No description available.

University, Diss., 2006--Würzburg. / Erscheinungsjahr an der Haupttitelstelle: 2005.

Thesis (doctoral)--Karolinska Institutet, Stockholm, 1991. / Extra t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (doctoral)--Karolinska Institutet, Stockholm, 1991. / Extra t.p. with thesis statement inserted. Includes bibliographical references.

Würzburg, Univ., Diss., 2001. / Erscheinungsjahr an der Haupttitelstelle: 2001

Made available in DSpace on 2016-03-28T12:41:00Z (GMT). No. of bitstreams: 2 diego_cambuy_ioc_mest_2014.pdf: 2689625 bytes, checksum: 9a0d86cf1fe73771c946b0bd687aec4b (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2015-04-14 / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil / A coqueluche, ou pertússis, é uma doença do trato respiratório causada principalmente pela bactéria Bordetella pertussis. Após 50 anos de vacinação, pertussis reemergiu, passando a ser a doença imunoprevinível mais frequente mesmo em países desenvolvidos. Várias são as hipóteses para a reemergência de pertússis, uma delas é a adaptação do patógeno frente à vacinação. Linhagens contemporâneas de B. pertussis diferem de linhagens do período pré-vacinal, especialmente em genes codificadores de proteínas usadas na produção de vacinas acelular. Esta re-emergência também tem sido observada no Brasil, assim, realizamos a caracterização genética por MLST baseado nesses genes, de 26 isolados B. pertussis de surtos de três regiões brasileiras (Norte, Sul e Nordeste). Foram identificados dois perfis alélicos, em 24 isolados: prn2-ptxS1A-fim3B-ptxP3, de surtos (2008-2013) de Alagoas, Pernambuco e Rio Grande do Sul - e o perfil prn2-ptxS1A-fim3A-ptxP3 , em dois isolados de Pará/2004. Análises filogenéticas agruparam esses perfis com isolados do período pós vacinal de outras partes do globo. Deste conjunto, três do perfil mais frequente e um do perfil menos frequente, tiveram seus genomas sequenciados na plataforma GS 454 Junior. A comparação desses genomas com outros genomas de B. pertussis disponíveis em dados públicos não identificou SNPs ou genes únicos que caracterizassem os isolados do Brasil Este estudo desenvolveu uma metodologia que permitiu definir a posição da IS481 nos genomas, e uma delas corresponde a um gene relacionado a regulação da transcrição da família MarR, Análise filogenômica, baseada em 826 SNPs, demonstrou que os isolados recentes do Brasil da linhagem pandêmica que presente em todos os continentes, exceto a África. Foi observado também que as relações filogenéticas inferidas pelo MLST são semelhantes àquelas inferidas quando se utiliza o genoma completo, isso denota a pressão seletiva sobre esses genes. Sendo assim, a cepa utilizada na produção da vacina no Brasil, que apresenta o perfil alélico prn1-ptxS1D - fim3A-ptxP2, pode não ser capaz de gerar uma resposta imune protetora frente às linhagens circulantes no país. Este estudo traz, pela primeira vez, informações genéticas e genômicas de isolados de B. pertussis do Brasil, país que apresenta cobertura vacinal bastante heterogênea, que utiliza, oficialmente, a vacina celular, mas que, também, aplica a vacina acelular. As informações reveladas neste estudo podem auxiliar a tomada de ações para o controle de pertússis no Brasil, além do conhecimento sobre epidemiologia e evolução de B. pertussis / Pertussis more commonly referred as whooping cough is respiratory tract disease mainly caused by the bacteria B. pertussis. After 50 years of vaccination pert ussis remerged, becoming the most frequent vaccine preventable disease in developed countries. Many hypotheses have been proposed for the re - emergence of pertussis, one being the pathogen adaptation in a vaccinated environment. Current pertussis strains ar e different than those from the prevaccination era, especially in genes that code for proteins used in acelluar pertussis vaccines. This re - emergence is also observed in Brazil, therefore we characterized 26 isolates from 3 regions of Brazil (North,South,N ortheast) using an MLST approach based on these genes. We identified two allelic profiles, 24 isolates from the states of Rio Grande do Sul (2008 - 2009), Alagoas (2008 - 2009), Pernambuco (2013) and Pará (2004) presented the prn2 - ptxS1A - fim3B - ptxP3 allelic pr ofile, while 2 isolates from Pará (2004) presented the prn2 - ptxS1A - fim3A - ptxP3 allelic profile. Phylogenetic analysis branch these two allelic profiles along with other post vaccination isolates around the globe. Four isolates, three from the dominant prof ile and one from the less frequent profile, had their genomes completed sequenced on the GS 454 Junior Platform. We compared these genomes with others available in public databases and no SNP or unique genes were identified in the Brazilian genomes. This s tudy also developed a methodology that identifies the location of the repetitive region IS481, and what genes it interrupted. One of them was the MarR transcriptional regulator gene. Phylogenomic analysis based on 826 SNPs revealed that Brazilian B. pertus sis lineages are part of the current pandemic linage present in all continents, except Africa. We also observed that phylogenomic relationships are similar to MLST’s. Therefore, strain used for pertussis vaccine in Brazil, that presents the prn1 - ptxS1D - f im3A - ptxP2 allelic profile, might not be able to induce immune response to the current linage circulating in the country. This is the first study with genetic and genomic informations of B. pertussis isolates in Brazil, which is a country with heterogeneou s vaccine coverage and mixed and has both cellular and acellular vaccine administrated to the population. Information brought with this study can help the decision making on the control of pertussis in Brazil and gives new insights on the epidemiology and evolution of B. pertussis

Submitted by PAULA FERNANDES CHADI null (pchadi@hotmail.com.br) on 2018-03-19T19:39:18Z No. of bitstreams: 1 Vacina dTpa em gestantes na redução da coqueluche na criança_ Paula Fernandes Chadi.pdf: 5748928 bytes, checksum: 303a79e29b44a02e7c23e3f872799555 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-20T12:38:55Z (GMT) No. of bitstreams: 1 chadi_pf_dr_bot.pdf: 5748928 bytes, checksum: 303a79e29b44a02e7c23e3f872799555 (MD5) / Made available in DSpace on 2018-03-20T12:38:55Z (GMT). No. of bitstreams: 1 chadi_pf_dr_bot.pdf: 5748928 bytes, checksum: 303a79e29b44a02e7c23e3f872799555 (MD5) Previous issue date: 2018-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A epidemiologia é uma ciência que estuda os processos de saúde e doença na população, sejam eles individuais ou coletivos. A lista Nacional de Notificação compulsória teve sua última atualização em 17 de fevereiro de 2016 por meio da portaria nº 204, que define novas doenças, agravos e eventos de saúde nos serviços públicos e privados em todo o território nacional, sendo a comunicação destes acontecimentos obrigatória. A coqueluche, que se encontra na lista das doenças de notificação compulsória, define-se por uma doença infecciosa aguda do trato respiratório inferior sendo seu agente etiológico a bactéria Bordetella pertussis. Apesar dos esforços dispendidos pelo Programa Nacional de Imunizações, da Vigilância Epidemiológica e outros Centros de Vigilância internacionais, no mundo, ainda, estima-se que a cada ano ocorram de 20 a 50 milhões de casos de coqueluche, com aproximadamente 200 a 400 mil mortes, sendo a maior parte em lactentes que não foram vacinados ou com a vacinação incompleta. Mesmo com a disponibilidade da vacina contra difteria, tétano e pertussis incluída no calendário vacinal da criança através da pentavalente, a imunidade não é permanente, surgindo então a pergunta deste estudo: Apenas a vacinação na gestante com dTpa elimina a coqueluche em crianças até dois anos? Objetivo: Analisar em dois municípios do interior do Estado de São Paulo, se as crianças menores de dois anos, filhos de mulheres vacinas pela dTpa tiveram coqueluche. Método: Trata-se de um estudo epidemiológico, observacional descritivo antes e depois de delineamento transversal, sobre avaliação das crianças que desenvolveram a coqueluche, notificadas nos municípios de Botucatu e Marília, interior do estado de São Paulo, no período retrospectivo (2008 a 2014) e prospectivo à vacina da dTpa na gestante (2014 a 2016). Resultados: Percebe-se que há uma carência de publicação sobre a abordagem da coqueluche na criança, sua prevenção, tratamento e controle. Todas as fichas de notificação avaliadas no estudo estavam parcialmente preenchidas, comprometendo a qualidade das informações. Em relação à avaliação comparativa entre os dois municípios em estudo, percebe-se que, no período retrospectivo o número de casos confirmados de coqueluche nos dois municípios totalizou-se em 56 casos, dos quais 25% (14) em Botucatu e 75% (42) em Marília. Já no período prospectivo, após a implantação da vacina ainda houve casos confirmados nos dois municípios, perfazendo 21 casos – 71,42% (15) em Botucatu e 28,58% (6) em Marília – e mesmo havendo redução, os casos ainda persistem apresentando exposição do público vulnerável, crianças menores de um ano a coqueluche. Conclusão: A introdução da dTpa no calendário vacinal da gestante não foi suficiente para impedir a transmissão do microorganismo Bordetella pertussis às crianças com idade inferior a dois anos, conforme a proposta do Ministério da Saúde. / Introduction: Epidemiology is an area of public health aimed at understanding health-disease processes within the population, an aspect that differentiates it from the clinic, since its objective is the study of these processes, individual or collective. The National Compulsory Notification list was last updated on February 17th, 2016 through ordinance No. 204, which defines new diseases, injuries and health events in public and private services throughout the national territory, and the communication is mandatory. Pertussis on the list of compulsorily notifiable diseases is defined as an acute infectious disease of the lower respiratory tract, its etiological agent being Bordetella pertussis. Despite the efforts made by the National Immunization Program (PNI), Epidemiological Surveillance and other International Surveillance Centers, it is still estimated that 20 to 50 million cases of pertussis occur every year, with approximately 200 to 400,000 deaths, most of them in infants who were not vaccinated or had incomplete vaccination. Even though the DTP vaccine is in the child's immunization schedule, immunity is not permanent, so the question arises in this study, only vaccination in the pregnant woman reduces the infection of the Bordetella pertussis bacterium in children up to 4 (four) years? Objective: To analyze in two municipalities of the interior of the State of São Paulo, if children under two years of age, children of dTpa vaccine women had pertussis. Method: This is a descriptive and observational epidemiological study before and after a cross-sectional study on the evaluation of children who developed the disease by the Bordetella pertussis microorganism reported in the municipalities of Botucatu and Marília, in the state of São Paulo, in the period retrospective and prospective study of the dTpa vaccine in the pregnant woman from 2008 to 2016. Results: It is noticed that there is a lack of publication about the pertussis approach in the child its prevention, treatment and control. All of the notification sheets evaluated in the study were partially completed. Regarding the comparative evaluation between the two municipalities under study, it can be seen that in the retrospective period from January 2008 to October 31th, 2014, the number of confirmed cases in the two municipalities was analyzed, in a total of 56 cases, of which 14 (25%) in Botucatu and 42 (75%) in Marília. Since the prospective period analyzed after the implementation of the vaccine from November 1th, 2014 to December 31th, 2016, there are still positive cases in the two municipalities, 21 cases, of which 15 (71.42%) were in Botucatu and six (28.58 %) in Marília, that even reducing still persist presenting risk to the vulnerable public. Conclusion: The introduction of dTpa into the pregnant woman's immunization schedule was not sufficient to prevent transmission of the Bordetella pertussis microorganism to children under two years of age, as proposed by the Ministry of Health.

Class of 2014 Abstract / Specific Aims: Tetanus, diphtheria, and pertussis are diseases, which are preventable through proper vaccination. In spite of the availability these vaccines, however, there has recently been a surge in the number of pertussis cases in the United States. The objective of this study is to determine provider adherence to tetanus, diphtheria and pertussis guidelines set forth by the Advisory Committee on Immunization Practices in a primary care setting before and after a clinical pharmacist intervention. Methods: A retrospective cohort of chart reviews was conducted between January 1 – September 30, 2013 to determine immunization adherence to tetanus, diphteria, and pertussis vaccination guidelines. A clinical pharmacist then preformed a series of cross-sectional chart reviews as an intervention. Following the intervention, a retrospective chart review was conducted to evaluate if Tdap vaccination rates improved between March 17-23, 2014. Main Results: Overall immunization rates greatly improved following the intervention (p<0.0001; x2=44.988). For non-pregnant adults between the ages of 19-64 the vaccination rate improved from 26% to 61.1% (p<0.0001; x2=47.07). A statistically significant improvement was not seen in the groups with patients 65 or older or pregnant women (p>0.05). Tdap vaccination status was appropriately evaluated and vaccinations given by primary doctors improved from 17.7% to 61.2% and those prescribed by nurse practitioners improved from 22.4% to 56.3%. Conclusion: Intervention by a Clinical Pharmacist helped improve overall provider adherence to the tetanus, diphteria, and pertussis vaccination guidelines.

Background and Significance: Pertussis infection rates have significantly increased in the United States even though pertussis is a vaccine preventable illness. Alaska has been significantly impacted by this disease and is ranked 3rd highest in the nation for infection rates per capita. Infants less than three months of age suffer the highest proportion of infections. The effects of pertussis are most severe in this age group, sometimes requiring hospitalization and causing death. One theorized contributing factor to the increased pertussis infection rates is the transition to an acellular pertussis vaccine. The acellular component of the Tdap vaccine may wane up to 42% a year, thus decreasing coverage from 10 years to approximately three to five years. The increased infection rate and decreased vaccine efficacy necessitates improved education regarding preventative measures. The cocooning vaccination strategy immunizes all eligible individuals in contact with the infant, thus creating a cocoon of protection.Purpose and Specific Aims: This Doctor of Nursing Practice (DNP) project addresses the need for improved educational material regarding infantile pertussis prevention for Alaskan families having a baby. Throughout this DNP project an educational brochure is developed, emphasizing the importance of pertussis prevention through cocooning vaccination.Methods: The educational brochure was created using the framework of the Health Belief Model (HBM). The HBM was utilized to structure the information included within the brochure to influence individual health behaviors towards immunization of pertussis through cocooning. Evaluation: Three content experts evaluated the brochure utilizing the Patent Education Materials Assessment Tool (PEMAT) auto-scoring tool. Content experts reviewed the brochure and determined the understandability and actionability of the brochure in the form of a percentage. The content expert evaluations all indicated scores of 100%. Conclusion: The brochure created within this DNP Project addresses the educational needs of Alaskan families regarding pertussis infection and the severity of these infections in the infant population. Future implications include brochure production and distribution. The brochure will have the most impact when distributed to maternity units, obstetrical, and gynecological offices in Alaska.

Although pertussis vaccines have been available for over 7 decades, countries are experiencing a pertussis resurgence. This study sought to establish a relationship between the European pertussis immunization schedule designs (with and without the inclusion of adolescent boosters) and the immunization requirement (recommended or required), which potentially influences immunity waning, and thus the incidence rate and epidemiologic cycles of pertussis. The theoretical foundation for this study was the theory of herd immunity. A quantitative research method was used, supported by a secondary data source. The statistical analysis included the use of linear regression to evaluate the relationship between the requirement of the vaccine and the addition of adolescent boosters on the incidence level and the length of the epidemiologic cycles. The study findings suggest that pertussis immunization, whether recommended or required, does have an influence on the incidence rate within the populations of the countries analyzed. The same influence on incidence was demonstrated in relation to adolescent boosters as part of the immunization schedule. A similar relationship was not observed between the immunization schedule requirement and design on the epidemiologic cycles. This study provided relevant data that contributes to the enhanced understanding of the relationship between the design of the immunization schedule on incidence. This understanding could help control the resurgence, reduce immune waning through adolescent boosters, enhance immunization schedule timing, and lower the incidence. The result would be a positive public health social change through improved immunization strategy.