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1.
MMWR Morb Mortal Wkly Rep ; 68(39): 851-854, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581162

RESUMO

Infection prevention and control (IPC) in health care facilities is essential to protecting patients, visitors, and health care personnel from the spread of infectious diseases, including Ebola virus disease (Ebola). Patients with suspected Ebola are typically referred to specialized Ebola treatment units (ETUs), which have strict isolation and IPC protocols, for testing and treatment (1,2). However, in settings where contact tracing is inadequate, Ebola patients might first seek care at general health care facilities, which often have insufficient IPC capacity (3-6). Before 2014-2016, most Ebola outbreaks occurred in rural or nonurban communities, and the role of health care facilities as amplification points, while recognized, was limited (7,8). In contrast to these earlier outbreaks, the 2014-2016 West Africa Ebola outbreak occurred in densely populated urban areas where access to health care facilities was better, but contact tracing was generally inadequate (8). Patients with unrecognized Ebola who sought care at health care facilities with inadequate IPC initiated multiple chains of transmission, which amplified the epidemic to an extent not seen in previous Ebola outbreaks (3-5,7). Implementation of robust IPC practices in general health care facilities was critical to ending health care-associated transmission (8). In August 2018, when an Ebola outbreak was recognized in the Democratic Republic of the Congo (DRC), neighboring countries began preparing for possible introduction of Ebola, with a focus on IPC. Baseline IPC assessments conducted in frontline health care facilities in high-risk districts in Uganda found IPC gaps in screening, isolation, and notification. Based on findings, additional funds were provided for IPC, a training curriculum was developed, and other corrective actions were taken. Ebola preparedness efforts should include activities to ensure that frontline health care facilities have the IPC capacity to rapidly identify suspected Ebola cases and refer such patients for treatment to protect patients, staff members, and visitors.


Assuntos
Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Administração de Instituições de Saúde , Doença pelo Vírus Ebola/prevenção & controle , Controle de Infecções/organização & administração , República Democrática do Congo/epidemiologia , Pesquisa sobre Serviços de Saúde , Doença pelo Vírus Ebola/epidemiologia , Humanos , Medição de Risco , Uganda
2.
MMWR Morb Mortal Wkly Rep ; 68(39): 865-869, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581166

RESUMO

In July 2019, the Illinois Department of Public Health and the Wisconsin Department of Health Services launched a coordinated epidemiologic investigation after receiving reports of several cases of lung injury in previously healthy persons who reported electronic cigarette (e-cigarette) use, or vaping (1). This report describes features of e-cigarette product use by patients in Illinois and Wisconsin. Detailed patient interviews were conducted by telephone, in person, or via the Internet with 86 (68%) of 127 patients. Overall, 75 (87%) of 86 interviewed patients reported using e-cigarette products containing tetrahydrocannabinol (THC), and 61 (71%) reported using nicotine-containing products. Numerous products and brand names were identified by patients. Nearly all (96%) THC-containing products reported were packaged, prefilled cartridges, and 89% were primarily acquired from informal sources (e.g., friends, family members, illicit dealers, or off the street). In contrast, 77% of nicotine-containing products were sold as prefilled cartridges, and 83% were obtained from commercial vendors. The precise source of this outbreak is currently unknown (2); however, the predominant use of prefilled THC-containing cartridges among patients with lung injury associated with e-cigarette use suggests that they play an important role. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. Given the diversity of products reported and frequency of patients using both THC- and nicotine-containing e-cigarette products, additional methods such as product testing and traceback could help identify the specific cause of this outbreak.


Assuntos
Surtos de Doenças , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Dronabinol/efeitos adversos , Feminino , Humanos , Illinois/epidemiologia , Masculino , Wisconsin/epidemiologia , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 68(39): 860-864, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581168

RESUMO

Electronic cigarettes (e-cigarettes), also called vapes, e-hookas, vape pens, tank systems, mods, and electronic nicotine delivery systems (ENDS), are electronic devices that produce an aerosol by heating a liquid typically containing nicotine, flavorings, and other additives; users inhale this aerosol into their lungs (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis (1). Use of e-cigarettes is commonly called vaping. Lung injury associated with e-cigarette use, or vaping, has recently been reported in most states (2-4). CDC, the Food and Drug Administration (FDA), state and local health departments, and others are investigating this outbreak. This report provides data on patterns of the outbreak and characteristics of patients, including sex, age, and selected substances used in e-cigarette, or vaping, products reported to CDC as part of this ongoing multistate investigation. As of September 24, 2019, 46 state health departments and one territorial health department had reported 805 patients with cases of lung injury associated with use of e-cigarette, or vaping, products to CDC. Sixty-nine percent of patients were males, and the median age was 23 years (range = 13-72 years). To date, 12 deaths have been confirmed in 10 states. Among 514 patients with information on substances used in e-cigarettes, or vaping products, in the 30 days preceding symptom onset, 76.9% reported using THC-containing products, and 56.8% reported using nicotine-containing products; 36.0% reported exclusive use of THC-containing products, and 16.0% reported exclusive use of nicotine-containing products. The specific chemical exposure(s) causing the outbreak is currently unknown. While this investigation is ongoing, CDC recommends that persons consider refraining from using e-cigarette, or vaping, products, particularly those containing THC. CDC will continue to work in collaboration with FDA and state and local partners to investigate cases and advise and alert the public on the investigation as additional information becomes available.


Assuntos
Surtos de Doenças , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Dronabinol/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
4.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(3): 323-325, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31544418

RESUMO

In China, the mountainous and hilly schistosomiasis-endemic areas are mainly distributed in 2 provinces of Sichuan and Yunnan. Although great success has been achieved in schistosomiasis control in mountainous and hilly areas, there is a risk of re-emerging schistosomiasis in local areas. Hereby, we described the emergency treatment of two schistosomiasis outbreaks that occurred in transmission-interrupted areas of Yunnan Province in 2011 and 2013, pointed out the risk of schistosomiasis rebounding in mountainous and hilly areas and proposed some suggestions.


Assuntos
Surtos de Doenças , Tratamento de Emergência , Esquistossomose , Animais , China/epidemiologia , Humanos , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Esquistossomose/transmissão , Caramujos
5.
MMWR Morb Mortal Wkly Rep ; 68(35): 766-770, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31487277

RESUMO

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations.† Individual water systems, which are not required to meet national drinking water standards,§ were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.


Assuntos
Surtos de Doenças/prevenção & controle , Água Potável/virologia , Hepatite A/epidemiologia , Hepatite A/prevenção & controle , Prática de Saúde Pública , Regulamentação Governamental , Vacinas contra Hepatite A/administração & dosagem , Humanos , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia , United States Environmental Protection Agency , Abastecimento de Água/legislação & jurisprudência
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 880-882, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484247

RESUMO

The recent developed diarrhea and acute respiratory infections surveillance systems were a breakthrough of the infectious disease surveillance and monitoring in Shanghai. This series "Infectious Disease Surveillance in Shanghai" briefly introduced current experiences of the updated surveillance systems, in order to provide evidences for promotion in other disease surveillance and to enhance the connection between different surveillance systems.


Assuntos
Diarreia/epidemiologia , Controle de Infecções/métodos , Vigilância da População/métodos , Vigilância em Saúde Pública/métodos , Doença Aguda , China/epidemiologia , Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Humanos , Infecções Respiratórias/epidemiologia , Vigilância de Evento Sentinela
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 988-991, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484266

RESUMO

Objective: To investigate the etiologic and epidemiologic features of an infectious diarrhea outbreak in a boarding school in Fuyang city, Anhui province. Methods: Traceability hypothesis of this study was tested according to the epidemiological characteristics of the cases. Feces, anal swabs, water samples and food residues related to the patients and chefs were collected for pathogen isolation and detection. Biochemical identification, virulence gene detection, drug susceptibility test, PFGE and multilocus sequence typing were performed. Results: The incidence rate (3.41%) of different dormitory buildings within the water supply area by shallow wells was higher than that (0.98%) of the deep wells, with statistical significance (χ(2)=17.215, P<0.001). Sixteen strains belonged to the Shigella Sonneri family were isolated from the patient's samples, and all carrying the ipaH gene. Seven strains belonged to sen and ial genes. Set1 gene that did not appear in all the 16 strains were highly resistant to ampicillin, tetracycline, compound xinnomine, cefazoline, cefotaxime, gentamicin, naphthidinic acid and streptomycin, including 9 strains to doxycycline. The pulse field pattern of the 16 strains of Shigella sonneri appeared the same, with the ST type as ST152. Conclusion: When combined data from the etiological and epidemiological investigation, it was confirmed that Shigella sonneri was the pathogen of this outbreak, and water from the shallow wells might be responsible for the source of infection.


Assuntos
Surtos de Doenças , Disenteria Bacilar/diagnóstico , Disenteria Bacilar/epidemiologia , Fezes/microbiologia , Adolescente , Antibacterianos/uso terapêutico , China/epidemiologia , Disenteria Bacilar/tratamento farmacológico , Disenteria Bacilar/microbiologia , Feminino , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Shigella sonnei/efeitos dos fármacos , Shigella sonnei/isolamento & purificação
8.
J Assoc Physicians India ; 67(7): 84-85, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559781

RESUMO

Chikungunya is an arboviral infection caused by Chikungunya virus, an RNA virus from Togaviridae family.1 The disease manifests as fever, rash and characteristically, with arthralgia.1 Chikungunya is strongly believed to have neurotropism but has not been well studied like other neurotropic arboviruses.2 Encephalitis appears to represent the most common clinical manifestation6 and occurs either simultaneously or within few days of onset of systemic symptoms, during the period of viremia. A delay of more than two weeks has been reported with other complications like myelitis, Guillian Barre syndrome and optic neuritis. This case describes the clinical, serological, neuroimaging and CSF findings of Chikungunya induced acute transverse myelitis in a 13 years old male patient who responded to steroid treatment. It is a relatively unknown and very rare complication of Chikungunya virus infection during outbreak of Chikungunya infection in September 2016.


Assuntos
Febre de Chikungunya , Vírus Chikungunya , Mielite Transversa , Adolescente , Artralgia , Surtos de Doenças , Febre , Humanos , Masculino
10.
Artigo em Inglês | MEDLINE | ID: mdl-31522662

RESUMO

A cluster of gastrointestinal illness was detected following receipt of a complaint of becoming ill after a multi-course dinner at a restaurant in Canberra, Australian Capital Territory (ACT), Australia. The complaint led to an investigation by ACT Health. Food samples retained by the restaurant for microbiological analysis returned an unsatisfactory level of Bacillus cereus in beef (19,000 colony forming units/gram [cfu/g]) and a satisfactory level in arancini (50 cfu/g). These positive samples underwent whole genome sequencing and genes encoding diarrhoeal toxins were detected with no laboratory evidence of the emetic toxin. No stool specimens were collected. A cohort study was undertaken and 80% (33/41) of patrons took part in a structured interview. There was no significant difference in age or sex between those ill and not ill. Due to universal exposure most foods were unable to be statistically analysed and no significant results were found from the food history. The ill cohort diverged into two distinct groups based on incubation period and symptoms suggesting this outbreak involved B. cereus intoxication with both diarrhoeal and potentially emetic toxins. Some hygiene practices during food preparation were noted to be inadequate and heating and cooling procedures were unverified when questioned. A combination of the incubation periods and symptom profile, food laboratory evidence, and genomic sequencing of the B. cereus diarrhoeal gene suggest a probable aetiology of B. cereus intoxication. Public health action included the restaurant rectifying hygiene practices and documenting heating/cooling procedures.


Assuntos
Bacillus cereus/isolamento & purificação , Toxinas Bacterianas/toxicidade , Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Gastroenterite/epidemiologia , Carne Vermelha/microbiologia , Animais , Território da Capital Australiana/epidemiologia , Bacillus cereus/genética , Bovinos , Estudos de Coortes , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/mortalidade , Eméticos , Feminino , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Doenças Transmitidas por Alimentos/mortalidade , Gastroenterite/microbiologia , Gastroenterite/mortalidade , Humanos , Masculino , Restaurantes , Estudos Retrospectivos , Inquéritos e Questionários
11.
Global Health ; 15(1): 53, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481126

RESUMO

Health security in the European Union (EU) aims to protect citizens from serious threats to health such as biological agents and infectious disease outbreaks- whether natural, intentional or accidental. Threats may include established infections, emerging diseases or chemical and radiological agents. Co-ordinated international efforts attempt to minimize risks and mitigate the spread of infectious disease across borders.We review the current situation (March 2019) with respect to detection and management of serious human health threats across Irish borders- and what may change for Ireland if/when the United Kingdom (UK) withdraws from the EU (Brexit).Specifically, this paper reviews international legislation covering health threats, and its national transposition; and EU legislation and processes, especially the relevant European Decision No. 1082/2013/EU of the European Parliament and of the Council on serious cross border threats to health with repeal of Decision No 2119/98/EC. We enumerate European surveillance systems and agencies which relate to port health security; we consider consortia and academic arrangements within the EU framework and established collaboration with the World Health Organization. We describe current Health Services Executive port health structures in Ireland which address preparedness and management of human health threats at points of entry. We appraise risks which Brexit could bring, reviewing literature on shared concerns about these risks, and we evaluate post-Brexit challenges for the EU, and potential opportunities to remain within current structures in shared health threat preparedness and response.It is imperative that the UK, Ireland and the EU work together to mitigate these risks using some agreed joint coordination mechanisms for a robust, harmonised approach to global public health threats at points of entry.


Assuntos
Surtos de Doenças/prevenção & controle , União Europeia/organização & administração , Saúde Global/legislação & jurisprudência , Regulamento Sanitário Internacional , Humanos , Irlanda , Reino Unido
12.
Acta Virol ; 63(3): 328-332, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31507200

RESUMO

Acute gastroenteritis (AGE) is one of the most frequently occuring illnesses in children and adults worldwide. In February 2017, two AGE outbreaks occurred in two adjacent schools in Huzhou city, Zhenjiang province of China. We detected high percentages of recombinant norovirus GII.P16/GII.2 in one school and chicken anemia virus (CAV) in another school using next generation sequencing (NGS) and specific PCR. The results highlight the importance of continuous surveillance of GII.P16/GII.2, and suggest the need of further studies on whether CAV causes AGE. Keywords: acute gastroenteritis; norovirus; chicken anemia virus; Huzhou; School.


Assuntos
Infecções por Caliciviridae , Vírus da Anemia da Galinha , Surtos de Doenças , Gastroenterite , Norovirus , Infecções por Caliciviridae/diagnóstico , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Criança , China/epidemiologia , Infecções por Circoviridae/epidemiologia , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Prevalência
14.
MMWR Morb Mortal Wkly Rep ; 68(36): 784-786, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31513559

RESUMO

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Electronic cigarettes (e-cigarettes) produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that users inhale, a behavior commonly referred to as "vaping." E-cigarettes can also be used to deliver marijuana and other drugs. In recent months, more than 200 possible cases of acute lung injury potentially associated with vaping were reported from 25 states (1). During July and August 2019, five patients were identified at two hospitals in North Carolina with acute lung injury potentially associated with e-cigarette use. Patients were adults aged 18-35 years and all experienced several days of worsening dyspnea, nausea, vomiting, abdominal discomfort and fever. All patients demonstrated tachypnea with increased work of breathing on examination, hypoxemia (pulse oximetry <90% on room air), and bilateral lung infiltrates on chest x-ray. All five patients shared a history of recent use of marijuana oils or concentrates in e-cigarettes. All of the products used were electronic vaping pens/e-cigarettes that had refillable chambers or interchangeable cartridges with tetrahydrocannabinol (THC) vaping concentrates or oils, which were all purchased on the street. Three of the patients also used nicotine-containing e-cigarettes, and two of the patients smoked marijuana or conventional cigarettes, although none used other illicit drugs. All five patients were hospitalized for hypoxemic respiratory failure; three required intensive care for acute respiratory distress syndrome, one of whom required intubation and mechanical ventilation. All of the patients survived.


Assuntos
Surtos de Doenças , Pneumonia Lipoide/epidemiologia , Vaping/efeitos adversos , Doença Aguda , Adolescente , Adulto , Humanos , North Carolina/epidemiologia , Adulto Jovem
16.
Rev Bras Parasitol Vet ; 28(3): 518-521, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31482939

RESUMO

The objective of this study was to report an outbreak of human toxoplasmosis at a research institution in Londrina, Paraná, from December 2015 to February 2016. Blood samples from 26 symptomatic individuals were collected and the microparticle chemiluminescence immunoassay was performed to detect IgM, IgG and specific IgG avidity test in the official laboratory. A total of 20 people with symptoms and serology compatible with acute toxoplasmosis (IgM positive and IgG with low avidity) were selected as cases, while 45 asymptomatic employees working in the same teams and during the same shifts were selected as controls. All the participants of the investigation answered an epidemiological questionnaire. Three samples of water and one sludge from the institution's supply cisterns, 10 soil samples, 11 plant samples, three cat fecal samples and one domestic feline cadaver were collected for analysis of the polymerase chain reaction (PCR) for T. gondii. After analyzing the epidemiological data, the consumption of vegetables in the restaurant of the institution was the only variable associated with the occurrence of the disease. In laboratory results, all the samples showed negative results to PCR. The rapid recognition of the outbreak, early notification and investigation could have broken the chain of transmission early, thus preventing the emergence of new cases. In addition, the adoption of good food handling practices could have prevented the occurrence of the outbreak.


Assuntos
Anticorpos Antiprotozoários/sangue , Surtos de Doenças , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Toxoplasma/imunologia , Toxoplasmose/epidemiologia , Adulto , Idoso , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Gatos , Feminino , Humanos , Imunoensaio , Luminescência , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
MMWR Morb Mortal Wkly Rep ; 68(31): 673-678, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31393865

RESUMO

Arthropodborne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the continental United States (1). Other arboviruses, including eastern equine encephalitis, Jamestown Canyon, La Crosse, Powassan, and St. Louis encephalitis viruses, cause sporadic cases of disease and occasional outbreaks. This report summarizes surveillance data reported to CDC for 2018 on nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses because they are primarily nondomestic viruses typically acquired through travel. In 2018, 48 states and the District of Columbia (DC) reported 2,813 cases of domestic arboviral disease, including 2,647 (94%) WNV disease cases. Of the WNV disease cases, 1,658 (63%) were classified as neuroinvasive disease (e.g., meningitis, encephalitis, and acute flaccid paralysis), for a national incidence of 0.51 cases of WNV neuroinvasive disease per 100,000 population. Because arboviral diseases continue to cause serious illness and have no definitive treatment, maintaining surveillance is important to direct and promote prevention activities. Health care providers should consider arboviral infections in patients with aseptic meningitis or encephalitis, perform appropriate diagnostic testing, and report cases to public health authorities.


Assuntos
Infecções por Arbovirus/epidemiologia , Surtos de Doenças , Vigilância da População , Febre do Nilo Ocidental/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Notificação de Doenças , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
20.
Rev Soc Bras Med Trop ; 52: e20180199, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390441

RESUMO

INTRODUCTION: The Jirau hydroelectric power plant built in Rondônia state has environmental impacts that could be relevant to rabies outbreaks. METHODS: Bat populations were monitored for rabies by fluorescent antibody testing and simplified fluorescent inhibition microtesting between 2010 and 2015. RESULTS: All 1,183 bats tested negative for rabies. The prevalence of rabies antibodies was 17.5% in 1,049 bats. CONCLUSIONS: The rabies antibody dosage was not reactive in samples collected before the environmental changes, and there was a progressive increase in subsequent collections that could indicate an increase in rabies virus circulation among bats and risk of a rabies outbreak.


Assuntos
Quirópteros/virologia , Vírus da Raiva/isolamento & purificação , Raiva/veterinária , Animais , Anticorpos Antivirais/isolamento & purificação , Brasil/epidemiologia , Surtos de Doenças , Imunofluorescência/métodos , Raiva/epidemiologia , Raiva/virologia , Vírus da Raiva/imunologia , Estudos Soroepidemiológicos , Fatores de Tempo
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