Mestrado em Medicina Tropical e Saúde Pública (IPTSP)
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Navegando Mestrado em Medicina Tropical e Saúde Pública (IPTSP) por Por Orientador "Andrade, Ana Lúcia Sampaio Sgambatti de"
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Item Uso de técnicas moleculares para determinação de Streptococcus pneumoniae e sorotipos colonizadores da nasofaringe na era pós-vacinal(Universidade Federal de Goiás, 2013-01-23) Garcia, Weslley José Moreira; Andrade, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899; Andrade, Ana Lúcia Sampaio Sgambatti de; Kipnis, André; Minamisava, RuthBrazil was the first country to introduce the pneumococcal conjugate 10valent vaccine into the National Immunization Program for infants, in 2010. The nasopharyngeal colonization by Streptococcus pneumoniae occurs early in life. It is the first step for the development of invasive diseases. So far no study has evaluated the impact of vaccination on the reduction on pneumococcal carriage. The evaluation of the impact of vaccination should based on technologies with high accuracy. In this investigation we applied molecular technologies, recently developed, to ascertain pneumococcal nasopharyngeal colonization and serotypes. Objectives: (i) to compare the prevalence of S. pneumoniae nasopharyngeal colonization by using real-time PCR (RT-PCR) and multiplex PCR, and culture (“gold standard”) in children residing in Goiania municipality; (ii) to evaluate the simultaneous colonization by different serotypes by using the multiplex PCR technique. Methods: A household populationbased survey was carried out between October/2010 and March/2011 by using a systematic sampling, weighted by census tract. Based on previous studies, the sample size was calculated taking into account an estimated 50% of pneumocococcal carriage. A total of 1,437 nasopharyngeal swabs were collected from children less than 24 months of age. Broth-enriched culture of nasopharynx specimens followed by pneumococcal isolation by both, culture and RT-PCR targeting the lytA gene (S. pneumoniae) were performed. Pneumococcal carriage was defined for RT-PCR Cycle threshold (Ct) < 35.0, and therefore all samples were submitted to multiplex PCR to detect serotypes. ROC curve (Receiver Operating Characteristics) were built up to identify Ct values predicted of S. pneumoniae positive culture. Results: The prevalence of pneumococcal carriage by RT-PCR (56.9%) was statistically higher (p< 0,001), compared to that obtained by culture (39.3%), regardless of the vaccination status. Among the 818 positive children/samples by RT-PCR, in 54.2% of them it was possible to detect the serotype. Simultaneous colonization by different types was found in 6.9% of the children. Ct values Ct33.0 showed the best accuracy (91.4%) to predict positive pneumococcal culture (Sensitivity=88% and Specificity=81.2%). When using Ct values 32.0 we found the best accuracy of multiplex PCR in detecting serotypes (Sensitivity =90% and Specificity =84,7%). Conclusion: Our findings suggest that RT-PCR and multiplex PCR techniques showed great potential to be used in evaluating the vaccination impact. Further studies are needed to evaluate the cost-effectiveness of using these technologies on a large scale.Item Cobertura vacinal e adesão aos esquemas recomendados da vacina pneumocócica conjugada 10 valente logo após sua introdução no calendário básico em Goiânia, GO: estudo transversal.(Universidade Federal de Goiás, 2014-11-03) Saraiva, Fabricia Oliveira; Andrade, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899; Andrade, Ana Lúcia Sampaio Sgambatti de; Costa, Paulo Sérgio Sucasas da; Soares, Cristiana Maria ToscanoBackground: Pneumococcal 10-valent conjugate vaccine (PCV10) was introduced to the routine immunization in Brazil in 2010. During PCV10 introduction year three schedules were used: (i) children aged ≤6 months: 3 doses + 1 booster; (ii) children aged 7-11 months: 2 doses + 1 booster (2p + 1), and (iii) children 12-15 months: single dose. The aim of this study was to assess vaccination coverage and compliance with recommended schedules after the introduction of PCV10 and to identify the factors associated with greater coverage and compliance. Methods: A household survey was conducted between December 2010 and February 2011 in Goiania, GO, where the PCV10 vaccination started on June, 2010. Systematic sampling was used to recruit 1,237 children. A sociodemographic questionnaire was applied during the home visits; dates of vaccination were obtained from the vaccination card. The child's age at vaccine introduction was calculated for July 14th, 2010 (30 days after the introduction of the vaccine on routine immunization) and the child was retrospectively classified into one of three age groups: ≤6 months, 7-11 months; 12-15 months. Vaccination coverage (percentage of children who received the number of recommended doses) and compliance with schedules (percentage of children who received all valid doses at the recommended time interval) were calculated for all children and for each of the three age groups; prevalence ratios were compared by chi-square test. Log binomial regression (prevalence ratio / PR) was used to identify variables independently associated with vaccination coverage and compliance with recommended schedules. Results: The overall vaccination coverage was 53.4% (95% CI: 50.8-56.2%), varying from 88.3% (12-15 months / single dose) to 39.3% (7-11 months / 2 doses). Compliance to vaccination schedules was 16.6% (95% CI: 14.5 to 18.7%), ranging from 35.6% (≥12 months / single dose) to 6.0% (7-11 months / 2 doses). Having a private health insurance was independently associated with both vaccination coverage (PR = 1.22; 95% CI: 1.04-1.43, p=0.013) and compliance with the vaccination schedule (PR = 1.08; 95% CI: 1.01-1.15, p=0.019). Conclusions: Vaccination coverage achieved high percentages before the first year of introduction of PCV10 on routine immunization. Compliance with PCV10 recommended schedules was low, being important gap in the program. Having private health insurance was associated with compliance and vaccination coverage, which may reflect an attitude of seeking health care frequently and not only on emergencies. Initiatives to increase rates of vaccination coverage and compliance should be pursued targeting children aged 7-11 months, who are under the highest risk of acquiring pneumococcal disease.Item Impacto da vacinação contra o meningococo C na morbidade da doença meningocócica(Universidade Federal de Goiás, 2016-08-15) Tomich , Lísia Gomes Martins de Moura; Andrade, Ana Lúcia Sampaio Sgambatti de; http://lattes.cnpq.br/7770363683068899; Morais Neto , Otaliba Libânio de; Afonso , Eliane Terezinha; Andrade, Ana Lúcia Sampaio Sgambatti deINTRODUCTION: Routine infant immunization with meningococcal C conjugate vaccine (MenC-V) started in Brazil in November 2010, administered at three, five and 12 months of age with no catch-up for older age-groups. However, by March 2010, a vaccination campaign with MenC-V was performed in Salvador in individuals under five years-old, and from 10 to 24 yearsold. In São Paulo state, the outbreaks occurred in teenagers and young adults prompting one-time vaccination campaign from 2010 to 2014 targeting these age-groups. OBJECTIVE: To assess the direct and indirect impact (herd effect) of vaccination on invasive meningococcal disease (MD) for capsular group C (MenC) four years after the introduction of MenC-V in three scenarios: i) Brazil as a whole (routine vaccination in childhood only); ii) Brazil except for Salvador (vaccination campaign with teenagers during the year of MenC-V introduction); and iii) São Paulo state (vaccination campaign for adolescents and young adults during 2010-2014 to control outbreaks). METHODS: We performed an ecological quasi-experimental design from 2008 to 2014 using data from the National Reference Laboratory for Meningitis, and data from the National Information System for Notifiable Diseases. A deterministic linkage was performed between the two databases to improve the accuracy of the detection of MD, especially in capsular groups. An interrupted time-series analysis was conducted using the Holt-Winters technique to control for pre-existing trends and seasonal variations. The MenC vaccination impact was evaluated as the percentage of reduction in the incidence rates of MenC in the post-vaccination period (2012 to 2014), using the pre-vaccination period (2008 to 2010) to estimate what would be expected on the post-vaccination period, whether the vaccination had not been introduced. For Salvador, we analyzed the effect of the vaccination on the number of MenC cases. RESULTS: A total of 18,136 invasive MD cases were analyzed. For Brazil as a whole, the vaccination reduced 67.4% (lower 95%CI 42.5%) the rates for MenC for infants under 12 months, 92.3% (lower 95%CI 77.7%) for the age-group 12-23 months, and 65.7% (lower 95%CI 28%) for children aged 2-4 years. Indirect impact (20-24.7%) was observed in the age-group 5-19 years. When excluding Salvador from the analysis of Brazil, the indirect impact was observed only for children in the age-group 5-9 years. In the scenario of São Paulo state, similarly to Brazil, significant impact was observed in the target age-groups, in addition to indirect impact in the age group 5-9 years. In Salvador, in addition to the effect on the vaccinated population a sharp and sustainable decline of MenC cases was observed in all age-groups not target for vaccination. Overall, 1,170 cases of MenC were averted in Brazil after the introduced of Men-C vaccination. CONCLUSION: The strategy of catch-up for adolescents and young adults, especially during the year of MenC-V introduction may lead to rapid and sustainable herd effect.