Teses em Doenças Tropicais (Doutorado) - PPGDT/NMT
URI Permanente para esta coleçãohttps://repositorio.ufpa.br/handle/2011/3560
O Doutorado Acadêmico em Doenças Tropicais iniciou em 2007 e pertence ao Programa de Pós-Graduação em Doenças Tropicais do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA).
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Item Acesso aberto (Open Access) Análise do dano neural em pacientes hansenianos e na coinfecção HIV/ Hanseníase através de duas coortes clínicas(Universidade Federal do Pará, 2013) BATISTA, Keila de Nazaré Madureira; XAVIER, Marília Brasil; http://lattes.cnpq.br/0548879430701901In Brazil where leprosy is endemic and where HIV infection continues to expand and internalizing, if expected to find an increased prevalence of individuals living with both leprosy and HIV / AIDS, but there are few reports on the neurological damage that can cause overlapping. The aim of this study was to investigate nerve damage in leprosy leprosy patients coinfected with human immunodeficiency virus, compared with leprosy coinfected not at the beginning of treatment and at discharge, through two clinical cohorts. The sample consisted of 99 patients of whom 46 had coinfection MH / HIV and only 53 leprosy, these patients were seen at the outpatient clinic of the Center for Tropical Medicine and evaluated by the Simplified Technique. As a result there was a predominance of males, aged between 15 and 45 and the origin of the Metropolitan Region of Belém In group coinfection MH / HIV were prevalent in these paucibacillary patients and the presence of neuritis , abnormal sensitivity , motor abnormalities, presence of disability and neural damage was higher in this group than in the MH. In group predominated MH multibacillary patients and the presence of these neuritis, abnormal sensitivity, motor abnormalities, presence of disability and nerve damage was higher in this group than in coinfected MH / HIV. Monitoring of patients coinfected MH / HIV there was a small reduction in the presence of failure and nerve damage while in the MH group monitoring the presence of disability remained increased and nerve damage. In the Kaplan-Meier survival analysis was found that in patients MH was maintaining the chance of the patient remains without nerve damage, while in the coinfected patients group, was observed a reduction in the chance of the patient to keep without nerve damage the end of treatment. Thus it is concluded that the neural damage behaves differently in the two groups manner, predominantly in the paucibacillary group coinfected patients coinfected and not in multibacillary patients, but with the same gravity, which is troubling since diagnosing this damage at the beginning of the appearance of leprosy is still a problem for public health.Item Acesso aberto (Open Access) Análise molecular dos genes VP4, VP7 e NSP4 de rotavírus do tipo G1 circulantes em Belém e Marituba, Pará, Brasil, de 1982 a 2008(Universidade Federal do Pará, 2011) SOARES, Luana da Silva; MASCARENHAS, Joana D'Arc Pereira; http://lattes.cnpq.br/5156164089432435; LINHARES, Alexandre da Costa; http://lattes.cnpq.br/3316632173870389Rotaviruses are major viral agents of acute gastroenteritis and responsible for 36% of hospitalization for diarrhea among children less than five years of age, resulting in 453.000 deaths annually, mostly in developing countries. Rotavirus is a member of Reoviridae family, and its genome consists of 11 double-stranded RNA (dsRNA) which encode 12 proteins. G1 rotavirus is commonly detected in epidemiological investigations, occurring under different prevalence rates. The aim of this study was to analyze the VP4, VP7 and NSP4 diversity genetic of G1 rotavirus circulating in Belém and Marituba, Pará, Brazil, from 1982 to 2008. We selected 83 samples previously characterized as G1 type and submitted to RT-PCR. The samples were from seven studies conducted in IEC. It was possible amplification for 63 (75.9%) specimens. Lineages 1 (8/63, 12.7%), 2 (29/63, 46.0%), 3 (18/63, 28.6%) and 9 (8/63, 12.7%) of VP7 gene were detected. The sublineages 2E and 3A were co-predominant detected in 57.1% (36/63) of samples. Three amino acid substitutions (97 [D→E], 147 [S→N] and 218 [I→V]) were observed in VP7 antigenic regions (A, B and C) in samples of 1, 2 and 9 lineages. All samples showed P[8] specificity for VP4 gene and lineages 2 (21/63, 33.3%) and 3 (42/63, 66.7%) were detected. Two substitutions (35 [I→V] and 38 [S→G]) occurred in antigenic region of VP4 of samples analyzed. For NSP4 gene, all samples belonged to E1 type. Phylogenetic analysis of NSP4 gene revealed that occurred changes in nucleotide positions 47 (C→T) and 101 (T→C), resulting in amino acid substitutions at positions 16 (S→P) and 34 (L → P) in all samples and 9 specimens displayed amino acid substitution in NSP4 toxicity residue (aa 131). This study allowed us to broaden our understanding about genetic diversity and circulation of G1 variants and represents the first molecular epidemiology analyze of this genotype in Brazil corroborating the high heterogeneity of this genotype.Item Acesso aberto (Open Access) Avaliação imunohistoquímica da densidade de vasos e expressão de moléculas de adesão celular da microvasculatura de lesões na doença de Jorge Lobo(Universidade Federal do Pará, 2013-03-27) BRITO, Maysa de Vasconcelos; QUARESMA, Juarez Antônio Simões; http://lattes.cnpq.br/3350166863853054Jorge Lobo's disease is a rare mycosis of chronic inflammation that causes injury to the skin without visceral dissemination. This disease is caused by the fungus Lacazia loboi. Its occurrence is prevalent in regions of hot and humid, with most cases reported in the Brazilian Amazon region. The histopathological findings showed lots of fungi at the site of injury, with a rich macrophages infiltrate with giant cells and limited presence of lymphocytes. The migration of leukocytes to the inflammatory site induced Lacazia loboi is supposedly co-ordinated by cytokines and chemokines that aided by blood and lymph vessels influence cell migration inducing the expression of adhesion molecules. In this paper we investigate possible microvascular changes associated with infection by Lacazia loboi at the site of injury that may interfere with the clinical evolution of patients. Therefore, we assessed the density of blood vessels and lymphatic vessels, as well as expression of molecules ICAM-1, VCAM-1 and E-selectin. Our results showed that in Jorge Lobo's disease, there is a reduced amount of blood and lymph vessels, when compared to control skin. There was a larger number of vessels expressing ICAM-1, being also higher number of vessels expressing the molecule VCAM-1, although in much less prominent ICAM-1. There were no differences in the expression of E-selectin. Together the results point to a change in the local microvasculature which may interfere with the development of an effective cellular immune response and justify the presence of the fungus confined to the injury site.Item Acesso aberto (Open Access) Caracterização da resposta imune citocínica na infecção humana pelo vírus oropouche e sua relação com o padrão de soroconversão e a presença de sintomas(Universidade Federal do Pará, 2011-12-19) OLIVEIRA, Euzébio de; VASCONCELOS, Pedro Fernando da Costa; http://lattes.cnpq.br/0973550817356564This thesis is the first global study that researches and analyzes the immune response of cytokine in human infections by Orthobunyavirus Oropuche virus. The study used 320 samples of human serum. Sixty were from the Blood Bank (negative control) and 260 were obtained from two outbreaks of the Oropouche virus in the State of Pará and Amapá (Brazil). The latter was divided into 8 subgroups for better data accuracy. The collected samples were analyzed for clinical data/symptoms with serologic testing by titration of antibodies by the hemagglutination inhibition (IgM/IgG) and the detection cytokines plasma levels by flow cytometry. This allowed for the technical description of cytokine. The data obtained allowed for the observation of the characteristics and the behavior of the cytokines signatures expressed by patients by the presence or not of the virus. This also allowed for the observation of changes to serum through the presence of specific symptoms such as fever, chills, headache and dizziness. This led to the following conclusions a) there is a pattern in the synthesis of pro-inflammatory and regulatory cytokines; b) there is a balance in the profile of the immune response between pro-inflammatory cytokines (Th1) and modulators (Th17); c) an infection by the Oropouche virus alters the production of cytokines in individuals; d) the results also show that whem comparing individuals no responders with early responders, there was an increase of IL-1β and decreased IL- 12; no responders with late responders, there was a decrease of IL-8, and increased IFN-α, IL-23 and IL-17; No responders occurred early responders compared with the increase IL-4 and IFN-g; However, when compared early responders and late responders, decreased IFN-α and IL-6; early responders generally showed a decrease in IL-10 and late responders showed an increase in IL-5; e) The results also show the expression of IL-5 in patients who showed symptoms specific for Oropouche infection (fever, chills, headache and dizziness), suggesting this signal to be directly associated with pathogenesis of the virus; f) there is a need to complement this research with more studies such as those related to the expression of chemokines.Item Acesso aberto (Open Access) Caracterização genética de micobactérias não tuberculosas isoladas de espécimes clínicos pulmonares no estado do Pará(Universidade Federal do Pará, 2012-11-29) COSTA, Ana Roberta Fusco da; LIMA, Karla Valéria Batista; http://lattes.cnpq.br/9795461154139260In recent years have been seen increased reports of nontuberculous mycobacteria (NTM) infections in the world. However, data on frequency and NTM species associated with pulmonary infections are still limited in Brazil, especially in states of Northern Brazil. The knowledge of species associated with NTM lung infections has clinical and epidemiological importance, being molecular techniques efficient tools to provide diagnostic species-specific, which is necessary for choice of appropriate therapy. This study describes the diversity of NTM isolated from respiratory specimens at the Evandro Chagas Institute between 1999 and 2011. The NTM were initially characterized by PCR-restriction analysis (PRA-hsp65) and reidentificated by sequencing of 16S rRNA, hsp65, rpoB and ITS1 targets. According to ours findings, the PRA-hsp65 method proved to be a convenient tool for identifying NTM, allowing distinction of a variety of species quickly, simply and inexpensively, as compared to the sequencing. Moreover, as suggested in this study, according to local species diversity, this method can be subject to modifications to provide greater discriminatory power. Sequence analysis of the rpoB gene of Mycobacterium avium complex (MAC) revealed that this target is not a suitable alternative for discrimination of isolates from State of Para, because it generated discrepant results with low taxonomic resolution. M. chelonae, M. avium and M. simiae complexes were the most frequent NTM. Two potential species were detected, M. paraensis sp. nov. and M. amazoniensis sp. nov., being proposed as new members of the M. simiae complex. Among the patients with NTM disease, the main characteristics found were women older than 50 years, pardo ethnic group and previous tuberculosis. Although this study does not show the real magnitude of NTM lung infections in State of Para, it describes the diversity of species and clearly reveals the importance of this group in the region, which has accounted 13.5% of mycobacterial isolates in a reference laboratory. The findings highlight the need for bacteriological confirmation of cases presumptively diagnosed as TB with primary resistance to therapy for TB.Item Acesso aberto (Open Access) Correlação entre o câncer bucal e de laringe e a presença do Papilomavírus Humano (HPV) e do vírus Epstein-Barr (EBV) no estado do Pará(Universidade Federal do Pará, 2013) ARAÚJO, Marizeli Viana de Aragão; FUZII, Hellen Thais; http://lattes.cnpq.br/0026958665547973; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539The oral and laryngeal cancer represents a growing public health problem in Brazil. Smoking and alcohol are the main causes of oral cancer and larynx, but a part of the population develops the disease without being exposed to these risk factors, suggesting the existence of other causes such as genetic predisposition, alteration of tumor suppressor genes, diet and viral agents, particularly human papillomavirus (HPV) and Epstein-Barr virus (EBV). The proposition of this study was to verify prevalence of HPV and EBV in normal oral mucosa, cancer of oral cavity and larynx, and what types are most prevalent in these two situations. For this study we established two groups: one consisting of 70 specimens embedded in paraffin, with a confirmed diagnosis of oral and larynx cancer and other with 166 individuals without lesions in the oral cavity. Laboratory analysis for the viral detection and typing HPV and EBV (EBV type 1 or 2) were performed by conventional PCR (Polymerase Chain Reaction). The typing of samples positive for HPV types (6, 11, 16, 18, 33, 35, 38, 52 and 58) was performed by real time PCR using probes specific for each type. The EBV and HPV prevalence found in the oral and laryngeal cancers was 78.6% for HPV and 84.3% for EBV and 24.1% and 45.8% for EBV and HPV, respectively, in individuals without oral lesions. The most prevalent HPV types were HPV 58 (50.9%), HPV 6 (9.1%) and HPV 16 (9.1%) in cancer group and HPV 18 (12.5%), HPV 6 (7.5 %) and HPV 58 (2.5%) in the group with no lesions. The EBV 2 was more prevalent in both the cancer lesions than subjects without lesions, with a frequency of 94.9% and 82.9%, respectively. There was no association of HPV infection with EBV and sex, the prevalence being similar for men and women. Association was observed between the prevalence of HPV and EBV and its co-infections with the group that developed cancer. The prevalence of HPV and EBV and the odds ratio in the occurrence of cancer was 8.86 (p <0.0001) in individuals infected with HPV and 4.08 (p = 0.0004) in patients infected by EBV. The probability value estimated for prevalence of HPV and EBV co-infection and the occurrence of cancer has shown that individuals infected by both viruses have 65.72% likelihood of developing cancer, while infected with HPV has 31.94% and infected with EBV 17.79%. The results of this study may suggest that viral agents (HPV and EBV) are important risk factors for the development of carcinogenesis, and HPV is more effective than EBV in triggering the disease.Item Acesso aberto (Open Access) Detecção, epidemiologia e análise molecular de rotavírus, picobirnavírus e reovírus em aves de corte criadas em granjas na mesorregião metropolitana de Belém, Pará, Brasil(Universidade Federal do Pará, 2012-08-29) SILVA, René Ribeiro da; SILVA, Artur Luiz da Costa da; http://lattes.cnpq.br/7642043789034070; MASCARENHAS, Joana D'Arc Pereira; http://lattes.cnpq.br/5156164089432435This study aimed to investigate the occurrence of avian rotavirus (AvRV), picobirnavirus (PBV) and avian reovirus (ARV) in chickens raised on farms located in the Metropolitan mesoregion of Belém, Pará state, in the period of 2008 to 2011. For this purpose, 85 pools of fecal samples were collected from 37 farms belonging to eight counties. Viral RNA was extracted from fecal suspensions and subjected to polyacrylamide gel electrophoresis (PAGE) followed by RT-PCR. At least one sample was selected of each municipality wich positive result for nucleotide sequencing of the genes NSP4 (AvRV), RdRp (PBV) and S2 (ARV), and in the case of the PBV samples were cloned before sequencing. PAGE showed positive in 0/85 (0%) samples for AvRV group A, 13/85 (15.3%) samples for PBV and 01/85 (1.2%) samples for ARV. In the case of RT-PCR positive results was observed in 35/85 (41.2%), 42/85 (49.4%) and 28/85 (32.9%) of the samples for AvRV, ARV and PBV, respectively. Of the eight counties studied, seven showed positivity to PBV, and six for AvRV and ARV. Of the 37 farms studied the presence of these viral infections was observed in 19 (51.4%) to AvRV and ARV and 21 (56.8%) to PBV. NSP4 gene sequences had a similarity between 86.3 and 90.5% at the nucleotide level (nt) with prototypes from chicken and 93.5 and 100% similarity at the nt level when compared among them. RdRp sequences showed a high genetic heterogeneity with gene variants resulting between 56.1 and 100% similarity at the nt level with prototypes belonging to different species and sources of contamination and between 50.3 and 100% similarity at nt level when compared among them. S2 gene sequences analysis showed between 90.9 and 94.4% similarity at the nt level with chicken prototypes and 90.1 and 100% similarity at the nt level when compared each other. AvRV, ARV and PBV were detected in broiler farms of the Metropolitan mesoregion of Belém, being the detection by RT-PCR more efficient to detect at least one type of virus in the eight counties surveyed. Except for the PBV, which showed heterogeneous relationship with the prototypes used, the AvRV and ARV of this study related specifically to the samples obtained in birds. This is the first study involving the genomic sequencing of the AvRV, ARV and PBV in broilers in northern Brazil.Item Acesso aberto (Open Access) Epidemiologia espacial e sorológica da hanseníase no estado do Pará(Universidade Federal do Pará, 2013) BARRETO, Josafá Gonçalves; KITRON, Uriel; http://lattes.cnpq.br/4693583802608442; SALGADO, Claudio Guedes; http://lattes.cnpq.br/2310734509396125Leprosy remains a severe public health problem in the State of Pará, Brazil. Over 80,000 cases were detected during the last 20 years in Pará, and currently, the annual case detection rate (50/100,000 inhabitants) is three-fold higher than the Brazilian average. The main objective of this study was to develop a method combining anti-PGL-I serology and spatial epidemiology as a tool for reducing the leprosy disease burden in Pará. An initial cross-sectional survey was conducted in eight municipalities of Pará at the residences of people reported to be affected by leprosy during the last five to six years. A group of researchers with experience treating leprosy patients, including dermatologists, nurses, physical therapists and lab technicians, performed a dermatoneurologic clinical examination and collected blood samples to test for anti-PGL-I IgM in 1,945 household contacts (HHC) of the 531 reported cases. Additionally, 1,592 school children (SC), aged 6-20 years, from 37 randomly selected elementary and secondary public schools underwent the same clinical and serologic evaluation. The residential addresses of reported leprosy cases and the residences of the examined SC were georeferenced to determine the spatial distribution pattern of leprosy. Two years later, based on the previous serological data, we returned to two cities to re-examine the same subjects. To evaluate the significance of geographic information in detecting new cases, we also selected two new public schools located in high-risk areas for leprosy. High-risk areas were determined by the spatial analysis of the distribution of cases in one municipality. During the initial survey, 156 (8%) HHC and 63 (4%) SC were diagnosed as new leprosy cases; 806 (41.4%) HHC and 777 (48.8%) SC tested positive for anti-PGL-I. Spatial analysis of one selected municipality demonstrated heterogeneity in the distribution of leprosy cases, with spatial clusters of high and low detection rates in specific regions of the city (p<0.01). Additionally, 94.7% of the initially examined SC lived within less than 200 meters of a leprosy case registered during the six years prior to this study. During follow-up, the incidence of leprosy was significantly higher among seropositive individuals (22.3%) when compared to seronegative individuals (9.4%) (OR = 2.7; 95%CI = 1.29 – 5.87; p = 0.01); leprosy rates were also significantly higher among dwellers of residences with at least one seropositive subject (17.4%), compared with dwellers of residences with no seropositive subjects (7.4%) (OR = 2.6; 95%CI = 1.18 – 5.91; p = 0.02). Selecting schools located in areas of the city at high-risk of leprosy increased the efficiency of detecting new cases among SC (8.2%) when compared to randomly selected schools (4%) (p = 0.04). The data indicate a high rate of undiagnosed leprosy cases and of subclinical infection with M. leprae in the State of Pará. Anti-PGL-I serology and spatial epidemiology are effective tools to increase the early detection of new cases, and these methods should be used by the municipalities of Pará to help reach leprosy control targets.Item Acesso aberto (Open Access) Fatores interferentes nas estratégias de controle do câncer do colo do útero com ênfase na infecção pelo HPV(Universidade Federal do Pará, 2014) PINHEIRO, Dirce Nascimento; XAVIER, Marília Brasil; http://lattes.cnpq.br/0548879430701901Cervical cancer is one of the serious health public problems in the world and in Brazil. Papanicolau test and health education strategies are tactics to the success of the program for prevention of cervical cancer in public health services. A cross-sectional analytical study aiming to identify and discuss interfering factors in strategies to control cervical cancer , with emphasis on HPV infection , from the perspective of program clients. The study population was formed by 858 women who were attended in public health facilities in two Family Health strategies and three basic Health Units , one of them is the Health Center School, in the city of Belém / PA . Data were collected by means of interviews. Among the factors that affect negatively strategies effectiveness of the respective program are included: client’s profile in age, educational level and family income; service characteristics and program demand type; women knowledge about uterine cervical cancer, cervical intraepithelial neoplasia, HPV virus and anti - hpv vaccine and the use of educational practices by Health Units in this study. It is concluded that interventions in public health organization services can contribute to the effectiveness of these strategies, such as efficient supervision to improve women access in the age groups which most infections prevail by HPV virus and women who delay the annual Pap smear exam. As well as the establishment of educational practices as a permanent organizational resource to raise the level of women knowledge about cervical cancer and HPV virus, Moreover taking effective monitoring of women under annual checkup. After all, get organizational tools in important primary and secondary prevention perspectives for the control of cervical cancer and HPV virus.Item Acesso aberto (Open Access) Interferentes bio-sócio-ambientais na exposição ao mercúrio em crianças ribeirinhas de diferentes regiões da Amazônia(Universidade Federal do Pará, 2011-06-27) AMORAS, Walter Wanderley; SILVEIRA, Luiz Carlos de Lima; http://lattes.cnpq.br/9383834641490219The present study examined possible bio-socio-environmental factors interfering in mercury exposure in children riverside. 103 children participated in the regions of the Tapajos and Acará Rivers and Marajó Island. The type of study was performed cross-sectional analysis. Hair samples were collected for analysis of the Hgtotal levels, blood (hemoglobin and hematocrit analysis) and faeces. Anthropometric indices were used to analyze children's growth. In the evaluation of psychomotor development test was applied modified Denver II screening. The highest average of Hgtotal levels in hair samples of children was in the Tapajós region (5.58 mg / g) and 0.65 g / g in other locations. The prevalence of Hgtotal> 10 mg / g was 25% and 7.5% in São Luiz do Tapajós and Barreiras. Daily consumption of fish by the families of the children as it relates to levels of Hgtotal p (value) was <0.05. The prevalence of breastfeeding duration in the groups of children under 12 months and greater than 6 months for locations in the Tapajos River, when Hgtotal related contents in hair of children with p (value) <0.05. The prevalence of anemia in the Tapajós region was 46.7% and when related to Hgtotal levels p (value) <0.0001. The parasitological tests indicated that 68.3% were multiinfested frequent when related Hgtotal p (value) <0.05. The profile of growth observed through the nutritional indicators status was 82.6% normal weight for age and 14.5% with very low weight and low. Psychomotor performance assessed by the Denver II screening test had changed five children as suspicions of developmental delays. It was concluded that in locations around the gold mining activities riverine children are at risk of mercury contamination. Bio-social- environmental factors interfering in exposure to mercury such as daily consumption of fish, length of breastfeeding, anemia, intestinal parasites showed significant statistical relationships with Hgtotal in the children's hair.Item Acesso aberto (Open Access) Perfil de anticorpos anti-pgl-1 em indivíduos sadios de áreas endêmicas em hanseníase do estado do Pará, método de Elisa(Universidade Federal do Pará, 2012) CUNHA, Maria Heliana Chaves Monteiro da; XAVIER, Marília Brasil; http://lattes.cnpq.br/0548879430701901Item Acesso aberto (Open Access) Soroprevalência para arboviroses humanas de interesse em saúde pública como marcador de impacto ambiental em comunidades ribeirinhas que vivem sob a influência da usina hidrelétrica de Tucuruí-Pará(Universidade Federal do Pará, 2011) BRITO, Mioni Thieli Figueiredo Magalhães de; QUARESMA, Juarez Antônio Simões; http://lattes.cnpq.br/3350166863853054The arboviruses are a major public health problem in Brazil, especially in the Amazon for its ability to cause epidemics with considerable rates of morbidity and mortality in both humans and animals. Four, Virus dengue (VDEN), Virus yellow fever (VYF), Virus Mayaro (VMAY) and Virus Oropouche (VORO) has special relevance for the region, particularly in those environments where environmental impacts are imminent. Studies on the prevalence of antibodies to arboviruses in this region are limited. This study aimed to estimate the prevalence of antibodies to arboviruses of the major public health concern in the communities that live under the influence of the Tucuruí dam in the state of Pará. The study was observational, cross-sectional analytical study carried out in individuals of both sexes, aged over 18, resident at the left and right margin of the lake Tucuruí power plant and from the RDS and Alcobaça Pucurui-ararão. The collection of blood samples and filling in the questionnaire were performed at two different times, flood and ebb of the lake. All samples were analyzed by the Evandro Chagas Institute where they were tested with hemagglutination inhibition for detection of antibodies against 19 types of Arboviruses and MAC-ELISA test for detection of IgM antibodies. Data analysis was descriptive and analytical, are used to calculate odds ratio with confidence interval 95% to determine the association between the study variables and chi-square or Fisher exact test to verify the significance statistical relationships between the variables of the study with an alpha level of 0.05. In all, 635 individuals were studied and the antibodies to arboviruses was significantly associated with sociodemographic characteristics of individuals such as sex, ossupation and residence time in study area. No association was found between the presence of antibodies arboviral and other traits.