ANA MARLI CHRISTOVAM SARTORI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina - Docente
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
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
conferenceObject Introduction of universal human papillomavirus vaccination of girls aged 11 years to the National Immunization Program in Brazil: a cost-effectiveness analysis(2014) NOVAES, Hillegonda M. D.; SILVA, Gulnar Azevedo e; ITRIA, Alexander; RAMA, Cristina H.; SARTORI, Ana M.; SOAREZ, Patricia Coelho de; CLARK, Andrew; RESCH, StephenconferenceObject COST-EFFECTIVENESS ANA LYSIS OF INCORPORATION OF THE HPV VACCINE TO THE NATIONAL IMMUNIZATION PROGRAM / NIP OF BRAZIL(2013) NOVAES, H. M. D.; SILVA, G. Azevedo e; AYRES, A.; ITRIA, A.; RAMA, C.; SARTORI, A. M. C.; SOAREZ, P. C. De; CLARK, A.; RESCH, S.- Pre-vaccination screening strategies for the use of the CYD-TDV dengue vaccine: A meeting report(2019) WILDER-SMITH, A.; SMITH, P. G.; LUO, R.; KELLY-CIRINO, C.; CURRY, D.; LARSON, H.; DURBIN, A.; CHU, M.; THARMAPHORNPILAS, P.; NG, L. C.; SARTORI, A. M. C.; LUNA, E. J. A.; GUBLERJ, D. J.; ESPANA, G.; YOON, I. K.; FLASCHE, S.The first licensed dengue vaccine, CYD-TDV (Dengvaxia) is efficacious in seropositive individuals, but increases the risk for severe dengue in seronegative persons about two years after administration of the first dose. For countries considering the introduction of Dengvaxia, WHO recommends a pre-vaccination screening strategy whereby only persons with evidence of a past dengue infection would be vaccinated. Policy-makers need to consider the risk-benefit of vaccination strategies based on such screening tests, the optimal age to introduce the vaccine, communication and implementation strategies. To address these questions, the Global Dengue and Aedes-transmitted diseases Consortium (GDAC) organized a 3-day workshop in January 2019 with country representatives from Asia and Latin America. The meeting discussions highlighted many challenges in introducing Dengvaxia, in terms of screening test characteristics, costs of such tests combined with a 3-dose schedule, logistics, achieving high coverage rates, vaccine confidence and communication; more challenges than for any other vaccine introduction programme. A screening test would require a high specificity to minimize individual risk, and at the same time high sensitivity to maximize individual and population benefit. The underlying seroprevalence dependent positive predictive value is the best indicator for an acceptable safety profile of a pre-vaccination screening strategy. The working groups discussed many possible implementation strategies. Addressing the bottlenecks in school-based vaccine introduction for Dengvaxia will also benefit other vaccines such as HPV and booster doses for tetanus and pertussis. Levels of public trust are highly variable and context specific, and understanding of population perceptions and concerns is essential to tailor interventions, monitor and mitigate risks.
- Human Papillomavirus (HPV) seroprevalence, cervical HPV prevalence, genotype distribution and cytological lesions in solid organ transplant recipients and immunocompetent women in Sao Paulo, Brazil(2022) MIYAJI, Karina Takesaki; INFANTE, Vanessa; PICONE, Camila de Melo; LEVI, Jose Eduardo; OLIVEIRA, Ana Carolina Soares de; LARA, Amanda Nazareth; TACLA, Maricy; DILLNER, Joakim; KANN, Hanna; EKLUND, Carina; CASTANHEIRA, Cristina Paula; MAYAUD, Philippe; SARTORI, Ana Marli ChristovamIntroduction Solid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus (HPV) persistent infection and disease. This study aimed to evaluate HPV seroprevalence, cervical HPV prevalence, genotype distribution, and frequency of HPV-related cervical lesions in SOT recipients in comparison to immunocompetent women. Methods Cross-sectional study including SOT and immunocompetent women aged 18 to 45 years who denied previous HPV-related lesions. Cervical samples were screened for HPV-DNA by a polymerase chain reaction (PCR)-based DNA microarray system (PapilloCheck (R)) and squamous intraepithelial lesions (SIL) by liquid-based cytology. A multiplexed pseudovirion-based serology assay (PsV-Luminex) was used to measure HPV serum antibodies. Results 125 SOT and 132 immunocompetent women were enrolled. Cervical samples were collected from 113 SOT and 127 immunocompetent women who had initiated sexual activity. HPV-DNA prevalence was higher in SOT than in immunocompetent women (29.6% vs. 20.2%, p = 0.112), but this difference was not statistically significant. High-risk (HR)-HPV was significantly more frequent in SOT than in immunocompetent women (19.4% vs. 7.9%, p = 0.014). Simultaneous infection with >= 2 HR-HPV types was found in 3.1% of SOT and 0.9% of immunocompetent women. HPV seropositivity for at least one HPV type was high in both groups: 63.8% of 105 SOT and 69.7% of 119 immunocompetent women (p = 0.524). Low-grade (LSIL) and high-grade SIL (HSIL) were significantly more frequent in SOT (9.7% and 5.3%, respectively) than in immunocompetent women (1.6% and 0.8%, respectively) (p= 0.001). Conclusions These results may reflect the increased risk of HPV persistent infection and disease progression in SOT women due to chronic immunosuppression.
- Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil(2012) SOAREZ, Patricia Coelho De; SARTORI, Ana Marli Christovam; SANTOS, Andreia; ITRIA, Alexander; NOVAES, Hillegonda Maria Dutilh; MARTELLI, Celina Maria TurchiThe aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil.
- Cost-effectiveness analysis of introducing universal human papillomavirus vaccination of girls aged 11 years into the National Immunization Program in Brazil(2015) NOVAES, Hillegonda Maria Dutilh; SOAREZ, Patricia Coelho de; SILVA, Gulnar Azevedo; AYRES, Andreia; ITRIA, Alexander; RAMA, Cristina Helena; SARTORI, Ana Marli Christovam; CLARK, Andrew D.; RESCH, StephenObjectives: To evaluate the impact and cost-effectiveness of introducing universal human papillomavirus (HPV) vaccination into the National Immunization Program (NIP) in Brazil. Methods: The Excel-based CERVIVAC decision support model was used to compare two strategies: (1) status quo (with current screening program) and (2) vaccination of a cohort of 11-year-old girls. National parameters for the epidemiology and costs of cervical cancer were estimated in depth. The estimates were based on data from the health information systems of the public health system, the PNAD 2008 national household survey, and relevant scientific literature on Brazil. Costs are expressed in 2008 United States dollars (US$), and a 5% discount rate is applied to both future costs and future health benefits. Results: Introducing the HPV vaccine would reduce the burden of disease. The model estimated there would be 229 deaths avoided and 6677 disability-adjusted life years (DALYs) averted in the vaccinated cohort. The incremental cost-effectiveness ratios (ICERs) per DALY averted from the perspectives of the government (US$ 7663), health system (US$ 7412), and society (US$ 7298) would be considered cost-effective, according to the parameters adopted by the World Health Organization. In the sensitivity analysis, the ICERs were most sensitive to variations in discount rate, disease burden, vaccine efficacy, and proportion of cervical cancer caused by types 16 and 18. However, universal HPV vaccination remained a cost-effective strategy in most variations of the key estimates. Conclusions: Vaccine introduction could contribute additional benefits in controlling cervical cancer, but it requires large investments by the NIP. Among the essential conditions for attaining the expected favorable results are immunization program sustainability, equity in a population perspective, improvement of the screening program, and development of a surveillance system.