No abstract

In 2010, 47 human cases of West Nile virus (WNV) infection, including 12 laboratory-confirmed and 35 probable cases, were identified in Turkey. These were the first cases detected during routine surveillance. The patients were from 15 provinces, mainly located in the western part of the country. Incidence was 0.19/100,000 with a maximum of 1.39 in Sakarya province. Forty of the total 47 cases showed neuroinvasive manifestation. Median age was 58 years with a range of four to 86. Ten of the patients died. Enhanced surveillance in humans and animals and mosquito control measures were implemented. The WNV infections were included in the national notifiable diseases list as of April 2011. In 2011, three probable and two confirmed cases of WNV infection were diagnosed in provinces where infections had been detected in the previous year, supporting a lower activity than 2010. However, detection of WNV infections in humans in 2010 and 2011 consecutively, may indicate that WNV has become endemic in the western part of Turkey. Field epidemiological studies were undertaken to understand more about the nature of infection in Turkey.

Background: In Turkey, newborns have been vaccinated for hepatitis B at birth, one, and six months of age since 1998. Objectives: The current study aimed at determining the seroprevalence of hepatitis B in pre-and post-vaccination periods in the population above two years of age in Manisa province during year 2014 and to evaluate the relationship between being vaccinated and infected with some social determinants of health. Methods: A total of 1230 people were randomly selected from the general population over two years of age. The presence of hepatitis B surface antigen (HBsAg), HBs antibody (anti-HBs), and hepatitis B core antibody was detected using commercial kits. The dependent variables were being vaccinated or infected, and the independent variables were gender, age, education level, occupational class, annual per capita equivalent income, perceived income, household density, and place of residence. Results: The percentage of participants with a seronegative, vaccinated or infected serologic profile was 50.8%, 28.0%, and 21.2%, respectively. Among participants vaccinated in the national immunization program, 0.6% were positive for HBsAg and 75.1% for anti-HBs only, whereas 22% were seronegative. In the vaccinated group, there was a statistically significant association between living in the village (OR: 3.13 %95 CI 1.49 to 6.58) or rural districts (OR 4.46 %95 CI 1.97 to 10.08) during childhood, having low income (OR: 1.78, 95% CI 1.05 to 3.01) and being vaccinated. In the unvaccinated group, people with low income were less likely to be vaccinated (OR = 0.56, 0.34 to 0.91); individuals, who lived in rural districts during childhood were 2.13 times (95% CI 1.01 to 4.51) more likely to be vaccinated for hepatitis B than individuals, who lived in a city or abroad. There was also an association between being male (OR: 1.40, 95% CI 1.03 to 1.92), living in a village (OR: 0.50, 95% CI 0.33 to 0.75) or rural district (OR: 0.64, 95% CI 0.42 to 0.97) during childhood and being infected. Conclusions: In this study, up-to-date data on the seroepidemiology of hepatitis B was obtained in a sample representing the community. The researchers concluded that routine hepatitis B vaccination initiated 16 years ago induced high levels of immunity in the great majority of the population aged < 22 years old living in Manisa.

Manisa ‹lindeki aile hekimli¤i birimlerinde 2011 y›l›nda sunulan hizmetler ve kay›tl› nüfusun say›sal olarak de¤erlendirilmesi; bölge ve ülke verisiyle karfl›laflt›r›lmas›; kay›tl› hizmetlere göre ifl yükünün incelenmesi ve ideal birim hizmet süreleri göz önüne al›narak gereken aile hekimi say›s›n›n belirlenmesidir. Yöntem: Araflt›rma, 2012 y›l›nda yürütülmüfl kesitsel bir çal›flma-d›r. Aile hekimleri ve hizmetlerine yönelik veri Manisa-AHBS'den derlenmifl; sayma ve karar verme arayüzleri için php-Oracle ortam-lar› kullan›lm›flt›r. Y›ll›k ifl yükü ve ifl gücü a盤›, her hizmet türü için Bakanl›k veya araflt›rmac› taraf›ndan belirlenen süre ile y›ll›k fiili ça-l›flma süresi dikkate al›narak hesaplanm›flt›r. Tan›mlay›c› istatistikler yüzde ve aritmetik ortalama±standart sapma olarak verilmifltir. Çözümlemede SPSS for Windows 15.0 program›ndan yararlan›l-m›flt›r. Verilerin analizinde ki-kare ve ba¤›ms›z gruplarda t testi kul-lan›lm›flt›r. Bulgular: Aile hekimlerinin (n=378) %74.9'u erkek, yafl ortalamas› 44.5±5.7'dir. Aile sa¤l›¤› merkezlerinin (n=154) %53.2'si, hekimlerinin %28.8'i k›rsal bölgededir. Aile hekimlerinin %51.9'u, nüfusun %18.4'ünü oluflturan gezici nüfusa (n=242.402) hizmet sunmakta-d›r. Aile hekimlerinin ortalama nüfusu 3486.6±465.9; bebek say›s› 47.1±18.2; 15-49 yafl kad›n 915.4±176.4; 65 yafl ve üzeri nüfusu 324.2±116.6'd›r. Aile hekimlerinin 2011'de sundu¤u hizmetlerin (n=6.272.831) %56.1'i poliklinik, %24.0'ü laboratuvar+poliklinik, %7.1'i afl›lama, %12.8'i izlemlerdir. Aile hekimi bafl›na ortalama günlük poliklinik say›s› 60.2, afl›lama 5.4, bebek izlem 1.4, çocuk izlem 1.6, gebe izlem 1.3, kad›n/aile planlamas› izlem 4.3, lohusa izlem 0.4, obezite izlem 0.7'dir. Manisa'da gebeler 5.1, bebekler 6.9; 1-5 yafl çocuklar 1.5; lohusalar 1.6; 15-49 yafl kad›nlar 1.0 ortalama ile aile hekimleri taraf›ndan izlenmifllerdir. Kifli bafl›na y›ll›k ortalama poliklinik say›s› 4.3'tür. Nüfusun %75.7'si poliklinik hizmetinden ya-rarlanm›flt›r. Yararlananlar›n %40.0'› 1-5 kere hizmet alm›flt›r. Y›ll›k poliklinik ortalamalar› 0 yaflta 3.2; 65 yafl ve üzerinde 7.4'tür. Üretilen hizmete göre, ilde bulunmas› gereken aile hekimi say›s› 446 olarak belirlenmifltir. Sonuç: AH'lerinin iflyükünün %80'ini poliklinik hizmetleri olufltur-maktad›r. Bu oran %76.8'lik KDS 2011 Türkiye ve %70'lik Birleflik Krall›k 2006/2007 iflyükü araflt›rmas› verisinden yüksektir. Manisa'daki AH'leri günlük ortalama 60 baflvuruyu karfl›lamakta olup; Birleflik Krall›k'ta bu say› 35'tir. AH'lerinin kay›tl› nüfus plan-lanmas›nda hizmete en çok ihtiyaç duyan gruplar dikkate al›nma-l›d›r. Yöneylem çal›flmalar› için aile sa¤l›¤› personelinin de dahil edildi¤i çal›flana özel iflyükü ve performans de¤erlendirilmelerine ihtiyaç duyulmaktad›r.

Vaccination is the most effective way of preventing pertussis disease. Turkey commenced a routine infant immunization program using whole cell (wP) pertussis vaccine in 1968. Immunization accelerated in 1985 after participation of Turkey in the Expanded Programme on Immunization initiated by the World Health Organization. Acellular vaccine (aP) replaced wP in 2008 and a booster was added to age 6 in 2010. The immunization programme was successful in reducing the morbidity rate from 20.58 per 100.000 in 1970 to the lowest level of 0.01 per 100.000 in 2009. However, reduction of vaccine-induced protection and reduced natural boosting of circulating Bordetella pertussis are likely to increase the susceptibility of the population. As a result, morbidity rate increased from 0.09 per 100.000 to 0.41 per 100.000 in 2015 compared to the previous year. The aim of this epidemiological study was to determine the seroprevalence of pertussis toxin (PT) antibodies among healthy people and its association with various social determinants in Manisa province in Turkey, 6 years after aP replaced wP vaccine. The study was conducted as a cross-sectional study with a sample of 1250 people that was randomly selected from the over 2 years of age population in Manisa in 2014. Seroprevalence of PT antibody was determined as the dependent variable of the study. Independent variables of the study were; gender, age, migration in the last 5 years, occupational class, perceived income, house ownership, number of people per room, annually per capita equivalent income. The presence of anti-PT IgG was detected by quantitatively using a commercially available ELISA kit. The antibody levels were categorized into groups according to pertussis infection or vaccination immune response status. The groups consisted of undetectable (< 5 IU/ml), mid-range (5-< 62.5 IU/ml: more than one year previously), high (62.5-< 125: with in 12 months) and very high (≥ 125 IU/ml: with in 6 months) antibody levels. The test results with ≥ 5 IU/ml were defined as seropositive. Level > 100 IU/ml detected among adolescent and adult participants indicated acute or recently recovered pertussis infection. Chi-square test was used to evaluate association between social determinants and pertussis seropositivity. The seroprevalence of the whole study population was 58.1% (95% CI 55.32-60.79) and no association was found with any of the social determinants. The highest seroprevalence was found among 2-9 age group (68.3%) followed by 70-79 age group (63.5%). The lowest seroprevalence was found among 20-29 age group (50.9%) followed by 10-19 age group (51.6%). When seropositivity levels according to ages were compared, it was found that there was a decrease one year after the first vaccination at 2nd, 4th and 6th months and the booster at the 6th year, with a lowest rate (19%) in 11 year-old. The highest seropositivity (77.3%) with a level of >100 IU/ml (13.6%) were detected at age 15 among all adolescent and adult participants. Adding an adolescent booster to immunization schedu...