Mestre -- Sao Paulo (Estado). Secretaria da Saude. Coordenacao dos Institutos de Pesquisa. Programa de Pos-Graduacao em Ciencias, Sao Paulo, 2003.

Orientador: Margarete Teresa Gottardo de Almeida / Banca: Márcia Maria Costa Nunes Soares / Banca: Lúcia Buchalla Bagarelli / Resumo: A candidíase vulvovaginal (CVV) é uma inflamação da mucosa genital decorrente de infecção por leveduras. Os principais sintomas são disúria, hiperemia, ardência, corrimento, prurido, dispareunia, fissuras. Aproximadamente 75% das mulheres sofrem ao menos um episódio de candidíase vulvovaginal, 40% apresentam mais de um episódio e menos de 5% tornam-se recorrentes (CVVR). A CVV tem como principal etiologia, Candida albicans, no entanto, episódios devido às espécies "não albicans" estão aumentando. O manejo das vaginites vem sendo realizado de modo empírico, levando a problemas quanto à terapêutica. Assim, este projeto teve como objetivos caracterizar fenotipicamente leveduras isoladas do conteúdo vaginal de 223 mulheres adultas, sintomáticas (S) e assintomáticas (A), atendidas pelo Serviço de Ginecologia do Hospital de Base de São José do Rio Preto e determinar os indicadores clínicos. Para tal, foi realizada análise micológica dos 223 isolados clínicos, sendo que, 87 amostras apresentaram cultura positiva. C. albicans foi a espécie mais prevalente nos dois grupos (A/S), seguida de Candida glabrata. A maior parte das mulheres era casada com média de idade de 30 a 40 anos, referiu uso de anticoncepcionais e ciclo menstrual regular. Em relação a práticas sexuais houve, para parte das pacientes, concomitância entre os hábitos, anal, oral e vaginal. Quando avaliado o tratamento prévio, não houve evidência de associação com sintomas particulares. A suscetibilidade a antifúngicos, realizada pelos dois métodos de referência disco-difusão e microdiluição, mostrou concordância, estatisticamente comprovada, apenas para o itraconazol. Em relação à produção de fator de virulência, apenas C. albicans produziu fosfolipase. Diferentemente, proteinase foi detectada em C. albicans, C. glabrata e Candida parapsilosis. Esse último fator de virulência... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Vulvovaginal candidiasis (CVV) is an inflammation of genital mucosa caused by infection by yeasts. The main symptoms are dysuria, hyperemia, burning, corrimento, pruritus, dyspareunia, cracks. Approximately 75% of women suffer at least one episode of vulvovaginal candidiasis, 40% have more than one episode and less than 5% become recurrent (CVVR). The main cause is to candidiasis is Candida albicans, however, episodes due to the species non albicans are increasing. The management of vaginitis has been done so empirically, leading to problems with therapy. Thus, this project aimed to phenotypically characterize yeasts isolated from vaginal content of 223 adult women, symptomatic (S) and asymptomatic (A), attended by the Service of Gynecology, Hospital de Base de São José do Rio Preto and determine the clinical indicators. This has mycological analysis of 223 clinical isolates, of which 87 samples showed positive culture. C. albicans was the species most prevalent in both groups (A / S), followed by Candida glabrata. Most women were married with an average age of 30 to 40 years, said use of contraceptives and menstrual cycle regularly. In relation to sexual practices was for the part of patients, concomitance between habits, anal, oral and vaginal. When assessing the previous treatment, there was no evidence of association with particular symptoms. The susceptibility to antifungal held by the two methods of reference disc-diffusion and microdilution, showed agreement, statistically proven, only to itraconazole. For the production of virulence factor, only C. albicans produced phospholipase. Conversely, proteinase was detected in C. albicans, C. glabrata and Candida parapsilosis. The latter factor was associated with virulence, mainly in isolates from symptomatic patients. Data from this study helped reveal association between virulence factors with clinical signs... (Complete abstract click electronic access below) / Mestre

Bakgrund: Svampinfektion i underlivet drabbar oftast kvinnor vid fertila ålder, ungefär 75% av kvinnor får det någon gång i livet. Svampinfektioner behandlas med antimykotika framförallt receptfria läkemedel, problemet med frekvent användning av receptfria läkemedel är att svampen kommer tillbaka inom kort igen eller förorsakar att det blir svårare att bli av med svampen. Syftet med studien är att sammanfatta och värdera kvalitén av de tillgängliga randomiserade kontrollerade studier samt avgöra om oral eller lokal antimykotika behandling är effektivast vid genital candidainfektion? Metod: Databassökning av studier genomfördes i både Pubmed och Cochrane Library för att söka efter systematiska reviews, reviews och RCT studier. RCT studierna värderades med CONSORTstatement och bedömdes antingen med låg, medel eller hög kvalité. Studierna sammanställdes i tabeller för att jämföra skillnaden i effektiviteten mellan oral eller lokal behandling. Resultat: Sökningen identifierade 190 studier varav fyra betraktades som relevanta. Bedömningen presenterade en av studierna som hög kvalité och resten medelkvalité. Tre av fyra studier visade ingen skillnad på effektiviteten mellan oral och lokal antimykotika behandling, medan endast en studie visade signifikant skillnad som gynnade den orala behandlingen. Slutsats: Generellt erhöll studier som var inkluderade i denna litteraturstudie bra kvalité vid bedömningen. Dessutom visade majoriteten av undersökningarna från både gamla och nya studier att det inte finns någon skillnad i effektivitet hos orala och intravaginala antimykotika behandling. / Background: Vaginal yeast infections usually affect women at fertile age, about 75% of women get it at some point in their lives. Vaginal yeast infections are treated with antimycotics, primarily with non-prescription drugs, the issue with frequent use of non-prescription drugs is that the fungus comes back shortly again, or it becomes difficult to get rid of. The aim of the study is to summarize and evaluate the quality of available randomized controlled trials and determine if oral or local antimycotics treatment is effective in genital candidiasis? Method: Database search of studies was conducted in both PubMed and Cochrane Library to search for systematic reviews, reviews, and RCT studies. RCT studies were evaluated with CONSORT statement and assessed with low, medium or high quality. The studies were compiled in tables to compare the difference in efficacy between oral or local treatment. Result: The search identified 190 studies, of which four were considered relevant. The assessment presented one of the studies as high quality and the rest medium quality. Three out of four studies showed no difference in efficacy between oral and local antifungal therapy, while only one study showed significant difference, which favored the oral treatment. Conclusion: Overall, studies that were included in this literature study were of good quality when assessing. Moreover, most of the researches from both old and new studies showed that there is no difference in the efficacy of oral and intravaginal antifungal therapy.

Resumo: A família Eriocaulaceae apresenta cerca de 1.200 espécies e 11 gêneros, com distribuição pantropical. Suas espécies são conhecidas popularmente como „sempre viva‟. Leiothrix spiralis Ruhland e Syngonanthus nitens (Bong) Ruhland são espécies de Eriocaulaceae, estudos químicos tem mostrado predominantemente a presença de xantonas e flavonas, principalmente O-glicosídeos e C-glicosídeos derivados da luteolina. Propriedades etnofarmacológicas de Eriocaulaceae são pouco conhecidas. Por esta razão, foi avaliado o potencial biológico dos extratos e compostos isolados das espécies L. spiralis e S. nitens. Os extratos metanólicos de escapos, capítulos e folhas destas espécies e os compostos fenólicos isolados do extrato metanólico de folhas de L. spiralis mostraram significativa atividade antimicrobiana contra bactérias Gram-positivas e Gram-negativas e leveduras, a capacidade antioxidante pelo ensaio de redução do ABTS●+ pode ser observada. Os extratos foram avaliados quanto à capacidade de inibir a formação de hifas de C. albicans, sendo verificado que o extrato de escapos de S. nitens foi capaz de inibir a fase de transição para a forma filamentosa. As atividades citotóxica e hemolítica dos extratos foram investigadas e o extrato metanólico de folhas de L. spiralis apresentou ação citotóxica sobre as células HeLa. O extrato de escapos de S. nitens foi incorporado a um creme vaginal e avaliada a atividade antifúngica e mutagênica em um modelo animal de candidíase vaginal. Os resultados mostraram que o tratamento com este produto foi eficaz neste modelo animal, erradicando a carga fúngica vaginal de ratas infectadas após 8 dias de tratamento. A atividade mutagênica foi avaliada pelo teste do micronúcleo, em tratamento agudo e subagudo, e o produto não apresentou mutagenicidade nessas condições. O presente estudo sugere que estas espécies podem ser uma fonte promissora para aplicação como antifúngico / Abstract: Eriocaulaceae is a pantropical family, comprising around 1200 species in 11 genera. Their species are popularly known as „sempre viva‟. Leiothrix spiralis Ruhland and Syngonanthus nitens (Bong.) Ruhland are two species of Eriocaulaceae, and chemical studies of these species showed predominantly flavones, mainly O-glucosides and C-glucosides derivatives of luteolin. The ethnopharmacological properties of Eriocaulaceae are little known. For this reason we evaluate the biological potential of extracts and isolated compounds from L. spiralis and S. nitens. The methanolic extracts from capitula and flower heads from this species and the phenolics isolated from the methanolic extract of leaves of L. spiralis showed significantly antimicrobial activity against Gram-positive and Gram-negative organisms and yeasts, and the antioxidant capacity by the ABTS●+ reduction assay could be observed. The extracts were evaluated as the ability to inhibit the hyphal formation on C. albicans and the extract of flower heads of S. nitens was able to inhibit the transition stage from budding to hyphal growth. The cytotoxic and hemolytic activities of the extracts were investigated and the extract of leaves of L. spiralis showed cytotoxic action on HeLa cells. A vaginal cream containing the methanolic extract of scapes from S. nitens was tested as antifungal and mutagenic in a vaginal candidiasis animal model. The results showed that treatment with this product was very effective in this animal model, and was able eradicate the vaginal fungal burden of infected rats after 8 days on treatment. The in vivo mutagenic activity of the vaginal cream was assessed by the micronucleus assay, in acute and subacute treatment, and it was not mutagenic in this conditions. The present study suggests that these Eriocaulaceae species could be a promising source of compounds to produce antifungal phytomedicines / Orientador: Taís Maria Bauab / Coorientador: Maria Virginia Costa Scarpa / Banca: Marlus Chorilli / Banca: Hérida Regina Nunes Salgado / Banca: Claudia Elena Sotomayor / Banca: Elfriede Marianne Bacchi / Doutor

No description available.

Made available in DSpace on 2014-06-11T19:31:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-20Bitstream added on 2014-06-13T19:20:29Z : No. of bitstreams: 1 araujo_mgf_dr_arafcf.pdf: 2084466 bytes, checksum: cbbeaab6200eb613c54158e1494c0dfd (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / A família Eriocaulaceae apresenta cerca de 1.200 espécies e 11 gêneros, com distribuição pantropical. Suas espécies são conhecidas popularmente como „sempre viva‟. Leiothrix spiralis Ruhland e Syngonanthus nitens (Bong) Ruhland são espécies de Eriocaulaceae, estudos químicos tem mostrado predominantemente a presença de xantonas e flavonas, principalmente O-glicosídeos e C-glicosídeos derivados da luteolina. Propriedades etnofarmacológicas de Eriocaulaceae são pouco conhecidas. Por esta razão, foi avaliado o potencial biológico dos extratos e compostos isolados das espécies L. spiralis e S. nitens. Os extratos metanólicos de escapos, capítulos e folhas destas espécies e os compostos fenólicos isolados do extrato metanólico de folhas de L. spiralis mostraram significativa atividade antimicrobiana contra bactérias Gram-positivas e Gram-negativas e leveduras, a capacidade antioxidante pelo ensaio de redução do ABTS●+ pode ser observada. Os extratos foram avaliados quanto à capacidade de inibir a formação de hifas de C. albicans, sendo verificado que o extrato de escapos de S. nitens foi capaz de inibir a fase de transição para a forma filamentosa. As atividades citotóxica e hemolítica dos extratos foram investigadas e o extrato metanólico de folhas de L. spiralis apresentou ação citotóxica sobre as células HeLa. O extrato de escapos de S. nitens foi incorporado a um creme vaginal e avaliada a atividade antifúngica e mutagênica em um modelo animal de candidíase vaginal. Os resultados mostraram que o tratamento com este produto foi eficaz neste modelo animal, erradicando a carga fúngica vaginal de ratas infectadas após 8 dias de tratamento. A atividade mutagênica foi avaliada pelo teste do micronúcleo, em tratamento agudo e subagudo, e o produto não apresentou mutagenicidade nessas condições. O presente estudo sugere que estas espécies podem ser uma fonte promissora para aplicação como antifúngico / Eriocaulaceae is a pantropical family, comprising around 1200 species in 11 genera. Their species are popularly known as „sempre viva‟. Leiothrix spiralis Ruhland and Syngonanthus nitens (Bong.) Ruhland are two species of Eriocaulaceae, and chemical studies of these species showed predominantly flavones, mainly O-glucosides and C-glucosides derivatives of luteolin. The ethnopharmacological properties of Eriocaulaceae are little known. For this reason we evaluate the biological potential of extracts and isolated compounds from L. spiralis and S. nitens. The methanolic extracts from capitula and flower heads from this species and the phenolics isolated from the methanolic extract of leaves of L. spiralis showed significantly antimicrobial activity against Gram-positive and Gram-negative organisms and yeasts, and the antioxidant capacity by the ABTS●+ reduction assay could be observed. The extracts were evaluated as the ability to inhibit the hyphal formation on C. albicans and the extract of flower heads of S. nitens was able to inhibit the transition stage from budding to hyphal growth. The cytotoxic and hemolytic activities of the extracts were investigated and the extract of leaves of L. spiralis showed cytotoxic action on HeLa cells. A vaginal cream containing the methanolic extract of scapes from S. nitens was tested as antifungal and mutagenic in a vaginal candidiasis animal model. The results showed that treatment with this product was very effective in this animal model, and was able eradicate the vaginal fungal burden of infected rats after 8 days on treatment. The in vivo mutagenic activity of the vaginal cream was assessed by the micronucleus assay, in acute and subacute treatment, and it was not mutagenic in this conditions. The present study suggests that these Eriocaulaceae species could be a promising source of compounds to produce antifungal phytomedicines

Made available in DSpace on 2014-12-17T14:14:05Z (GMT). No. of bitstreams: 1 AntonioARH.pdf: 1355873 bytes, checksum: c7ebee3518ab1fe810e379bbdf3b4446 (MD5) Previous issue date: 2007-08-31 / Post-menarche patients with clinical signs of vulvovaginitis were analyzed in this study, whose aims were the following: identify the frequency of C. albicans and non C. albicans species and negative results, correlate the vaginal culture for yeast with risk factors and symptomatology; compare positive and negative results for yeast in the vaginal and anal cultures; compare the positive results for C. albicans with other results found in the vaginal and anal cultures; and compare concomitant positivity for C. albicans and non C. albicans in the vaginal and anal cultures. Sample selection occurred between May, 2003 and May, 2005, and included 99 patients from Natal, Brazil. The laboratory methods used consisted of CHROMagar Candida culture medium, thermotolerance test at 42-45?C and hypertonic NaCL, in addition to the classic methods of carbohydrate assimilation and fermentation. We used absolute numbers, percentages, means of central tendency, chi-squared test (χ2) with Yates correction, Fisher s exact test and odds ratio for statistical analysis. The most frequent species was C. albicans in 69% of the cases. The positivity for Candida spp showed an association with the use of tight-fitting intimate clothing and/or synthetics, allergic diseases and the occurrence of itching, leukorrhea and erythema. Anal colonization increased the likelihood of vaginal contamination by 2.8 and 4.9 times, respectively, for Candida spp and C. albicans. When compared to the other species, C. albicans-positive anal colonization increased by 3.7 times the likelihood of vaginal positivity. These data suggest likely vaginal contamination originating in the anus / Pacientes ap?s a menarca, com quadro cl?nico compat?vel com vulvovaginite foram analisadas no presente estudo, cujos objetivos foram: identificar a frequ?ncia de esp?cies de C. albicans, n?o C. albicans e resultados negativos; correlacionar a cultura vaginal para leveduras com fatores de risco e sintomatologia; comparar resultados positivos com os negativos para leveduras nas culturas vaginais e anais; comparar os resultados positivos para C. albicans com outros resultados encontrados nas culturas vaginais e anais; comparar a positividade concomitante para C. albicans e n?o C. albicans nas culturas vaginais e anais. A sele??o da casu?stica ocorreu entre maio de 2003 e maio de 2005, sendo inclu?das 99 pacientes, procedentes de Natal, RN. Os m?todos laboratoriais utilizados consistiram em cultivo em CHROmagar Candida, provas de termotoler?ncia a 42-45oC e NaCl hipert?nico, al?m dos m?todos cl?ssicos de assimila??o e fermenta??o de carboidratos. Para a an?lise estat?stica foram utilizados n?meros absolutos, percentuais, medidas de tend?ncia central, Teste do qui-quadrado (χ2) com corre??o de Yates e Teste exato de Fisher, al?m de Odds ratio. A esp?cie mais freq?ente foi C. albicans em 69% dos casos. A positividade para Candida spp apresentou associa??o com o uso de roupas ?ntimas justas e/ou sint?ticas, doen?as al?rgicas e ocorr?ncia de prurido, leucorr?ia e eritema. A coloniza??o anal determinou um aumento da chance para coloniza??o vaginal, sendo 2,8 e 4,9 maior, respectivamente para Candida spp e C. albicans. A coloniza??o anal positiva para C. albicans implicou numa chance 3,7 vezes maior para a positividade vaginal em compara??o ?s outras esp?cies. Esses dados sugerem uma prov?vel contamina??o vaginal a partir do ?nus

Made available in DSpace on 2014-12-17T14:16:31Z (GMT). No. of bitstreams: 1 MarianaAPM_DISSERT.pdf: 2606420 bytes, checksum: 97be52d447dc533f85354f32faddd0ad (MD5) Previous issue date: 2013-03-27 / Funda??o de Apoio ? Pesquisa do Estado do Rio Grande do Norte / Vulvovaginal candidiasis (VVC) is one of the most common causes of vaginitis and affects about 75% of women of reproductive age. The majority of cases (80 to 90%) are due to C. albicans, the most virulent species of the genus Candida. Virulence attributes are scarcely investigated and the source of infection remains uncertain. Objective: This study aimed to evaluate the virulence factors and genotypes of clinical isolates of C. albicans sequentially obtained from the anus and vagina of patients with sporadic and recurrent VVC. Materials and methods: We analyzed 62 clinical isolates of C. albicans (36 vaginal and 26 anal strains). Direct examination of vaginal and anal samples and colony forming units (CFU) counts were performed. Yeasts were identified using the chromogenic media CHROMagar Candida? and by classical methodology, and phenotypically characterized regarding to virulence factors, including the ability to adhere to epithelial cells, proteinase activity, morphogenesis and biofilm formation. The genotypes of the strains were investigated with ABC genotyping, microsatellite genotyping with primer M13 and RAPD. Results: We found 100% agreement between direct examination and culture of vaginal samples. Filamentous forms were present in most of the samples of vaginal secretion, which presented CFU counts significantly higher than the samples of anal secretion. There was no statistically significant difference between virulence factors of infecting vaginal isolates and those presented by colonizing anal isolates; as well as for the comparison of the vaginal isolates from patients with different clinical conditions (sporadic or recurrent VVC). There was a decrease in the ability to adhere to HBEC, morphogenesis and biofilm formation of the vaginal isolates during the progress of infection. There was an association between the ability to express different virulence factors and the clinical manifestations presented by the patients. Genotype A was the most prevalent (93.6%), followed by genotype C (6.4%). We found maintenance of the same ABC genotype and greater prevalence of microevolution for the vaginal strains of C. albicans sequentially obtained. Vaginal and anal isolates of C. albicans obtained simultaneously from the same patient presented the same ABC genotype and high genetic relatedness. Conclusion: It is noteworthy that the proliferation of yeast and bud-to-hypha transition are important for the establishment of CVV. The expression of virulence factors is important for the pathogenesis of VVC, although it does not seem to be determinant in the transition from colonization to infection or to the installation of recurrent condition. Genotype A seems to be dominant over the others in both vaginal and anal isolates of patients with VVC. The most common scenario was microevolution of the strains of C. albicans in the vaginal environment. It is suggested that the anal reservoir constituted a possible source of vaginal infection, in most cases assessed / Candid?ase vulvovaginal (CVV) ? uma das causas mais comuns de vaginite e acomete cerca de 75% das mulheres em idade reprodutiva, sendo a maioria dos casos (80 a 90%) devido ? C. albicans, esp?cie mais virulenta do g?nero. Atributos de virul?ncia em CVV s?o pouco investigados, bem como a fonte da infec??o permanece incerta. Objetivo: Este trabalho teve por finalidade avaliar os fatores de virul?ncia e gen?tipos de isolados cl?nicos de C. albicans sequencialmente obtidos do ?nus e da vagina de pacientes com CVV espor?dica e recorrente. Material e m?todos: Foram analisados 62 isolados cl?nicos de C. albicans (36 isolados vaginais e 26 isolados anais). Realizou-se o exame direto das amostras de secre??o vaginal e anal e contagem de unidades formadoras de col?nia (UFC); as leveduras foram identificadas por meio cromog?nico CHROMagar Candida? e por metodologia cl?ssica e caracterizadas fenotipicamente quanto a fatores de virul?ncia, incluindo a capacidade de ader?ncia a CEBH, a atividade de proteinase, a morfog?nese e a forma??o de biofilme. Para a avalia??o da variabilidade genot?pica, empregou-se a t?cnica de genotipagem ABC, al?m da genotipagem por microssat?lites e RAPD. Resultados: Verificou-se 100% de concord?ncia entre o exame direto e a cultura de amostras vaginais, observando-se a presen?a de formas filamentosas na maioria das amostras de secre??o vaginal, as quais apresentaram contagem de UFC significativamente superior ?quela apresentada pelas amostras de secre??o anal. N?o se observou diferen?a estatisticamente significativa quando se comparou os fatores de virul?ncia dos isolados vaginais infectantes com aqueles apresentados pelos isolados anais colonizantes; bem como comparando-se os isolados vaginais de C. albicans obtidos de grupos de pacientes com diferentes condi??es cl?nicas (CVV espor?dica e com CVVR). Observa-se uma tend?ncia ? diminui??o da capacidade de ader?ncia, morfog?nese e forma??o de biofilme do isolado vaginal infectante ao longo do tempo e sugere-se associa??o entre a capacidade de expressar os diferentes fatores de virul?ncia estudados e as manifesta??es cl?nicas apresentadas pelas pacientes. O gen?tipo A foi o mais prevalente (93,6%), seguido do gen?tipo C (6,4%). Houve manuten??o do mesmo gen?tipo ABC e maior preval?ncia de microevolu??o das cepas vaginais de C. albicans obtidas sequencialmente, bem como se observou o mesmo gen?tipo ABC e alta similaridade gen?tica entre isolados vaginais e anais de C. albicans obtidos simultaneamente da mesma paciente. Conclus?o: Ressalta-se que a prolifera??o da levedura e a transi??o levedura-hifa s?o importantes no estabelecimento da CVV. A express?o dos fatores de virul?ncia ? importante na patog?nese de CVV, contudo n?o parece ser determinante na transi??o de coloniza??o para infec??o nem na instala??o de quadro recorrente de CVV. O gen?tipo A demonstra ser dominante em rela??o aos demais tanto em isolados vaginais quanto em isolados anais de pacientes com CVV. Verifica-se a ocorr?ncia de microevolu??o das cepas de C. albicans no ambiente vaginal como cen?rio mais comum. Sugere-se que o reservat?rio anal constituiu uma poss?vel fonte da infec??o vaginal, na grande maioria dos casos avaliados

The purpose of this study is to examine how women with genital pain experience health care in terms of information, availability, treatment and resources. Through interviews with women with vulvovaginal pain these experiences are further compared to the Swedish guidelines and criteria’s regarding equal health care. Applying critical theories of gender and power to the material enables to examine if discourses of female bodies and diseases affect women’s right to health and health care. The analysis shows that women with genital pain are in general dissatisfied with the quality of the health care given to them. Discourses about women's bodies, pain and diseases contribute to the normalization and elimination of female genital pain in the health care system and in the society as whole. The conclusions are that a more fundamental and accurate effort on gender equality is needed to determine how gender and normative male standards in medicine affect women's access to a satisfactory health care on equal terms.

L'évaluation médico-économique (EME) joue un rôle de plus en plus important dans le développement des recommandations cliniques et les décisions de prix et remboursement des produits de santé, notamment des vaccins. L'EME des vaccins fait l'objet de procédures et de recommandations méthodologiques spécifiques, distinctes des médicaments, dans de nombreux pays. Cette thèse illustre et répertorie les différentes questions méthodologiques concernant l'EME des programmes de vaccination sur la base de six études : estimation de la morbidité, mortalité et coûts liés aux infections à cytomégalovirus chez les receveurs de greffe d'organe solide ; description de l'état de santé subjectif et qualité de vie liée à la santé chez les femmes atteintes de candidose vulvovaginale récurrente (CVVR) ; revue critique des EME de la vaccination de rappel contre la coqueluche ; revue critique des EME de la vaccination contre le rotavirus ; analyse coût-efficacité de la vaccination antigrippale chez les personnes de 50 à 64 ans ; analyse coût-efficacité d'un vaccin antigrippal quadrivalent en Ontario. L'EME des programmes de vaccination nécessite de prédire l'effet d'un vaccin dans la vie réelle à partir d'essais cliniques, ce qui est particulièrement difficile pour plusieurs raisons : l'épidémiologie d'une infection peut varier dans le temps et l'espace, la réduction du risque d'infection après vaccination est différente de celle du risque de maladie, et la vaccination peut conduire à une augmentation ou diminution du risque chez les personnes non-vaccinées. De plus, la mesure et la valorisation des effets sur la qualité de vie soulèvent des questions méthodologiques et requièrent des choix normatifs liés aux faits que de nombreux vaccins ciblent les enfants, et que la réduction du risque peut améliorer la qualité de vie en dehors des périodes de maladie. Nous établissons finalement des recommandations pour les futures EME de programmes de vaccination, concernant la définition des stratégies à comparer, le choix de structure de modèle, l'estimation des paramètres cliniques et épidémiologiques, et la mesure et la valorisation de la qualité de vie et des coûts / Economic evaluation plays an increasingly important role in the development of clinical recommendations and pricing and reimbursement decisions for healthcare interventions, and particularly for vaccination. Specific processes and methodological recommendations have been developed for the economic evaluation of vaccines in many countries. This thesis identifies and illustrates different methodological questions about the economic evaluation of vaccination programs based on six studies: estimation of morbidity, mortality and costs associated with cytomegalovirus infections among receivers of solid organ transplant; description of subjective health state and quality of life among women with recurrent vulvovaginal candidosis; critical review of economic evaluations of pertussis booster vaccination; critical review of economic evaluations of rotavirus vaccination; cost-effectiveness analysis of influenza vaccination for people aged 50 to 64 years; cost-effectiveness analysis of a quadrivalent influenza vaccine in Ontario. The economic evaluation of vaccines requires predicting the effectiveness of vaccination based on clinical trial data, which is particularly difficult for several reasons: the epidemiology of an infection may vary over time and space, the effectiveness against infection may differ from effectiveness against disease, and vaccination may lead to an increase or decrease in the burden of disease among non-vaccinated persons. In addition, the measurement and valuation of effects of vaccination on quality of life raises methodological questions and requires normative choices related to the facts that many vaccines target children and that the reduction in risk may improve quality of life outside illness periods. We finally establish recommendations for future economic evaluations of vaccination programs, related to the definition of vaccination strategies to compare, the choice of model structure, the estimation of clinical and epidemiological parameters, and the measure and valuation of quality of life and costs