ortalidad en niños menores de 5 años, a pesar de contar con medidas preventivas como la vacunación.  Objetivo: Evaluar el impacto de la vacuna antineumocócica conjugada sobre la incidencia de neumonía en niños menores de 5 años, a nivel nacional y departamental, así como las hospitalizaciones y mortalidad a nivel nacional, desde 2001-2019 en el Perú. Además, realizar un análisis entre departamentos con coberturas altas de vacunación y aquellos que alcanzan coberturas bajas.  Metodología: Diseño: Series de tiempo definidas por la introducción de la vacuna antineumocócica heptavalente (PCV7) en el periodo de tiempo entre 2009 y 2011 a nivel nacional y departamental. Posteriormente, se realizó un análisis multivariado contrastando la incidencia de casos entre los departamentos con alta y baja cobertura de vacunación. Procedimiento de obtención de datos: Los datos agrupados sobre la incidencia, hospitalización y mortalidad por neumonía fue obtenida de la CDC (Centro de Enfermedades Contagiosas); la cobertura de vacunación fue obtenida como base de datos del Ministerio de Salud (MINSA) Análisis específicos: se realizó un análisis multivariado contrastando la incidencia de casos de neumonía entre los departamentos con alta y baja cobertura de vacunación.  Resultados: Para las hospitalizaciones a nivel nacional, la tendencia de cambio post vacunación fue negativa y significativa (p <0.001). La incidencia y mortalidad tuvieron cambios no significativos. A nivel regional, Callao, Lima, Moquegua, Cusco, Huancavelica, Pasco, Loreto, San Martín y Ucayali tuvieron tendencia de cambio post vacunación negativa y significativa (p <0.001). Conclusiones: La vacunación ha demostrado ser efectiva para disminuir hospitalizaciones por neumonía en algunos departamentos y a nivel nacional. Sin embargo, existen factores individuales que pueden alterar la efectividad de la intervención, propias de la estrategia aplicada y del tipo de estudio utilizado. / Introduction: Pneumonia is an acute respiratory infection, the most common bacterial cause is Streptococcus pneumoniae and represents one of the major causes of mortality in children under 5 years of age, despite preventive measures. Objective: Assess the impact of the pneumococcal vaccine on the incidence of pneumonia in children under 5 years of age, at the national and departmental level, as well as hospitalizations and mortality at the national range, over 2001-2019 in Peru. In addition, perform an analysis between departments that achieve high vaccination coverage and those with low coverage.  Methodology: Study design: Time series interrupted by the inclusion of the heptavalent pneumococcal vaccine (PCV7) in the period between 2009 and 2011 at the national and departmental level. Multivariate analysis, contrasting the incidence of cases between departments with high and low vaccination coverage. Data collection procedure: Pooled data on pneumonia incidence, hospitalization, and mortality obtained from the CDC (Center for Communicable Diseases); vaccination coverage obtained as a database from the Ministry of Health (MINSA) Specific analyzes: multivariate contrasting the incidence of pneumonia cases between departments with high and low vaccination coverage. Results: Hospitalizations at the national level had a negative trend of change after vaccination (p <0.001). At regional level, Callao, Lima, Moquegua, Cusco, Huancavelica, Pasco, Loreto, San Martín and Ucayali had a negative and significant change trend post vaccination (p <0.001). Conclusions: Vaccination has proven to be effective in some departments and at the national level. However, there are individual factors and limitations of the study that may affect the outcome. / Tesis

S. pneumoniae é um patógeno de grande impacto em saúde pública e vacinas comerciais têm cobertura limitada e alto custo. Como alternativa, desenvolveu-se uma vacina celular de baixo custo, cuja produção envolve apenas a separação das bactérias do caldo e sua inativação. Neste trabalho, foram avaliados processos descontínuo, descontínuo alimentado e contínuo com reciclo de células, cuja produção de biomassa foi 3 vezes maior que a do descontínuo. Vacinas obtidas nos 3 processos foram utilizadas em ensaios de imunização de camundongos e induziram níveis similares de IgG e IL-17A. Anticorpos ligaram-se e induziram a deposição de moléculas do sistema complemento sobre a superfície do pneumococo. Ademais, induziram fagocitose de diferentes cepas encapsuladas da bactéria. Camundongos imunizados foram protegidos contra sepse após aspiração da cepa virulenta WU2. Portanto, o processo contínuo com reciclo permitiu a obtenção de maior número de doses sem alterar a qualidade da vacina e o ensaio opsonofagocítico poderia ser utilizado como potencial correlato de proteção. / S. pneumoniae is a pathogen of great impact on public health and commercially available vaccines have limited coverage and high cost. As alternative, a low-cost whole cell vaccine was developed, whose production involves only the cell separation and inactivation. In this work, we evaluated batch, fed-batch and continuous cultivation with cell recycle. The biomass production was 3-fold higher in continuous process than batch. Vaccines obtained from these 3 processes were used to immunize mice and all vaccines induced comparable levels of IgG and IL-17A. Antibodies were able to bind and induce deposition of complement onto pneumococcal surface, besides to induce phagocytosis of several encapsulated pneumococcal strains in opsonophagocytic assays. Immunized mice were protected from fatal aspiration-sepsis using the virulent pneumococcal strain WU2. Therefore, the continuous process with cell recycle yielded a higher number of doses without altering the quality of the vaccine and opsonophagocytic assay could be used as a potential correlate of protection.

S. pneumoniae é um patógeno de grande impacto em saúde pública e vacinas comerciais têm cobertura limitada e alto custo. Como alternativa, desenvolveu-se uma vacina celular de baixo custo, cuja produção envolve apenas a separação das bactérias do caldo e sua inativação. Neste trabalho, foram avaliados processos descontínuo, descontínuo alimentado e contínuo com reciclo de células, cuja produção de biomassa foi 3 vezes maior que a do descontínuo. Vacinas obtidas nos 3 processos foram utilizadas em ensaios de imunização de camundongos e induziram níveis similares de IgG e IL-17A. Anticorpos ligaram-se e induziram a deposição de moléculas do sistema complemento sobre a superfície do pneumococo. Ademais, induziram fagocitose de diferentes cepas encapsuladas da bactéria. Camundongos imunizados foram protegidos contra sepse após aspiração da cepa virulenta WU2. Portanto, o processo contínuo com reciclo permitiu a obtenção de maior número de doses sem alterar a qualidade da vacina e o ensaio opsonofagocítico poderia ser utilizado como potencial correlato de proteção. / S. pneumoniae is a pathogen of great impact on public health and commercially available vaccines have limited coverage and high cost. As alternative, a low-cost whole cell vaccine was developed, whose production involves only the cell separation and inactivation. In this work, we evaluated batch, fed-batch and continuous cultivation with cell recycle. The biomass production was 3-fold higher in continuous process than batch. Vaccines obtained from these 3 processes were used to immunize mice and all vaccines induced comparable levels of IgG and IL-17A. Antibodies were able to bind and induce deposition of complement onto pneumococcal surface, besides to induce phagocytosis of several encapsulated pneumococcal strains in opsonophagocytic assays. Immunized mice were protected from fatal aspiration-sepsis using the virulent pneumococcal strain WU2. Therefore, the continuous process with cell recycle yielded a higher number of doses without altering the quality of the vaccine and opsonophagocytic assay could be used as a potential correlate of protection.

No description available.

Die bakterielle Meningitis (BM) ist trotz antibiotischer Therapie eine Erkrankung mit einer hohen Mortalität und Morbidität. Kopfschmerzen und Meningismus sind Hauptsymtome und ein klinischer Hinweis für die Aktivierung trigeminaler Fasern. Ziel dieser Arbeit war es zu prüfen ob die freigesetzten Neuropeptide einen proinflammatorischen Effekt auf zerebrale Endothelzellen, einen wesentlichem Bestandteil der Blut-Hirn-Schranke haben. Wir verwendeten primär kultivierte zerebrale Kapillarendothelzellen (BMEC) der Ratte und als Stimulus Neuropeptide und/oder Pneumokokkenzellwände (PCW). Beide Neuropeptide, CGRP mehr als SP, verstärken den Effekt von PCW auf die mRNA Expression und Freisetzung von TNF-alpha, IL-1beta, IL-6, IL-10 und MIP-2 aus den BMEC. CGRP und SP haben nur eine geringe Wirkung. PCW regulieren die Dichte der CRLR (CGRP1-R) bzw. NK-1 Rezeptoren und erklären damit die kostimulatorische Wirkung. Zudem untersuchten wir den Effekt von PCW und/oder CGRP auf die Adrenomedullin (AM)- Synthese. AM ist ein vasodilatorisch wirkendes Peptid, dass vorwiegend in Endothelzellen konstitutiv gebildet wird und am CRLR Rezeptor wirkt. PCW und CGRP verstärken die Synthese von AM. Mit dieser Arbeit konnte gezeigt werden, dass PCW zur Hochregulation von Neuropeptidrezeptoren führt und CGRP und SP über diese Rezeptoren einen modulatorischen Effekt auf die Zytokinproduktion in BMEC haben. Ein genaues Verständnis dieser Interaktionen könnte die Entwicklung immunmodulatorischer Interventionen und damit eine Verbesserung der Prognose der bakteriellen Meningitis bewirken. / Despite antibiotic treatment bacterial meningitis is still associated with a high mortality and morbidity. Headache and meningismus as key symptoms, provide clear evidence for the activation of trigeminal nerve fibers. Aim of the study was to test whether the released neuropeptides have a proinflammatory effect in cerebral endothelial cells the major compartment of the blood brain barrier. We used primary brain microvascular endothelial cells of the rat (BMEC) which were stimulated with CGRP, SP and/or pneumococcal cell walls (PCW). Both neuropeptides CGRP more than SP enhanced PCW-induced mRNA expression and the release of TNF-alpha, IL-1-beta, IL-6, IL-10 and MIP-2. Neuropeptides alone were not able to induce these cytokines. PCW upregulate the density of CRLR receptor and regulate the NK-1 receptor and therefore may explain the costimulatory effect. Furthermore the effect of PCW and/or CGRP on adrenomedullin synthesis in BMEC was investigated. Adrenomedullin is a vasodilatatory peptide, which is constitutivly produced by endothelial cells and act on the CRLR receptor. PCW as well as CGRP enhance the synthesis of AM. Our data suggest that PCW upregulate neuropeptide receptors and modulate via these specific receptors the cytokine production. A detailed understanding of these interactions may open new immunmodulatory interventions and therefore may contribute to a better prognosis of bacterial meningitis.