama.

The aim of this thesis is to design and manufacture a lifting device to the Volkswagen Crafter long vehicle. In the first part, I present a simple descriptive overview of different lifting devices based on their principle and use. Next, commercially available alternative solutions to the given problem are shown and discussed. The main goals of the practical part are the design of the lifting device that fits to a carriage van according to given specifications and the description of the technological processes for the manufacturing of individual components of the device. The design includes selection of proper machines, measuring devices and working tools, which was carried out based on the available equipment. Finally, manufacturing, testing and evaluation are described and discussed together with the possibilities for future improvement.

For a wounded soldier to have as good a chance of survival as possible, an important variable during care is the time it takes for the wounded to get to a high-quality medical facility where there is expertise in surgery. If the injured person is to be transported with a stretcher carried by other soldiers, the speed for which this can be done is limited by the strength of the bearer in the hands and forearms.This study aims to explore how the speed and perceived ergonomics of those who carry a stretcher can change for a group if it is issued a relieving carrying system that redistributes the load of the stretcher to the hips, back and legs. The study is largely based on a study by Knapik et al (2000) where similar tests were done in a controlled indoor environment but where this study was done in a field environment with groups of 2 or 4 people carrying a stretcher.The study is done in the form of tests and experiments with conscripts from Skaraborg Wing, F 7. The conscripts carried a stretcher in a field-like environment where speed, comfort and usability were in focus. The study was also done with a questionnaire belonging to the experiments to value the experience.The study resulted in a relieving carrying system integrated in the Swedish Armed Forces' combat vest 2000 having an increased average speed with the median 30.7% when carrying a stretcher loaded with 100 kg. The analysis shows that it is above all women who benefit greatly from not carrying a stretcher with their hands. Something they are statistically worse at than men. The study also shows that there are tendencies that the comfort is improved for a soldier. / För att en sårad soldat ska ha så goda chanser till överlevnad som möjligt är en viktig variabel under omhändertagandet tiden det tar för den sårade att komma till en högkvalitativ sjukvårdsinrättning, där det finns expertis inom kirurgi. Om den skadade ska transporteras med sjukbår som bärs av andra soldater, är hastigheten för vilket detta kan göras begränsad av de bärandes styrka i händer och underarmar.Denna studie syftar till att utforska hur hastigheten samt den upplevda ergonomin för de som bär en sjukbår kan förändras för en grupp om den tillförs ett avlastande bärsystem som omfördelar lasten till höfter, rygg och benen. Studien baseras till stor del på en studie av Knapik med flera (2000) där liknande tester gjordes i en kontrollerad inomhusmiljö, men där denna studie är gjord i en fältmiljö med grupper om 2 eller 4 personer som bär en sjukbår.Studien är gjord i form av prov och försök med värnpliktiga ur Skaraborgs Flygflottilj, F 7, som bär en bår i en fältliknande miljö där hastigheten, komforten och användbarheten stod i fokus. Studien är även gjord med en enkätundersökning tillhörande försöken i syfte att skatta upplevelsen.Studien resulterade i att ett avlastande bärsystem integrerat i Försvarsmaktens stridsväst 2000 medförde en ökad snitthastighet, med medianen 30,7%, vid bärande av en sjukbår 2 lastad med 100 kg. Analysen påvisar att det framför allt är kvinnor som har stor nytta av att inte bära en sjukbår med händerna, något de statistiskt sett är sämre på än män. Studien visar även att det finns tendenser för att komforten förbättras för en soldat men användbarheten är oförändrad.

No description available.

Made available in DSpace on 2014-07-29T15:26:24Z (GMT). No. of bitstreams: 1 tese caritas medicina tropical.pdf: 1784866 bytes, checksum: b85c7ab5508fd90ff809159f179430cc (MD5) Previous issue date: 2009-02-17 / Objectives: (i) to identify risk factors for S. pneumoniae penicillin nonsusceptible isolates (PNSp) in children attending day-care centers (DCCs) in Goiânia, Brazil and to assess the genetic patterns of pneumococcal isolates; (ii) to estimate the coverage for carriage serotypes for the 7-valente (PCV7) pneumococcal conjugate vaccine, and for the investigational 10 (PCV10) and 13-valent (PCV13) vaccines; (iii) to assess the genetic relatedeness between isolates expressing capsular type 14 and those non(sero)- typeable isolates (NTPn); (iv) to investigate if carriage isolates match genetically to any international pneumococcal clone (PMEN network). Methods: A cross-sectional survey of carriage PNSp was conducted among 1.192 children, 2 months to 5 years of age, attending 62 DCCs in Central Brazil. Capsular typing was performed in PNSp isolates (CLSI, 2007) and in a sample of isolates susceptible to penicillin (PSSp) matched to PNSp and DCCs whenever possible. Serotyping was performed by Quellung reactions and confirmed by multibead assay. NTPn isolates and serotype 14 were tested by PCR for capsule genes. Odds ratio for PNSp carriage and respective 95% confidence interval (95%CI) were assessed by logistic regression. Pulsed field gel electrophoresis (PFGE) was applied to assess the genetic similarity between PNSp serotype 14 and NTPn isolates. PCR was performed for the presence of pneumococcal capsule gene locus. For comparison purpose we also evaluated the genetic profile of PNSp serotype 14 invasive strains derived from the current pneumococcal invasive disease surveillance for the same pediatric population. Isolates were epidemiologically related if they shared &#8805;80% similarity on the dendrogram (Dice coefficient). A cluster was defined as three or more related isolates. Results: A total of 686 pneumococci were isolated for a colonization rate of 57.6% and 178 (25.8%) were PNSp. Among the PNSp isolates the usual common types were found: 14 (53%), 23F (10.2%), 6B (6%), 19F (4.8%) and 19A (4.2%). PSSp isolates displayed 30 different serotypes although serotype 14 was the most common. Overall a high prevalence of NTPn (11.1%) was observed with 62.9% PNSp. Serotypes coverage xvi for the PCV7, PCV10 and PCV13 vaccines were 55.2%, 55.9% and 65.1%, respectively. Being less than 24 months of age (OR=1.79; p=0.006), hospitalization in the previous three months (OR=2.19; p=0.025), and recurrent acute otitis media (OR=2.89; p=0.013) were independently associated with PNSp in a multivariate model. Among the 123 PNSp submitted to PFGE (106/carriage and 17/ invasive isolates) a major group of 34 serotype 14 strains (8 invasive and 26 carriage) was identified and found to be genetically related to the global pneumococcal clone Spain 9V-3 (82.7% similarity). All NTPn presented capsule gene locus and 10 (45.4%) of them presented capsule gene locus to type 14. Conclusions: (i) DCC attendees with history of recurrent AOM could significantly contribute to the spread of nasopharyngeal PNSp strains into the community; (ii) epidemiologic and molecular evidences support the findings that pneumococcal nonypeable carriage isolates are genetically similar to carriage and invasive isolates expressing capsular type 14; (iii) carriage and invasive isolates circulating in Goiânia belong to a serotype 14 variant of the Spain 9V -3 clone and play a critical role in the spread of PNSp strains to the entire pediatric community of Goiânia / Objetivo: (i) identificar fatores associados à colonização nasofaríngea por S. pneumoniae não suscetíveis à penicilina em crianças que frequentam creches no município de Goiânia-GO e caracterizar geneticamente as cepas não suscetíveis; (ii) determinar a cobertura das vacinas conjugadas pneumocócicas 7, 10 e 13 valente; (iii) avaliar o relacionamento genético entre cepas do sorotipo 14 e pneumococos não tipáveis (PnNT); (iv) identificar a presença de cepas colonizadoras relacionadas geneticamente aos clones internacionais de S. pneumoniae. Metodologia: Um estudo de prevalência de portador de pneumococo não suscetível à penicilina (SpNP) foi conduzido de agosto a dezembro de 2005, em 1192 crianças de dois a 59 meses de idade, atendidas em 62 creches em Goiânia. Os testes de suscetibilidade antimicrobiana seguiram as recomendações do CLSI de 2007 e a sorotipagem foi realizada pela reação de Quellung e confirmada por ensaio multibead. Isolados PnNT e do sorotipo 14 foram analisados por reação de PCR. Odds ratio para portador de SpNP e respectivos intervalos de 95% de confiança foram estimados por regressão logística. Para avaliar a similaridade genética entre os isolados de portador (sorotipo 14 e PnNT) e isolados invasivos (sorotipo 14) obtidos de crianças de Goiânia utilizou-se amostras de isolados invasivos de um estudo maior de vigilância populacional que vem sendo conduzido desde 2007. Assim, eletroforese em campo pulsado (PFGE) foi utilizada para a tipagem molecular. Definiu-se como linhagem a presença de três ou mais cepas resistentes com similaridade genética &#8805; 80%. Resultados: S. pneumoniae foi isolado de 686 (57,6%) crianças das creches e 178 (25,9%) dessas eram portadoras de SpNS. Sorotipo 14 (53%), 23F (10,2%), 6B (6%), 19F (4,8%) e 19A (4,2%) estavam presentes em 78,2% dos PnNS. Detectou-se alta prevalência (11,1%) de isolados não tipáveis, dos quais 62.9% eram resistentes à penicilina. A cobertura dos sorotipos colonizadores para as vacinas 7-valente, 10- valente e 13-valente foi respectivamente 55,2%, 55,9% e 65,1%. Crianças menores de 24 meses de idade (OR=1,79; p=0,006), hospitalização nos últimos três meses (OR=2,19; p=0,025), e otite média aguda recorrente (OR=2,89; p=0,013) foram fatores xiv independentemente associados com SpNS na análise multivariada. Entre os 123 isolados submetidos à PFGE, 106 eram de nasofaringe de crianças das creches, dos quais 84 expressavam a cápsula tipo 14 e 22 eram isolados PnNT. Todas as cepas invasivas eram sorotipo 14. A maior linhagem agrupou 34 pneumococos do sorotipo 14, com 82,7% de similaridade, os quais foram geneticamente relacionados ao clone Spain 9V-3. Todas as cepas PnNT apresentaram locus para o gene da cápsula para o tipo 14. Houve uma diferença estatisticamente significante entre os valores da CIM para a penicilina entre as três principais linhagens (Krukal-Wallis, p<0,001). Conclusões: (i) crianças com otite média recorrente podem exercer papel importante na disseminação de pneumococos resistentes para a comunidade; (ii) Evidências genéticas apóiam os achados de que cepas de pneumococo não tipáveis assemelham-se ao genótipo das cepas do sorotipo 14; (iii) isolados de portadores e invasivos que circulam em Goiânia pertencem a um sorotipo 14 variante do clone Spain9V-3, responsável pela disseminação da resistência do pneumococo na população pediátrica de Goiânia