Dissertations / Theses on the topic 'Leptospirosis/epidemiology'

Background The burden of leptospirosis in sub-Saharan Africa remains unclear although it is accepted that this infection is widely spread in this region. The global estimated number of cases is one million with 58 900 deaths attributable to leptospirosis annually. Objective To describe the profile of patients with suspected leptospirosis and to compare their in hospital outcomes. Methods & Material We performed a retrospective study at a tertiary referral hospital in South Africa. All adults with suspected leptospirosis who had a laboratory request for leptospirosis ELISA IgM testing between 2005 and 2015 were included. Clinical and laboratory findings at presentation were correlated with the patient's subsequent clinical course and ELISA IgM status. Results During the study period 223 patients who had ELISA IgM test requests were enrolled. Leptospirosis ELISA IgM was positive in 45 (20%) patients. Enrolled patients had a median age of 38 (IQR 31 – 53) years, 147/223 (66%) were males and 80/223 (36%) were HIV positive. There were 12/45 (27%) HIV-positive patients in the IgM-positive group compared to 68/178 (38%) in the IgM-negative group, p=0.22. Compared to IgM-negative patients, patients with positive IgM were more likely to present with jaundice 37/45 (82%) vs. 82/178 (46%), p <0.01, and acute kidney injury (AKI) 34/45 (76%) vs.102/178(57%), p=0.06. The median length of hospital stay was 13 days (IQR 8-22 days) for IgM-positive compared to 10 days (IQR 6-21 days) in IgM-negative patients, p= 0.10. A total of 11/45 (24%) IgMpositive patients required ICU admission compared to 41/178 (23%) of IgM-negative patients, p=0.84 and the median length of ICU stay was 7 days (IQR 4-11) for IgM-positive compared to 6 days (IQR 3-9.5) for IgM-negative patients, p=0.51. There were 13/45 (29%) IgM-positive patients who needed dialysis compared to 42/178 (24%) of IgM-negative patients, p= 0.46. The mortality rate was 7/45 (16%) in IgM-positive compared to 52/178 (29%) in IgM-negative patients, p=0.07. Conclusion Patients with positive IgM presented predominantly with jaundice and AKI. There was no statistically significant difference in HIV status and outcomes between the two groups of patients

Realizamos uma investigação epidemiológica em uma zona que fora inundada pela rio Aricanduva e seus afluentes, a leste do município de São Paulo, em 61 coabitantes de casos confirmados laboratorialmente de leptospirose humana ocorridos em 1983, residentes nessa área, com o objetivo de conhecer o nível de infecção por leptospiras nesse grupo de pessoas. Para pesquisa de anticorpos anti-leptospiras realizamos o teste de soroaglutinação microscópica nas 61 amostras de soro colhidas, tendo sido considerado soro reagente aquele que apresentou um título mínimo igual ou superior a 1:100. Para diferenciarmos se a infecção encontrada era recente ou passada, além de outros dados epidemiológicos investigamos a presença de anticorpos da classe IgM nesses soros por meio da prova de hemaglutinação passiva, considerando significante o título igual ou maior que 1:128. Os resultados nos mostraram que 18 pessoas, ou seja 29,6 por cento dos coabitantes eram de prendas domésticas, enquanto que 18,2 por cento eram menores e 6,6 por cento eram aposentados; 6,6 por cento eram operários não qualificados, ficando outras ocupações com 3,3 por cento ou 1,6 por cento . Em relação ao meio ambiente, as unidades residenciais investigadas eram diferentes daquelas descritas na literatura no tocante a casos de leptospirose humana. Estas apresentavam codições de urbanismo, ou seja, eram servidas por transporte coletivo nas proximidades em 95,8 por cento , tinham iluminação pública em 79,2 por cento , apresentavam ruas pavimentadas em 75 por cento , além de serem servidas por rede de esgoto em 70,8 por cento e por rede pública de abastecimento de água em 100. por cento . Quanto ao tipo de construção, 100 por cento era de alvenaria. Em relação a fatores que poderiam favorecer a infecção humana por leptospiras verificamos que quase 90 por cento das unidades residenciais estudadas tinham terrenos baldios a menos de 100 m de distincia, 58,4 por cento apresentavam ratos ou nas próprias dependências ou nas suas proximidades e 79,1 por cento das casas estavam localizadas até 200 m de correntes fluviais. Dos 61 coabitantes estudados, 42 (67,8 por cento ) tiveram um ou mais contato com enchentes, a maioria das quais ocorreram nos meses de janeiro e fevereiro de 1983, época aproximada em que 127 (63,5 por cento ) dos 200 doentes desse ano também o fizeram. Quanto ao nível de infecção, encontramos 6(9,8 por cento ) amostras de soro, reagentes para os sorotipos panama (2), copenhageni (1), javanica (2) e patoc (1). Todos esses dados sugeriram influência do binômio enchente-população murina sobre esse nível de infecção. As 61 amostras de soro examinadas foram negativas para pesquisa de IgM fazendo-nos considerar os soros reagentes como relativos a uma infecção passada, presumivelmente relacionados à época de infecção do caso.
It was investigated actual leptospirosis prevalence, using epidemiological methodology, in a zone that was flood in 1983 by Aricanduva river and their tributaries situated at the east side of São Paulo country. On that time, this zone was affected by human leptospirosis, diagnosticated through laboratory. The population selected for the present survey was a group of 61 human beings who dwelled together with subjects affected by leptospirosis, in order to establish the actual level of infection by leptospira remaining on such a population. In 61 serum samples it was determined the antileptospira anti-body activity following microscopic agglutination test, considering as a reagent serum that having a lower tittle equal or higher than 1:100. In order to differentiate if the infection was either recent or anciently adquired, it was investigated, together with epidemiological data, the presence of antibodies concerning to IgM class using passive hemagglutination test, considering as significant a tittle equalor higher than 1:128. The population distribution according to the occupational activities showed that 29,6 per cent (18subjects) belonged to home task category, 18,2 per cent were children, 6,6 per cent were retired by social security laws, 6,6 per cent non-qualified manual workers. The rest of surveyed population belonged to indetermined or to different labor activities. In relation to living environment, the residential units were different to those previously descrived in cases of human leptospirosis. Houses showed characteristics of an urban environment, having 95,8 per cent a public transport system, 79,2 per cent had public lighting, 75 per cent had streets with pavement, 70,8 per cent showed drainage system and 100 per cent drinking water service. Masonry was detected in 100 per cent of buildings. Those factors which could favor human infection development by leptospira were also studied. It was verified that 90 per cent of residential units showed uncultivated yards in a radio lower to 100 m around the house, 58,4 per cent of cases studied had rats in or near the house and 79,1 per cent of houses were localized near the river (less than 200m). 67,8 per cent (42 subjects) had the chance to contact with flood water once or many times, ocurred most of them, during the months of january or february 1983. At that time, also 127 from 200 patients affected by leptospirosis (63,5 per cent ) had a similar chance of contact with flood water in 1983. It was found that 9,8 per cent (6 cases) of serum samples showed reagents for serovars panama (2), copenhageni (1), javanica (2) and patoc (1). All the data obtained from this research suggest the influence of flood-rat population binomial on the level of infection detected. Looking for IgM, 61 serum samples were found negative, which could be interpreted as the serum reagents were compatible with an past infection, may be related to the time of infection of the cases considered as leptospirosis in 1983.

A serological and questionnaire study on zoonoses was performed among cattle farms in Tanga, Tanzania. The study revealed that leptospirosis and other zoonoses are common in cattle in Tanga. Herd sero-prevalences were 58% for leptospirosis, 12% for brucellosis. 6% for tuberculosis and 12% for toxoplasmosis. Prevalence was higher in traditional herds than in smallholder herds. The zoonoses were not restricted to rural areas, but also occurred in urban and peri-urban areas, where livestock keeping is expanding.

La leptospirose, spirochetose tropicale négligée, est considérée comme la zoonose la plus répandue dans le monde. Selon l’Organisation Mondiale de la Santé, les formes sévères représentent 5 à 15% des infections humaines et le taux de létalité peut varier entre 5% et 30%. En Océanie et particulièrement en Nouvelle-Calédonie et à Futuna, la leptospirose est une préocupation majeure de santé publique: son incidence annuelle moyenne est de 45 pour 100 000 habitants et peut atteindre 150 pour 100 000 habitants pendant les saisons pluvieuses. Malgré les progrès considérables accomplis pour comprendre la physiopathologie de la maladie, plusieurs aspects de la leptospirose encore négligés méritent d’être exploré: les infections symptomatiques pédiatriques, la réaction de Jarisch-Herxheimer (JH) pourtant bien étudiée dans les autres spirochetoses, et les reinfections nécessitant une hospitalisation. Questions posées et objectifs: La pratique clinique suggère que les enfants hospitalisés pour leptosirose sont moins sévèrement atteints que les adultes. Les raisons susceptibles d’expiquer cette différence de présentation sont peu claires. L’obejctif de l’étude 1 était de décrire l’épidemiologie et le profil clinico-biologique des formes pédiatriques de leptospirose nécessitant une hospitalisation en Nouvelle Calédonie et d’identifier des différences en fonction des classes d’âge. La réalité de la réaction de Jarisch-Herxheimer – bien connue dans les autres spirochetoses – reste un sujet controversé dans la leptospirose. Afin d’effectuer une mise au point sur le sujet, une revue systématique de la littérature préalable à été réalisée (Etude 2) avant de préciser la prévalence, la sévérité, et les facteurs de risque des réactions de Jarisch-Herxheimer au cours des épisodes de leptospirose humaine traitée par antibiotiques en Nouvelle Calédonie et à Futuna (Etude 3)
Leptospirosis is an endemo-epidemic zoonotic disease associated with potentially fatal renal, cardiovascular or pulmonary failure. Several aspects of the disease are poorly explored, including infections in children, Jarisch-Herxheimer reactions (JHR) and symptomatic re-infections. The objectives of the studies were the following: to describe disease spectrum and outcome differences in children and adolescents admitted for leptospirosis in a large at-risk population; to quantify frequency of and risk factors for JHR in leptospirosis management; and to assess incidence and characteristics of reinfection by leptospirosis in the Pacific region. Using a retrospective data collection, clinical and laboratory data were obtained on hospitalized confirmed cases in New Caledonia and in Futuna. A case-control study was designed to identify risk factors using a logistic regression model. There are four principal findings from this series of studies with direct implications for clinical practice in those settings. First, leptospirosis in New Caledonia is responsible for a limited number of admissions among children due to milder symptomatic clinical presentation. Second, although generally assumed to be a rare event, the true prevalence of JHR in leptospirosis is unknown in most part of the world. The awareness of this event is probably insufficient considering the significantly high proportion of JHR observed in Futuna. Third, recurrent episodes of symptomatic leptospirosis appear to be non-severe. Finally, specific immunity resulting from a previous episode of leptospirosis with the serovar Copenhageni did not protect against subsequent infection against the same serovar. Future research based those results may provide insights into the still challenging pathogenesis of this complex infectious disease

Para relacionar possíveis variáveis para infecção pelos agentes N. caninum, B. abortus e Leptospira spp em rebanhos bovinos do Estado do Pará utilizando a frequência de anticorpos foram colhidas amostras de sangue de 3466 vacas provenientes de 176 propriedades, nas quais um questionário foi aplicado. A prova de RIFI foi utilizada para pesquisa de anticorpos anti-N.caninum; a prova de triagem do AAT seguida pela SAL e 2-ME como confirmatórias para pesquisa de anticorpos anti-B. abortus; e o método de SAM para pesquisar anticorpos contra Leptospira spp., utilizando uma bateria de 22 antígenos. As análises estatísticas foram realizadas pelas provas do Qui-quadrado (X2) e Mann-Whitney, com intervalo de confiança de 95%. A ocorrência de anticorpos anti-N. caninum, B. abortus e Leptospira spp. em bovinos foi de 14,7%, 3,7% e 65,5% em 87,4%, 41,3% e 98,8% das propriedades analisadas, respectivamente. O sorovar Hardjo foi o mais freqüente, seguido por Wolffi, Grippotyphosa e Hebdomadis, e o mais provável causador da infecção nos animais, seguido de Grippotyphosa, a associação Hardjo+Wolffi e a sorovariedade Wolffi. A presença de abortamentos foi associada à ocorrência de N.caninum (p<0,05), assim como a realização de inseminação artificial e o destino inadequado dos produtos de abortamento foram associados à ocorrência de anticorpos anti-B. abortus e a presença de cães, destino inadequado de vacas que abortaram e a inseminação artificial foram variáveis associadas à ocorrência das sorovariedades Hardjo, Grippotyphosa e Hebdomadis. Demonstrou-se a necessidade de um controle sanitário efetivo para neosporose e leptospirose e de mais estudos para determinar a causa da alta ocorrência do sorovar Grippotyphosa, que pode estar relacionada com a degradação ambiental
Aiming for association of possible infection variables with antibodies frequency of the agents N. caninum, B. abortus and Leptospira spp., 3466 female cattle from 176 herds were examined and a inquiry was applied. IFAT was used for research of antibodies against N. caninum; serum samples were examined for B. abortus antibodies using TAA trial test and SAA plus 2-ME for confirmation; and antibodies against Leptospira spp. were searched using MAT, with a 22 antigens battery. Statistical analysis were performed using Chi-Square (X2) and Mann-Whitney tests, with 95% confidence interval. Occurrence of antibodies against N. caninum, B. abortus and Leptospira spp. in cattle was 14,7%, 3,7% and 65,5% in 87,4%, 41,3% and 98,8% of analysed herds, respectively. Serovar Hardjo was the most frequent, followed by Wolffi, Grippotyphosa and Hebdomadis, and also most probable responsible for infection in animals, followed by Grippotyphosa, Hardjo+Wolffi association and serovar Wolffi. Occurrence of anti-N. caninum antibodies was associated with abortion presence (p<0,05), as artificial insemination and inappropriate destination of abortion products were linked with frequency of antibodies against B. abortus and occurrence of antibodies anti-Hardjo, Grippotyphosa and Hebdomadis was associated with dog presence, inappropriate destination of aborting cows and artificial insemination. It was demonstrated lack of sanitary control for neosporosis and leptospirosis and also necessity for more studies to determine causes for serovar Grippotyphosa high occurrence, condition that may be related with environmental destruction

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Infection with bacteria of the genus Leptospira spp. is the origin of the clinic disease called leptospirosis and has significant impact on equine husbandry and public health. This study aimed to investigate the prevalence of anti-Leptospira spp antibodies. in horses in the municipality of Rorainópolis, State of Roraima, Brazil's Amazon, and identify the predominant serotypes in positive serological reactions, and possible factors associated with the presence of Leptospira spp. A cross-sectional observational study using an epidemiological questionnaire and the collection of 303 samples of equine rural and urban areas that were only entered in the research after reading and signing the informed consent and informed the owner was accomplished. Samples of equine serum used in the research were obtained by puncturing the jugular vein by means of a closed vacuum collection system and sent for analysis by microscopic agglutination test (MAT / MAT) on Leptospirosis Diagnostic Laboratory of the Veterinary School and Animal Science of the Federal University of Goiás. Statistical analyzes were performed using chi-square test that provided evidence of potential factors associated with Leptospira spp. As a result of research, it was observed prevalence of 72.94% of infections in horses, prevalence of 96.43% of foci of infection, and the prevalence of serovars Patoc, Sentot, Icterohaemorrhagiae, Grippotyphosa, Hardjoprajitno and Castellonis in serological reactions positive. Presence of rodents, Veterinary care and Use of animals were found to associads factors for infection by Leptospira spp. Therefore, it was found to endemic infection with Leptospira spp. in the municipality due to the high number of cases and outbreaks, and significant occurrence of positive for the serovars Sentot, Grippotyphosa, Butembo and castellonis indicate the contact and the circulation of these serotypes also in wild animals, and the occurrence of positive for the serovars icterohaemorrhagiae and serovar respectively suggests contact with synanthropic rodents and cattle.
A infecção por bactérias do gênero Leptospira spp. é a origem da enfermidade clínica denominada leptospirose e que possui impacto significativo na pecuária equina e na saúde pública. Este estudo teve como objetivo investigar a prevalência de anticorpos anti-Leptospira spp. em equinos no município de Rorainópolis, Estado de Roraima, Amazônia brasileira, além de identificar os sorovares predominantes nas reações sorológicas positivas, e os possíveis fatores associados à presença da infecção por Leptospira spp. Foi realizado um estudo observacional seccional (transversal) com a utilização de um questionário epidemiológico e a colheita de 303 amostras de equinos da zona rural e urbana que somente foram inseridos na pesquisa após a leitura e assinatura do termo de consentimento livre e esclarecido pelo proprietário. As amostras de soros de equinos utilizados na pesquisa foram obtidas através da punção da veia jugular por meio de sistema fechado de colheita a vácuo e encaminhadas para análise através da soroaglutinação microscópica (SAM/MAT) no Laboratório de Diagnóstico de Leptospirose da Escola de Veterinária e Zootecnia da Universidade Federal de Goiás. As análises estatísticas foram realizadas por meio do teste de chi-quadrado que evidenciassem potenciais fatores associados com a infecção por Leptospira spp. Como resultado da pesquisa, foi constatada prevalência de 72,94% de casos de infecção nos equinos, prevalência de 96,43% de focos de infecção, e a predominância dos sorovares Patoc, Sentot, Icterohaemorrhagiae, Grippotyphosa, Hardjoprajitno e Castellonis nas reações sorológicas positivas. Presença de roedores, Assistência veterinária e o Uso dos animais foram verificados como fatores associados para infecção por Leptospira spp. Portanto, verificou-se a endemicidade da infecção por Leptospira spp. no município devido ao alto número de casos e de focos, e que a ocorrência significativa de positividade para os sorovares Sentot, Grippotyphosa, Butembo e Castellonis indicam o contato e a circulação destes sorovares também em animais silvestres, e a ocorrência de positividade para os sorovares Icterohaemorrhagiae e Hardjo sugere respectivamente o contato com roedores sinantrópicos e bovinos.

Doctor of Philosophy
Department of Diagnostic Medicine/Pathobiology
K.R. Harkin
T.G. Nagaraja
Associations of land cover/land use, socio-economic and housing, and hydrological and soil-hydrological variables were evaluated retrospectively as potential risk factors for canine leptospirosis in Kansas and Nebraska using Geographic Information Systems (GIS). The sample included 94 dogs positive for leptospirosis based on a positive polymerase chain reaction test for leptospires in urine, isolation of leptospires on urine culture, a single reciprocal serum titer of 12,800 or greater, or a four-fold rise in reciprocal serum titers over a 2 to 4 week period; and 185 dogs negative for leptospirosis based on a negative polymerase chain reaction test and reciprocal serum titers less than 400. Publicly available geographic datasets representing land cover/land use, socio-economic and housing characteristics, and hydrologic and soil hydrologic themes were analyzed along with geocoded addresses of case/control locations in GIS. Among different land cover/land use variables evaluated, urban areas (high and medium intensity urban areas and urban areas in general) and evergreen forests and forest/woodlands in general were significant risk factors. Among socio-economic and demographic determinants evaluated, houses lacking complete plumbing facilities, poverty status by age (18-64), and living within 2500 meters of a university/college or parks/forests were significant risk factors. Proximity to water features, hydrologic density and frequently flooded areas were identified as significant risk factors for canine leptospirosis among hydrologic and soil-hydrologic variables. Pet owners whose dogs live in such areas or under these circumstances should consider vaccination to prevent canine leptospirosis.

Orientador: Antonio Carlos Paes
Resumo: A leptospirose figura entre as principais zoonoses em todo o mundo. Os animais domésticos e silvestres são elos fundamentais na cadeia de transmissão do patógeno para os seres humanos. Dentre os animais domésticos, o cão é reconhecido como importante fonte de infecção em áreas urbanas, representando sério problema de saúde pública. Mesmo imunizados, os cães podem eliminar leptospiras na urina durante longos períodos. O contato com água ou solo contaminado pela urina destes animais constitui importante via de transmissão o humano. O objetivo desse trabalho foi avaliar 318 cães portadores assintomáticos para o gênero Leptospira spp. em amostras obtidas do HV da FMVZ, do canil municipal e de cães domiciliados no munícipio de Botucatu – SP pelas técnicas de soroaglutinação microscópica (SAM), reação em cadeia da polímerase (PCR) para Leptospira spp, e avaliação bioquímica. Aplicou-se também um questionário epidemiológico para avaliação dos fatores de risco da doença no município. Os sorovares mais prevalentes foram NUP 50%, Gryppotyphosa 42%, Copenhageni 52%, Icterohaemorrhagiae 42%, observando-se uma prevalência de 42,77% de sororeagentes. Não foram encontradas amostras positivas pela técnica de PCR. O fator de risco estatisticamente significante foi a variável zona urbana, sendo mais prevalente os animais sororreagentes provenientes dos bairros da zona sul e oeste do município de Botucatu - SP. Conclui-se que a bactéria leptospira está circulante nos cães assintomáticos avaliad... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Leptospirosis is among the leading zoonoses worldwide. Domestic and wild animals are key links in the transmission chain of the pathogen to humans. Among domestic animals, the dog is recognized as an important source of infection in urban areas, representing a serious public health problem. Even immunized, dogs can eliminate leptospires in the urine for long periods. Contact with water or soil contaminated by urine of these animals constitutes an important human transmission route. The objective of this study was to evaluate 318 dogs asymptomatic carriers for the genus Leptospira spp. In samples obtained from the veterinary hospital of UNESP, the municipal kennel and dogs domiciled in the municipality of Botucatu - SP by the microscopic serum agglutination (SAM) techniques, polymerase chain reaction (PCR) for Leptospira spp, and biochemical evaluation. An epidemiological questionnaire was also applied to evaluate the risk factors of the disease in the municipality. The most prevalent serovars were NUP 50%, Gryppotyphosa 42%, Copenhageni 52%, Icterohaemorrhagiae 42%, with a prevalence of 42.77% of seroreagents. No positive samples were found by the PCR technique. The statistically significant risk factor was the urban zone variable, the most prevalent being the seroreagent animals from the southern and western districts of the city of Botucatu - SP. It is concluded that leptospira bacteria are circulating in the asymptomatic dogs evaluated, being able to disperse the bacteria ... (Complete abstract click electronic access below)
Doutor

Submitted by (edna.saturno@ufrpe.br) on 2016-07-25T11:00:10Z No. of bitstreams: 1 Gesika Maria da Silva.pdf: 1078979 bytes, checksum: 16c10f51f06bb62881de2a9fd68eba5a (MD5)
Made available in DSpace on 2016-07-25T11:00:11Z (GMT). No. of bitstreams: 1 Gesika Maria da Silva.pdf: 1078979 bytes, checksum: 16c10f51f06bb62881de2a9fd68eba5a (MD5) Previous issue date: 2014-02-24
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The objective of the present work was to determine the presence of anti-Hantavirus antibodies and anti-Leptospira spp. occupational groups in the municipality of Garanhuns Pernambuco State, Brazil. To perform the serology for Hantavirus and leptospirosis, 156 and 154 samples were obtained, respectively. The method used for the detection of IgG antibodies to Hantavirus N protein was Araraquara in-house ELISA serology and leptospirosis was used technique Microscopic Agglutination Test (MAT). To analyze the risk factors applied a questionnaire with objective questions. The prevalence of anti-Hantavirus Antibodies were 1.9 % (3/156 CI 0.4 %-5.5%) , with two reagent samples with titers of 200 (66.7%) and 400 (33.3%). All seropositive individuals to Hantavirus (100.0%) in this study were male and the village. Regarding age, there was a higher number of seropositive subjects aged between 18 and 40 years (p=0.009). The prevalence of antibodies to Leptospira spp. was 5.2 % (8/154 CI 2.2%-9.9%), a prevalence of 5.7 % (5/88 CI 1.8 %-12 7 % ) participants was observed in the urban area, and countryside of 4.6% (3/66 , CI 0.9%-12.7%). The most common serotypes were the Grippotyphosa (12.5 %) in rural areas and in the urban area autumnalis (12.5 %), while the Wolffi (25.0%) and Australis (50.0%) were observed both in rural areas as in urban. In the analysis of risk factors, no association was observed between these variables and serology. This was the first study conducted in the city of Garanhuns to report the presence of IgG anti-Hantavirus in human serum samples and report the presence of anti-Leptospira spp. in urban and rural workers of the municipality. These findings draw attention to the care and conduct research in areas where there is a low prevalence and even silent areas, because this way of control and prevention measures can be implemented in order to ensure the health of the exposed population.
Objetivou-se com o presente trabalho determinar a presença de anticorpos anti-Hantavirus e anti-Leptospira spp. em grupos ocupacionais do município de Garanhuns no Estado de Pernambuco, Brasil. Para a realização da sorologia para hantavirose e leptospirose, foram obtidas 156 e 154 amostras, respectivamente. O método utilizado para a detecção de anticorpos IgG contra a proteína N do Hantavirus Araraquara foi o ELISA in house e para a sorologia de leptospirose, utilizou-se a técnica de Soroaglutinação Microscópica (MAT). Para análise dos fatores de risco aplicou-se um questionário com perguntas objetivas. A prevalência de anticorpos anti-Hantavirus foi de 1,9% (3/156; I.C. 0,4% - 5,5%), com duas amostras reagentes com títulos de 200 (66,7%) e uma de 400 (33,3%). Todos os indivíduos sororreagentes para Hantavirus (100,0%) desta pesquisa eram do sexo masculino e da zona urbana. Em relação à idade, observou-se um maior número de sororreagentes na faixa etária entre 18 e 40 anos (p=0,009). A prevalência de anticorpos anti-Leptospira spp. foi de 5,2% (8/154; I.C. 2,2% - 9,9%), sendo observada nos participantes da zona urbana uma prevalência de 5,7% (5/88; I.C. 1,8% - 12,7%) e nos da zona rural 4,6% (3/66; I.C. 0,9% - 12,7%). Os sorovares mais frequentes foram o Grippotyphosa (12,5%) na área rural, e na área urbana o Autumnalis (12,5%), enquanto o Wolffi (25,0%) e o Australis (50,0%) foram verificados tanto na área rural como na urbana. Na análise de fatores de risco não foi observada associação entre as variáveis estudadas e a sorologia. Este foi o primeiro estudo realizado no município de Garanhuns a relatar a presença de IgG anti-Hantavirus em amostras séricas humanas e relatar a presença de anticorpos anti-Leptospira spp. em trabalhadores urbanos e rurais do município. Estes achados alertam para a atenção e realização de pesquisas em áreas em que há uma baixa prevalência e até mesmo para áreas silenciosas, pois desta forma medidas de controle e prevenção poderão ser implementadas com o intuito de garantir a saúde da população exposta.

Le rat (Rattus spp.) est une source de nombreux pathogènes zoonotiques responsables de morbidité et de mortalité dans le monde. Ces espèces sont particulièrement problématiques en santé publique car leur mode de vie synanthrope favorise la proximité rat-Homme et la transmission potentielle de pathogènes. Selon l'approche « une seule santé », la surveillance sanitaire des rats et d'autres espèces animales sensibles devrait contribuer à améliorer la santé de ces dernières et de l'Homme. Notre objectif était de développer la surveillance des zoonoses associées aux rats chez une espèce source (R. norvegicus) et chez des espèces cibles (bovins, chiens et porcs) en tant que sentinelles de l'exposition de l'Homme. L'intérêt de méthodes de détection dont la micro-puce à ADN développée dans le cadre du projet européen « WildTech » et l'investigation de la distribution du risque étaient les thèmes majeurs de ces travaux. Ils ont été documentés à partir de 181 rats capturés dans le Rhône entre 2010 et 2013 et, de données diagnostiques de leptospiroses animales enregistrées au Laboratoire des Leptospires – Lyon entre 2008 et 2012. Les méthodes de détection directes et indirectes utilisées à des fins de surveillance ont montré leur intérêt par la mise en évidence de quatre pathogènes potentiellement zoonotiques chez les rats (Hantavirus Séoul, virus de l'hépatite E, Leptospira spp. et Toxoplasma gondii). Malgré la spatialisation hétérogène des statuts infectieux, Leptospira spp. et l'hantavirus Séoul étaient les dangers prédominants avec respectivement, 26%, CI95%=20%-33% et 14%, CI95%=8%-20% de rats infectés par ces agents. Leur distribution spatiale a été caractérisée par des indices socio-économiques et, dans le cas des infections par les leptospires, une étude approfondie des souches circulantes a montré que leur persistance relevait de facteurs locaux, intrinsèques à la colonie. L'étude des leptospiroses animales (chiens et bovins) suggère leur exposition accrue au sérogroupe Australis, leur distribution spatiale hétérogène et une croissance significative de l'incidence annuelle canine. Ces trois observations également rapportées chez l'Homme soulignent l'intérêt de la surveillance de ces espèces en tant que sentinelles. Les informations obtenues par l'ensemble des méthodes appliquées contribuent à une meilleure compréhension de l'épidémiologie des zoonoses associées aux rats et de la leptospirose en particulier, afin d'orienter la mise en œuvre de leur surveillance et les décisions de santé publique à venir
Rats (Rattus spp.) are a source of a number of zoonotic pathogens responsible for morbidity and mortality worldwide. These species are particularly problematic with regards to rat associated health risks because rats are living in close contact with people leading to potentially rat disease transmission. Based on the "One Health" approach, surveillance of zoonotic pathogens in rats and other susceptible hosts should help to improve animal and human health. Our aim was to develop the surveillance of rat-associated zoonoses in a source species (Rattus norvegicus) and, in some target populations (cattle, dogs and pigs) as sentinels of human exposure. The screening methods including DNA microarray developed for the purpose of the "WildTech" project and the spatial distribution of the risk were the major themes in this work. They have been documented based on 181 rats captured in the administrative unit “département du Rhône” between 2010 and 2013 and, diagnostic data of leptospirosis in cattle, dogs and pigs, recorded at "Laboratoire des Leptospires – Lyon" between 2008 and 2012. The application of various screening methods (direct and indirect) for the purpose of surveillance were relevant and detected four potentially zoonotic pathogens circulating in rats, (hantavirus Seoul, hepatitis E virus, Leptospira spp. and Toxoplasma gondii). Although the location of infected rats varied among a short geographic distance, Leptospira spp. and hantavirus Seoul were the predominant hazard with respectively 26%, IC95% = 20% -33% and 14%, IC95% = 8% -20% of infected rats. Their spatial distribution could be characterized with socio-economic indices and, regarding Leptospira-infected rats, a further study shown that the maintenance of strains was related to local and intrinsic factors. The study of leptospirosis in dogs and cattle revealed their increased exposure to the serogroup Australis, their heterogeneous spatial distribution and the significant increase of annual incidence in dogs. The same trends were observed in humans which underlines the relevance of surveillance of animal leptospirosis as sentinels of human exposure. All together, the information obtained contributes to a better understanding of the epidemiology of rat-associated zoonoses to support implementation of surveillance and public health decisions in the future

A dengue e a leptospirose estão entre as principais zoonoses de ocorrência no mundo. A primeira pelo elevado potencial epidêmico e a segunda pela alta letalidade. Na cidade de São Paulo, anualmente ocorrem dezenas de casos de leptospirose e centenas de casos de dengue, fazendo desses agravos alguns dos eventos de maior interesse da vigilância em saúde do município. Para melhor compreender o efeito de fenômenos climáticos e o impacto de medidas de prevenção e controle sobre a transmissão desses agravos ao longo do tempo, dois diferentes modelos estatísticos de estudo de séries temporais foram usados: 1) Função de Transferência, com erros dados por modelos ARIMA (ARIMAX), os quais foram modelados segundo a filosofia de Box-Jenkins e 2) Modelos Aditivos Generalizados (GAM) de regressão de Poisson, com estrutura de defasagem dada por funções polinômios PDL (Polynomial Distributed Lags). Os principais fatores climáticos associados ao aumento do número de casos de dengue na cidade de São Paulo foram a elevação da temperatura mínima do ar, dos níveis de precipitação pluviométrica, da densidade do vetor e a entrada de casos importados da doença, estimulada pelo feriado de carnaval. A chegada de frentes frias (temperatura < 16°C) e valores extremos de precipitação ( 70mm) reduzem o número de casos de dengue. Medidas de prevenção adotadas pelas equipes de vigilância em saúde do município também contribuem com a redução do número de casos. Os fatores associados ao aumento do número de casos de leptospirose foram o aumento da precipitação pluviométrica e da temperatura máxima do ar. O aumento das horas de brilho do sol reduz o número de casos. Os métodos adotados foram adequados aos objetivos do estudo e conseguiram captar as relações defasadas entre os fatores de interesse e a transmissão de dengue e de leptospirose na cidade de São Paulo. Tais técnicas também parecem adequadas como ferramentas a serem incorporadas à rotina da vigilância em saúde, permitindo fazer previsões do número de casos futuros e compreender as relações temporais entre as doenças e seus fatores determinantes e condicionantes
Dengue and leptospirosis are among the major zoonosis of occurrence in the world; the first because of the epidemic potential and the second due to high lethality. In São Paulo, dozens of leptospirosis cases and hundreds of dengue fever cases are registered annually, being some of the most important events to the municipal public health surveillance system. To understand the effect of climatic conditions and the impact of measures of prevention and control over the transmission of such diseases in the time context, two time series approaches were used: 1) Transfer Functions, with ARIMA error structure (ARIMAX), modeled by Box-Jenkins methods and 2) Additive Generalized Models (GAM) of Poisson regressions, with time structure given by Polynomial Distributed Lags (PDL). The most important climatic factors that increased the number of cases of dengue fever in the city of São Paulo were the elevation in air temperature, precipitation, vector density and the number of imported cases, which increased after carnival holiday (an important calendar event). The arrival of cold fronts from the south (air temperature < 16°C) and extreme precipitations (70mm) are factors that decrease the number of new dengue cases. The public health preventive interventions adopted by the municipality were effective in diminishing the dengue occurrence. The most important factors that increased the number of leptospirosis cases in São Paulo were elevation in maximum air temperature and precipitation. Largest amount of hours of sunshine decreased the number of new cases of leptospirosis. The methods used were adequate to the study objectives, the relations among the interest lagged factors and dengue and leptospirosis transmission in the city of São Paulo were satisfactorily modeled. Such techniques also seem appropriate as tools to be incorporated into the municipal health surveillance system, allowing the prediction of the number of future disease cases and understanding temporal relations between diseases and their determinants and conditioning factors

Com o objetivo de estudar a situação epidemiológica da leptospirose bovina, canina e humana nas propriedades rurais do município de Pirassununga, SP, partiu-se de um banco de soros e um banco de dados já estruturados de 86 propriedades amostradas. Através da técnica de soroaglutinação microscópica, 2259 soros de bovinos, 273 de cães e 445 de humanos foram examinados, empregando-se uma coleção de antígenos vivos de 24 sorovares de leptospiras. As prevalências aparentes de focos de leptospirose nas propriedades rurais de Pirassununga, segundo as espécies examinadas foram: 88,4% [79,7-94,3] para os bovinos, sendo Hardjo o sorovar mais provável, com 43,4% [32,1-55,3], seguido do Wolffi com 11,8% [5,6-21,3], Autumnalis e Patoc empatados em 5,3% [1,5-12,9], Australis com 3,9% [0,8-11,1], Hebdomadis com 2,6% [0,3-9,2] e Shermani com 1,3% [0-7,1]; 14,3% [7,4-24,1] para os cães, sendo Bratislava o sorovar mais provável, com 54,5% [23,4-83,3], seguido do Australis,Autumnalis e Pyrogenes empatados com 9,1% [0,2-41,3]; 14,1% [7,5-23,4] para os humanos, sendo Patoc o sorovar mais provável, com 58,3% [27,7-84,8], seguido pelo Pyrogenes com 16,7% [2,1-48,4] e empate entre os sorovares Bratislava, Autumnalis e Icterohaemorragiae com 8,3% [0,2-38,5] cada. A prevalência aparente da leptospirose nos bovinos da área rural do município de Pirassununga foi de 30,3% [28,4-32,2], nos cães de 5,1% [2,8-8,5] e nos humanos de 2,9% [1,6-4,9]. Os fatores de risco associados à condição de foco de leptospirose bovina para qualquer sorovar foram ter mais de 21 cabeças no rebanho, OR =14,354 [1,535-134,215] e presença de cocho para sal mineral, OR = 6,995 [1,180-41,470]. Os fatores de risco associados à condição de foco para os sorovares Hardjo e/ou Wolffi foram ter mais de 21 cabeças no rebanho, OR =15,750 [1,264- 196,269] e presença de cocho para sal mineral, OR = 6,537 [1,008-42,397]. Foram discutidas as implicações destes resultados para o entendimento da epidemiologia da leptospirose na área rural de Pirassununga e também foram feitas recomendações para o controle da doença no rebanho bovino.
With the aim of studying the epidemiologic situation of bovine, canine and human leptospirosis in rural area of Pirassununga, SP, it was used a serologic and data bank already structured of 86 sampled farms. Through the microscopic agglutination test, serum of 2259 bovines, 273 dogs e 445 humans were analyzed for the microscopic agglutination test, using a collection of 24 serovars of Leptospira. The prevalence of infected farms for leptospirosis, according to examined species, were: 88,4% [79,7-94,3] for cattle, where serotype Hardjo was the most often observed - 43,4% [32,1-55,3], followed by Wolffi with 11,8% [5,6-21,3], Autumnalis and Patoc with 5,3% [1,5-12,9] each, Australis with 3,9% [0,8-11,1],Hebdomadis with 2,6% [0,3-9,2] and Shermani with 1,3% [0-7,1].; 14,3% [7,4-24,1] for dogs, where serovar Bratislava was the most often observed with 54,5% [23,4-83,3], followed by Australis, Autumnalis and Pyrogenes with 9,1% [0,2-41,3] each and 14,1% [7,5-23,4] for humans, where serotype Patoc was the most often observed with 58,3% [27,7-84,8], followed by Pyrogenes with 16,7% [2,1-48,4] and Bratislava, Autumnalis and Icterohaemorragiae with 8,3% [0,2-38,5] each. The serologic prevalence of bovine leptospirosis in rural area of Pirassununga, SP, was 30,3% [28,4-32,2], canine leptospirosis was 5,1% [2,8-8,5] and human leptospirosis was 2,9% [1,6-4,9]. The study of risk factors showed that bovine leptospirosis caused by any serovar was associated with herds with more than 21 animals - OR =14,354 [1,535-134,215] ? and presence of mineralized salt feeder - OR = 6,995 [1,180-41,470]. The final model of logistic regression pointed as risk factors of bovine leptospirosis caused by serovars Hardjo and/or Wolffi herds with more than 21 animals - OR =15,750 [1,264-196,269] - and presence of mineralized salt feeder - OR = 6,537 [1,008-42,397]. The impact of these results was discussed in relation to the epidemiology of leptospirosis in rural area of Pirassununga and suggestions were also made in order to control this disease in cattle.

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This study aimed to investigate the prevalence of anti-Leptospira spp, identify the most prevalent serovars and to assess possible factors associated with Antileptospire seroprevalence in urban dogs in Araguaina city,Tocantins state. A cross-sectional study covering the canine population residing in urban areas was conducted. Household collection of sera was performed by prior consent of the dog owners. The houses that were involved in the study were drawn previously it started. There were analyzed 275 samples at total. Samples were obtained through cephalic vein puncture, with a 25 x 7 needle and then transferred to 5 to 10 ml test tubes with gel separator sequentially centrifuged, cryopreserved and sent for laboratory diagnosis of leptospirosis, at the Department of Veterinary Medicine at Federal University of Goiás Veterinary Medicine School (DMV / EV / UFG), which were processed by the microscopic agglutination test. In each household, a questionnaire was applied to obtain data on the possible associated factors that were analyzed by bivariate analysis. The leptospira seroprevalence detected was 13,8%, the most prevalent serovar was Castellonis (26.3%) and, Pyrogenes and Pomona, both with 10,5% of seropositive. The search for factors associated with infection by leptospira demonstrated statistically significant positive association between the variables season, rainy season (p = 0,03) and the location Sonhos Dourados (p = 0,02). The results showed that Araguaina city canine leptospirosis presents a different epidemiological profile of most Brazilian regions surveyed.
Este estudo teve como objetivo investigar a prevalência de anticorpos anti- Leptospira spp, identificar os sorovares mais prevalentes, bem como avaliar possíveis fatores associados à prevalência sorológica antileptospírica em cães urbanos de Araguaína, Tocantins. Foi realizado um estudo transversal, abrangendo a população canina domiciliada na zona urbana do município. Analisaram-se 275 amostras, tendo sido realizada colheita domiciliar dos soros, em unidades sorteadas, após o consentimento esclarecido dos proprietários. As amostras foram obtidas através de punção cefálica ou jugular, com agulha 25 x 7, em seringas descartáveis de 5 a 10 mL transferidas para tubos de ensaio com gel separador, sequencialmente centrifugadas, criopreservadas e encaminhadas para Laboratório de Diagnóstico de Leptospirose do Departamento de Medicina Veterinária da Escola de Veterinária da Universidade Federal de Goiás (DMV/EV/UFG), onde foram processadas segundo a técnica de soroaglutinação microscópica. Em cada domicílio sorteado, foi aplicado questionário para obtenção de dados referentes a possíveis fatores associados, que foram analisados por meio da análise bivariada. A soroprevalência detectada foi de 13,8%, sendo mais prevalentes os sorovares Castellonis (26,3%), Pyrogenes e Pomona, ambos com 10,5% dos sororeagentes. A pesquisa de fatores associados à infecção por leptospira, demonstrou associação positiva estatisticamente significativa entre as variáveis, estação do ano, período chuvoso (p=0,03) e a localidade Sonhos Dourados (p=0,02). Os resultados demonstraram que, no município de Araguaína, a leptospirose canina apresenta um perfil epidemiológico diferente da maioria das regiões brasileiras pesquisadas.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
The objective of this study was to describe characteristics of systems creations of goats and sheep farming exhibitions of participants, and to study the occurrence of Brucella ovis infections in sheep and lentivirus, and leptospirosis caseous lymphadenitis in goats and sheep and their risk factors. Carried out 64 questionnaires, examined 327 sera from 246 goats and sheep. The worms, foot pad dermatitis and lymphadenitis were more health problems reported by producers. The sanitary practices adopted, in general, are little used in the properties of goats and sheep. The semi-intensive system (67.7%) is the most used and 71% of producers buy animals from other places. The frequency of seropositive sheep B. ovis was 28% accounting for 71.9% of farms with sheep positive for B. ovis in the study. 25% of farms surveyed had one or more seropositive goats and sheep lentiviruses. Of the 138 animals tested positive for leptospirosis serovar Autumnalis was the most frequent, being found in 76.19% 38.88% in goats and sheep. In the study of case-control analysis of risk factors, herd size and purchase of animals showed a strong association. The caseous lymphadenitis has a high incidence in herds serological (92.2%). It can be concluded that the animals are seropositive for exposure to infectious diseases and inadequate management observed in most producers can spread the disease spread and put other animals at risk.
O objetivo deste trabalho foi caracterizar os sistemas de criações de caprinos e ovinos participantes das exposições agropecuárias, assim como estudar a ocorrência das infecções por Brucella ovis em ovinos e lentivírus, linfadenite caseosa e leptospirose em caprinos e ovinos e seus fatores de risco. Foram realizados 64 questionários, sendo examinados 327 e 246 soros de caprinos e ovinos, respectivamente. A verminose, linfadenite e pododermatite foram os problemas sanitários mais relatados pelos produtores. As práticas sanitárias adotadas, de maneira geral, são pouco utilizadas nas propriedades de caprinos e ovinos. O sistema semi-intensivo (67,7%) é o mais utilizado e 71% dos produtores compram animais de outros lugares. A frequência de ovinos soropositivos para B. ovis foi 28% representado em 71,9% das propriedades com criação de ovinos. 25% das propriedades investigadas apresentaram um ou mais caprinos e ovinos soropositivos para os lentivírus. Dos 138 animais soropositivos para leptospirose, o sorovar Autumnalis foi o mais frequente, sendo encontrado em 76,19% dos caprinos e 38,88% dos ovinos. No estudo de caso-controle para análise de fatores de risco, tamanho do rebanho e compra de animais apresentaram associação. A linfadenite caseosa possui uma elevada soropositividade nos rebanhos (92,2%). Pode concluir que os animais de exposição estão soropositivos para algumas doenças infecciosas e o manejo inadequado observado na maioria dos produtores, pode disseminar a propagação de doenças e colocar outros animais em risco.

La leptospirose est une maladie négligée émergente touchant plus particulièrement les régions tropicales, et plus encore les îles tropicales telles que les Seychelles, qui enregistrent des incidences humaines parmi les plus élevées au monde. Cette thèse a pour objectifs d’explorer l’éco épidémiologie de la leptospirose aux Seychelles (i) en utilisant les rats comme marqueurs d’exposition environnementale, (ii) en décrivant l’épidémiologie moléculaire de la maladie chez l’homme et l’animal à travers une approche “One Health”, et enfin (iii) en identifiant les comportements et professions à risque tout en en comparant la situation actuelle à celle décrite il y a 25 ans. La combinaison d’approches géographique, moléculaire et clinique vise à dresser un tableau complet de la situation épidémiologique de cette maladie aux Seychelles en intégrant les réservoirs animaux, l’homme et l’environnement qu’ils occupent.La fragmentation de l’habitat et la proximité de ressources alimentaires apparaissent comme de bons prédicteurs d’infection chez les rats. Les analyses géo-spatiales permettent de mettre en évidence d’autres variables corrélées négativement (altitude ou distance à un point d’eau douce) ou positivement (niveau d’urbanisation, pluviométrie) au statut d’infection chez les rats. Ces résultats pourraient être pris en compte dans les politiques d’aménagement du territoire mises en place dans des buts de conservation des habitats ou de contrôle des rongeurs, afin de réduire l’exposition de l’homme à des pathogènes maintenus dans l’environnement par les rats. Si le niveau d’urbanisation est positivement corrélé avec le statut d’infection, ce patron pourrait au moins en partie résulter de la distribution des deux espèces Rattus norvegicus et Rattus rattus. En effet la première espèce, retrouvée essentiellement en milieu urbain, est nettement plus infectée que la deuxième que l’on retrouve partout sur l’île. Néanmoins, la comparaison des leptospires retrouvés chez les rats et chez les cas humains graves indique que les rats ne sont impliqués que dans un tiers des transmissions à l’homme, la majorité des cas humains étant causée par des leptospires dont le(s) réservoir(s) reste(nt) à identifier. Une incidence annuelle de 54,6 (95% IC 40,7-71,8) pour 100 000 habitants confirme l’importance médicale majeure de cette maladie dans le pays. La maladie touche très majoritairement les hommes (96%) et présente un taux de mortalité élevé (11,2%), essentiellement associé à des formes sévères (dysfonctions rénales et hépatiques, hémorragie pulmonaire). Les activités agricoles et le jardinage, la proximité d’élevages et de chats, une thrombocytopénie, une leucocytose, un taux de bilirubine élevé et des valeurs élevées aux tests de fonction rénale sont de bons prédicteurs de leptospirose. La distribution géographique des cas humains ne correspond pas à celle des districts hébergeant des populations de rats aux prévalences d’infection élevées, en cohérence avec un rôle restreint des rats dans la leptospirose humaine.La comparaison des données présentées ici avec celles publiées il y a 25 ans révèle un changement dans les comportements et les expositions, et montre qu’une meilleure prise en charge hospitalière a vraisemblablement contribué à faire diminuer la mortalité liée à la leptospirose, même si celle-ci reste élevée. Un faible niveau de connaissance de la maladie en population générale souligne l’importance de mettre en place des campagnes de sensibilisation. Les données produites dans le cadre de cette thèse stimulent la mise en place d’études complémentaires visant à mettre en évidence le(s) réservoir(s) complémentaire(s) et adapter les mesures de prévention pour limiter le fardeau que représente cette maladie aux Seychelles, aujourd’hui encore reconnue comme la maladie infectieuse causant le plus de décès dans le pays
Leptospirosis is an emerging neglected disease representing a heavy burden in the tropics, especially in tropical islands such as Seychelles, which record among the highest human incidence worldwide. This thesis aims at exploring the eco-epidemiology of leptospirosis in Seychelles by (i) using rats as markers of environmental exposure to Leptospira infection, (ii) describing the molecular epidemiology of the disease in humans and animals in a One Health framework, and (iii) identifying occupational and behavioural risk factors while comparing the current situation to that described 25 years ago. The combination of fine spatial distribution, molecular and clinical epidemiology complement each other in providing a comprehensive picture of the continuum involving reservoirs and human hosts within a shared environment.Habitat fragmentation and proximity to nutritional sources are found good predictors of Leptospira-laden Rattus spp. Geospatial analyses determined a selection of other important variable factors that are strongly correlated with Leptospira infection in Rattus spp., including altitude or distance to surface water (negative correlation), urbanization and heavy rainfall (positive correlation). Results of these analyses can guide policy makers and especially urban planners to best implement landscape structures for conservation or pest control goals leading to reduced exposure of humans to rat-borne diseases.Rattus norvegicus is found significantly more infected than Rattus rattus. Therefore, increased infection in urbanized/fragmented habitats may result at least in part from Rattus spp distribution, as R. norvegicus is mostly found in urban areas. Most importantly, genotyping of Leptospira in human acute cases and rats suggests that these rodents are involved in only a third of human acute infections, while most human cases originate from yet to be identified reservoir(s).An annual incidence of 54.6 (95% CI 40.7-71.8) per 100,000 confirms the major medical and public health importance of the disease in the country. The disease affects mainly men (96%) and displays a case fatality rate of 11.2%, mostly associated with severe forms (acute renal failure, hepatic failure and pulmonary haemorrhage). Farming and gardening related activities, proximity to cattle and cats, thrombocytopaenia, leukocytosis, elevated bilirubin and high values for renal function tests are predictors of leptospirosis. The geographical distribution of human cases poorly overlaps districts of high prevalence in rats in keeping with a restricted role of rats in human disease.The comparison of figures reported herein and in previous studies published 25 years ago reveals changes in behaviour and exposure, and shows that the development of health care has lowered the case fatality despite still high disease incidence in the country. A low level of knowledge on leptospirosis is reported, urging the need for implementing health education campaigns. Altogether, the data presented in this thesis strongly supports the implementation of a research program aiming at discovering alternative reservoir(s) to provide a full understanding of the epidemiological situation, which will allow fine tuning preventive measures for an efficient control of a disease that is still recognised as the infectious disease causing the highest mortality in the country

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CNPq
Capes
A leptospirose em pequenos ruminantes é uma doença que pode causar perdas econômicas devido a ocorrência de abortamentos, natimortalidade e diminuição da produção de leite. Este trabalho teve como objetivos determinar a prevalência de propriedades de caprinos leiteiros positivas e de animais soropositivos para leptospirose no semiárido paraibano, bem como identificar fatores de risco associados à prevalência de propriedades positivas. A amostragem foi delineada para a determinação da prevalência de propriedades positivas (focos) e de animais soropositivos para a infecção por Leptospira spp. No total, foram colhidas amostras de sangue de 975 animais procedentes de 110 propriedades leiteiras localizadas no Munícipio de Monteiro, microrregião do Cariri Ocidental, Estado da Paraíba. Para o diagnóstico da infecção por Leptospira spp., foi utilizado o teste de soroaglutinação microscópica (SAM), utilizando como antígenos 24 sorovares. Uma propriedade foi considerada foco quando apresentou pelo menos um animal soropositivo. As prevalências de propriedades positivas e de animais soropositivos foram de 43,6% (IC 95% = 34,2% - 53,4%) e de 8,7% (IC 95% = 5,7% - 12,9%), respectivamente. Nos animais, os sorovares mais frequentes foram Autumnalis (1,74%; IC 95% = 0,97% – 3,09%), Sentot (1,71%; IC 95% = 0,82% – 3,52%) e Whitcomb (1,39%; IC 95% = 0,65% – 2,93%), e nas propriedades, os sorovares Autumnalis (10,9%; IC 95% = 5,8% – 18,3%), Whitcomb (8,2%; IC 95% = 3,8% – 15,0%) e Sentot e Patoc (7,3%; IC 95% = 3,2% – 13,8%) foram os mais frequentes. Presença de roedores (OR = 2,78, P = 0,015) foi identificada como fator de risco. Também houve associação entre o histórico de infertilidade (OR = 14,74, P = 0,015) e a prevalência de rebanhos positivos. Sugere-se que a infecção está distribuída em caprinos da região, e um programa de controle de roedores deve ser incluído nas práticas de manejo dos rebanhos com o intuito de reduzir a transmissão do agente e, consequentemente, reduzir a prevalência de rebanhos positivos e ocorrência de problemas reprodutivos, tais como infertilidade.
Leptospirosis in small ruminants is a disease that can causes economic losses due to occurrence of abortions, stillbirths and decreased milk production. This work aimed to determine the prevalence of positive dairy goat herds and seropositive animals for leptospirosis in semiarid region of Paraíba State. Sampling was designed to determine the prevalence of positive herds (foci) and seropositive animals for leptospirosis. A total of 975 serum samples were collected from goats from 110 dairy herds in the Monteiro, Cariri Ocidental microregion of the Paraiba State. For the serological diagnosis of leptospirosis the microscopic agglutination test (MAT) was carried out usind 24 Leptospiraspp. serovars as antigens. A herd was considered positive when presented at least one seropositive animal. The prevalence of positive herds and seropositive animals were 43.6% (95% CI = 34.2% - 53.4%) and 8.7% (95% CI = 58.7% - 12.9%), respectively. The most frequent serovars in animals were Autumnalis (1.74%; 95% CI = 0.97% – 3.09%), Sentot (1.71%; 95% CI = 0.82% - 3.52%) and Whitcomb (1.39%; 95% CI = 0.65% – 2.93%), and by herd, serovars Autumnalis (10.9%; 95% CI = 5.8% – 18.3%), Whitcomb (8.2%; 95% CI = 3.8% – 15.0%) and Sentot and Patoc (7.3%; 95% CI = 3.2% – 13.8%) were the most frequent. Presence of rodents (OR = 2.78; P = 0.015) was identified as a risk factor. There was also association between history of infertility (OR = 14.74; P = 0.015) and prevalence of positive flocks. It is suggested that leptospirosis is spread in goats in the region, and that a program of rodent control should be included in the flock management practices aiming to reduce transmission of the agent and then to reduce prevalence of positive flocks and occurrence of reproductive disorders such as impaired fertility.

La leptospirose est une maladie tropicale négligée qui touche surtout les habitants des régions rurales en Thaïlande. A l’échelle de la province de Mahasarakham en Thaïlande, les objectifs de cette étude sont d’identifier les facteurs expliquant l’épidémiologie de la leptospirose, de décrire les politiques qui ont été mises en place pour sa prévention et son contrôle, et d’analyser les représentations, les pratiques et les attitudes des patients, des habitants, des volontaires en santé et des personnels de santé publique au regard de la maladie et de sa prévention.L’étude des politiques mises en place montre que la Thaïlande a progressivement développé un ensemble de politiques de prévention à l’échelle nationale dont elle a transféré la mise en oeuvre à une échelle administrative locale. Malgré cela, le contrôle et la prévention de la leptospirose pourraient être améliorés en stimulant la collaborations entre les services de santé publique, les services vétérinaires, et les services agriculturaux avec une implication forte des communautés locales dans une approche de type “One Health”. L’analyse spatiotemporelle de la distribution des cas de leptospirose humaine montre que les facteurs associés avec les nouvelles infections sont multiples et complexes, incluant la densité de population humaine, la densité de bétail, les précipitations atmosphériques, l’étendue des aires inondables et d’autres paramètres de la géographie physique comme la pente moyenne. Le rôle du bétail dans la transmission à l’homme est mise en évidence et discutée. Cibler des zones géographiques à risque (avec une densité de bétail élevée et d’importantes surfaces inondables) peut permettre de limiter les risques, et doit être complétée en améliorant la communication avec les publics les plus exposés (c.a.d. les fermiers). L’analyse intersectorielle pour estimer les connaissances, attitudes et pratiques montre que les patients, leurs voisins, les volontaires en santé, et les chefs de villages et de sous-districts n’ont pas une compréhension suffisante de la maladie et de ces modes de transmission pour permettre une bonne prévention et un bon contrôle. Pour être mieux informé, ces publics doivent pouvoir avoir accès aux dernières informations scientifiques parfois complexes.Finalement, l’ensemble de ces résultats a permis d’établir un ensemble de recommandations pour développer la coopération entre différents services et populations locales en vue d’améliorer la prévention et la prévention de la leptospirose dans la province de Mahasarakham
Leptospirosis is a neglected tropical disease that affects mostly rural people in Thailand. This study aims to identify the factors explaining leptospirosis epidemiology, to describe the health policy implemented for leptospirosis prevention and control and its implementation in the rural province of Mahasarakham (Thailand), and to analyse the representations, practices, and attitudes of patients, people, health volunteers and health officers toward the disease and its prevention.The analysis of health policies showed that Thailand has progressively developed a national prevention and control policy framework and transferred its implementation to local administrative levels. However, leptospirosis prevention and control still need enhanced collaboration between public health, livestock, and agriculture departments with an important local community involvement under the One Health approach.The analysis of the spatiotemporal distribution of human leptospirosis cases showed that the factors associated with leptospirosis infection are complex and multifactorial, including human population density, livestock density, rainfall, flood cover and physical geography, i.e. average slope. The results stressed the importance of livestock that may contribute to leptospirosis transmission to humans. Targeting areas prone at risk, i.e. with high livestock or in flooded areas, should be complemented by improving communication to people at risk, i.e. farmers.The cross sectional study conducted to assess knowledge, attitudes, and practices showed that patients, neighbors, village health volunteers and community leaders did not have a clear comprehension of the disease and its transmission to really improve the prevention of infections. People need to have access to a complex and up-to-date scientific knowledge in order to improve their awareness about leptospirosis.Finally, taking results of above issues allowed “Guidelines for developing cooperation between departments for prevention and control leptospirosis of Mahasarakham Province, Thailand” to be produced

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior
Leptospirosis is a worldwide zoonosis of considerable medical and economical importance that affects humans in both urban and rural contexts, as well as domestic animals and wild fauna. Leptospira interrogans is the causative agent and is transmitted to humans by indirect contact with contaminated soil or water. The clinical syndromes include sub clinical infection, self-limited anicteric febrile illness, and severe and potentially fatal illness, known as Weil?s syndrome. In developed countries, leptospirosis is related to occupational or recreational activities while in developing countries, outbreaks occur during floods. In those regions, traditional strategies to prevent the transmission are difficulties to be implemented because of costs and lack of community acceptance. In addition, no efficient vaccine is available for human use. Several studies have suggested that chemoprophylaxis with doxycycline pre and post-exposure may be effective to prevent leptospirosis. Leptospirosis has been reported in rural areas of the State of Rio Grande do Norte, Brazil since 1985 in rice farmers who present the anicteric illness. The disease cause great social and economics impact. The study was conducted in S?o Miguel where an epidemic of leptospirosis in rice farmers was reported. The main objective was to determine the efficacy of doxycycline in preventing Leptospira exposure. A taxa de soropreval?ncia de leptospirose na popula??o estudada antes e ap?s a colheita foi de 14,2% (n=22) e de 16.6% (n=27) respectivamente. Anti-Leptospira serology was determined for 61 subjects in two instances, pre and post-exposure to potential contaminated water. There was an increased risk of 29.0 per cent in acquiring infection for individuals that did not use doxycycline. In addition, an increased risk of 30.0 % observed in farmers who did not use protection when exposed to Leptospira. The adhesion to preventive chemoprophylaxis was 55.7%. Therefore doxycycline, under specific circunstances appears to be an effective alternative to protect against leptosprirosis infection. A large sample composed of individuals to adhere to preventive therapy is needed to define time, dosage and length of use of doxycycline in this area
A leptospirose ? uma zoonose de distribui??o mundial que afeta, acidentalmente, o homem tendo como reservat?rios animais dom?sticos e silvestres. O agente causal, a Leptospira interrogans, ? transmitido ao homem, principalmente, por contato indireto com ?gua ou solo contaminados com a urina de ratos. O espectro cl?nico inclui infec??o subcl?nica, doen?a febril anict?rica e doen?a severa potencialmente fatal conhecida como s?ndrome de Weil. Em pa?ses desenvolvidos ? descrita, quase sempre, associada ? atividade profissional ou recreativa, enquanto nas regi?es em desenvolvimento epidemias tamb?m s?o associadas a enchentes. Nestas ?reas, medidas tradicionais de preven??o da doen?a, como, melhoria das condi??es sanit?rias, prote??o individual e controle de roedores s?o dif?ceis de serem implementadas por problemas econ?micos e pela baixa aceita??o da comunidade. Por outro lado, at? o momento n?o h? uma vacina eficaz para uso em humanos, mas, a quimioprofilaxia com doxiciclina tem sido apontada na literatura como uma alternativa adequada pra preven??o pr? e p?s-exposi??o de indiv?duos sob risco por determinado per?odo de tempo. Epidemias de leptospirose t?m sido relatadas na ?rea rural do Rio Grande do Norte, Brasil desde 1985, atingindo lavradores de arroz que apresentam a forma anict?rica da doen?a. Tais epidemias causam forte impacto econ?mico-social na regi?o por incapacitarem agricultores durante a ?poca da colheita do arroz e aumentarem os gastos da sa?de. O objetivo deste estudo foi avaliar a efic?cia da doxiciclina na prote??o contra infec??o por Leptospira em agricultores de arroz do munic?pio de S?o Miguel/RN, cuja taxa de soropreval?ncia antes da interven??o foi de 14,2%(n=22). Avalia??o sorol?gica pr? e p?s-colheita realizada em 61 indiv?duos demonstraram uma taxa de soroconvers?o de 8,8% (n=34) nos que utilizaram a droga e de 11,1%(n=27) naqueles que n?o utilizaram. A an?lise estat?stica revelou um risco adicional de aquisi??o da infec??o de 29% entre os agricultores que n?o utilizaram a doxiciclina, al?m de um risco adicional de 30% de adquirir a infec??o naqueles indiv?duos que trabalharam descal?os. A taxa de ades?o a quimioprofilaxia foi de apenas 55,7%. A doxiciciclina pode ser uma medida efetiva na profilaxia pr?-exposi??o de lavradores de arroz, entretanto, uma amostra maior composta por indiv?duos que apresentem maior ader?ncia ? terapia ? necess?ria para uso efetivo deste antibi?tico como profilaxia da infec??o por Leptospira nessa regi?o

The role of infection with Leptospira as a cause of infertility in Papua New Guinea(PNG) has not been confirmed, mainly because of the lack of robust and simple diagnostic tests in PNG. The aims of this study were to determine the seroprevalence and distribution of infection in livestock in PNG and to develop and validate a diagnostic test for use in PNG that was sufficiently accurate and reliable for confident interpretation of the results. The nested and real-time PCRs were assessed for use as diagnostic tools. The first survey was conducted on 3 commercial, 3 smallholder cattle farms and 4 abattoirs in March 2004 in PNG. Each herd was stratified into 3 age groups (<2, 2-5 and >5 years), and sera from 1379 animals were sampled in Lae and Kimbe. In addition, 73 kidneys were collected from cattle at the abattoir and aseptically processed for culture. Two hundred and eighty three sera were collected from pigs killed at the abattoirs and 79 pig kidneys were collected and cultured. All sera were tested using the microscopic agglutination test (MAT). The dominant serovar infecting the cattle in PNG was Hardjo with a seroprevalence of 53.7%. The prevalence of serovar Hardjo in the six farms and the abattoir was significantly higher than serovars Tarassovi and Pomona (P < 0.05). All pig sera were negative for Leptospira. Leptospires were isolated by culture and the isolates were typed and identified as L. borgpetersenii serovar Hardjo. Cattle are a recognized reservoir for serovar Hardjo and may have a role in transmission to humans. The second survey was conducted in June 2006 to determine if cattle from smallholder farmers, village pigs and dogs in the Markham Valley in Lae, PNG were infected with Leptospira. In addition, pigs from a commercial piggery and horses from commercial and smallholder farms were also sampled. A total of 69 pig sera, 22 dog sera, 15 horse sera and 111 cattle sera were collected. The results showed that 1 dog and 1 pig were seropositive with serovar Canicola. Of the 111 cattle sampled, 21 were seropositive for Hardjo. It was concluded that the seroprevalence with serovar Hardjo in these cattle was significantly lower than cattle from commercial properties. Smallholder cattle may therefore not be a major source of Hardjo infection for animals on commercial farms and pigs do not appear to be infected with Leptospira. The Ab-ELISAs were constructed using one crude preparations of L. interrogans serovar Pomona and 2 different crude preparation of L. biflexa serovar Patoc. The three antigen preparations were evaluated using 21 MAT-positive and 96 MAT-negative pig sera to determine which antigen preparation was suitable for use in an Ab-ELISA. The selected antigen preparation (L1) was validated in the test using serum from 2 cattle and 1 pig population that were seropositive for Leptospira. A sub-population of seronegative cattle and pigs were also used. The Ab-ELISA was used to test 1,465 bovine sera from 8 cattle populations and the results were compared with the MAT using a Bayesian framework, to obtain an unbiased estimate of the accuracy of the tests. The ELISA had high sensitivity and specificity. Results from the Bayesian analysis showed that the sensitivity and specificity estimates for the Ab-ELISA were high compared to the MAT. Based on the test accuracy and its performance the Ab-ELISA using the L1 antigen described in this study is suitable for use in countries like PNG where the MAT is difficult to perform. Samples of kidneys from livestock in PNG were tested using culture and a PCR-based assay to detect Leptospira species. A total of 72 samples of kidney were collected from cattle and a total of 74 samples were collected from pigs slaughtered in Lae and Port Moresby. A second study was designed to assess the use of a real-time PCR for detecting leptospiral DNA in urine from cattle. One hundred and ninety-three urine samples were collected from a beef cattle farm in WA. Whole genomic DNA from kidney samples was extracted from each kidney using the QIAamp DNA Mini kit (Qiagen). Heat lysis was used to extract genomic DNA from clear urine samples and the QIAamp Mini Kit was used for urine that was contaminated with faeces. The PCR-based test was able to detect a higher number of Leptospira-positive kidneys compared to culture in EMJH medium. Results of testing DNA extracted from urine using the realtime PCR showed that this test is sensitive and able to detect cattle infected with pathogenic leptospires.

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The main economic activity of the state of Tocantins, in Brazilian Amazon is cattle farms, with extensive breeding. Looking for contribution to cattle sanity, this study was devoted to the prevalence of antibodies against Leptospira in livestock of those farms, as production animals (cattle and equids), dogs and animal workers, from a rural governmental settlement in Aragominas, in the northwestern part of Tocantins. The statistically proofed sample was composed by 242 cows, 78 equids, 59 dogs and 41 animals workers, distributed in 38 small properties. All sampling was performed after informed consent, written in the case of human beings. For the diagnosis of leptospirosis, microscopic seroagglutination was performed in the Laboratório de Diagnóstico de Leptospirose do Setor de Medicina Veterinária Preventiva da Escola de Medicina Veterinária da UFG, Goiânia-GO. The seroprevalence for Leptospira spp in cattle was 76,5% [70,7% 81,7%], with serovar predominance of Hardjo (26,2%), followed by Wolffi (23,4%) Hebdomadis (14,1%), Castellonis (11,7%), Grippotyphosa (9,1%) e Pyrogenes (4,8%). In equids the seroprevalence was 79,3% [68,9% 87,4%], with agglutinins more intense to wild life serovars Castellonis (24,4%), Grippotyphosa (13,7%), Patoc (13,1%), Butembo (8,9%), Pomona (7,1%), Hardjo (6,6%), Pyrogenes (6,6%) e Wolffi (6,6%). Dogs presented seroprevalence of 30,5% [19,2 43,9], prevailing Canicola (26,3%), Hardjo (13,3%), Bratislava (10,0%) and Pyrogenes (10,0%). Human leptospirosis seroprevalence in animal workers was 31,7% [18,1%-48,1%], cwith detections of serovars Hardjo (26,3%), Grippotyphosa (15,8%), Pyrogenes (10,5%), Wolffi (10,5%), Autumnalis (10,5%) e Bratislava (10,5%). Looking for association with environmental and breeding conditions, the seroprevalence was associated in cattle to Bos indicus cattle (OR=7,51; [0,99-56,97]), in equids to the use of antihelminths (OR=7,64[0,95 61,50]) and for dogs with use for shepherd cattle (OR=4,44[1,35 14,58]). These data point to endemicity of Leptospira infection in the area and are highly suggestive of extensive environmental contamination with wildlife and production animal serovars. These results also emphasize the importance of the control of livestock leptospirosis, lowering environmental contamination and allowing better animal sanitation, with measures that could be implemented in new adequate settlements.
A exploração pecuária bovina constitui-se em uma atividade fundamental para o Estado do Tocantins, que tem sua economia pautada no agronegócio. Visando contribuir para a sanidade bovina na região, objetivou-se neste estudo determinar a prevalência de anticorpos anti-Leptospira spp. em animais de interesse econômico (bovinos e equinos), em cães e em humanos que tinham contato direto com animais, oriundos de assentamento rural do município de Aragominas, Tocantins, Brasil. A amostragem estatisticamente representativa foi constituída por 242 bovinos, 78 equídeos, 59 cães e 41 humanos, distribuídos em 38 propriedades. As colheitas de sangue dos animais e a aplicação de questionários foram realizadas após o aceite dos proprietários e, no caso dos humanos, após a leitura e assinatura do termo de consentimento livre e esclarecido. Para diagnóstico da leptospirose foi empregada a técnica de soroaglutinação microscópica (SAM) realizada no Laboratório de Diagnóstico de Leptospirose do Setor de Medicina Veterinária Preventiva da Escola de Medicina Veterinária da UFG, em Goiânia-GO. A prevalência de infecção por Leptospira spp. em bovinos foi de 76,5% [70,7% 81,7%], com predominância de anticorpos aos sorovares Hardjo (26,2%), seguido do Wolffi (23,4%), Hebdomadis (14,1%), Castellonis (11,7%), Grippotyphosa (9,1%) e Pyrogenes (4,8%); em equídeos foi de 79,3% [68,9% 87,4%], com maior detecção de aglutininas para os sorovares Castellonis (24,4%), Grippotyphosa (13,7%), Patoc (13,1%), Butembo (8,9%), Pomona (7,1%), Hardjo (6,6%), Pyrogenes (6,6%) e Wolffi (6,6%). Já em cães, foi detectada soroprevalência de 30,5% [19,2 43,9], com maiores respostas aos sorovares Canicola (26,3%), seguido Hardjo (13,3%), Bratislava (10,0%) e Pyrogenes (10,0%) e em humanos constataram-se 31,7% [18,1%-48,1%] de reagentes, com detecção de anticorpos para os sorovares Hardjo (26,3%), Grippotyphosa (15,8%), Pyrogenes (10,5%), Wolffi (10,5%), Autumnalis (10,5%) e Bratislava (10,5%). Dentre os fatores avaliados, a prevalência mostrou-se associada na espécie bovina à raça zebu (OR=7,51; [0,99-56,97]), nos equídeos ao uso de vermífugo (OR=7,64[0,95 61,50]) e para cães a lida com gado (OR=4,44[1,35 14,58]). Os resultados encontrados apontam para uma situação de endemicidade e são sugestivos de alta contaminação ambiental por sorovares que possuem como hospedeiro natural animais de produção e silvestres; evidenciando a necessidade de controle da infecção animal, com a finalidade de diminuir a contaminação ambiental e a consequente infecção em seres humanos.

Em países em desenvolvimento, doenças infecciosas se constituem ainda um grave problema de saúde pública. Muitas vezes, essas doenças estão altamente relacionadas a condições urbanas que podem ser encontradas em áreas mais pobres. Nesses casos, o sensoriamento remoto (SR) pode ser utilizado como uma poderosa ferramenta de estudo. Novos produtos de SR se encontram disponíveis no mercado, permitindo o desenvolvimento de análises espaciais cada vez mais profundas e precisas. No entanto, a complexidade que envolve a epidemiologia de doenças, a irregularidade de ocupações urbanas e a heterogeneidade das imagens de alta resolução espacial têm restringido o desenvolvimento de estudos nesse campo científico. O desafio de identificar elementos e tipologias urbanas em imagens de sensoriamento remoto relacionadas à ocorrência da leptospirose justifica-se pela crença de que ferramentas de SR podem ser mais amplamente utilizadas no monitoramento de carências urbanísticas e, consequentemente, na gestão de ações e investimentos públicos. A metodologia contempla uma revisão bibliográfica sistemática, com base na qual foram criados modelos de transmissão da leptospirose e investigadas tipologias urbanas presentes na área de estudo. As variáveis baseadas em dados de SR que formam os indicadores dos modelos e que caracterizam as tipologias foram usadas para definir objetos e atributos, alvos das investigações em imagens de alta resolução espacial. Os procedimentos de SR adotados baseiam-se na segmentação multi-nível, classificação baseada em objeto, e utilizam ortofotografias aéreas, imagem QuickBird e base cartográfica do eixo viário do Subúrbio Ferroviário de Salvador. Para o cálculo das variáveis utilizou-se produtos do processamento da imagem QuickBird. Procedimentos de geoprocessamento foram realizados em sistema de informações geográficas. Por fim, realizaram-se as primeiras análises epidemiológicas que investigam a relação da leptospirose com os elementos e tipologias urbanas identificados por meio de SR, cujos resultados apontam maior influência do percentual de pavimentação das vias, sua largura e qualidade da edificação na possibilidade de ocorrência da leptospirose no Subúrbio. Possíveis fontes de viés são discutidas ao lado de propostas de continuação da pesquisa. Apesar dos problemas e limitações identificados no processo, o estudo mostra que a metodologia desenvolvida baseada em SR se constitui uma poderosa ferramenta de análise do espaço intra-urbano, uma vez que permite a identificação de elementos e tipologias relacionados a situações de risco, apoiando assim, o direcionamento de investimentos públicos que venham refletir na melhoria das condições de saúde da população.
In developing countries, infectious diseases are still a serious public health problem. These diseases are often and highly related to urban conditions found in poor areas, in these cases, remote sensing (RS) can be used as a powerful tool. New RS products are now available allowing the development of more complex and precise spatial analysis. On the other hand, the complexity of epidemiological studies, the lack of regularity of precarious urban settlements and the heterogeneity of high spatial resolution images have been restricting the development of studies in this areas. The challenge of identifying urban elements and typologies related to the leptospirosis using RS products is pursued due the belief that RS can be more used among professionals and researchers in the task of monitoring the urban environment, and directing public investments and actions. The methodology presented consists in a broad literature review, which was used to support leptospirosis transmission risk models and to find urban typologies at the study area. Variables based on RS were identified in the disease models and in the typologies characterization. This models and typologies also defined targets to look for in the high spatial resolution images. RS procedures were based on multi-level segmentation, object-based classification, aerial photography, QuickBird satellite images and street axis vector data of the Railroad Suburb of Salvador. In order to obtain the variable\'s values, results of QuickBird image processing were added to a geographic database and processed using vector and raster over layering techniques. At last, epidemiological analysis were initiated aiming to find its relationship with the urban elements and typologies identified using RS. The results points paved streets, streets wideness and house quality as the RS variables that have more influence on the leptospirosis transmission chance. The dissertation also presents research restrains, potentials, possible sources of bias and future studies proposals. It concludes that the RS based methodology presented is a powerful tool for urban analysis, due to its capabilities for identifying urban targets related to risky situations, and, therefore, for helping direct public investments to improve life conditions an unprivileged city areas.

Missing pages 93, 264 & 313 from electronic and Vault (preservation) copy.
Leptospirosis has been reported in farmed deer in New Zealand since 1980 but knowledge was limited. Studies presented in this thesis investigated the epidemiology and distribution of infection associated with serovars Hardjobovis, Pomona, and Copenhageni in farmed deer, efficacy of a vaccine and the influence of maternally derived antibody, and aspects of exposure of humans to leptospirosis. Serology, bacteriology, and pathology were employed as determinants of infection and vaccine efficacy. A serological survey of 2016 deer from 110 herds confirmed leptospirosis throughout New Zealand with 61.3% of herds infected with Hardjobovis and 3.6% with Pomona alone, 16.4% with dual infections with those serovars, and none with Copenhageni, giving an overall herd prevalence of 81.3%. Epidemiological studies involved serological analysis of samples from a serum bank involving weaner, yearling and adult deer (n=10/group) from 15 farms sampled 3-monthly for 21 months, and intensive blood and urine sampling of young deer on three farms over 1-2 production cycles (n=15-65/group). Infection with Hardjobovis followed an age-related endemic cycle with some animals infected by 3-4 months of age and seroconversion peaking at up to 57% at 12-15 months and mild kidney lesions typical of a host-adapted organism. Infection with Pomona followed an epidemic pattern with seroprevalence of up to 100%, more severe kidney lesions, clinical signs and evidence of reduced growth and reproduction, typical of an accidental host relationship. Leptospira were observed in 30.4% of urine samples and 37.0% of kidneys. Vaccination with "Leptavoid 3" (Schering-Plough Animal Health Ltd) was studied on one non-infected, one Hardjobovis infected, and two dual Hardjobovis/Pomona infected herds. Vaccination produced sustained titres in uninfected young and adult deer, and no maternally derived antibody interference was observed in progeny vaccinated at approximately 3-4 months of age. In infected herds, vaccination enhanced seroprevalence and antibody titres, and reduced urine shedding by 44% and culture from urine and kidneys by 37% in the face of continued natural challenge. Analysis of previous data combined with pooled data from the above studies, indicated that 73.0% of lines and 29.0% of individual deer at slaughterhouses had kidney lesions indicative of leptospirosis with a relative risk (RR) of 1.08 and 1.6 for the relationship between seropositivity to Hardjobovis and Pomona, respectively. The overall RR between positive serology, lesion and culture was 2.1. The kidney culture rate ranged from 2.5-33% between herds demonstrating significant risk of exposure to humans, particularly slaughterhouse workers. This study has provided an understanding of the epidemiology in farmed deer and control options available to the industry.

Leptospirosis is a bacterial zoonotic disease of global importance. It is caused by infection with pathogenic Leptopsira species. Leptospirosis encompasses a wide spectrum of clinical or subclinical disease in both humans and animals. In New Zealand (NZ), leptospirosis is considered to be the most important occupational zoonosis. Livestock farming plays an important role as a major occupational risk factor for human leptospirosis and farmed deer is one of the contributing factors. Commercial farming of deer began in NZ in the early 1970s. It remains the world’s largest and most advanced deer farming industry. Leptospirosis in farmed deer can cause illness and possibly sub-clinical production losses. Farmed deer also play an important role in the transmission of leptospirosis by shedding the organisms in their urine, putting both other animals and humans at risk. Leptospira serovars Hardjobovis and Pomona are the most commonly found serovars in this stock group. The first substantial case report of leptospirosis in farmed deer was in the 1980s but it was not until 2006 that a substantial epidemiological study of this disease in farmed deer was reported. The purpose of this research was to improve and extend current knowledge on the epidemiology of leptospirosis on mixedspecies deer farms, to develop and validate a novel molecular diagnostic tool and to enhance understanding of control measures and their outcomes by means of vaccination. A pilot longitudinal seroprevalence survey of leptospirosis on mixed-species deer farms was conducted. Results from this study revealed that leptospiral infection averaged 70% in all species on mixed-species farms in the lower North Island of NZ. Co-grazing with infected sheep and/or cattle was positively associated with deer herd serological status to both serovars Hardjobovis and Pomona which suggests the possibility of inter-species transmission. Results from this study justify further investigation of leptospirosis on mixedspecies farm at the national level. A collaborative study between Massey University and the WHO/FAO/OIE reference laboratory for leptospirosis in Brisbane to investigate for exotic serovars in farmed deer revealed seropositivity to Arborea which has never been found before in NZ. Attempts to isolate Arborea from kidney samples of farmed deer were unsuccessful and require further investigation. Real-time PCR assay was developed and validated against culture as the gold standard for use on deer kidney tissue and urine as a research and diagnostic tool for determining infection, carrier and shedding status of deer. This research revealed that the real-time PCR assay was highly sensitive (sensitivity: 85% for kidney and 96.7% for urine) and specific (specificity: 99.2% for kidney and 100% for urine). It is a useful tool for the rapid and cost-effective detection of pathogenic leptospires in clinical samples. It can also be used to quantify the concentration of leptospires from clinical samples and identify the likely infecting serovar in NZ when adjunct with a DNA sequencing technique. Vaccination control for leptospirosis has proven to be efficacious and likely to be costeffective. Present research has determined the effect of a commercial bivalent leptospiral vaccine (Leptavoid-2, Intervet/Schering-Plough Animal Health Limited, NZ) on leptospiral shedding, growth and reproduction of farmed deer under NZ pastoral conditions. The study was designed to simulate an infection-free herd scenario followed by exposure to natural challenge. Results have shown the potential of vaccine to improve mean weight gain (up to 6.5 kg) and weaning rate (average 6.9%) in infected herds and prevent urinary shedding after natural challenge with Hardjobovis. It also provides the first evidence of adverse subclinical effects on deer production by Hardjobovis alone. A pilot study to investigate the presence and localisation of pathogenic Leptospira in the uterus and foetus of female deer revealed evidence of a foetal infection using real-time PCR. This finding suggests a possible explanation for effects of leptospiral infection on NZ farmed deer reproduction. However, further study is required to justify this proposition. This research has contributed significantly to understanding of epidemiology of leptospirosis in NZ farmed deer, providing objective data to assist producers in decision-making on leptospirosis control. Furthermore, this study has made available a valuable diagnostic resource for future leptospirosis studies, and has provided direction for future research into leptospirosis on farmed deer and mixed-species farms.