O Javali (Sus scrofa scrofa) é uma espécie com ampla distribuição mundial e presente no Brasil. No Rio Grande do Sul, nos últimos anos, aumentaram os relatos de ataques e prejuízos causados pela presença de javalis asselvajados, sendo seus impactos negativos observados na degradação da vegetação nativa e água de superfície, na predação sobre a fauna e pecuária, e na possibilidade de transmissão de doenças para humanos e animais. A localização destes animais de vida livre e os possíveis fatores associados à sua presença são de extrema importância para a Gestão Ambiental e de Saúde Animal, uma vez que estes animais podem assumir um importante papel na introdução e disseminação de doenças para a pecuária gaúcha. Um estudo foi realizado nos anos de 2012 e 2014 no Estado do Rio Grande do Sul visando identificar possíveis fatores associados à presença destes animais de vida livre junto às propriedades de suínos de subsistência e apresentar uma análise espacial para identificar possíveis aglomerados da presença destes animais no Estado. As propriedades amostradas no estudo foram propriedades de suínos de subsistência, que apresentam uma menor tecnificação e biosseguridade quando comparada com as propriedades comerciais, o que pode facilitar essa interação. Foi utilizada uma amostragem proposital, onde foram selecionadas 640 propriedades em cada ano, primeiramente destinada para comprovar a ausência de atividade do vírus da Peste Suína Clássica nos criatórios do Rio Grande do Sul. Um questionário epidemiológico foi aplicado nas propriedades amostradas a fim de caracterizar e identificar as que apresentam relatos da presença de javalis asselvajados e elencar os possíveis fatores associados a sua presença. De todas as 640 propriedades amostradas, em 63 (9,8%) os proprietários relataram a possível presença de suínos asselvajados. Para análise dos fatores associados, foi utilizado um modelo de regressão de Poisson com variância robusta. No modelo final, os fatores associados à presença de javalis asselvajados foram: ter suínos criados próximos a reservas naturais (RP=2,29; IC 95% 1,10- 4,75), criação extensiva de suínos (RP=2,63; IC 95% 1,59- 4,34), ter criação de híbridos de javalis e suínos (RP=2,37; IC 95%1,09-5,19), criações de javalis na propriedade (RP=3,22; IC 95% 1,21- 8,58) e tamanho da propriedade em Km²(RP=0,54; IC 95% 0,26-1,11). Através da análise espacial foi possível identificar aglomerados de relatos da presença destes animais nas regiões sul e nordeste do Estado. Com esse estudo, espera-se dar auxilio do ponto de vista teórico a gestores públicos na implantação de políticas de saúde animal e de conservação que visem mitigar os possíveis riscos da interface animais de produção e vida selvagem. / The wild boar is a species from Eurasia which is widely distributed, being introduced in several countries, including Brazil, where it is considered an exotic invasive species. Considering the fact that pigs and wild boar belong to the same species and share the same pathogens, they have been regarded a reservoir for various harmful diseases for livestock. It is essential scientific knowledge about these free-living populations interactions with commercial pig farming. There are increasing reports numbers regarding attacks and damage caused by feral pig presence in Rio Grande do Sul. It has been causing negative impacts on native vegetation, wildlife predation, and the likelihood of transmitting diseases to humans and animals. This study aims to identify where feral pigs are in the state and assess factors associated with domestic pigs contact. The study was conducted in 2012 and 2014 using a purposive sampling, intended primarily to demonstrate and document the absence of classical swine fever virus in the farms within a free zone. A total of 640 subsistence farms were sampled throughout the state. An epidemiological questionnaire was applied in these farms to identify attack and/or wild boar existence in the vicinities of the property (response variable). A Poisson regression model was used to determine factors associated with wild boar presence in these farms through the estimates of prevalence ratio (PR) and a scan statistic was used to find possible cluster of the wild boars presence in Rio Grande do Sul state. The variables associated with wild boar presence were farms located near forest reserves (PR=2.29; CI 95% 1,10-4,45), Total farm Area (PR=0.54; CI 95% 0.26-1.11), Farms raising outdoors pigs (PR=2.63; CI 95% 1.59-4.34) and farms raising wild boars (PR=3.22; CI 95%1.21- .8.58) and farms raising hybrid with wild boar and swine (PR=2,37; CI 95% 1,09-5,19). In the Northeast region and the Southern state two clusters were identified and overlapped in each year of study. Factors associated with feral pig presence in backyard pig farms were primarily linked with environmental variables. Properties near forest reserves, indigenous reserves and rural settlements had higher prevalence ratio (PR). This can be explained due to feral animals necessity to find refuge areas for its maintenance and stabilization, which increases contact probability with domestic pigs raised round these areas. It is proposed to support decision makers on animal health implementation policies in order to mitigate contact´s risk between domestic species and wild animals, minimizing pathogens transmission probabilities among them.

Foodborne diseases form a large group of infectious diseases. These substantial diseases are occurring more in developing countries but they do not avoid developed countries. The originators of the disease are bacteria and their toxins, viruses, parasites and prions, whose source is an infected person or animal. The disease is passed on by contaminated soil, contaminated water and food, sometimes contaminated items. Greatest importance in the prevention of foodborne disease are nonspecific measures, protection of drinking water, safe food production, waste disposal, functional sewer system, rodenticides and insecticides measures and of course the principles of personal hygiene, certain standards of hygiene and health education of the population. Intestinal infections are preventable. The consumer can effectively protect by following the fundamental principles established by the World Health Organization. The aim of this study was to explore knowledge of foodborne disease prevention measures and compliance with these principles by adolescents in the Milevsko region. The theoretical part of the study summarizes the basic information about intestinal diseases and describes their effect on health from a variety of perspectives. The preventive measures which everyone should be aware of and apply them in everyday life to protect health are described in great detail. The paper summarizes the information about the process of spreading foodborne diseases and epidemiological measures focused on supply, routes of transmission and susceptible individuals. The theoretical part includes basic information about specific intestinal infections which are most significant for the population in the Czech Republic. Briefly described are treatment of these diseases and the most important legislative measures. In the research part quantitative research was applied by questionnaire. The research groups were students of higher secondary vocational schools and vocational schools in the region Milevsko. Three hypotheses were formulated. Statistical hypothesis testing was performed using the t test. The values of the achieved significance level are compared with a predetermined level of significance. The first hypothesis assumed that knowledge about prevention of intestinal diseases is higher among girls than boys. This statement has not been confirmed. Knowledge of the principles of prevention does not differ according to the criteria of gender. Two further hypotheses assumed that the observance of hygienic measures in the prevention of foodborne disease is higher among girls than among boys and higher for high-school graduates than apprentices. These hypotheses are valid. Precautionary principles are indeed respected more by girls than boys and high-school graduates than apprentices. The carried out research shows that adolescents in the region Milevsko have a good knowledge of foodborne infections and do known also essential preventive measures. However, knowledge of these rules does not mean they are applied in practice. The results showed that some rules, such as washing fruits and vegetables before eating, adequate boiling or roasting of food, especially hand hygiene before eating food or after contact with an animal are observed by a smaller percentage of respondents than that reported knowledge of these principles. A positive finding is that respondents comply with certain rules, without being aware of them, such as the principle of proper preservation of precooked food. Foodborne diseases are diseases which can be prevented in compliance with precautionary principles. Especially in the Czech Republic, where nonspecific principles are at a high level. It is up to each user/consumer how consistent these principles will be. Respecting preventive measures is a prerequisite for reducing the incidence of foodborne disease in the population.

This thesis deals with the problems of pertussis epidemiological problems in the Czech Republic, especially the possibilities of improvement of the epidemiological situation of pertussis. Pertussis is a serious infectious disease of the respiratory system and is monitored long-term in Czech Republic. The incidence of pertussis in its epidemic cycles continues to increase since the 90s. Last year's reported sickness rate was 11.7 of 100 000 people (1233 cases total).The thesis is divided into theoretical and practical part. The theoretical part shows the characteristics of pertussis and describes the preventive and repressive measures. Last part of the theoretical section describes epidemiological situation of pertussis from history to the present day while last four years are described in more detail. The practical part of the thesis consists of research.The research was conducted using qualitative method. As data collection method was chosen interviews with first contact physicians, which are pediatricians and physicians for adults. Two objectives were set in research area. The first objective was to map the compliance with the conditions laid down under the "case" definition of pertussis and its methods of diagnosis for pediatricians and physicians for adults (first contact physicians). The second objective was to create intervention for affecting the adverse epidemiological situation of pertussis. Intervention is based on the results of research aimed at compliance with procedures of "case" definition of pertussis and on knowledge of pediatricians and physicians for adults about the epidemiology of pertussis issue and their views on vaccination.

O presente estudo discute a questão da integração das vigilâncias em âmbito hospitalar (vigilância epidemiológica hospitalar e vigilância do controle de infecção hospitalar), analisando as possibilidades e impossibilidades dessa integração. Examina os aspectos histórico-políticos e as concepções teórico-práticas de organização dos serviços de vigilância hospitalar, buscando identificar as diferenças e semelhanças entre as duas vigilâncias. A análise inicial permitiu examinar em que medida os limites impostos pelas especificidades de cada vigilância contribuem para sua prática de forma desintegrada. Em seguida realizou-se pesquisa de natureza qualitativa, por meio de entrevistas com grupos focais de profissionais que atuam na vigilância das infecções hospitalares e da vigilância epidemiológica em âmbito hospitalar. O material localizado nos grupos focais foi analisado utilizando-se categorias construídas a partir do próprio material. As vigilâncias hospitalares têm tentado encontrar formas de mudar suas práticas, buscando romper com os caminhos neutralizados, buscando uma aproximação entre as vigilâncias, pois havia muito conflito relacionado a questões técnicas advindas da formação diversificada entre os profissionais que atuam na área. Hoje a busca de novos caminhos foi possível pela mudança da percepção dos profissionais apenas, sem a imposição da gestão, ao perceberem a necessidade de reorganizar o serviço de vigilância hospitalar de forma horizontalizada, construindo um diagnóstico com múltiplos olhares/saberes, como práticas aliançadas com a transformação da realidade de sua unidade hospitalar. Alguns apontam a necessidade de se discutir um novo conceito para Vigilância Hospitalar, capaz de reconhecer além da vigilância das infecções hospitalares e vigilância epidemiológica, capaz de incluir também a vigilância ambiental, assim o conceito de vigilância em saúde no território hospitalar deve possibilitar uma visão mais ampla para a VH. Esta vem enfrentando dificuldades ao tentar reorganizar suas práticas, principalmente em sua infra-estrutura, e os recursos humanos têm sido o maior problema. Reconhecem que um serviço de VH requer normas, fluxos, protocolos, etc. para integrar suas práticas, o que exige construir a integração. Embora acreditem que a integração não deva começar pela mudança da estrutura do serviço, mas pelo processo de trabalho, esperam que, ao final dessa construção, seja criada uma regulamentação que proponha a integração das vigilâncias, efetivando a proposta. / This study discusses the integration between surveillances in hospitals (epidemiological surveillance and hospital infections control), analyzing the possibilities and impossibilities of such integration. It assesses the historical and political aspects, and the theoretical and practical concepts of services organizations in hospital surveillance, trying to identify the differences and similarities between both surveillances. The initial analysis allowed examining how limits imposed by the specificities of each surveillance help their practice in a non-integrated way. Then a qualitative research was carried out, through interviews with focal groups that work in hospital surveillance and epidemiological surveillance in hospitals, and in the hospital infection controlling committee. The material collected from the focal groups was analyzed through categories that arose from this same material. Hospital surveillances have been trying to change their practices, trying to break with neutralized ways, since there were many conflicts concerning technical issues coming from the differentiated formation of professionals who work in this field. Nowadays the search for new ways has been made possible by the change of perception among these professionals only, not imposed by managers, when they realized the need to reorganize hospital surveillance in a horizontal manner, building a diagnosis with multiple lights/knowledge, as practices committed to transforming reality in their hospital unit. Some point to the need of discussing a new concept for hospital surveillance, able to recognize hospital infection and epidemiological surveillances, as to include environmental surveillance, so the concept of health surveillance in hospital will allow a wider view of hospital surveillance. This one has hardly reorganized its practices, mainly its infrastructure, and human resources are the main problem. They realize that hospital surveillance demands rules, trends, protocols etc. to integrate their practices, and this requires integration. Although they believe integration must not start with changes in the services structure, but in the work process, they hope that, after this construction, legislation is created to propose integration among surveillances, thus making this proposal affective.

The objective of this study is to characterize the hospitalizations that occurred in the Pediatric Intensive Care Unit (PICU) at Santa Maria University Hospital from 2006 to 2013. It is a retrospective, descriptive and cross-sectional study that evaluated 1805 patients admitted to the PICU by secondary data collection and a database built based on the Inpatient Unit Records Book.The variables considered were: sex, age, origin, cause and outcome hospitalization and length of stay. It was performed a descriptive analysis followed by non-parametric inferential analysis with a 5% significance level. Out of the 1805 patients who were hospitalized during the eight-year study (2006-2013), 56.1% were male, where 42.4% were from the city of Santa Maria and 57.6% from others cities belonging the region that HUSM is the reference (4th Health Regional Coordination) or from other locations inside Rio Grande do Sul. There was no significant difference in the number of hospitalizations related to the months or the year. The average length of stay in the PICU was 7.5 days. Most patients (41.6%) were under one old, being the most frequent age of two months. The total mortality rate was 14.3% and 85.7% of the patients discharged from the unit. There was no significant difference between mortality rate and the evaluated year (minimum of 11% in 2012 and maximum of 17.7% in 2009) and age group. The most frequent causes of hospitalization were pneumonia, abdominal postoperative, trauma and sepsis wherein mortality for sepsis was significantly higher than mortality for abdominal postoperative and trauma, but there was no difference from the mortality caused by pneumonia. The data obtained is very similar to the data from others Brazilian PICU. The knowledge of epidemiological profile of patients at PICU of HUSM, still unpublished, can contribute to the decision-making and improve the quality of the care provided to users. In addition, the use of such data through appropriate analysis, dissemination and development of protocols and practices for the team, can also contribute to subsidy future studies, as well as provide guidance for patient care. / O objetivo desde estudo é caracterizar as internações que ocorreram na Unidade de Terapia Intensiva Pediátrica (UTIP) do Hospital Universitário de Santa Maria (HUSM) de 2006 a 2013. Constitui um estudo retrospectivo, descritivo, transversal, onde se avaliou, mediante dados secundários, 1805 internações neste período. As variáveis consideradas foram: sexo, idade, procedência, desfecho da internação, tempo de internação e causa. Foi realizada a análise descritiva seguida da análise inferencial não paramétrica com nível de significância de 5%. Das 1805 internações a maioria (56,1%), foi do sexo masculino, sendo que 42,4% eram da cidade de Santa Maria e 57,6% da região à qual o HUSM é referência (4ª Coordenadoria Regional de Saúde) ou de outro local do Estado do Rio Grande do Sul. Não houve diferença significativa em relação ao número de internações mensais e entre o número de internações anuais. O tempo médio de permanência na UTIP foi de 7,5 dias. A maioria dos pacientes (41,6%) tinha até um ano de idade, sendo a idade mais frequente de dois meses. A mortalidade encontrada foi de 14,3%, ou seja, 85,7% tiveram alta da unidade. Não houve diferença significativa entre a mortalidade entre os anos avaliados (mínimo de 11% em 2012 e máximo de 17,7% em 2009) e entre as faixas etárias. As causas de internação mais frequentes foram: pneumonia, pós-operatório abdominal, trauma e sepse, sendo que a mortalidade por sepse foi significativamente maior do que por pós-operatório abdominal e por trauma, mas não diferiu da mortalidade por pneumonia. Considerando as características de cada local, os dados encontrados se assemelham aos de outras UTIP no Brasil. O conhecimento dos resultados deste serviço, ainda inéditos, pode contribuir para a tomada de decisões, melhoria na assistência prestada aos usuários, qualificação do serviço e facilidade no acesso às informações. Além disso, o uso desses dados, por meio da análise adequada, divulgação, elaboração de protocolos e condutas para a equipe, podem contribuir para subsidiar estudos futuros, bem como orientar políticas de atendimento e cuidados aos pacientes.

The last two decades have seen several large-scale epidemics of international impact, including human, animal and plant epidemics. Policy makers face health challenges that require epidemic predictions based on limited information. There is therefore a pressing need to construct models that allow us to frame all available information to predict an emerging outbreak and to control it in a timely manner. The aim of this thesis is to develop an early-warning modelling approach that can predict emerging disease outbreaks. Based on Bayesian techniques ideally suited to combine information from different sources into a single modelling and estimation framework, I developed a suite of approaches to epidemiological data that can deal with data from different sources and of varying quality. The SEIR model, particle filter algorithm and a number of influenza-related datasets were utilised to examine various models and methodologies to predict influenza outbreaks. The data included a combination of consultations and diagnosed influenza-like illness (ILI) cases for five influenza seasons. I showed that for the pandemic season, different proxies lead to similar behaviour of the effective reproduction number. For influenza datasets, there exists a strong relationship between consultations and diagnosed datasets, especially when considering time-dependent models. Individual parameters for different influenza seasons provided similar values, thereby offering an opportunity to utilise such information in future outbreaks. Moreover, my findings showed that when the temperature drops below 14°C, this triggers the first substantial rise in the number of ILI cases, highlighting that temperature data is an important signal to trigger the start of the influenza epidemic. Further probing was carried out among Maltese citizens and estimates on the under-reporting rate of the seasonal influenza were established. Based on these findings, a new epidemiological model and framework were developed, providing accurate real-time forecasts with a clear early warning signal to the influenza outbreak. This research utilised a combination of novel data sources to predict influenza outbreaks. Such information is beneficial for health authorities to plan health strategies and control epidemics.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-15T13:37:53Z No. of bitstreams: 1 DISS_2014_Letícia Borges da Silva Heinen.pdf: 4369897 bytes, checksum: 2e00a8b07d093787dbdb2e23dd6ac34e (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-19T12:59:17Z (GMT) No. of bitstreams: 1 DISS_2014_Letícia Borges da Silva Heinen.pdf: 4369897 bytes, checksum: 2e00a8b07d093787dbdb2e23dd6ac34e (MD5) / Made available in DSpace on 2017-09-19T12:59:17Z (GMT). No. of bitstreams: 1 DISS_2014_Letícia Borges da Silva Heinen.pdf: 4369897 bytes, checksum: 2e00a8b07d093787dbdb2e23dd6ac34e (MD5) Previous issue date: 2014-03-28 / CNPq / O gênero Flavivirus, família Flaviviridae, alberga arbovírus como os vírus dengue (DENV) e da febre amarela, que possuem importância médica e são envolvidos em epidemias de doença febril em áreas urbanas e rurais em regiões tropicais e subtropicais. No Brasil, atualmente, o DENV e o vírus da encefalite de Saint Louis (SLEV) são os dois flavivírus circulantes em áreas urbanas mais frequentes. Desde a introdução e emergência dos diferentes sorotipos de DENV a partir da década de 1980, extensas epidemias de febre do dengue vêm sendo reladas por todo o país. O SLEV, anteriormente reconhecido apenas em ciclos enzoóticos e com pouca relevância médica no Brasil, tem sido implicado em casos de doença febril durante epidemia de dengue no sudeste do país. O objetivo deste estudo foi investigar a circulação de flavivírus em pacientes com doença febril aguda com suspeita de dengue em Mato Grosso (MT) em 2011 e 2012. Material e Métodos: 604 amostras de soro obtidas entre outubro de 2011 e julho de 2012 de pacientes com doença febril aguda suspeita de dengue com até cinco dias do início dos sintomas em MT foram submetidas à multiplex semi-nested RT-PCR para a pesquisa de flavivírus, como os quatro sorotipos de DENV, SLEV, vírus da febre amarela, do Oeste do Nilo, Rocio, Bussuquara, Iguape e Ilhéus. Amostras positivas foram testadas em pelo menos duas reações independentes de single-nested RT-PCR e submetidas a sequenciamento nucleotídico de região do gene da glicoproteína de envelope para análise filogenética. Resultados: Dentre os 604 pacientes, 315 (52,2 %) foram positivos para DENV-4, 24 (4,0 %) para DENV-1, 3 (0,5 %) para SLEV, 1 (0,2 %) para DENV-2 e 1 (0,2 %) para DENV-3. Todas as amostras eram de pacientes oriundos de áreas urbanas de 17 municípios de MT. Entre as amostras positivas, 9 eram co-infecções entre DENV-1/DENV-4, 1 entre DENV-2/DENV-4, 2 por SLEV/DENV-4 e 1 entre SLEV/DENV-1/DENV-4. Os demais flavivírus pesquisados não foram detectados. Amostras negativas para flavivírus totalizaram 273/604 (45,20 %). Discussão: A ocorrência das arboviroses na população geralmente é subestimada, devido a fatores como quadro clínico inespecífico, infecções inaparentes e ausência de diagnóstico diferencial. O DENV-4 foi introduzido no MT em 2012, responsável pela maior casuística nas cidades da Baixada Cuiabana. Co-infecções são frequentes quando há circulação hiperendêmica dos quatro sorotipos do DENV, situação já relatada no Brasil em Manaus e Rio de Janeiro em 2011. O SLEV foi detectado em pacientes de Cuiabá e Várzea Grande. Infecções por SLEV são primariamente inaparentes ou brandas. Em MT, espécies de Culex e outros vetores deste virus são amplamente dispersas. Como humanos são hospedeiros finais e apresentam baixa viremia, sua ocorrência é provavelmente subestimada. Conclusão: DENV-1 e DENV-4 foram os flavivírus identificados com maior frequência. Os quatro sorotipos do DENV foram detectados em Cuiabá e infecções esporádicas pelo SLEV foram identificadas em pacientes co-infectados com o DENV-4 ou o DENV-4/DENV-1 em Cuiabá e Várzea Grande, indicando que outros arbovírus podem circular silenciosamente durante epidemia de dengue em áreas urbanas em MT. / The genus Flavivirus, Flaviviridae family, comprises arboviruses such as the medical important dengue virus (DENV) and yellow fever virus, involved in febrile illness epidemics in urban and rural areas of tropical and subtropical regions. In Brazil, DENV and Saint Louis encephalitis (SLEV) virus are currently the two most important flaviviruses circulating in urban areas. Since the introduction and emergence of different DENV serotypes in the 1980´s, extensive dengue outbreaks have been reported throughout the country.SLEV, previously recognized only in enzootic cycles without medical relevance in Brazil, has been implicated to febrile illness etiology during dengue fever outbreaks in the Southeast region. The aim of this study was to investigate the circulation of flaviviruses in patients with acute febrile illness suspected of harboring dengue in Mato Grosso (MT) between 2011 and 2012. Material and Methods: 604 serum samples obtained between October 2011 and July 2012 from patients with acute febrile illness suspected of dengue lasting less than 5 days in MT were subjected to multiplex semi-nested RT-PCR for flaviviruses, including all four serotypes of DENV, SLEV Yellow Fever, West Nile, Rocio, Bussuquara, Iguape and Ilheus viruses. Positive samples were tested at least twice in independent single-nested RT-PCR reactions and subjected to nucleotide sequencing of the envelope glycoprotein (E) gene region for phylogenetic analysis. Results: Among 604 patients, 315 (52.2 %) were positive for DENV-4, 24 (4.0 %) for DENV-1, three (0.5 %) for SLEV, one (0.2 %) for DENV-2 and one (0.2 %) for DENV-3. All patients are residents in urban areas of 17 cities of MT. Among then, 9 were co-infections among DENV-1/DENV-4, 1 between DENV-2/DENV-4, two between SLEV/DENV-4 and one with SLEV/DENV-1/DENV-4. The other flaviviruses were not detected. Negative samples for flavivirus totaled 273/604 (45.20 %). Discussion: The occurrence of arboviruses in the population generally is underestimated, probably due to unapparent infection or unspecific clinical presentation, associated to the absence of differential diagnosis. The DENV-4 serotype was introduced in MT in 2012, responsible for the largest number of cases in Cuiabá and Varzea Grande. Co-infections are common when hiperendemic circulation of all four serotypes of DENV is observed. This situation has already been reported in Brazil in Manaus and Rio de Janeiro cities in 2011. Three patients were positive for SLEV in Cuiaba and Várzea Grande. SLEV infections are primarily mild or unapparent. In MT, species of Culex and other vectors are widely dispersed. As humans are final hosts and, therefore, present low titer viremia, the occurrence of SLEV in the population is probably underestimated. Conclusion: DENV-1 and DENV-4 were the most frequently flaviviruses identified. The four DENV serotypes were detected in Cuiaba and sporadic SLEV infections were identified in patients co-infected with DENV-4 or DENV-1/DENV-4 in Cuiaba and Várzea Grande, indicating that other arboviruses may circulate silently during dengue epidemics in urban areas of MT.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-21T14:53:07Z No. of bitstreams: 1 DISS_2014_Nayara Zuchi.pdf: 3111436 bytes, checksum: 8b58de352642d734fc2fdd8891b32e5e (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-26T12:55:13Z (GMT) No. of bitstreams: 1 DISS_2014_Nayara Zuchi.pdf: 3111436 bytes, checksum: 8b58de352642d734fc2fdd8891b32e5e (MD5) / Made available in DSpace on 2017-09-26T12:55:13Z (GMT). No. of bitstreams: 1 DISS_2014_Nayara Zuchi.pdf: 3111436 bytes, checksum: 8b58de352642d734fc2fdd8891b32e5e (MD5) Previous issue date: 2014-03-27 / CAPES / Introdução: O gênero Alphavirus, família Togaviridae, alberga arbovírus de importância médica relatados em áreas tropicais mundialmente. Nas Américas, os alfavírus de maior importância compreendem os das encefalites equinas e o vírus Mayaro (MAYV). No Brasil, o MAYV tem sido relatado em epidemias de doença febril principalmente no norte do país. O principal objetivo deste estudo foi investigar a situação epidemiológica de alfavírus em pacientes febris durante epidemia de dengue em Mato Grosso (MT). Material e Métodos: Entre 2011 e 2012, 604 amostras de soro de pacientes com doença febril aguda suspeita de dengue durante epidemia em MT foram submetidas a Duplex-RT-PCR seguida de Multiplex-semi-nested-PCR para pesquisa dos alfavírus MAYV, vírus Aura e os vírus das encefalites equinas do Leste, Oeste e Venezuelana. Amostras positivas foram confirmadas em dois testes independentes e os produtos de PCR submetidos a sequenciamento nucleotídico. Amostras positivas foram submetidas a RT-PCR em tempo real (RT-qPCR) e isolamento viral em cultura de células. Todas as amostras foram também investigadas para flavivirus em um estudo paralelo. Resultados: Foram encontrados 15/604 (2,5 %) pacientes positivos para o MAYV em Cuiabá (9), Várzea Grande (3), Nossa Senhora do Livramento (1) e Sorriso (2). Destes, 12 (80,0 %) apresentaram co-infecções com DENV-4 e 3 (20,0 %) infecções únicas pelo MAYV. Dentre 13 amostras submetidas a RT-qPCR, 10 (76,9 %) apresentaram carga viral entre log 0,965-3,321 cópias/μL. Discussão: Casos esporádicos de infecção pelo MAYV foram identificados durante uma grande epidemia de dengue no MT em residentes de áreas urbanas, sem histórico recente de viagem ou visita a áreas rurais e/ou silvestres. A ocorrência do MAYV em estados adjacentes, em cidades afetadas pela rodovia Cuiabá-Santarém e soroprevalência em índios Xavantes no estado corroboram a evidência da circulação de MAYV no MT. Apesar do MAYV ser transmitido principalmente por Haemagogus janthinomys em áreas silvestres, as evidências encontradas no presente estudo sugerem a circulação de MAYV em área urbana de MT. Contudo, o ciclo de transmissão do vírus no estado não foi elucidado. A evidência de circulação do MAYV em indivíduos febris durante epidemia de dengue em área urbana deve ser motivo de atenção das autoridades locais de saúde pública para a eventual circulação silenciosa de outros arbovírus no estado. / Introduction: The Alphavirus genus, Togaviridae family, comprises arboviruses of medical importance reported in tropical areas worldwide. In the Americas, the most important alfaviruses are the equine encephalitis group and Mayaro virus (MAYV). In Brazil, MAYV has been reported in outbreaks of febrile illness mainly in the North region of the country. The aim of this study was to investigate the epidemiological situation of alfaviruses in febrile patients during a dengue outbreak in Mato Grosso (MT). Material and methods: Between 2011 and 2012 in MT, 604 serum samples collected from patients suspected of acute febrile illness were submitted to Duplex-RT-PCR followed by Multiplex-semi-nested-PCR for MAYV, Aura virus and East, West and Venezuelan equine encephalitis viruses. Positive samples were confirmed twice in independent tests and, PCR products were submitted to nucleotide sequencing. Positive samples were also submitted to Real time RT-PCR (RT-qPCR) and inoculation in cell culture. The samples were also investigated for flaviviruses in a parallel study. Amostras positivas foram submetidas a RT-PCR em tempo real (RT-qPCR) e isolamento viral em cultura de células. Todas as amostras foram também investigadas para flavivirus em um estudo paralelo. Results: 15/604 (2.5 %) patients from Cuiabá (9), Várzea Grande (3), Nossa Senhora do Livramento (1) and Sorriso (2) were positive for MAYV; 12 (80 %) are co-infected with DENV-4 and 3 (20 %) are single infections with MAYV. Co-infected patients presented a wider variety of clinical manifestations. Among 13 samples tested by RT-qPCR, 10 (76.9 %) presented viral load ranging from log 0,965-3,321 copies/μL. Discussion: Sporadic infections with MAYV were identified during a massive Dengue outbreak in MT in residents of urban areas without recent history of travel or visit to rural or sylvatic areas. The occurrence of MAYV infections in neighboring states, including cities affected by the Cuiabá-Santarém highway and seroprevalence in Xavante Indians from MT, corroborate the evidence of MAYV circulation in MT. Despite MAYV is transmitted mainly by Haemagogus janthinomys in sylvatic areas, the evidence found in this study suggests the circulation of MAYV in urban areas of MT. However, the transmission cycle of MAYV in MT remains to be determined. The evidence of MAYV circulation in febrile individuals during a dengue outbreak in urban areas should cause concerns in the local public health authorities about the eventual silent circulation of arboviruses in the state.

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2018-04-18T20:33:59Z No. of bitstreams: 1 DISS_2015_Belgath Fernandes Cardoso.pdf: 3865065 bytes, checksum: 3b7d79b4224429f58cb6ca5c3d96d7e9 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2018-04-27T17:29:40Z (GMT) No. of bitstreams: 1 DISS_2015_Belgath Fernandes Cardoso.pdf: 3865065 bytes, checksum: 3b7d79b4224429f58cb6ca5c3d96d7e9 (MD5) / Made available in DSpace on 2018-04-27T17:29:40Z (GMT). No. of bitstreams: 1 DISS_2015_Belgath Fernandes Cardoso.pdf: 3865065 bytes, checksum: 3b7d79b4224429f58cb6ca5c3d96d7e9 (MD5) Previous issue date: 2015-03-26 / CAPES / O gênero Orthobunyavirus, família Bunyaviridae, alberga arbovírus de importância médica. Estes estão envolvidos em epidemias de doença febril em áreas tropicais. No Brasil, o vírus Oropouche (OROV) é considerado o arbovírus mais frequente após o vírus da dengue (DENV). O objetivo deste estudo foi investigar a circulação de orthobunyavírus em Mato Grosso (MT). 529 amostras de soro obtidas entre outubro de 2011 e julho de 2012 de pacientes com doença febril aguda suspeita de dengue com até cinco dias do início dos sintomas em MT e 387 pools de mosquitos Cx quinquefasciatus capturados entre janeiro e abril de 2013 foram submetidos à nested RT-PCR para o segmento S de orthobunyavírus pertencentes ao sorogrupo Simbu. Amostras positivas foram testadas em pelo menos duas reações independentes e submetidas a sequenciamento nucleotídico para análise filogenética. Inoculou-se as amostras positivas em células vero. Dentre os 529 pacientes, 5 (0,94%) foram positivos para orthobunyavirus do sorogrupo Simbu por nested RT-PCR e isolamento viral. O vírus foi isolado de 3/8 pools. O segmento S do OROV foi identificado em cinco pacientes, quatro do sexo feminino, com 14-62 anos. Dois pacientes encontravam-se co-infectados com DENV-4. Estes pacientes são oriundos das cidades de Cuiabá (n=3), Várzea Grande (n=1) e Nova Mutum (n=1), todos residentes em área urbana, que apresentavam febre, cefaleia, dor retroorbital, mialgia, artralgia, prostação e náuseas. 8/387 pools de Cx. quinquefasciatus foram positivos para o segmento S do OROV por nested-RT-PCR, com taxa mínima de infecção (MIR) de 2,3 por 1000 mosquitos. As sequências obtidas do segmento S apresentaram 98% a 100% de homologia com o mesmo segmento das cepas do OROV verificadas no GenBank. A análise filogenética indica que as amostras de humanos e mosquitos pertencem ao subgenótipo Ia, similares a cepas do Pará obtidas de humanos, preguiças, Aedes (Ochlerotatus) serratus e Cx. quinquefasciatus. O genótipo I é o mais conservado e frequente no Brasil dentre os genótipos do OROV. Cx. quinquefasciatus, culicídeo de maior abundância em Cuiabá, é considerado vetor secundário do OROV em área urbana. Culicoides paraensis, principal vetor do OROV em áreas urbanas na região amazônica, não foi capturado neste estudo. Sorologia para o OROV foi identificada em residentes de cidades do Pará afetadas pela rodovia Cuiabá-Santarém e em primatas do Pantanal Sul-matogrossense, corroborando com a identificação do OROV em cidades do MT geograficamente interligadas por esta mesma rodovia. Infecções esporádicas por um orthobunyavirus do sorogrupo Simbu, possivelmente o OROV, foram identificadas em pacientes de MT, além de oito pools de Cx. quinquefasciatus em Cuiabá, indicando que este mosquito possui capacidade vetorial e pode estar envolvido no ciclo urbano de transmissão do vírus no estado. / The genus Orthobunyavirus, family Bunyaviridae, contains medically importante arboviruses. These are involved in epidemics of febrile illness in tropical areas. In Brasil, Oropouche virus (OROV) is considered the most frequent arbovirus after dengue virus (DENV). The aim of this study was to investigate the circulation of orthobunyaviruses in Mato Grosso (MT). 529 serum samples collected between October, 2011 and July, 2012 of patients with acute febrile illness suspected of dengue for up to five days of symptom onset from MT and 387 pools of Cx. quinquefasciatus mosquitoes captured between January and April, 2013, were subjected to nested RT-PCR for the segment S of orthobunyaviruses belonging to Simbu serogroup. Positive samples were tested in at least two independent reactions and subjected to nucleotide sequencing for phylogenetic analysis. Positive samples were inoculated in vero cells. Among the 529 patients, five (0.94%) were positive for serogroup Simbu by nested RT-PCR and viral isolation. The virus was isolated from 3/8 pools. The OROV segment S was identified in five patients, four females, with 14-62 years-old. Two patients were co-infected with DENV-4. These patients are from Cuiabá (n=3), Várzea Grande (n=1) and Nova Mutum (n=1), all residents in urban areas, presenting fever, headache, retroorbital pain, myalgia, arthralgia, prostration and nausea. 8/387 pools of Cx. quinquefasciatus were positive for OROV segment S by nested-RT-PCR with a minimum infection rate (MIR) of 2.3 per 1,000 mosquitoes. The segment S nucleotide sequences presented 98% to 100% of homology with the same segment of OROV strains available in GenBank. Phylogenetic analysis indicate the human and mosquito samples belong to genotype Ia, similar to strains obtained in Pará from humans, sloths, Aedes (Ochlerotatus) serratus and Cx. quinquefasciatus. The genotype I is the most conserved among OROV genotypes. Cx. quinquefasciatus, the most abundant culicidae in Cuiabá, is considered a secondary vector for OROV in urban areas. Culicoides paraensis, the main vector for OROV in urban areas in the Amazon region, was not captured in the study. Serology for OROV was identified in humans in cities of Pará affected by the Cuiabá-Santarém highway and in primates in South Pantanal, corroborating for the findings in cities of MT geographically linked by the same highway. Sporadic infections by an orthobunyavirus from Simbu serogroup, possibly OROV, were identified in patients from MT, also eight Cx. quinquefasciatus pools from Cuiabá, indicating that has vectorial capacity and may be involved in the urban cycle of virus transmission in the state.

Orientador: Ildeberto Muniz de Almeida / Resumo: Este estudo teve como objetivo geral descrever e discutir o processo de implantação da vigilância do câncer relacionado ao trabalho no município de Londrina-Paraná. Apoia-se no método de pesquisa-ação como estratégia para sensibilização e implantação da notificação do câncer relacionado ao trabalho. Realizou-se uma Oficina de Sensibilização em abril de 2011, que buscou identificar quais tipos de câncer constantes das Diretrizes para a Vigilância do Câncer Relacionado ao Trabalho do Ministério da Saúde teriam prioridades na notificação. Tomaram-se por base as características locais, a vivência dos atores e documentos técnicos para subsidiar as discussões entre a relação de nexo com a ocupação. Participaram 35 técnicos de diversos serviços e membros do Conselho Municipal de Saúde e da Comissão Intersetorial em Saúde do Trabalhador. O conteúdo temático foi compartilhado e suscitou amplo debate público, que corroborou para a validação social dos cânceres de bexiga e cabeça e pescoço para iniciar a notificação no SINAN. Além disso, gestores firmaram apoio e disponibilizaram hospital de referência para busca dos casos. A implantação da notificação se deu em hospital classificado como Centro de Assistência de Alta Complexidade em Oncologia do município. De 1º de abril de 2013 a 31 de dezembro de 2014 foram identificados 229 casos de câncer elegíveis para a anamnese ocupacional. Destes, em 130 (56,8%) casos foi possível estabelecer nexo epidemiológico e houve notificação no SINAN. A ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed at describing and discussing the implementation process of work-related cancer surveillance in Londrina–Paraná. It is based on the action research method as a strategy to raise awareness and build implementation of the notification process of work-related cancer. A sensitization workshop held in April 2011 sought to identify which types of cancers listed in the Ministry of Health Guidelines for Work-related Cancer Surveillance would have priority in the notification. This was based on the local characteristics, individuals’ experiences and technical documents to support the discussions between the nexus of association with the occupation. The workshop at issue was attended by 35 technicians of various services and members of the Municipal Council of Health and the Intersectoral Commission on Occupational Health. The thematic content was shared and aroused wide public debate, which corroborated for social validation of bladder, head and neck cancer to start reporting at SINAN, in addition, managers have signed agreement on mutual support and provided referral hospital to search for cases. The implementation of the notification took place in a hospital classified as Oncology High Complexity Assistance Center in the municipality. From 1 April 2013 to 31 December 2014, 229 cancer cases were identified as eligible for occupational history. Of these, in 130 cases (56.8%) an epidemiological link could be established and they were notified at SINAN. A search of patie... (Complete abstract click electronic access below) / Doutor