Tem-se atribuído ao flebotomíneo o papel de transmissor das leishmanioses. Com relação a leishmaniose tegumentar americana, 23 espécies parecem estar incriminadas na transmissão. Contudo, somente em Psychodopygus trapidoi, Ps.ylephiletor, Ps. intermedius, Ps. welcomei, Ps. flaviscutellatus, Ps. panamensis, Ps. olmecus, Lutzomyia gomezi e Pinzomyia pessoai, foi possível o isolamento da Leishmania. O caráter zoonótico desta doença denota uma situação ainda complexa devido aos escassos conhecimentos sobre os hospedeiros, vetores e epidemiologia das diversas Leishmania. A presente revisão confirma que esta função é desempenhada por dípteros da subfamília Phlebotominae. / The function of transmitting Leishmaniasis is generally attributed to phlebotomine sandfly. In relation to American Cutaneous Leishmaniasis, 23 species appears to be involved in the transmission process. However, Leishmania organisms could be isolated from only Psychodopygus trapidoi, Ps. ylephiletor, Ps. intermedius, Ps. welcomei, Ps. flaviscutellatus, Ps. panamensis, Ps. olmecus, Lutzomyia gomezi and Pintomyia pessoai. The zoonotic charater of this disease is yet a complex situation due to lack of adequate knowledge about host, vector and epidemiology of various Leishmania. The present revision confirms that the function is perfomed by diptera of sub-family, Phlebotominae.

Durante o repasto sanguíneo, fêmeas do mosquito Aedes aegypti inoculam saliva na pele de seu hospedeiro vertebrado, modulando suas funções imunológicas e facilitando a transmissão de doenças. Alguns componentes presentes na saliva de Ae. aegypti já foram descritos e caracterizados como alérgenos. No presente estudo, desenvolvemos um modelo de inflamação alérgica em camundongos expostos naturalmente às picadas de mosquitos Ae. aegypti. Nossos dados revelam que a sensibilização e posterior desafio com componentes salivares desse mosquito induz inflamação pulmonar com aumento no número de eosinófilos, células T CD4+, CD19+ e citocinas IL-4 e IL5 no lavado broncoalveolar, produção de muco e colágeno no pulmão, anticorpos IgE total e IgG1 e IgG2a específicos no soro, porém, sem alterações no padrão respiratório e reatividade das vias aéreas. Em conjunto, os resultados gerados neste trabalho confirmam o desenvolvimento de uma resposta alérgica diferente dos modelos clássicos dessa área com a presença de elementos que sugerem tanto um perfil Th1 quanto Th2 de resposta. / During blood feeding, Aedes aegypti female mosquitoes inoculate saliva into the skin of their vertebrate hosts, modulating their immune functions and facilitating disease transmission. Some components presents in the saliva of Ae. aegypti have been described and characterized as allergens. In this study, we developed a model of allergic inflammation in mice naturally exposed to Ae. aegypti mosquito bites. Our data show that the sensitization and subsequent challenged with this mosquito salivary components induces lung inflammation with increased numbers of eosinophils, T CD4+ and CD19+ cells and IL-4 and IL-5 in bronchoalveolar lavage, mucus and collagen production in lung, total IgE and specific IgG1 and IgG2a antibodies in serum, but no changes in breathing pattern and in the airways reactivity. Together, the results generated in the present study confirm the development of an allergic response that is different from classic models of this area with the presence of components which suggest both Th1 and Th2 responses.

Introdução: O enfermeiro é responsável em atuar no controle da contaminação do ambiente, visando a prevenção de transmissão de infecções relacionadas à assistência à saúde. Surtos de gastroenterite causados por norovirus (NoV) em locais fechados são caracterizados pela persistência do vírus no ambiente, aerolização das partículas virais e baixa dose infectante, mesmo em indivíduos saudáveis. Portanto, há necessidade de definição de um protocolo seguro para limpeza e desinfecção do piso contaminado com vômito e fezes, considerando a possibilidade de dispersão de aerossóis a partir do piso. Objetivo: Avaliar a presença residual de partículas de NoV-GII no ar e no piso quando implementados diferentes protocolos de descontaminação do piso, após contaminação intencional. Método: Trata-se de um estudo experimental laboratorial. Dois tipos de piso, vinil e granito (matérias primas frequentemente utilizadas nos pisos dos serviços de saúde), foram contaminados intencionalmente com fezes humanas positivas 10% para NoV-GII, dissolvidas em 500ml de solução tampão salino-fosfato. Os pisos foram submetidos a três tipos de tratamento: limpeza padronizada com fricção manual, água e detergente neutro; limpeza seguida de desinfecção com hipoclorito de sódio 1% por 10 minutos; limpeza seguida de desinfecção com dispositivo portátil de luz ultravioleta por cinco minutos (SURFACE-UV®). Amostras foram obtidas do piso, por meio do swab, e do ar, por meio de um coletador de ar (Coriolis® - Bertin Technologies, França), nos seguintes momentos: antes e após a contaminação intencional; após a limpeza e após os métodos de desinfecção. Para detecção de NoV-GII nas amostras, utilizou-se a técnica 4.6.2. Reação em Cadeia pela Polimerase quantitativa precedida de Transcrição Reversa (RT-qPCR), pelo método TaqMan®. Resultados: Não foram encontradas diferenças estatisticamente significantes entre os tipos de piso após os protocolos de descontaminação, tanto para o residual de NoV-GII no piso, quanto no ar. Os valores médios de Cycle Threshold (Ct) após limpeza seguida de desinfecção foram maiores (38,75 40,00) comparados aos de após limpeza (35,67 38,66), comprovando a maior eficácia desse protocolo (p<0,001). Em algumas amostras, a limpeza isolada foi capaz de reduzir a contaminação por NoV do piso até níveis indetectáveis. Quando houve residual de NoV-GII após a limpeza do piso, o protocolo cuja desinfecção foi realizada com hipoclorito de sódio foi mais eficaz do que a luz ultravioleta (p<0,001), sendo que os valores de Ct de todas as amostras foram acima de 40. Em 27 das 36 (75%) amostras de ar coletas após a limpeza do piso, foram detectadas partículas de NoV, com diferenças estatisticamente significantes entre as segundas e terceiras amostras, coletadas a 150cm do piso. Foram identificadas que, em média, 17 cópias de RNA viral/L estavam presentes no ar após a limpeza, com redução gradual após a desinfecção. Conclusões: Quando vômito e fezes com NoV-GII contaminam o piso, há aerolização desse vírus já no ato da limpeza. Essas partículas podem ser inaladas ou depositarem em superfícies frequentemente tocadas pelas mãos, estabelecendo o ciclo de transmissão oro-fecal. As partículas virais residuais no piso após a limpeza, indiscutivelmente devem ser eliminadas, evitando assim a reaerolização do NoV a partir dessa fonte. Nesse sentido, a limpeza seguida de desinfecção com hipoclorito de sódio a 1% por 10 minutos mostra superioridade como protocolo de descontaminação do piso, quando comparado ao protocolo com limpeza seguida de desinfecção com luz ultravioleta por 5 minutos de exposição. / Introduction: Nurses are responsible for controlling contamination of the environment, working to prevent the transmission of health-care-associated infections. Gastroenteritis outbreaks caused by Norovirus (NoV) in closed settings are characterized as the result of persistence of the virus in the environment, aerosolization of viral particles, and small infectious dose, even in healthy individuals. Therefore, a safe protocol to decontaminate the floor after vomit or feces have spilled must be defined, considering that subsequent aerosol dispersal may occur. Objective: To assess the presence of residual NoV-GII particles in the air and on the floor after different decontamination protocols are conducted on a deliberately contaminated floor. Method: This is an experimental laboratory study. Two types of floor, vinyl and granite (materials which are often used in the flooring of healthcare facilities), were intentionally contaminated with 10% NoV-GII-positive human feces dissolved in 500ml of a saline-phosphate buffer solution. The floors received three types of treatment: standard cleaning, with manual friction, water, and neutral detergent; cleaning followed by a ten- minute disinfection procedure using 1% sodium hypochlorite; and cleaning followed by a five- minute disinfection procedure using a portable ultraviolet light device (SURFACE-UV®). Swab samples were taken from the floor, and air samples were obtained using an air sampler (Coriolis® - Bertin Technologies, France) at the following moments: before and after the intentional contamination, after cleaning, and after disinfection. The TaqMan® method for real-time Reverse Transcription-Polymerase Chain Reaction was used to detect NoV-GII in the samples. Results: No statistically significant difference between the two types of floor was found for residual NoV-GII, either in the air or on the floor, after the decontamination protocols. The average Cycle Threshold (Ct) values found after cleaning followed by disinfection were higher (38.75 - 40.00) than those recorded after cleaning (35.67 - 38.66), thus attesting to the greater effectiveness of the latter protocol (p<0.001). In some samples, cleaning alone was enough to reduce floor contamination by NoV to undetectable levels. When residual NoV-GII was found after cleaning the floor, the disinfection protocol that involved using sodium hypochlorite proved more effective than UV-light exposure (p<0.001), and Ct values were higher than 40 for all samples. NoV particles were detected in 27 of the 36 (75%) air samples obtained after cleaning the floor, and significant statistical differences were found between the second and third samples, collected 150cm from the floor. An average of 17 copies of viral RNA/L were identified in the air after cleaning, gradually decreasing after disinfection. Conclusions: When NoV-GII-infected vomit or feces contaminate the floor, the virus is aerosolized even during cleaning. These particles may then be inhaled or settle on frequently touched surfaces, establishing the fecal-oral transmission cycle. Residual viral particles on the floor must undoubtedly be eliminated, thereby preventing NoV aerosolization from this source. Along these lines, cleaning followed by disinfection by 1% sodium hypochlorite for ten minutes proved to be a superior floor decontamination protocol when compared with cleaning followed by disinfection by UV-light exposure for five minutes.

Diante da necessidade de responder algumas indagações relacionadas a epidemiologia da Estomatite Vesicular, principalmente aquelas que dizem respeito a ocorrência de surtos em locais onde existem coleções d\'água, foi desenvolvido um modelo de transmissão do VSA utilizando a água como via de transmissão, a tilápia nilótica, inoculada intraperitonealmente, como fonte de infecção e o cobaio como hospedeiro susceptível. O objetivo da utilização deste modelo biológico de transmissão do Vírus da Estomatite Vesicular foi de avaliar o papel desempenhado pelos peixes no ciclo epidemiológico, propor um modelo de ciclo epidemiológico do VSA, destacando o papel da água como via de transmissão e padronizar uma técnica de RT-PCR para a detecção do VSA, em amostra de tecidos. Através do modelo desenvolvido, fica demonstrado que estes peixes eliminaram partículas virais na água, decorridos 13 dias pós-inoculação e que esta última se caracteriza como via de transmissão, possibilitando a infecção dos hospedeiros susceptíveis (cobaios) através de inoculações experimentais em coxim plantar. A tilápia nilótica pode ser considerada como uma fonte de infecção, por ser capaz de eliminar um agente infeccioso no meio ambiente e através de uma via de transmissão este agente alcançou o hospedeiro susceptível; os peixes podem ser inseridos no ciclo epidemiológico da Estomatite Vesicular como fonte de infecção, sendo capazes de eliminar na água partículas virais infectantes, destacando o papel da água como via de transmissão; fica padronizada uma técnica de RT-PCR dirigida ao gene codificador da proteína RNA-polimerase, útil para a detecção direta do Vírus da Estomatite Vesicular Alagoas e Indiana em amostras de tecidos. / A model of transmission of Vesicular Stomatitis was developed to Vesicular Stomatitis Alagoas (VSA) serotype employing water as a way of transmission, the Nile tilapia intraperitoneal inoculated as a source of infection and guinea pigs as susceptible hosts aiming to answer many questions concerning Vesicular Estomatitis epidemiology, as the risk of disease on farms with dose relationship with riverine areas and the role of fishes in the epidemiological cycle of the disease. Furthermore, a RT-PCR assay was developed to detect VSA in tissue samples. According to the experimental transmission, fishes eliminated virus into the water after 13 days pos-infection and a model to VSA epidemiological cycle is proposed in which water was characterized as a way of transmission, carrying the virus to the susceptible host through experimental inoculation and the Nile tilapia should be thought as a source of infection, once it was able to eliminate the infective agent into the environment. A useful tool to the diagnosis of both Indiana and Alagoas serotypes was developed.

As medidas preventivas da transmissão vertical do HIV podem efetivamente reduzir as taxas da infecção nas crianças. No entanto, são necessárias a participação e adesão das mães ao tratamento. Buscando compreender as crenças que influenciam o comportamento das mães portadoras do HIV em relação às medidas profiláticas da transmissão vertical, desenvolvemos este estudo qualitativo. Foram entrevistadas 14 mulheres portadoras do HIV cujos filhos nasceram no município de Ribeirão Preto e tinham no mínimo 6 meses de vida. Os dados foram tratados de acordo com o método da Análise de Conteúdo e interpretados utilizando-se como referencial teórico o Modelo de Crenças em Saúde (Rosenstock, 1974), composto pelas dimensões susceptibilidade percebida, severidade percebida, benefícios percebidos e barreiras percebidas. Na análise emanaram categorias que evidenciam as contradições da epidemia da aids: na susceptibilidade percebida emergiram “invulnerabilidade antes da gravidez", “o pré-natal" e “susceptibilidade da criança"; quanto à severidade da doença – “subestimação do HIV" e “medo da morte"; “crescer saudável" e “não ser como eu", foram os benefícios percebidos pelas mães; em relação às barreiras possíveis, encontramos a “descrença na existência do vírus", “dificuldades financeiras" e “omissão do diagnóstico". Alguns aspectos das crenças podem ser considerados tanto como facilitadores como dificultadores da adesão materna, dependendo do contexto sócio-econômico e cultural em que vive a mãe. Conhecer a percepção das mães acerca das crenças que motivam os seus comportamentos proporciona aos profissionais de saúde maior compreensão desses comportamentos, permitindo ainda a possibilidade de elaboração de um planejamento mais efetivo de cuidados dentro de um contexto culturalmente significativo, com maior probabilidade de promover a adesão da clientela. / Prevention measures for the mother-to-child transmission of the HIV virus may effectively reduce infection rates in children. However, for such effectiveness to come true, mothers have to comply with the treatment. This study was carried out aiming to understand the beliefs which influence the HIV positive mothers’ behaviors towards prevention methods against mother-to-child transmission. Fourteen HIV infected women whose children were at least 6 months old and all born in Ribeirão Preto county were interviewed. Data were studied according to the Content Analyses method and interpreted using as a theoretical reference the Health Belief Model (Rosenstock, 1974), formed by the following dimensions: perceived susceptibility, perceived severity, perceived benefits and perceived obstacles. As we analyzed those data we came up with some under categories showing the AIDS epidemic paradox: in the perceived susceptibility appeared: “invulnerability prior to pregnancy"; “pre delivery"; “a child’s susceptibility" as for the disease seriousness. “Underestimation of the HIV virus";" fear of death"; “healthy growing up"; and “not the same as me" were the benefits mentioned by the mothers. As for the possible barriers, we found things like: “disbelief in the virus existence"; “financial problems"; “diagnosis omission". Some aspects of the beliefs may be considered both helpers and trouble-makers for a mother’s adhesion, varying according to the social, economic and cultural environment the mother lives in. Getting to know a mother’s perception regarding the beliefs motivating their behaviors provides the health professionals a higher understanding of such behaviors, allowing the possibility of making up an effective care plan within the context culturally meaningful, with a higher probability of promoting patients’ adhesion.

Considera-se que viver em grupo aumenta a probabilidade de transmissão de parasitos entre co-específicos, dada a maior proximidade e/ou frequência de interação entre os indivíduos. A transmissão de doenças entre diferentes espécies de hospedeiros, entre indivíduos de uma mesma espécie ou de um mesmo grupo social pode levar populações de animais selvagens ao declínio. Dada a relevância do tema, neste trabalho, buscamos contribuir para o entendimento dos fatores que afetam a ocorrência de parasitoses em primatas selvagens. Investigamos a ocorrência de parasitos intestinais em uma população selvagem de macacos-prego (Sapajus libidinosus), analisando os efeitos de três fatores distintos: proximidade geográfica entre primatas humanos e não humanos; características intrínsecas dos hospedeiros e climáticas do ambiente e, por fim, relações sociais diferenciadas. Encontramos que a sobreposição de área de vida não é suficiente para explicar a co-ocorrência de parasitos intestinais entre as diferentes espécies de hospedeiros na Fazenda Boa Vista (Piauí, Brasil). Ao considerarmos os efeitos dos hospedeiros e do ambiente sobre as parasitoses intestinais de acordo com o modo de transmissão dos parasitos, confirmamos que parasitos com diferentes ciclos de vida e modos de transmissão são afetados diferentemente por características dos hospedeiros e do ambiente: parasitos transmitidos diretamente foram afetados somente por características dos hospedeiros; parasitos transmitidos via hospedeiros intermediários foram afetados somente por características climáticas do ambiente, enquanto parasitos transmitidos via ambiente foram afetados por ambos (hospedeiros e ambiente). Por fim, ao investigarmos os efeitos das interações sociais sobre as parasitoses com base nos modos de transmissão dos parasitos, encontramos que a transmissão de parasitos, mesmo os com modo de transmissão direta, não depende exclusivamente da frequência de associação espacial entre os indivíduos. Os resultados deste trabalho contrariaram as principais premissas do efeito da socialidade sobre a transmissão de parasitos. Assim, é preciso considerar que a chance de aquisição e transmissão de parasitos em espécies sociais é complexa e está sujeita à interação de diversos fatores: individuais, ambientais e dos próprios parasitos, os quais, portanto, devem ser incorporados aos estudos de transmissão de doenças em populações de animais selvagens / Living in a group theoretically increases the probability of transmission of parasites between co-specifics, given the greater proximity and / or frequency of interaction between individuals. Transmission of diseases among different host species, among individuals of the same species or of the same social group, may lead to a decline in wild animal populations. Given the relevance of this research area, we seek to contribute in this thesis to the understanding of the factors that affect the occurrence of intestinal parasites in wild primates. We investigated the occurrence of intestinal parasites in a wild population of capuchin monkeys (Sapajus libidinosus), analyzing the effects of three distinct factors: geographical proximity between human and non-human primates; intrinsic host and environment climatic characteristics of the environment and, finally, differentiated social relationships. We found that the living area overlap is not sufficient to explain the co-occurrence of intestinal parasites between the different host species at Fazenda Boa Vista (Piaui State, Brazil). When we considered the effects of host and environmental characteristics on intestinal parasites according to the mode of transmission of the parasites, we confirmed that parasites with different life cycles and modes of transmission are differently affected differently: directly transmitted parasites were affected only by host characteristics; parasites transmitted via intermediate hosts were affected only by climatic characteristics of the environment, and parasites transmitted through the environment were affected by both host and environmental characteristics. Finally, when investigating the effects of social interactions on the occurrence of parasites according to parasite transmission modes, we found that the transmission of parasites, even those with direct transmission, do not depend exclusively on the frequency of spatial association between individuals. The results of this work contradict the main premises about the effect of sociality on the transmission of parasites. Thus, it is necessary to consider that the likelihood of acquisition and transmission of parasites in social species is complex and is subject to the interaction of several factors: individual, environmental and of the parasites themselves, which, therefore, must be considered in studies of disease transmission in wild animal populations

abstract: Understanding the consequences of changes in social networks is an important an- thropological research goal. This dissertation looks at the role of data-driven social networks on infectious disease transmission and evolution. The dissertation has two projects. The first project is an examination of the effects of the superspreading phenomenon, wherein a relatively few individuals are responsible for a dispropor- tionate number of secondary cases, on the patterns of an infectious disease. The second project examines the timing of the initial introduction of tuberculosis (TB) to the human population. The results suggest that TB has a long evolutionary history with hunter-gatherers. Both of these projects demonstrate the consequences of social networks for infectious disease transmission and evolution. The introductory chapter provides a review of social network-based studies in an- thropology and epidemiology. Particular emphasis is paid to the concept and models of superspreading and why to consider it, as this is central to the discussion in chapter 2. The introductory chapter also reviews relevant epidemic mathematical modeling studies. In chapter 2, social networks are connected with superspreading events, followed by an investigation of how social networks can provide greater understanding of in- fectious disease transmission through mathematical models. Using the example of SARS, the research shows how heterogeneity in transmission rate impacts super- spreading which, in turn, can change epidemiological inference on model parameters for an epidemic. Chapter 3 uses a different mathematical model to investigate the evolution of TB in hunter-gatherers. The underlying question is the timing of the introduction of TB to the human population. Chapter 3 finds that TB’s long latent period is consistent with the evolutionary pressure which would be exerted by transmission on a hunter- igatherer social network. Evidence of a long coevolution with humans indicates an early introduction of TB to the human population. Both of the projects in this dissertation are demonstrations of the impact of var- ious characteristics and types of social networks on infectious disease transmission dynamics. The projects together force epidemiologists to think about networks and their context in nontraditional ways. / Dissertation/Thesis / Doctoral Dissertation Anthropology 2019

Individual-level models are a class of complex statistical models, often fitted within a Bayesian Markov chain Monte Carlo framework, that have been effectively used to model the spread of infectious diseases. The ability of these models to incorporate individual-level covariate information allows them to be highly flexible, and to account for such characteristics as population heterogeneity. However, these models can be subject to inherent uncertainties often found in infectious disease data. As well, their complex nature can lead to a significant computational expense when fitting these models to epidemic data, particularly for large populations. An individual-level model that incorporates a latent grouping structure into the modeling procedure, based on some heterogeneous population characteristics, is investigated. The dependence of this latent conditional individual-level model on a discrete latent grouping variable alleviates the need for explicit, although possibly unreliable, covariate information. A simulation study is used to assess the posterior predictive ability of this model, in comparison to individual-level models that utilize the full covariate information, or that assume population homogeneity. These models are also applied to data from the 2001 UK foot-and-mouth disease epidemic. When attempting to compare complex models fitted within the Bayesian framework, the identification of appropriate model selection tools would be beneficial. The use of deviance information criterion (DIC) as model comparison tool, particularly for the latent conditional individual-level models, is investigated. A simulation study is used to compare five variants of the DIC, and the ability of each DIC variant to select the true model is determined. Finally, an investigation into methods to reduce the computational burden associated with individual-level models is carried out, based on an individual-level model that also incorporates population heterogeneity through a discrete grouping variable. A simulation study is used to determine the effect of reducing the overall population size by aggregating the data into spatial clusters. Reparameterized individual-level models, accounting for the aggregation effect, are fitted to the aggregated data. The effect of data aggregation on the ability of two reparameterized individual-level models to identify a covariate effect, as well as on the computational expense of the model fitting procedure, is explored.

Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health problem, placing millions at risk. Further, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. Effective tuberculosis (TB) infection prevention and control (IPC) policies in high-risk settings must use evidence-based science and should be customized to the setting. However, the growing incidence of MDR/XDR-TB in some global settings raises questions about whether adequate healthcare-related TB IPC policies are in place and whether they are implemented effectively. The purpose of this systematic literature review was to catalogue healthcare-related TB IPC policy research conducted in high-prevalence settings and draw a picture of existing evidence-based TB IPC policies and their implementation, with a focus on preventing and controlling nosocomial transmission of MDR/XDR-TB. Two databases (PubMed and Embase) were searched from 1990 – 2013 and outputs were categorized by region/country, income, MDR/XDR-TB incidence, level of IC intervention, and time period. None of the 20 captured research studies were conducted in TB high-prevalence, low-income settings. Most (12/20) were implemented within the Pan American Health Organization region, followed by the African (4/20) and European (4, 20%) regions. Most studies reviewed (70%) were undertaken because of an outbreak and most (70%) were published between 1990 – 2000. This systematic literature review showed a gap in research on TB IPC policies addressing nosocomial transmission of MDR/XDR-TB in high-prevalence, low-income settings. TB IPC policy development and implementation should be routinely undertaken as a part of effective and efficient public health practice. Development of TB IPC global best practices should be guaranteed and a concerted effort to promote, distribute, train, and implement these TB IPC best practices in low-resource countries would help mitigate the growing incidence of MDR/XDR-TB worldwide.

Diss. (sammanfattning). Umeå : Sveriges lantbruksuniv., 2003. / Härtill 4 uppsatser.