AMANDA NAZARETH LARA
Projetos de Pesquisa
Unidades Organizacionais
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/48 - Laboratório de Imunologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/48 - Laboratório de Imunologia, Hospital das Clínicas, Faculdade de Medicina
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
bookPart Imunizações(2016) LARA, Amanda Nazareth; SARTORI, Ana Marli Christovam; IBRAHIM, Karim Yaqub; MIYAJI, Karina Takesaki; LOPES, Marta Heloísa; INFANTE, Vanessa- Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach(2022) GOMES, Ana Beatriz Ayroza Galvao Ribeiro; FEO, Lucas Bueno; SILVA, Guilherme Diogo; DISSEROL, Caio Cesar Diniz; PAOLILO, Renata Barbosa; LARA, Amanda Nazareth; TONACIO, Adriana Coracini; MENDES, Maria Fernanda; PEREIRA, Samira Luisa Apostolos; CALLEGARO, DagobertoBackground Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease. Objective To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients. Methods Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario. Conclusion We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.
- Spontaneous reporting of adverse events following pandemic influenza A (H1N1) immunization in a reference center in the State of Sao Paulo, Brazil(2013) OLIVEIRA, Danise Senna; LARA, Amanda Nazareth; LUIZ, Andre Machado; MIYAJI, Karina Takesaki; SARTORI, Ana Marli Christovam; LOPES, Marta HeloisaIntroduction: This paper describes adverse events (AEs) temporally associated to the pandemic influenza A (H1N1) vaccine observed in a reference center in So Paulo, Brazil, during a 2010 mass vaccination campaign. Methods: A retrospective study involving persons who sought medical care for AEs following influenza vaccination. Data were retrieved from medical records, vaccine AE notification forms, and a computerized system for immunobiological registration. Results: Sixty-six vaccinees sought medical care for AEs after immunization. The most frequent AEs were fever, headache, myalgia, and pain at the injection site. No serious AEs were reported. Conclusions: Few vaccinees spontaneously reported AEs to influenza A (H1N1) vaccine at this center.
- Low tetanus-diphtheria-acellular pertussis (Tdap) vaccine coverage among healthcare workers in a quaternary university hospital in Sao Paulo, Brazil: need for continuous surveillance and implementation of active strategies(2019) RANDI, Bruno Azevedo; MIYAJI, Karina Takesaki; LARA, Amanda Nazareth; IBRAHIM, Karim Yaqub; INFANTE, Vanessa; RODRIGUES, Camila Cristina Martines; LOPES, Marta Heloisa; SARTORI, Ana Marli ChristovamIntroduction: Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. Objective: To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. Methods: A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. Results: The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. Conclusions: Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake. (C) 2019 Sociedade Brasileira de Infectologia.
- Common pathogen-associated molecular patterns induce the hyper-activation of NLRP3 inflammasome in circulating B lymphocytes of HIV-infected individuals(2021) LEAL, Vinicius Nunes Cordeiro; REIS, Edione Cristina; FERNANDES, Fernanda Pereira; SOARES, Jaine Lima da Silva; OLIVEIRA, Iohana Gabriely Costa; LIMA, Dhemerson Souza de; LARA, Amanda Nazareth; LOPES, Marta Heloisa; PONTILLO, AlessandraObjective: Despite the antiretroviral treatment, people with HIV (PWH) still experience systemic chronic inflammation and immune-senescence, which represent risk factors for severe comorbidities and inefficient response to pathogens and vaccines. Given the dysregulation of NLRP3 inflammasome in PWH and the recently demonstrated role played by NLRP3 in B lymphocytes, we hypothesized that NLRP3 dysregulation in B cells can contribute to chronic inflammation and humoral dysfunction in PWH. Design: NLRP3 inflammasome activation was evaluated in B lymphocytes and correlated with antibodies production and immunization response in PWH. Methods: NLRP3 inflammasome activation was compared in B lymphocytes isolated from PWH and healthy donors, in resting and stimulated conditions. Functional polymorphic variants in NLRP3 and IL1B genes were analysed in a cohort of PWH submitted to anti-HBV vaccine to assess the effect of NLRP3 inflammasome on humoral response. Results: The NLRP3 inflammasome activation in response to common PAMPs (LPS, ss-glucan) resulted higher in B lymphocytes of PWH than in HD. CpG-induced IgM secretion was also increased in B cells of PWH. NLRP3, but not IL1B, gain-of-function polymorphism associated to anti-HBs levels. Conclusion: These data reveal the dysregulation of NLRP3 inflammasome in B lymphocytes of PWH. Differently from myeloid compartment, which present an exhausted NLRP3 inflammasome, the complex appears to be hyper-activated in B cells of PWH, likely contributing to chronic inflammation and affecting humoral response.
- Active assessment of adverse events following yellow fever vaccination of persons aged 60 years and more(2013) MIYAJI, Karina Takesaki; LUIZ, Andre Machado; LARA, Amanda Nazareth; CHAVES, Tania do Socorro Souza; PIORELLI, Roberta de Oliveira; LOPES, Marta Heloisa; SARTORI, Ana Marli ChristovamIntroduction: Older age has been associated to serious adverse events (AE) following yellow fever (YF) vaccination in passive surveillance studies, but few prospective studies involving seniors have been published. Results: Nine hundred and six persons were evaluated; 78 were not vaccinated and 828 received the vaccine; 700 (84.7%) were interviewed after vaccination: 593 (84.7%) did not report any symptoms or signs following YF vaccine; 107 (15.3%) reported at least one AE temporally associated to YF vaccination: 97 (13.9%) had systemic AE and 17 (2.4%) reported AE at the injection site (7 had both systemic and local AE). Data regarding previous vaccination was available for 655 subjects. Statistically significant higher rates of systemic AE were observed among subjects who received the first YF vaccination (17.5%) in comparison to persons who had been previously vaccinated (9.5%). Methods: This observational prospective study aimed to describe AE following YF vaccination in persons aged >= 60 y. From March 2009 to April 2010, seniors who sought YF vaccination at a reference Immunization Center in Sao Paulo city, Brazil, were included. Demographic and clinical data, previous YF vaccination, travel destination and the final decision regarding YF vaccination or not were collected from standardized medical records. Active AE assessment was done through telephone or electronic mail interview performed approximately 14 d after immunization. Conclusion: Most persons aged >= 60 y may be safely vaccinated against YF. Before vaccination, they must be carefully screened for conditions associated to altered immunocompetence and for risk of exposure to YF.
- A systematic review of adult tetanus-diphtheria-acellular (Tdap) coverage among healthcare workers(2019) RANDI, Bruno A.; SEJAS, Odeli Nicole Encinas; MIYAJI, Karina T.; INFANTE, Vanessa; LARA, Amanda N.; IBRAHIM, Karim Y.; LOPES, Marta H.; SARTORI, Ana Marli C.During the last decades pertussis incidence raised globally. Several vaccination strategies targeting adults to reduce pertussis among young infants have been proposed, including vaccination of healthcare workers (HCWs). The aim of this study was to analyse, by performing a systematic review of literature, published papers that evaluated Tdap coverage among HCWs, variables associated with vaccine uptake and efforts implemented to raise vaccination rates. We searched the MedLine, Embase, SCOPUS, LILACS, Web of Science and Cochrane for full-text studies that evaluated Tdap coverage in HCW. Two independent reviewers screened the articles and extracted the data. Twenty-eight studies published from 2009 to 2018 were reviewed. Most studies were conducted in the USA. Initial Tdap coverage varied from 6.1% to 63.9%. USA and France are the only two countries with studies evaluating Tdap coverage within HCWs using national data. In the USA, Tdap coverage in HCWs raised from 6.1% to 45.1% from 2007 to 2015. In the analysis of French national data, a Tdap coverage of 63.9% was observed. Five studies used interventions to raise Tdap coverage in HCWs. Two intervention studies implemented mandatory vaccination and three used educational strategies. All of them achieved coverages over 86%. Only eleven studies analysed the association of Tdap vaccination with variables of interest. Previous immunization with other vaccines recommended for HCWs (like influenza, hepatitis B and MMR) was positively associated with Tdap uptake in four studies. In conclusion, overall Tdap coverage among HCWs is low, but seems to increase over the years after the vaccine introduction and with implementation of interventions to increase coverage.
- Healthcare resource utilization and costs of outpatient follow-up after liver transplantation in a university hospital in Sao Paulo, Brazil: cost description study(2015) SOAREZ, Patricia Coelho de; LARA, Amanda Nazareth; SARTORI, Ana Marli Christovam; ABDALA, Edson; HADDAD, Luciana Bertocco de Paiva; D'ALBUQUERQUE, Luiz Augusto Carneiro; NOVAES, Hillegonda Maria DutilhCONTEXT AND OBJECTIVE: Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation. DESIGN AND SETTING: Cost description study conducted in a university hospital in Sao Paulo, Brazil. METHODS: Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011. RESULTS: Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs. CONCLUSION: This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.
- Adverse events following immunization of elderly with COVID-19 inactivated virus vaccine (CoronaVac) in Southeastern Brazil: an active surveillance study(2022) MIYAJI, Karina Takesaki; ITTO, Lucas Yuji Umesaki; JACINTHO, Lucas Caue; SALES, Amanda Caroline Ribeiro; HIRATSUKA, Marcel; LEONEL, Fabio Campos; HIGA-TANIGUCHI, Keila Tomoko; PICONE, Camila Melo; LARA, Amanda Nazareth; RODRIGUES, Camila Cristina Martini; LOPES, Marta Heloisa; SARTORI, Ana Marli ChristovamHealthcare workers, the elderly and other vulnerable populations were the first to receive COVID-19 vaccines in public health programs. There were few vaccine safety data available on the elderly. This observational study aimed to evaluate the inactivated vaccine (CoronaVac) safety in the elderly, at the beginning of the vaccination program, in Sao Paulo city, Brazil. The elderly people that received CoronaVac at the Reference Center for Special Immunobiologicals (CRIE) or at home, administered by the Interdisciplinary Home Care Team (NADI) of the Hospital das Clinicas were invited to participate in this phase 4 observational study. The vaccination schedule included two CoronaVac doses 28 days apart. The information on solicited and unsolicited adverse events following immunization were collected by phone calls on days 4 and 8 after each vaccine dose. We enrolled 158 adults aged 65 to 101 years (mean of 84.1 years); 63.9% were females and 95.6% had chronic conditions, 21.5% had moderate or severe impairment in daily living activities; 34.2% were pre-frail and 19.6% were frail. We were able to contact 95.6% and 91.6% of the vaccinated people, after the first and second doses, respectively; 31.8% and 23.4% of the contacted participants reported some adverse events (AE) following the first and second doses, respectively. Pain at the injection site, fatigue, myalgia and headaches were the most frequent solicited AE. Most AE were mild to moderate. There were eight severe adverse events, but none of them were considered related to the vaccine. The CoronaVac was safe and well tolerated by these adults of advanced age with frailty and comorbidities.
- Safety and immunogenicity of CoronaVac in people living with HIV: a prospective cohort study(2022) NETTO, Lucas C.; IBRAHIM, Karim Y.; PICONE, Camila M.; ALVES, Ana Paula P. S.; V, Eliane Aniceto; SANTIAGO, Mariana R.; PARMEJANI, Patricia S. S.; AIKAWA, Nadia E.; MEDEIROS-RIBEIRO, Ana C.; PASOTO, Sandra G.; YUKI, Emily F. N.; SAAD, Carla G. S.; PEDROSA, Tatiana; LARA, Amanda N.; CENEVIVA, Carina; BONFA, Eloisa; KALLAS, Esper G.; I, Vivian Avelino-SilvaBackground People living with HIV might have a poor or delayed response to vaccines, mainly when CD4 cell counts are low, and data concerning COVID-19 vaccines in this population are scarce. This prospective cohort study assessed the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine CoronaVac in people with HIV compared with people with no known immunosuppression. Methods In this prospective cohort study, adults (aged >= 18 years) living with HIV who were regularly followed up at the University of Sao Paulo HIV/AIDS outpatient clinic in Sao Paulo, Brazil, were included in the study. Eligibility for people with HIV was independent of antiretroviral use, HIV viral load, or CD4 cell count. Adults with no known immunosuppression with CoronaVac vaccination history were included as a control group. CoronaVac was given intramuscularly in a two-dose regimen, 28 days apart. Blood was collected before vaccine administration and 6 weeks after the second dose (day 69). Immunogenicity was assessed at baseline (day 0), before second vaccine (day 28), and 6 weeks after second vaccine dose (day 69) through SARS-CoV-2 IgG titre and seroconversion, neutralising antibody (NAb) positivity and percentage activity, and factor increase in IgG geometric mean titres (FI-GMT). We investigated whether HIV status and CD4 count (<500 or 500 cells per mu L) were associated with CoronaVac immunogenicity by use of multivariable models adjusted for age and sex. Findings Between Feb 9, 2021, and March 4, 2021, 776 participants were recruited. Of 511 participants included, 215 (42%) were people with HIV and 296 (58%) were people with no known immunosuppression. At 6 weeks after the second vaccine dose (day 69), 185 (91%) of 204 participants with HIV and 265 (97%) of 274 participants with no known immunosuppression had seroconversion (p=0.0055). 143 (71%) of 202 participants with HIV were NAb positive compared with 229 (84%) of 274 participants with no known immunosuppression (p=0.0008). Median IgG titres were 48.7 AU/mL (IQR 26.6.88.2) in people with HIV compared with 75.2 AU/mL (50.3.112.0) in people with no known immunosuppression (p<0.0001); and median NAb activity was 46.2% (26.9.69.7) compared with 60.8% (39.8.79.9; p<0.0001). In people with HIV who had CD4 counts less than 500 cells per .L seroconversion rates, NAb positivity, and NAb activity were lower than in those with CD4 counts of at least 500 cells per .L. In multivariable models for seroconversion, NAb positivity, IgG concentration, and NAb activity after a complete two-dose regimen, adjusted for age and sex, people with HIV who had CD4 counts of at least 500 cells per .L and people with no known immunosuppression had higher immunogenicity than did people with HIV with CD4 counts less than 500 cells per .L. No serious adverse reactions were reported during the study. Interpretation Immunogenicity following CoronaVac in people with HIV seems strong but reduced compared with people with no known immunosuppression. Our findings highlight the need for strategies to improve vaccine immunogenicity in people with HIV. Funding Fundacao de Amparo a Pesquisa do Estado de S.o Paulo (FAPESP), Conselho Nacional de Desenvolvimento Cientifico e Tecnol.gico (CNPq), and B3.Bolsa de Valores do Brasil.