Traditional disease surveillance can be augmented with a wide variety of open sources, such as online news media, twitter, blogs, and web search records. Rapidly increasing volumes of these open sources are proving to be extremely valuable resources in helping analyze, detect, and forecast outbreaks of infectious diseases, especially new diseases or diseases spreading to new regions. However, these sources are in general unstructured (noisy) and construction of surveillance tools ranging from real-time disease outbreak monitoring to construction of epidemiological line lists involves considerable human supervision. Intelligent modeling of such sources using text mining methods such as, topic models, deep learning and dependency parsing can lead to automated generation of the mentioned surveillance tools. Moreover, real-time global availability of these open sources from web-based bio-surveillance systems, such as HealthMap and WHO Disease Outbreak News (DONs) can aid in development of generic tools which will be applicable to a wide range of diseases (rare, endemic and emerging) across different regions of the world. In this dissertation, we explore various methods of using internet news reports to develop generic surveillance tools which can supplement traditional surveillance systems and aid in early detection of outbreaks. We primarily investigate three major problems related to infectious disease surveillance as follows. (i) Can trends in online news reporting monitor and possibly estimate infectious disease outbreaks? We introduce approaches that use temporal topic models over HealthMap corpus for detecting rare and endemic disease topics as well as capturing temporal trends (seasonality, abrupt peaks) for each disease topic. The discovery of temporal topic trends is followed by time-series regression techniques to estimate future disease incidence. (ii) In the second problem, we seek to automate the creation of epidemiological line lists for emerging diseases from WHO DONs in a near real-time setting. For this purpose, we formulate Guided Epidemiological Line List (GELL), an approach that combines neural word embeddings with information extracted from dependency parse-trees at the sentence level to extract line list features. (iii) Finally, for the third problem, we aim to characterize diseases automatically from HealthMap corpus using a disease-specific word embedding model which were subsequently evaluated against human curated ones for accuracies. / Ph. D.

Infectious diseases attract a lot of mediatic, cultural and political attention. But are those diseases like Ebola, or ‘disease x’ actually what kills us? Since 1946, the WHO is the most authoritative figure in the fights against infectious disease outbreaks. So how does the WHO maintain this power and authority after tremendous budget cuts, competition for authority, and a shift to non-communicable disease epidemiology? This thesis uses a mixed-methods approach of quantitative analysis of ‘Disease Outbreak News’ reports, and qualitative analysis of key WHO literature, to develop the alternative narrative answering those questions. This thesis found that the WHO activities surrounding the collection and distribution of data create a political and institutional environment in which the WHO seems to be the only logical solution to prevent them. Additionally, the narrative put forth by the WHO prioritizes the ‘alert and response’ and operational capabilities of the organization to further expand authority in outbreak response. This study concludes that the WHO, through the collection and distribution of knowledge, and efforts to increase operational capability as seen through the Global Outbreak Alert and Response Network (GOARN), seeks to maintain normative authority and power as an international organization. / M.A. / Globalization of trade and travel has only increased the fear of infectious disease transmission. There is a great demand for a global health security system that is alert and capable. Based on this ‘threat’ the WHO justifies their role as global health leader. The Global Outbreak Alert and Response Network (GOARN) is the system that currently acts as the operational arm of the WHO, monitoring and coordinating response to infectious disease outbreaks globally. Despite the critical role of GOARN, its day-to-day endeavors remain unexplored by the public health field. This thesis analyzes how the WHO uses GOARN and its surveillance capabilities to collect and transform data as a method to maintain normative authority, and projects a powerful narrative as the leader of ‘alert and response’. In a competitive environment with limited financial resources, the WHO has adapted in terms of surveillance and operational capability to maintain its leadership and authority in the global public health field.

Distributional ecology is a branch of ecology which aims to reconstruct and predict the geographic range of free-living and symbiotic organisms in terrestrial and aquatic ecosystems. More recently, distributional ecology has been used to map disease transmission risk. The implementation of distributional ecology for disease transmission has, however, been erroneous in many cases. The inaccurate representation of disease distribution is detrimental to effective control and prevention. Furthermore, ecological niche modeling experiments are generally developed and tested using data from terrestrial organisms, neglecting aquatic organisms in case studies. Both disease and aquatic systems are often data limited, and current modeling methods are often insufficient. There is, therefore, a need to develop data-driven models that perform accurately even when only limited amounts of data are available or when there is little to no knowledge of the species' natural history to be modeled. Here, I propose a data-driven ecological niche modeling method that requires presence-only data (i.e., absence, pseudoabsence, or background records are not needed for model calibration). My method is expected to reconstruct environmental conditions where data-limited aquatic organisms are more likely to be present, based on a density-based clustering algorithm as a proxy of the realized niche (i.e., abiotic, and biotic environmental conditions occupied by the organism). Supported by ecological theories and methods, my central hypothesis is that because density-based clustering machine-learning modeling prevents extrapolation and interpolation, it can robustly reconstruct the realized niche of a data-limited aquatic organism. First, I assembled a comprehensive dataset of abiotic (temperature) and biotic (phytoplankton) environmental conditions and presence reports using Vibrio cholerae, a well-understood aquatic bacterium species in coastal waters globally (Chapter 2). Second, using V. cholerae as a model system, I developed detailed parameterizations of density-based clustering models to determine the parameter values with the best capacities to reconstruct and predict the species' distribution in global seawaters (Chapter 3). Finally, I compared the performance of density-based clustering modeling against traditional, correlative machine-learning ecological niche modeling methods (Chapter 4). Density-based clustering models, when assessed based on model fit and prediction, had comparable performance to traditional 'data-hungry' machine-learning correlative methods used in modern applications of ecological niche modeling. Modeling the environmental and geographic ranges of V. cholerae, an aquatic organism of free-living and parasitic ecologies, is a novel approach itself in distributional ecology. Ecological niche modeling applications to pathogens, such as V. cholerae, provide an opportunity to further the knowledge of directly-transmitted emerging diseases for which only limited data are available. Density-based clustering ecological niche modeling is termed here as Marble, honoring a previous, experimental version of this analytical approach, and is expected to provide new opportunities to understand how an ecological niche modeling method influences estimates of the distribution of data-limited organisms of complex ecology. These are lessons applicable to novel, rare, and cryptic aquatic organisms, such as emerging diseases, endangered fishes, and elusive aquatic species. / Master of Science / Distributional ecology is a branch of ecology which aims to reconstruct and predict the geographic distribution of land and water organisms. In the case of diseases, a correct representation of their geographic distributions is key for successful management. Previous studies highlight the need to develop new models that perform accurately even when limited amounts of data are available and there is little to no knowledge of the organisms' ecology. This thesis proposes a data-driven method, originally termed Marble. Marble is expected to help reconstruct environmental conditions where data-limited aquatic organisms are more likely to be found. Supported by ecological theories and methods, my hypothesis is that because Marble prevents under- and over-fitting, this method will produce results which better fit the data. Using V. cholerae, an aquatic organism, as a model system, I compared the performance of Marble against other traditional modeling algorithms. I found that Marble, in terms of model fit, performed similarly to traditional methods used in distributional ecology. Modeling the ecology of V. cholerae is a new approach in and of itself in ecological modeling. Furthermore, modeling pathogens provides an opportunity to further the knowledge of directly transmitted diseases, and Marble is expected to provide opportunities to understand how algorithm selection can reconstruct (or not) the distribution of data-limited aquatic organisms of diverse ecologies.

CD4 T cell homeostasis and competency are critical for the effectiveness of antiviral immunity. However, CD4 T cells derived from people living with HIV (PLWH) and individuals with chronic HCV infection often exhibit an inflammaging phenotype, evidenced by persistent inflammation, immune activation, exhaustion, senescence, and cellular apoptosis. Despite intensive investigations, the molecular mechanisms underlying CD4 T cell dysfunction in antiretroviral therapy (ART)-controlled PLWH and HCV-infected patients remain poorly understood. By investigating the roles of non-coding (nc)RNA transcripts in regulating the functions of CD4 T cells derived from PLWH and HCV-infected patients, we demonstrated that long non-coding (lnc)RNA - growth arrest-specific transcript 5 (GAS5) - is downregulated and plays a crucial role in regulating CD4 T cell functions through and beyond the microRNA (miR)-21-mediated signaling network. Our data suggest that disrupting the GAS5-miR21 axis may restore CD4 T cell homeostasis and competency during latent HIV infection and prevent premature CD4 T cell aging or immune senescence. Moreover, our results also showed that TRF2, a component of the shelterin complex maintaining the integrity of telomeres, is post-transcriptionally inhibited, which is one of the major forces driving cellular dysregulation in CD4 T cells from PLWH and HCV patients. Importantly, our study identified miR-23a as the key regulator of TRF2 translational expression by targeting its 3’UTR in CD4 T cells and that targeting miR-23a may restore the TRF2 protein level, and thereby reconstitute CD4 T cell homeostasis and competency to rescue CD4 T cells from premature aging and immunosenescence during latent HIV infection. The findings from these studies improved our understanding and knowledge of how ncRNA-mediated networks regulate the functions of CD4 T cells during chronic viral (HIV and HCV) infections. Understanding such mechanisms is important for developing therapeutic approaches to reverse the inflammaging phenotype observed in CD4 T cells from ART-controlled PLWH and chronically HCV-infected patients to improve their immunological functions and quality of life.

Recent research has shown that climate change had and will likely continue to have impacts on biological processes, including the propagation of infectious and zoonotic diseases. Assessments of local level impacts at the human-wildlife interface are imperative for stakeholders and policy makers, and empirical review of such research is undoubtedly necessary to understand the current state of the field, gaps of knowledge, and to identify future lines of research. In that vein, this thesis focuses on the impacts of climate change on disease at the human-wildlife interface. Specifically, my thesis works to quantify the recent temporal and spatial distribution of empirical research linking climate change with changes in the burden of infectious diseases (Chapter 2). This retrospective scoping of the last five years of empirical research identified if, and to what extent, there are biases in the diseases, species, or geographic areas studied within this scientific field. My study revealed both geographic and topical biases within the scope of recent literature, with an overwhelming emphasis on vector-borne diseases in temperate areas. There was also unequal representation in publication demographics of authors and institutions with most research originating from well developed countries. As a proof-of-concept case study, my thesis provides an empirical assessment of the plausible climatic drivers of a wildlife-disease transmission risk in an understudied region (Chapter 3), which could function to fill some of the identified research gaps in Chapter 2. Therein, my work assessed the impacts of climate variation from the last century on the environmental suitability of the rabies host Desmodus rotundus (common vampire bat) in Latin America. Findings revealed that average and standard deviation of temperature were the most important drivers of D. rotundus geographic distribution according to species' records between 1901 and 2019. Nevertheless, high uncertainty was detected regarding the predictability of D. rotundus environmental suitability across the United States-Mexico border and in the Andes Mountains of Chile. The overall modeling efforts did, however, reveal a northward distributional shift of the rabies reservoir as a likely response to climate change. Together, studies contained in this thesis provide empirical, retrospective evidence that demonstrates the effects of climate change on the increased risk of disease transmission at the human-wildlife interface. / Master of Science / Climate change is understood as the change in global or regional climate patterns, including variations of temperature and humidity factors beyond normal ranges, mostly attributed to increased levels of atmospheric carbon dioxide. Climate change is expected to influence many biological systems and presents an imminent threat to almost all organisms and geographic areas across the globe. Previous studies suggest that climate change will increase the burden of infectious diseases, including those originating from wildlife. This thesis aims to assess the availability of empirical evidence supporting the idea of a link between climate change and infectious diseases of wildlife origin. Chapter 2 examines recent scientific literature assessing climate change and infectious disease, and identifies biases in the diseases, species, and geographic areas commonly studied. This study found that literature generally focused on diseases transmitted by arthropods (e.g., insects, arachnids, or crustaceans) in temperate areas. There was little focus on diseases transmitted directly (e.g., via bites) or in non-temperate areas (e.g., tropics). Chapter 3 attempts to address issues detected in Chapter 2 by studying a directly-transmitted infectious disease in the tropics. More specifically, Chapter 3 assessed the impacts of climate variation from the last century on the distribution of the common vampire bat (Desmodus rotundus), which is a known rabies host in Latin America. Chapter 3 revealed that temperature variables were the largest drivers of common vampire bat distribution. Nevertheless, high uncertainty was detected regarding the vampire bat's ability to invade new areas such as the continental United States-Mexico border or the lowlands to the Andes Mountains in Chile. Together, studies contained in this thesis provide support for current and future research on the study of climate change as an amplifier for the risk of infectious diseases.

This study evaluates the roles of temperature variability and disease awareness in the emergence of Chagas disease (American trypanosomiasis). Chagas disease is endemic in Latin America and primarily spreads to humans directly via the triatomine vector. Hosts for most triatomine species are mainly rodents and occasionally dogs. The disease itself is caused by a parasitic protozoan, Trypanosoma cruzi (T. cruzi) which is found in the triatomine's feces and is often spread while the triatomine is consuming a blood meal. T. cruzi from feces enters the body via an abrasion on the skin, the mucous membranes, conjunctivae, or through consumption. To determine the risk of Chagas disease transmission one must define qualities that make the triatomine an effective disease vector as well as investigate the level of disease awareness among physicians and the population within the vector's range. This thesis maps triatomine species within the U.S. that harbor T. cruzi naturally and that exhibit qualities of domesticity. These qualities are defined by whether the species bites humans and dogs as well as reports that the species has been found in the domestic setting. Ranges illustrating temperature thresholds for increased triatomine activity for 2000 and 2030 are also depicted. Additionally, outcomes of a physician survey are presented to gauge the status of Chagas disease awareness in areas at higher risk for disease transmission. Results reveal limited consideration of Chagas disease in physician diagnosis despite the higher risk range which extends through the southern U.S. and is predicted to expand significantly by 2030. / Master of Science

Yes / The majority of Mycobacterium tuberculosis isolates resistant to isoniazid harbour a mutation in katG. Since these mutations cause a wide range of minimum inhibitory concentrations (MICs), largely below the serum level reached with higher dosing (15 mg/L upon 15–20 mg/kg), the drug might still remain partly active in presence of a katG mutation. We therefore investigated which genetic mutations predict the level of phenotypic isoniazid resistance in clinical M. tuberculosis isolates. To this end, the association between known and unknown isoniazid resistance-conferring mutations in whole genome sequences, and the isoniazid MICs of 176 isolates was examined. We found mostly moderate-level resistance characterized by a mode of 6.4 mg/L for the very common katG Ser315Thr mutation, and always very high MICs (≥19.2 mg/L) for the combination of katG Ser315Thr and inhA c-15t. Contrary to common belief, isolates harbouring inhA c-15t alone, partly also showed moderate-level resistance, particularly when combined with inhA Ser94Ala. No overt association between low-confidence or unknown mutations, except in katG, and isoniazid resistance (level) was found. Except for the rare katG deletion, line probe assay is thus not sufficiently accurate to predict the level of isoniazid resistance for a single mutation in katG or inhA. / European Research Council (Starting Grant INTERRUPTB 311725 to CM, LR and BdJ), The Damien Foundation

Thesis advisor: Tim van Opijnen / Although vaccines and antibiotics have been historically successful in combating bacterial infections, limited vaccine coverage and the rise of antibiotic resistance emphasize the need to develop alternative, broadly effective, and/or targeted treatment strategies to reduce the health burden of bacterial infections. Rather than relying on therapeutics solely targeting the bacterial pathogen, such as standard antibiotics, therapies that simultaneously focus on host responses are emerging. In this thesis, we propose 'host-informed therapies' (HITs) in two categories: those that aid patients with fully functional immune systems and those that aid patients with perturbed immune processes, as promising alternative or adjunctive treatment strategies for bacterial infections. The host-pathogen interaction during infection is a highly dynamic process between diverse bacterial pathogens and hosts with varying degrees of susceptibility. Systems biology approaches have provided an understanding of host-pathogen parameters globally through the detection of putative biomarkers for diagnosis and identification of critical interactions to discover novel drug targets. However, there remains a gap in understanding bacterial pathogenesis in the context of designing novel host-informed therapies. Here, we use Streptococcus pneumoniae, the gram-positive pathogen responsible for the majority of bacterial respiratory tract infections worldwide, as a case study to: (1) Generate a genome-wide map of bacterial immune (complement) evasion targets to design novel host-informed therapies, (2) generate a dual host/pathogen transcriptome map to identify signatures of infection outcome, and (3) validate signatures of bacterial antibiotic tolerance in a mouse lung infection model. Overall, this work exemplifies how systems biology methods can elucidate the intricacies of bacterial pathogenesis but, more importantly, aid in the target identification, validation, and design of antibacterial host-informed therapies. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Biology.

Streptococcus zooepidemicus (Sz) and Streptococcus equi (Se) share 98% DNA sequence homology, but display different pathogenic properties. Infection by one organism does not cross-protect against the other. To better understand pathogenic differences between these organisms and gain information about which proteins are expressed in horses infected experimentally with Se, intrauterine Sz or naturally with respiratory Sz we compared antibody specificities of convalescent sera using ELISA. These comparisons were based on sets of 8 and 14 immunoreactive recombinant proteins of Se strain CF32 and Sz strain NC78, respectively. Sera from donkeys that were previously naturally affected with strangles and later developed Sz pneumonia secondary to an experimental influenza challenge were also included. Serum antibody responses were quantitatively and qualitatively much greater following recovery from strangles than following respiratory Sz infection. Increased reactions to Se proteins IdeE2, Se75.3, Se46.8, Se18.9 and Se42.0 were observed for the majority of strangles sera but not for sera from respiratory Sz infection cases. Reactions of sera from Sz respiratory disease to Sz proteins varied greatly and were mostly to HylC and ScpC. Interestingly, sera of donkey recovered from Sz bronchopneumonia did not show increased antibody reaction to any of the proteins even though these donkeys had also recovered from clinical strangles 6 months previously. Only 1/5 mare with Sz placentitis presented increased serum antibody responses to MAP. In conclusion, adaptive immune responses to Se of horses with strangles are stronger and involve a greater number of proteins than adaptive immune responses to Sz infection of the lower respiratory tract. In an effort to develop an improved vaccine against Se, modified live strain of EHV-1, RacH was constructed to express three recombinant antigens of Se SeM, IdeE and Se18.9. Two groups of 10 and 2 ponies were vaccinated intramuscularly or intranasally, respectively. Another group (n=6) vaccinated with empty RacH served as controls. Sera from 2/3 ponies from each vaccination groups and 1/2 serum from IN vaccinated ponies showed increased serum neutralizing antibodies to EHV-1. ELISA detected no significant increase in antibodies to proteins. Only one IM and IN vaccinated pony showed serum bactericidal activity post vaccination.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A Escala de AvaliaÃÃo da Capacidade para Cuidar de CrianÃas Expostas ao HIV (EACCC-HIV) à um instrumento que estima o cuidado de mÃes Ãs crianÃas nascidas na vigÃncia do HIV. Objetivou-se avaliar a capacidade de mÃes para cuidar de crianÃas expostas ao HIV mediante a EACCC-HIV e verificar a associaÃÃo entre as dimensÃes da escala e as caracterÃsticas maternas. Estudo transversal desenvolvido em 2010 em Fortaleza-CE. Participaram 62 cuidadoras (mÃes) HIV+ com 64 filhos (dois gemelares) nascidos expostos ao HIV menores de 1 ano. Apreciaram-se as caracterÃsticas das mÃes e das crianÃas; as estratÃgias para reduÃÃo da transmissÃo vertical do HIV; Apgar familiar e a EACCC-HIV. A escala possui 52 itens e cinco fatores que sÃo utilizados para determinadas idades entre zero e 1 ano: Fator 1: capacidade para administrar o AZT xarope (crianÃas atà 42 dias de vida); Fator 2: capacidade para preparar e administrar o leite em pà (crianÃas atà 1 ano); Fator 3: capacidade para preparar e administrar alimentaÃÃo complementar (crianÃas > de 4 meses); Fator 4: capacidade para administrar a profilaxia com sulfametoxazol e trimetoprim (crianÃas > 42 dias); Fator 5: capacidade para garantir a adesÃo ao acompanhamento clÃnico e vacinaÃÃo (todas as crianÃas). As respostas sÃo mediadas por fator ou pela somatÃria de todos os itens, indicando-se o grau de cuidado desenvolvido pela mÃe. Para anÃlise utilizou-se o STATA 11.0, empregando-se nÃvel de significÃncia de 5%. A idade materna oscilou entre 18 e 42 anos, 33,9% com aids, 61,3% integrantes das classes D e E. Das crianÃas uma tinha aids (1,6%), 98,4% iniciaram o AZT nas primeiras horas de vida, 3,1% foram amamentadas, 61,3% tiveram consumo inadequado de leite artificial e 36,2% consumo inadequado de alimentaÃÃo complementar. O Apgar familiar indicou 34,4% severamente funcional. Enquanto o fator 1 da EACCC-HIV avaliou 11 crianÃas, das quais 72,7% recebiam cuidados considerados adequados, o fator 2 avaliou 64 crianÃas e indicou que 86,0% das mÃes possuÃam alta capacidade de cuidar. Pelo fator 3, o cuidado concentrou-se entre moderado (44,4%) e alto (50%). O fator 4 estimou o cuidado oferecido para 51 crianÃas, indicando que 76,5% tiveram alta capacidade para o cuidado, e o fator 5 avaliou respostas das 62 mÃes sobre as 64 crianÃas. Destas, 95,3% possuÃam alta capacidade para adesÃo ao acompanhamento clÃnico e vacinaÃÃo. Pela avaliaÃÃo global, 29,7% dos cuidados foram considerados como adequados (alta capacidade para o cuidado). A associaÃÃo de variÃveis indicou significÃncia entre Apgar da famÃlia e capacidade para administrar o leite em pà (fator 2); paridade e capacidade para administrar a profilaxia com sulfametoxazol e trimetropim; paridade e escolaridade e capacidade para garantir adesÃo ao acompanhamento clÃnico e vacinaÃÃo; e estÃdio evolutivo e tempo de diagnÃstico com avaliaÃÃo global da escala. Com a EACCC-HIV favoreceu-se avaliar o cuidado materno dispensado Ãs crianÃas e realizar intervenÃÃes em prol da saÃde infantil para a manutenÃÃo da qualidade de vida na vigÃncia da exposiÃÃo ao HIV ou para aquelas infectadas pelo vÃrus. / A Escala de AvaliaÃÃo da Capacidade para Cuidar de CrianÃas Expostas ao HIV (EACCC-HIV) à um instrumento que estima o cuidado de mÃes Ãs crianÃas nascidas na vigÃncia do HIV. Objetivou-se avaliar a capacidade de mÃes para cuidar de crianÃas expostas ao HIV mediante a EACCC-HIV e verificar a associaÃÃo entre as dimensÃes da escala e as caracterÃsticas maternas. Estudo transversal desenvolvido em 2010 em Fortaleza-CE. Participaram 62 cuidadoras (mÃes) HIV+ com 64 filhos (dois gemelares) nascidos expostos ao HIV menores de 1 ano. Apreciaram-se as caracterÃsticas das mÃes e das crianÃas; as estratÃgias para reduÃÃo da transmissÃo vertical do HIV; Apgar familiar e a EACCC-HIV. A escala possui 52 itens e cinco fatores que sÃo utilizados para determinadas idades entre zero e 1 ano: Fator 1: capacidade para administrar o AZT xarope (crianÃas atà 42 dias de vida); Fator 2: capacidade para preparar e administrar o leite em pà (crianÃas atà 1 ano); Fator 3: capacidade para preparar e administrar alimentaÃÃo complementar (crianÃas > de 4 meses); Fator 4: capacidade para administrar a profilaxia com sulfametoxazol e trimetoprim (crianÃas > 42 dias); Fator 5: capacidade para garantir a adesÃo ao acompanhamento clÃnico e vacinaÃÃo (todas as crianÃas). As respostas sÃo mediadas por fator ou pela somatÃria de todos os itens, indicando-se o grau de cuidado desenvolvido pela mÃe. Para anÃlise utilizou-se o STATA 11.0, empregando-se nÃvel de significÃncia de 5%. A idade materna oscilou entre 18 e 42 anos, 33,9% com aids, 61,3% integrantes das classes D e E. Das crianÃas uma tinha aids (1,6%), 98,4% iniciaram o AZT nas primeiras horas de vida, 3,1% foram amamentadas, 61,3% tiveram consumo inadequado de leite artificial e 36,2% consumo inadequado de alimentaÃÃo complementar. O Apgar familiar indicou 34,4% severamente funcional. Enquanto o fator 1 da EACCC-HIV avaliou 11 crianÃas, das quais 72,7% recebiam cuidados considerados adequados, o fator 2 avaliou 64 crianÃas e indicou que 86,0% das mÃes possuÃam alta capacidade de cuidar. Pelo fator 3, o cuidado concentrou-se entre moderado (44,4%) e alto (50%). O fator 4 estimou o cuidado oferecido para 51 crianÃas, indicando que 76,5% tiveram alta capacidade para o cuidado, e o fator 5 avaliou respostas das 62 mÃes sobre as 64 crianÃas. Destas, 95,3% possuÃam alta capacidade para adesÃo ao acompanhamento clÃnico e vacinaÃÃo. Pela avaliaÃÃo global, 29,7% dos cuidados foram considerados como adequados (alta capacidade para o cuidado). A associaÃÃo de variÃveis indicou significÃncia entre Apgar da famÃlia e capacidade para administrar o leite em pà (fator 2); paridade e capacidade para administrar a profilaxia com sulfametoxazol e trimetropim; paridade e escolaridade e capacidade para garantir adesÃo ao acompanhamento clÃnico e vacinaÃÃo; e estÃdio evolutivo e tempo de diagnÃstico com avaliaÃÃo global da escala. Com a EACCC-HIV favoreceu-se avaliar o cuidado materno dispensado Ãs crianÃas e realizar intervenÃÃes em prol da saÃde infantil para a manutenÃÃo da qualidade de vida na vigÃncia da exposiÃÃo ao HIV ou para aquelas infectadas pelo vÃrus. / The Assessment Scale of the Ability to take Care of Children Exposed to HIV (EACCC-HIV) estimates mothersâ care delivery to children born in conditions of HIV. The goal was to assess mothersâ ability to take care of children exposed to HIV through the EACCC-HIV and to verify the association between scale dimensions and maternal characteristics. This cross-sectional study was carried out in Fortaleza-CE in 2010. Participants were 62 HIV+ caregivers (mothers) with 64 children (two twins) exposed to HIV at birth and younger than one year. The mothers and childrenâs characteristics were evaluated; strategies to reduce vertical HIV transmission: Family Apgar and EACCC-HIV. The scale contains 52 items and five factors, used for certain ages between zero and 1 year: Factor 1: ability to administer AZT syrup (children up to 42 days of life); Factor 2: ability to prepare and administer powder milk (children up to 1 year); Factor 3: ability to prepare and administer complementary feeding (children > 4 months); Factor 4: ability to administer prophylaxis with sulfamethoxazole and trimethoprim (children > 42 days); Factor 5: ability to guarantee adherence to clinical monitoring and vaccination (all children). Answers are mediated by a factor or by the sum of all items, indicating the degree of care the mother develops. STATA 11.0 software was used for analysis, with significance set at 5%. Maternal age ranged between 18 and 42 years, 33.9% suffering from aids, 61.3% in lower socioeconomic classes. One of the children had aids (1.6%), 98.4% had starting AZT in the first hours of life, 3.1% was breastfed, 61.3% showed inadequate artificial milk consumption and 36.2% inadequate complementary feeding consumption. The Family Apgar indicated 34.4% severely functional. While factor 1 of the EACCC-HIV assessed 11 children, 72.7% of whom received adequate care, factor 2 assessed 64 children and indicated high ability for care delivery in 86.0% of the mothers. According to factor 3, care was concentrated between moderate (44.4%) and high (50%). Factor 4 estimated the care offered to 53 children, indicating high ability for care delivery in 76.5%, and factor 5 assessed the 62 mothersâ answers on the 64 children. In total, 95.3% showed high ability for adherence to clinical monitoring and vaccination. According to the global assessment, 29.7% of care was considered adequate (high ability for care delivery). The association between variables indicated significance between family Apgar and ability to administer powder milk (factor 2); parity and ability to administer prophylaxis with sulfamethoxazole and trimethropim; parity and education level and ability to guarantee adherence to clinical monitoring and vaccination: and staging and diagnosis time with global assessment of the scale. Through the EACCC-HIV, maternal care for the children could be assessed and interventions could be made to enhance child health, with a view to maintaining quality of life in cases of exposure to or contamination by HIV. / The Assessment Scale of the Ability to take Care of Children Exposed to HIV (EACCC-HIV) estimates mothersâ care delivery to children born in conditions of HIV. The goal was to assess mothersâ ability to take care of children exposed to HIV through the EACCC-HIV and to verify the association between scale dimensions and maternal characteristics. This cross-sectional study was carried out in Fortaleza-CE in 2010. Participants were 62 HIV+ caregivers (mothers) with 64 children (two twins) exposed to HIV at birth and younger than one year. The mothers and childrenâs characteristics were evaluated; strategies to reduce vertical HIV transmission: Family Apgar and EACCC-HIV. The scale contains 52 items and five factors, used for certain ages between zero and 1 year: Factor 1: ability to administer AZT syrup (children up to 42 days of life); Factor 2: ability to prepare and administer powder milk (children up to 1 year); Factor 3: ability to prepare and administer complementary feeding (children > 4 months); Factor 4: ability to administer prophylaxis with sulfamethoxazole and trimethoprim (children > 42 days); Factor 5: ability to guarantee adherence to clinical monitoring and vaccination (all children). Answers are mediated by a factor or by the sum of all items, indicating the degree of care the mother develops. STATA 11.0 software was used for analysis, with significance set at 5%. Maternal age ranged between 18 and 42 years, 33.9% suffering from aids, 61.3% in lower socioeconomic classes. One of the children had aids (1.6%), 98.4% had starting AZT in the first hours of life, 3.1% was breastfed, 61.3% showed inadequate artificial milk consumption and 36.2% inadequate complementary feeding consumption. The Family Apgar indicated 34.4% severely functional. While factor 1 of the EACCC-HIV assessed 11 children, 72.7% of whom received adequate care, factor 2 assessed 64 children and indicated high ability for care delivery in 86.0% of the mothers. According to factor 3, care was concentrated between moderate (44.4%) and high (50%). Factor 4 estimated the care offered to 53 children, indicating high ability for care delivery in 76.5%, and factor 5 assessed the 62 mothersâ answers on the 64 children. In total, 95.3% showed high ability for adherence to clinical monitoring and vaccination. According to the global assessment, 29.7% of care was considered adequate (high ability for care delivery). The association between variables indicated significance between family Apgar and ability to administer powder milk (factor 2); parity and ability to administer prophylaxis with sulfamethoxazole and trimethropim; parity and education level and ability to guarantee adherence to clinical monitoring and vaccination: and staging and diagnosis time with global assessment of the scale. Through the EACCC-HIV, maternal care for the children could be assessed and interventions could be made to enhance child health, with a view to maintaining quality of life in cases of exposure to or contamination by HIV.