Should Varicella Vaccination Be Included in the National Childhood Vaccination Program?

The purpose of vaccination is firstly to protect individuals from infectious diseases and secondly to control, eliminate, and if possible, eradicate diseases. Vaccination is the most effective, safe and economic healthcare intervention. Chickenpox is known as a self-limited disease usually occurring in childhood. However, it may cause serious complications and mortality with increasing age. The most common complications are secondary bacterial infections, pneumonia, arthritis, osteomyelitis, cerebellar ataxia, meningitis, meningoencephalitis, and vasculopathy. Since 1995, varicella vaccination has been recommended for routine use in the United States of America (USA), and a dramatic decrease (approximately 75%) in the incidence of the disease was detected. A reduction in hospitalizations by 75-80% was also reported. Varicella-related deaths decreased by 75-92% in children and by 74% in adults. Although varicella vaccination has been included in childhood vaccination programs in Australia, Canada, Germany, Greece, Qatar, Republic of Korea, Saudi Arabia, Taiwan, USA, Uruguay, and Lithuania, and in some parts of Italy and Spain, it has not yet been included in the childhood vaccination program in our country. In this report, views about inclusion of the varicella vaccination into the national childhood vaccination program are discussed together with various seroepidemiologic data and a cost analysis

Tüberküloz meninjitte beyin-omirilik sıvısında adenozin deaminaz aktivitesi

überküloz meninjit; tüberkülozun en ağır klinik şeklidir. Mortalite ve sekel oranlarının yüksek olması nedeniyle hastalığın erken tanı ve tedavisi çok önemlidir. Tüberküloz meninjit tanısında hızlı sonuç veren ve duyarlılığı yüksek testlere gereksinim vardır. Bu amaçla, bu çalışmada; tüberküloz meninjitli olguların beyin-omurilik sıvısı (BOS)'nda Adenozin Deaminaz (ADA) aktivitesi ölçümünün tanıya katkısı değerlendirildi. Çalışmaya 20 tüberküloz meninjit öntanılı olgu ve 20 kontrol olgusu alındı. Beyin-omurilik sıvısı ADA aktivitesi bu iki grupta sırasıyla 16.02 + 10.95 U/L ve 2.30 + 1.27 U/L olarak saptandı. Tüberküloz meninjit öntanılı grupta BOS ADA aktivitesi kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (p= 0.000). Farklı cut-off değerlerine göre BOS ADA düzeylerinin özgüllüğü ve duyarlılığı hesaplandı. Sonuç olarak; BOS'ta ADA ölçümünün, tüberküloz meninjitin ayırıcı tanısında destekleyici bir test olduğu saptandı.uberculous meningitis is the most severe form of tuberculosis. Because of high morbidity and mortality rates, early diagnosis and treatment are very important. For diagnosis of tuberculous meningitis there is requirement for rapid laboratory tests with high sensitivity. For this purpose, in this study the contribution of cerebrospinal fluid (CSF) Adenosine Deaminase (ADA) activity measurement to the diagnosis of tuberculous meningitis was evaluated. Twenty suspected tuberculous meningitis cases and 20 control cases were taken into the study. Cerebrospinal fluid ADA measurements were 16.02 + 10.95 U/L and 2.30 + 1.27 U/L in these two groups, respectively. In the suspected tuberculous meningitis group CSF ADA activity was significantly higher than the control group (p= 0.000). Specifity and sensitivity of the CSF ADA levels were calculated for different cut-off values. As conclusion, measurement of CSF ADA activity was found to be helpful in the diagnosis of tuberculous meningitis

Cost Analysis of Ertapenem Therapy for Urinary Tract Infections and Assessment of Its Suitability for Outpatient Parenteral Antibiotic Therapy Programme in Turkey

Introduction: The primary aim of this study was to evaluate whether there was a difference between outpatient parenteral antibiotic therapy (OPAT) and inpatient parenteral antibiotic therapy (IPAT) costs of ertapenem for urinary tract infections (UTI"s) due to extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli, and to discuss suitability of ertapenem for OPAT programme of Turkey for the near future. Materials and Methods: A total of 53 patients hospitalized with the diagnosis of UTI and treated with ertapenem were retrospectively evaluated. The cost of ertapenem treatment as IPAT was actual costs retrieved from the hospital records. The estimated cost of the same antibiotic for the same patients as an OPAT programme was then calculated and the costs were compared. Results: The cost difference between IPAT and OPAT was 12.305 (€ 5783). Outpatient parenteral antibiotic therapy programme would provide an estimated 20% reduction in treatment costs. The estimated number of bed days saved, if the patients had received the treatment as OPAT, was calculated to be 583 days, which constitutes about 5% of the total number of hospitalization days. Conclusion: Applying ertapenem therapy through OPAT programme for UTIs caused by ESBL-producing Gram-negative bacilli will decrease the financial burden of health expenditures and the number of inpatient bed days in Turkey

Empirical cefepime plus vancomycin versus ceftazidime plus vancomycin versus meropenem plus vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study

Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM).Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018.Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34).Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci

Two Cases of Travel-Related Acute Hepatitis E

Hepatitis E virus (HEV) infection is an acute viral hepatitis that is transmitted primarily by the fecal-oral route. The highest incidence of HEV infection is in Asia, Africa, the Middle East, and Central America, and HEV is the second most common cause of sporadic hepatitis in North Africa and the Middle East. In western countries, although sporadic cases are limited to visitors who traveled to areas of the world in which the infection is endemic, cases unassociated with travel are also reported. In this article, we describe acute viral hepatitis E diagnosed in two travelers from a nonendemic region, Australia, in whom the transmission of the infection was related to their travel to an endemic region. The couple, each aged 52 years, admitted to the hospital with the complaint of jaundice. On the physical examination, both patients appeared well, except for subicteric sclerae and skin. Alanine aminotransferase (ALT) was 2992 U/L and 1849 U/L in the male and female patient, respectively. They had a history of travel to India approximately three months before admission, and no other risk factor was found. HBsAg and anti-HAV IgM, anti-HCV, and anti-HBc IgM and IgG antibodies were negative, while anti-HEV IgM and anti-HEV IgG antibodies were positive in both patients. At the third week, ALT had decreased to 143 U/L and 100 U/L in the male and female patient, respectively, and both were discharged. These cases are presented to highlight the importance of medical history regarding travel in patients with acute viral hepatitis

Management of Chronic Hepatitis B in Pregnancy: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases set up a task force to develop a consensus report focused on chronic hepatitis B in pregnancy, a complex issue for both the mother with an advanced liver disease and the unborn child who is under the risk of hepatitis B virus (HBV) transmission. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented in the report. An algorithm adapted from actual publications is also proposed for management of chronic hepatitis B in the pregnant patient. Since many women of childbearing age are in the immune tolerant phase of infection, there is generally no need for therapy and no indication to start therapy during the early stages of pregnancy. Initiation of antiviral therapy in the beginning of the third trimester in highly viremic (HBV DNA > 200 000 IU/mL) pregnant women can prevent mother-to-child-transmission of HBV despite postnatal passive and active immunoprophylaxis provided. Given its potency and its high genetic barrier to resistance, tenofovir might be an appropriate option for mothers who might need to continue their treatment for active hepatitis B after delivery