Maria Flávia Gazzinelli

Hookworm, Ascaris lumbricoides infection and polyparasitism associated with poor cognitive performance in Brazilian schoolchildren.

Objective  To investigate the relationship between hookworm and Ascaris lumbricoides infection and performance on three subsets of the Wechsler Intelligence Scale for Children – third edition (WISC‐III) (Digit Span, Arithmetic and Coding) and Raven Colored Progressive Matrices.

Exposure to Schistosoma mansoni infection in a rural area in Brazil. Part III: household aggregation of water-contact behaviour.

Much research points to the importance of the household in the study of water‐borne diseases such as schistosomiasis. An important aspect of the household is the clustering of domestic activities associated with water collection, storage and usage. Such activities can result in the sharing of water‐contact sites and water‐contact behaviour, which expose household members to similar risks of infection. In previous studies, we determined that shared residence accounted for 28% of the variance in Schistosoma faecal egg excretion rates. We now quantify the effect of shared residence on the variation in water‐related health behaviours. We found that shared residence accounted for 30% of the variation in total water contacts per week. It also accounted for a large proportion of the variation in individual water‐contact behaviour: e.g. agricultural contacts (63%), washing limbs (56%) or bathing (41%). These results implicate the household as an important composite measure of the complex relationships between socioeconomic, environmental and behavioural factors that influence water‐contact behaviour and, therefore, the transmission of schistosomiasis. Our results also support a focus on the household in the implementation of schistosomiasis prevention and control efforts.

Sociocultural aspects of schistosomiasis mansoni in an endemic area in Minas Gerais, Brazil

A study to determine the sociocultural factors influencing knowledge, attitudes, and practices of individuals from a small community toward Schistosoma mansoni infection was carried out in an endemic area in the State of Minas Gerais, Brazil. The study used qualitative approaches to collect data from school-aged children and teachers. Specific findings were that the individuals interviewed were aware of the disease, but also held inaccurate popular beliefs about transmission. Misconceptions coexisted with accurate knowledge both in children and teachers. The disease was not seen as a major health problem and does not affect their activities since it does not cause severe symptoms in most of the individuals. Although the majority of the participants relate transmission to water and lack of sanitation, they do not take any preventive measures since their subsistence is highly dependent on irrigation, farming, fishing, and other essential work that is directly related to water activities. The authors discuss the development of a health education program based on the knowledge and perception of individuals about the disease and its determinants as being important for the context and behavioral change.

A history of hookworm vaccine development

The human hookworms Necator americanus and Ancylostoma duodenale remain among the most common infections of humans in areas of rural poverty in the developing regions of the world, with an estimated 1 billion people infected with one or more of these parasites. Herein, we review the nearly 100 years of research, development, animal testing, and fieldwork that have led to our current progress in recombinant hookworm vaccines. We begin with the identification of hookworm at the start of the 20th century in Southern US, then discuss the progress in developed countries to eliminate human hookworm infection, and then the industrial development and field use in the 1970s a canine hookworm vaccine(Ancylostoma caninum), and finally our progress to date in the development and clinical testing of an array of recombinant antigens to prevent human hookworm disease from N. americanus infection. Special attention is given to the challenges faced in the development of a vaccine against a blood-feeding nematode, including the epidemiology of infection (high prevalence of infection), pathogenesis (chronic infection that increases with the age of the host), and a robust immune response that fails to confer the protection in the host and a concomitant absence of correlates of protection by a successful vaccine could be developed and tested. Finally, we provide the optimal and acceptable profiles of a human hookworm vaccine, including the proposed indication, target population, and route of administration, as developed by the Human Hookworm Vaccine Initiative, the only group currently working on vaccines targeting this parasite.

Health Education through Analogies: Preparation of a Community for Clinical Trials of a Vaccine against Hookworm in an Endemic Area of Brazil

Background Obtaining informed consent for clinical trials is especially challenging when working in rural, resource-limited areas, where there are often high levels of illiteracy and lack of experience with clinical research. Such an area, a remote field site in the northeastern part of the state of Minas Gerais, Brazil, is currently being prepared for clinical trials of experimental hookworm vaccines. This study was conducted to assess whether special educational tools can be developed to increase the knowledge and comprehension of potential clinical trial participants and thereby enable them to make truly informed decisions to participate in such research. Methodology/Principal Findings An informational video was produced to explain the work of the research team and the first planned hookworm vaccine trial, using a pedagogical method based on analogies. Seventy-two adults living in a rural community of Minas Gerais were administered a structured questionnaire that assessed their knowledge of hookworm, of research and of the planned hookworm vaccine trial, as well as their attitudes and perceptions about the researchers and participation in future vaccine trials. The questionnaire was administered before being shown the educational video and two months after and the results compared. After viewing the video, significant improvements in knowledge related to hookworm infection and its health impact were observed: using a composite score combining related questions for which correct answers were assigned a value of 1 and incorrect answers a value of 0, participants had a mean score of 0.76 post-video compared to 0.68 pre-video (p = 0.0001). Similar improvements were seen in understanding the purpose of vaccination and the possible adverse effects of an experimental vaccine. Although 100% of participants expressed a positive opinion of the researchers even before viewing the film and over 90% said that they would participate in a hookworm vaccine trial, an increase in the number who expressed fear of being vaccinated with a novel vaccine was seen after viewing the video (51.4% post-video versus 29.2% pre-video). Increases were also seen in the proportion who thought that participation in a vaccine trial would be inconvenient or disrupt their daily activities. Conclusions/Significance Even in rural, resource-limited populations, educational tools can be specially designed that significantly improve understanding and therefore the likelihood of obtaining truly informed consent for participation in clinical research. The observed changes in the knowledge and perceptions of the research participants about hookworm infection and the experimental hookworm vaccine demonstrate that the video intervention was successful in increasing understanding and that the subjects acquired knowledge pertinent to the planned research.

Educação para a promoção da saúde no contexto da atenção primária

OBJETIVO: Investigar se as praticas educativas realizadas nas unidades basicas de saude de Belo Horizonte, Estado de Minas Gerais, Brasil, atendem aos principios da promocao da saude. METODOS: Este estudo descritivo analisou 33 praticas educativas de promocao da saude para verificar se eram pautadas por cinco principios, utilizados como categoria de analise: multicausalidade do processo saude-doenca, intersetorialidade, participacao social, sustentabilidade e utilizacao de metodos dialogicos (participacao ativa do sujeito na pratica educativa, conducao da pratica de forma a proporcionar a construcao do conhecimento e utilizacao de diferentes estrategias de ensino). A tecnica utilizada foi a observacao estruturada. Determinou-se a frequencia de cada uma dessas categorias nas praticas avaliadas. RESULTADOS: A multicausalidade do processo saude-doenca foi a categoria mais incorporada as praticas educativas (73,0%), enquanto a intersetorialidade foi a menos incorporada (9,0%). Quanto ao uso de metodos dialogicos, 38,0% das praticas promoveram a participacao ativa do sujeito, 6,0% proporcionaram a construcao do conhecimento e 40,0% utilizaram diferentes estrategias de ensino. CONCLUSOES: A maioria das praticas educativas nao estava orientada ativamente em direcao a promocao da saude no sentido de fortalecimento da autonomia na gestao dos processos de saude, da participacao social e do emprego de abordagens dialogicas de ensino. Entretanto, observam-se movimentos de ruptura em relacao aos modelos de educacao hegemonicos na atencao primaria.

A pesquisa científica na saúde: uma análise sobre a participação de populações vulneráveis

Thisisaqualitativestudywiththeaimtoanalyzetheparticipationofvulnerablepopulationsinscientifichealthcare� research.�ThestudywascarriedoutinAmericaninhas,�NovoOrientedeMinas,�MinasGerais,�Brazil,�withninevolunteersenrolled� in the clinical trial of a hookworm infection vaccine developed by an international research institution. The data was collected using semi-structuredinterviewsaftertestingthevaccineandanalyzedusingBardinsContentAnalysismethod.�Mostvolunteersdecided� to participate in the study motivated by the possibility of receiving access to health care services. We conclude that the decision to participatewasinfluencedbythesocio-economicandpsychosocialvulnerabilityofthepopulationandhowtheysymbolicallyconstruct� this vulnerability. The study points out the need to prepare the community in order to participate in the study through an education translated into action, considering the need for developing autonomy among the participating subjects. DESCRIPTORS: Research in health. Vulnerable population. Personal autonomy.This is a qualitative study with the aim to analyze the participation of vulnerable populations in scientific health care research. The study was carried out in Americaninhas, Novo Oriente de Minas, Minas Gerais, Brazil, with nine volunteers enrolled in the clinical trial of a hookworm infection vaccine developed by an international research institution. The data was collected using semi-structured interviews after testing the vaccine and analyzed using Bardin’s Content Analysis method. Most volunteers decided to participate in the study motivated by the possibility of receiving access to health care services. We conclude that the decision to participate was influenced by the socio-economic and psychosocial vulnerability of the population and how they symbolically construct this vulnerability. The study points out the need to prepare the community in order to participate in the study through an education translated into action, considering the need for developing autonomy among the participating subjects. DESCRIPTORS: Research in health. Vulnerable population. Personal autonomy. LA INVESTIGACION CIENTIFICA EN SALUD: UN ANALISIS SOBRE LA PARTICIPACION DE LAS POBLACIONES VULNERABLES RESUMEN: Estudio cualitativo con el objetivo de analizar la participacion de las poblaciones vulnerables incluidas en investigaciones sobre salud. El estudio se desarrollo en Americaninhas, Novo Oriente de Minas, en Minas Gerais Brasil, con nueve voluntarios de las pruebas clinicas para experimentacion de la vacuna contra Ancilostomideos, realizado por un consorcio internacional de instituciones de investigacion. Los datos fueron recogidos despues de las pruebas de la vacuna, mediante entrevistas semiestructuradas analizadas por medio del analisis de contenido de Bardin. La mayoria de los voluntarios decidio participar en el estudio motivados por la posibilidad de acceso a la atencion de la salud. Se concluye que la decision de participar en el estudio fue caracterizada por la vulnerabilidad socioeconomica y psicosocial de esa poblacion y por la forma como esos voluntarios construyen simbolicamente esta vulnerabilidad. El estudio indica la necesidad de preparar a la comunidad a participar en el estudio a traves de una educacion que se traduzca en una accion dada la necesidad de desarrollo de la autonomia de los sujetos participantes. DESCRIPTORES: Investigacion en salud. Poblaciones vulnerables. Autonomia personal.

A interdição da doença: uma construção cultural da esquistossomose em área endêmica, Minas Gerais, Brasil

This study was conducted in a rural area endemic for schistosomiasis in Minas Gerais, Brazil. The objective was to determine the relationship between an environmental and health education program for schistosomiasis, implemented for teachers and students from the state secondary school in the village of Boa União, and the subsequent actions of its participants in regards to the environment and the illness. An important difference in this program is its perspective that it is not merely the implementation of instrumental and cognitive knowledge of the environment and illness, but an approach in which subjects are asked to question and investigate their perception of reality, the environment, and the illness. The study demonstrated that a change in attitude could occur from reflection on ones experience in relation to both the environment and diseases endemic it.

The impact of two education methods on knowledge of schistosomiasis transmission and prevention among schoolchildren in a rural community in northern Minas Gerais, Brazil

The objective of this study was to analyse the effect of using two health education approaches on knowledge of transmission and prevention of schistosomiasis of school children living in a rural endemic area in the state of Minas Gerais, Brazil. The 87 children participating in the study were divided into three groups based on gender, age and presence or absence of Schistosoma mansoni infection. In the first group the social representation model and illness experience was used. In the second group, we used the cognitive model based on the transmission of information. The third group, the control group, did not receive any information related to schistosomiasis. Ten meetings were held with all three groups that received a pre-test prior to the beginning of the educational intervention and a post-test after the completion of the program. The results showed that knowledge levels in Group 1 increased significantly during the program in regard to transmission (p = 0.038) and prevention (p = 0.001) of schistosomiasis. Groups 2 and 3 did not show significant increase in knowledge between the two tests. These results indicate that health education models need to consider social representation and illness experience besides scientific knowledge in order to increase knowledge of schistosomiasis transmission and prevention.

Safety and immunogenicity of the Na -GST-1 hookworm vaccine in Brazilian and American adults

Necator americanus Glutathione-S-Transferase-1 (Na-GST-1) plays a role in the digestion of host hemoglobin by adult N. americanus hookworms. Vaccination of laboratory animals with recombinant Na-GST-1 is associated with significant protection from challenge infection. Recombinant Na-GST-1 was expressed in Pichia pastoris and adsorbed to aluminum hydroxide adjuvant (Alhydrogel) according to current Good Manufacturing Practice. Two Phase 1 trials were conducted in 142 healthy adult volunteers in the United States and Brazil, first in hookworm-naïve individuals and then in residents of a N. americanus endemic area in Brazil. Volunteers received one of three doses of recombinant Na-GST-1 (10, 30, or 100 μg) adjuvanted with Alhydrogel, adjuvanted with Alhydrogel and co-administered with an aqueous formulation of Glucopyranosyl Lipid A (GLA-AF), or the hepatitis B vaccine. Vaccinations were administered via intramuscular injection on days 0, 56, and 112. Na-GST-1/Alhydrogel was well tolerated in both hookworm-naïve and hookworm-exposed adults, with the most common adverse events being mild to moderate injection site pain and tenderness, and mild headache and nausea; no vaccine-related severe or serious adverse events were observed. Antigen-specific IgG antibodies were induced in a dose-dependent fashion, with increasing levels observed after each vaccination in both trials. The addition of GLA-AF to Na-GST-1/Alhydrogel did not result in significant increases in specific IgG responses. In both the US and Brazil studies, the predominant IgG subclass induced against Na-GST-1 was IgG1, with lesser amounts of IgG3. Vaccination of both hookworm-naïve and hookworm-exposed adults with recombinant Na-GST-1 was safe, well tolerated, and resulted in significant antigen-specific IgG responses. Based on these results, this vaccine will be advanced into clinical trials in children and eventual efficacy studies. Trial registration ClinicalTrials.gov (NCT01261130 for the Brazil trial and NCT01385189 for the US trial)