Methods and challenges for the health impact assessment of vaccination programs in Latin America

ABSTRACT OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", and "impact" in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.

Antigen characterization of vector-borne and cultured metacyclic trypomastigotes of Trypanosoma cruzi

Metacyclic trypomastigotes ol the CL strain of Trypanosoma cruzi obtained from triatomid vectors and from axenic cultures were comparatively analysed as to their antigen make-up and immunogenic characteristics. They were found to be similar by the various parameters examined. Thus, sera of mice immunized with either one of the two metacyclic types precipitated a 82Kd surface protein from 131I-labeled culture metacyclics. Sera of mice protected against acute T. cruzi infection by immunization with killed culture metacyclics of a different strain (G) recognized, by immunoblotting, a 77Kd protein in both types of CL strain metacyclics. A monoclonal antibody raised against G strain metacyclics, and specific for metacyclic stages of this strain, reacted with both CL strain metacyclic types. Both metacyclic forms were similarly Iysed by various anti-T. cruzi sera, in a complement-mediated reaction.

On-line self-healing of circuits implemented on reconfigurable FPGAs

To boost logic density and reduce per unit power consumption SRAM-based FPGAs manufacturers adopted nanometric technologies. However, this technology is highly vulnerable to radiation-induced faults, which affect values stored in memory cells, and to manufacturing imperfections. Fault tolerant implementations, based on Triple Modular Redundancy (TMR) infrastructures, help to keep the correct operation of the circuit. However, TMR is not sufficient to guarantee the safe operation of a circuit. Other issues like module placement, the effects of multi- bit upsets (MBU) or fault accumulation, have also to be addressed. In case of a fault occurrence the correct operation of the affected module must be restored and/or the current state of the circuit coherently re-established. A solution that enables the autonomous restoration of the functional definition of the affected module, avoiding fault accumulation, re-establishing the correct circuit state in real-time, while keeping the normal operation of the circuit, is presented in this paper.

A framework for self-healing radiation-tolerant implementations on reconfigurable FPGAs

To increase the amount of logic available in SRAM-based FPGAs manufacturers are using nanometric technologies to boost logic density and reduce prices. However, nanometric scales are highly vulnerable to radiation-induced faults that affect values stored in memory cells. Since the functional definition of FPGAs relies on memory cells, they become highly prone to this type of faults. Fault tolerant implementations, based on triple modular redundancy (TMR) infrastructures, help to keep the correct operation of the circuit. However, TMR is not sufficient to guarantee the safe operation of a circuit. Other issues like the effects of multi-bit upsets (MBU) or fault accumulation, have also to be addressed. Furthermore, in case of a fault occurrence the correct operation of the affected module must be restored and the current state of the circuit coherently re-established. A solution that enables the autonomous correct restoration of the functional definition of the affected module, avoiding fault accumulation, re-establishing the correct circuit state in realtime, while keeping the normal operation of the circuit, is presented in this paper.

A framework for fault tolerant real time systems based on reconfigurable FPGAs

To increase the amount of logic available to the users in SRAM-based FPGAs, manufacturers are using nanometric technologies to boost logic density and reduce costs, making its use more attractive. However, these technological improvements also make FPGAs particularly vulnerable to configuration memory bit-flips caused by power fluctuations, strong electromagnetic fields and radiation. This issue is particularly sensitive because of the increasing amount of configuration memory cells needed to define their functionality. A short survey of the most recent publications is presented to support the options assumed during the definition of a framework for implementing circuits immune to bit-flips induction mechanisms in memory cells, based on a customized redundant infrastructure and on a detection-and-fix controller.

Risco de crédito na banca face ao novo enquadramento normativo em contexto de crise : o caso do crédito a particulares

Mestrado em Auditoria

Cell mediated immune response in human antirabies revaccination

The occurrence of secondary cell mediated immune response (CMI) in human antirabies immunization was studied. The Puenzalida & Palácios vaccine was used because it is routinely used in Brazil. CMI was evaluated by lymphoblastic transformation indices obtained in whole blood culture in the presence of rabies and control (nervous tissue) antigens. Eleven volunteers submitted to revaccination constituted the group under study, while three other volunteers submitted primo vaccination were utilized as control group. A clear secondary CMI to rabies antigen was detected in all the revaccinated volunteers who showed earlier and more intense response than the control group. Response to the control antigen, however, present in all the components of the first group was not detectable in two out of the three primovaccinated and very low in the third one.

Projeto e implementação de um pré-regulador de fator de potência com controlo digital

Hoje em dia as fontes de alimentação possuem correção do fator de potência, devido às diversas normas regulamentares existentes, que introduziram grandes restrições no que respeita à distorção harmónica (THD) e fator de potência (FP). Este trabalho trata da análise, desenvolvimento e implementação de um Pré-Regulador de fator de potência com controlo digital. O controlo digital de conversores com recurso a processamento digital de sinal tem vindo a ser ao longo dos últimos anos, objeto de investigação e desenvolvimento, estando constantemente a surgirem modificações nas topologias existentes. Esta dissertação tem como objetivo estudar e implementar um Pré-Regulador Retificador Boost e o respetivo controlo digital. O controlo do conversor é feito através da técnica dos valores médios instantâneos da corrente de entrada, desenvolvido através da linguagem de descrição de hardware VHDL (VHSIC HDL – Very High Speed Integrated Circuit Hardware Description Language) e implementado num dispositivo FPGA (Field Programmable Gate Array) Spartan-3E. Neste trabalho são apresentadas análises matemáticas, para a obtenção das funções de transferência pertinentes ao projeto dos controladores. Para efetuar este controlo é necessário adquirir os sinais da corrente de entrada, tensão de entrada e tensão de saída. O sinal resultante do módulo de controlo é um sinal de PWM com valor de fator de ciclo variável ao longo do tempo. O projeto é simulado e validado através da plataforma MatLab/Simulink e PSIM, onde são apresentados resultados para o regime permanente e para transitórios da carga e da tensão de alimentação. Finalmente, o Pré-Regulador Retificador Boost controlado de forma digital é implementado em laboratório. Os resultados experimentais são apresentados para validar a metodologia e o projeto desenvolvidos.

Desenho e implementação de um data warehouse para a empresa AdClick

Esta dissertação incide sobre a problemática da construção de um data warehouse para a empresa AdClick que opera na área de marketing digital. O marketing digital é um tipo de marketing que utiliza os meios de comunicação digital, com a mesma finalidade do método tradicional que se traduz na divulgação de bens, negócios e serviços e a angariação de novos clientes. Existem diversas estratégias de marketing digital tendo em vista atingir tais objetivos, destacando-se o tráfego orgânico e tráfego pago. Onde o tráfego orgânico é caracterizado pelo desenvolvimento de ações de marketing que não envolvem quaisquer custos inerentes à divulgação e/ou angariação de potenciais clientes. Por sua vez o tráfego pago manifesta-se pela necessidade de investimento em campanhas capazes de impulsionar e atrair novos clientes. Inicialmente é feita uma abordagem do estado da arte sobre business intelligence e data warehousing, e apresentadas as suas principais vantagens as empresas. Os sistemas business intelligence são necessários, porque atualmente as empresas detêm elevados volumes de dados ricos em informação, que só serão devidamente explorados fazendo uso das potencialidades destes sistemas. Nesse sentido, o primeiro passo no desenvolvimento de um sistema business intelligence é concentrar todos os dados num sistema único integrado e capaz de dar apoio na tomada de decisões. É então aqui que encontramos a construção do data warehouse como o sistema único e ideal para este tipo de requisitos. Nesta dissertação foi elaborado o levantamento das fontes de dados que irão abastecer o data warehouse e iniciada a contextualização dos processos de negócio existentes na empresa. Após este momento deu-se início à construção do data warehouse, criação das dimensões e tabelas de factos e definição dos processos de extração e carregamento dos dados para o data warehouse. Assim como a criação das diversas views. Relativamente ao impacto que esta dissertação atingiu destacam-se as diversas vantagem a nível empresarial que a empresa parceira neste trabalho retira com a implementação do data warehouse e os processos de ETL para carregamento de todas as fontes de informação. Sendo que algumas vantagens são a centralização da informação, mais flexibilidade para os gestores na forma como acedem à informação. O tratamento dos dados de forma a ser possível a extração de informação a partir dos mesmos.

Antibody response to heat-inactivated hepatitis B vaccine (CLB-3mg) in hemodialysis patients and occupational risk personnel: a one year follow-up

Immune response against hepatitis B vaccine (CLB 3mg) was evaluated in 59 hemodialysis patients and 20 occupational risk personnel. Seroconversion was induced in 52.5% and 70.0% respectively. Twelve months after the first dose, 37.5% of patients and 60.0% of occupational risk personnel had detectable anti-HBs level. Antibody level was expressed in sample ratio units (SRU). Considering only the responders, in the patients group 38.7% had a low anti-HBs response (2.1-9.9 SRU) 32.3% a medium response (10-99.9 SRU) and 29.0% a high response (>100 SRU) while in occupational risk personnel these values were 14.3%, 64.3% and 21.4% respectively. The authors suggest the use of HBV vaccines with more elevated HBsAg concentration or a reinforced immunization schedule to improve the anti-HBs response not only for patients but also for healthy persons.

Approaches to tuberculosis mucosal vaccine development using nanoparticles and microparticles: a review

Next-generation vaccines for tuberculosis should be designed to prevent the infection and to achieve sterile eradication of Mycobacterium tuberculosis. Mucosal vaccination is a needle-free vaccine strategy that provides protective immunity against pathogenic bacteria and viruses in both mucosal and systemic compartments, being a promising alternative to current tuberculosis vaccines. Micro and nanoparticles have shown great potential as delivery systems for mucosal vaccines. In this review, the immunological principles underlying mucosal vaccine development will be discussed, and the application of mucosal adjuvants and delivery systems to the enhancement of protective immune responses at mucosal surfaces will be reviewed, in particular those envisioned for oral and nasal routes of administration. An overview of the essential vaccine candidates for tuberculosis in clinical trials will be provided, with special emphasis on the potential different antigens and immunization regimens.

Prevention of electrocardiographic and histopathologic alterations in the murine model of Chagas' disease by preinoculation of an attenuated Trypanosoma cruzi strain

The effects of infection with Trypanosoma cruzi on the electrocardiographic tracings of mice were studied in 4.groups of animals: (1) normal; (2) infected with a pathogenic T. cruzi strain (TS COB); (3) immunized with 3 intraperitoneal inocula of 10(6) attenuated T. cruzi epimastigotes (TCC) and (4) immunized-infected, which sequentially received the treatments of groups 3 and 2. Infection and protection were confirmed by xenodiagnosis and histopathology. Isolated alterations such as extrasystolia, 1st degree atrioventricular block, arrhythmia and ST elevation were observed in normal as well as infected mice. However, tracings taken repeatedly on each mouse over a 293 day period revealed a set of alterations which were more frequently seen in infected (14/22) than in normal (4/27) animals (p = 0.00048). These alterations consisted of supraventricular tachycardia, sinus bradycardia and persisting, first degree AV blocks, often associated to pacemaker changes. Inoculation of attenuated T. cruzi (group 3) did not increase these alterations (2/27 mice) but significantly prevented their development after challenge with the pathogenic strain (1/19 versus 14/22 mice, p = 0.000095). Thus, preimmunization reduced not only parasitemia but also a pathogenic consequence of T. cruzi infection. This evidence is relevant for immunoprevention studies against Chagas' disease.

Measles vaccination: influence of age on its efficacy

The authors compare the serologic efficacy and the clinical protection afforded by three different measles vaccination schemes in adequately nourished children in São Paulo city, Brazil. Two hundred forty two children were divided into three groups. Group A, comprising 117 children who had received the vaccine before 12 months of age and a second dose at 12 months of age or more. Group B, comprising 46 children who had received only one dose, before 12 months of age. Group C, comprising 79 children who had received only one dose, at 12 months of age or more. The geometric mean titer of antibodies in Group A was 790.1; in Group B, 251.1; and in Group C, 550.3. There was no statistically significant difference between Groups A and C. The exposure to the measles virus was probably similar in all groups, and the children in Groups A and C had similar chances of acquiring the disease after vaccination whereas in Group B the chances were higher when compared to the other two groups. The results obtained in this study favor the use, in developing countries, of a vaccination program against measles that includes an early first dose at eight months of age and revaccination after 12 months of age.

Reinfection after treatment of schistosomiasis: environment or "predisposition"?

Although very efficient for the control of morbidity due to S. mansoni in individual patients, chemotherapy has not proven successful in the management of transmission within hyperendemic areas when used alone, even if repeated at short intervals. Consequently, a great deal of effort has been expended toward immunologic investigation and development of a specific vaccine. Based upon a study of a group of children (5-14 years) from the state of Alagoas, the author demonstrates that the outcome one year after chemotherapy depends essentially on the "risk rating" of the area of domicile. A regression analysis did not reveal significant correlation to neither age, sex or initial egg counts. Although the study was not designed to reveal individual variations in the immune status, it is postulated that putative differences in genetic make-up are irrelevant in terms of large-scale intervention. Since morbidity due to S. mansoni has substantially declined during the last two or three decades, a control policy based on vaccination can only be justified if high levels of protective immunity can be attained. At any rate, such a vaccine will have to be administered in early childhood (preferably below the age of three). It can also be demonstrated that immunization in adolescence or adulthood serves no purpose whatsoever. The author is convinced that environmental intervention, usually dismissed as unrealistic in terms of the developing countries, is not only feasible, if done on a selective basis, but prioritary.

O líder enquanto dinamizador da comunicação interna nas organizações

Dissertação apresentada à Escola Superior de Comunicação Social como parte dos requisitos para obtenção de grau de mestre em Gestão Estratégica das Relações Públicas.