EVALUATION OF PCR AND ELISA-IgM RESULTS IN THE LABORATORY DIAGNOSIS OF CRIMEAN-CONGO HAEMORRHAGIC FEVER CASES IN 2008 IN TURKEY

Crimean-Congo hemorrhagic fever (CCHF) is a fatal zoonotic viral haemorrhagic infection described in Africa, Asia, Eastern Europe, and the Middle East. CCHF virus (CCHFV) classified in Bunyaviridae family and Nairovirus genus, is transmitted to humans by tick (Hyalomma and Ixodid) bites and human to human transmission may occur by direct contact with blood or other infected tissues. The disease became endemic and a public health problem since 2002 outbreak in Turkey. The specific laboratory diagnosis and confirmation of the disease is performed in Refik Saydam National Public Health Agency, by using molecular and serological methods. For this purpose serum and/or plasma samples from suspected CCHF patients are submitted to the reference laboratory with an official "possible case report form". According to the algorithm in our laboratory, the first samples which were sent from possible acute cases were searched initially by an in-house real time-polymerase chain reaction (PCR) method and those which were found negative with PCR, were then studied by in-house ELISA method in terms of CCHF-IgM antibodies. In 2008, a total of 4634 samples obtained from 2855 CCHF suspected patients have been examined for the positivity of CCHFV, and 1315 (46%) cases were found to be positive by molecular and/or serologic methods. The aim of this study was to evaluate the results of 726 cases whose at least 2 samples were sent to laboratory, with at least 1 positivity in at least 1 clinical sample with either PCR or IgM ELISA, or both, and with complete informations in possible case report form, during 2008 in Turkey. The positive results were also analyzed according to the starting date of the complaints and the date samples received in order to evaluate the positivity rates of molecular and serological methods with regard to the time. The first serum samples in 94.1% (683/726) of cases were found to be positive with PCR and/or ELISA-IgM methods. PCR positivity was found as 78.1% (5671726), while CCHFV-IgM positivity was detected in 116 (72.9%) in the remaining 159 PCR negative samples. In the first sera, PCR and ELISA results were evaluated in relation to the start of complaints and the date samples received. After the onset of symptoms, PCR positivity was determined as 83.4% in the samples taken in the first 5 days, and reduces to 67.5% in the samples between 6-10 days. The detection rate of CCHFV-IgM increases up to 95% when PCR positivity rate decreases after the 5(th) day. As expected, positivity is determined to be high by PCR in the first days, and ELISA-IgM after the 5(th) day. In conclusion, recording clinical data such as the onset of disease and the date of sample received ensure the accurate evaluation of the disease and the laboratory results are reliably accomplished in a short time

INFLUENZA SURVEILLANCE RESULTS IN 2007-2008 WINTER SEASON IN NINE PROVINCES OF TURKEY

Influenza virus infections constitute a serious public health problem owing to their epidemic and pandemic potential. Turkish Ministry of Health established the national influenza surveillance programme in two institutes to detect the virus types leading to the illness and the efficiency of the seasonal vaccine. Influenza surveillance is performed by Refik Saydam Hygiene Center, National Influenza Laboratory in nine provinces (which are located at central, northeast, south and east parts of Turkey) and by Istanbul University, Medical Faculty, Virology Laboratory in five provinces (which are located at west and northwest parts of Turkey). These two centers are the members of international information networks. The surveillance was aimed to contribute to the detection of influenza viruses with pandemic potential and also to determine the predominant strain circulating in Turkey. During November 2007-May 2008 period a total of 1157 clinical specimens collected from 90 health centers which were the representatives of nine provinces (Ankara, Samsun, Trabzon, Erzurum, Adana, Konya, Diyarbakir, Malatya and Van) were investigated for the presence of influenza virus and other respiratory viruses (Parainfluenza virus types 1-3, Respiratory Synctial Virus and Adenovirus). Samples were identified and subtyped by both molecular (real-time PCR) and cell culture techniques (MDCK and Hep-2). Influenza virus and at least one of the other respiratory viruses were detected in 321 (27.7%) and two different viruses in 16 of the specimens (total= 337). When all the specimens were considered, the most frequently identified virus was influenza A (n= 188, 16.2%), H1N1 being 6.3% and H3N2 9.9%. The rate of identification for influenza B was 7.6% (n= 88), for parainfluenza was 2.3% (n= 27), for adenovirus was 2% (n= 24) and for RSV was 0.9% (n= 10). When only the positive specimens (n= 337) were evaluated, influenza A was again the most frequently (55.7%) encountered virus, H1N1 being 38.8% and H3N2 61.2% of all. Influenza B was in the second rank with 26.1% frequency among the positive specimens. The results showed that influenza activity started around November and ended around May. When the distribution of influenza viruses were analysed according to months, Influenza A H1N1 predominated in January, influenza A H3N2 in December and February. influenza B viruses started to increase in February, and were also detected in May. The 2007-2008 influenza season in Turkey was characterized by moderate clinical activity, and a predominance of influenza A H3N2. These results indicate good match between the vaccine virus strains and the reported virus strains

Monitoring Genetic Diversity of Influenza A(H1N1)pdm09 Virus Circulating during the Post-Pandemic Period in Turkey

WOS: 000322850800007PubMed: 23883840The aimes of the present study were to monitor genetic alterations in the hemagglutin (HA) gene and oseltamivir resistance-related alterations in the neuraminidase (NA) gene of influenza A(H1N1)pdm09 viral isolates detected during the post-pandemic period in Turkey. A total of 2601 clinical specimens obtained from suspected cases of influenza A(H1N1)pdm09 viral infections were analyzed by real-time reverse transcription polymerase chain reaction. Viral RNA was detected in 233 (9%) clinical specimens. Sequence analysis of the HA gene in 16 random isolates showed >98.7% homology among each other and with the A/California/07/2009 vaccine strain. These 16 isolates had common (75%-100%) amino acid substitiutions at positions P83S, D97N, S203T, R205K, I216V, V249L, I321V, and E374K in the HA gene. In addition, two additional rare mutations were also observed at positions S162N (addition of a glycosylation site, 6.25%) and A186T (receptor binding region, 6.25%). On the basis of amino acid substitutions in the HA1 domain, majority of the Turkish isolates were classified in the genetic group v and others in the genetic groups ii, iii, and vi. In the present study, we observed an increase in the variety and ratio of mutations detected in the HA1. and HA2 domains of the HA gene; however, these alterations have not yet resulted in vaccine escape mutants in Turkey. In addition, analysis of the NA regions of the isolates revealed that oseltamivir resistance was not an issue in Turkey

Pandemic (H1N1) influenza in Diyarbakir, 2009

Objective: This study was conducted to evaluate the pandemic (H1N1) influenza outbreak in 2009. Method: Influenza like illness (ILI) cases were reported between the 36th to 53rd weeks of the pandemic, from all health centres. 731 nasopharyngeal swabs were collected from ILI cases. Results: The first H1N1 confirmed case was reported at the 36th week and an increasing trend continued. At the 43rd week the outbreak reached its maximum level and at the 53rd week the level had decreased to the level at the start. During the outbreak 31117 cases were reported as ILI and 635 cases were hospitalized (hospitalization rate was 2.0%) and 17 H1N1 laboratory confirmed cases died (mortality rate 11.5/1.000.000). Symptoms of laboratory confirmed cases were similar to seasonal influenza. Coughing (90.9%), fever (84.5%), running nose (69.5%), headache (73.4%), diarrhoea (17.5%) were the some of the symptoms in laboratory confirmed cases. The median interval between the onset of symptoms and hospital admission was 3.5 days (min: 1, max: 11 days) and this was 7.5 days for the occurrence of death. Conclusion: During 36th to 53rd week an important outbreak of ILI was occurred. The mortality rate was not so high as expected but the infectivity was high. The delay for hospital admission may lead to higher mortality particularly for pregnant women.Key Words: Pandemic influenza; H1N1; case fatality rate; hospitalization rateDiyarbakır’da pandemik (H1N1) influenza, 2009Amaç: Bu çalışmada 2009 yılında -Türkiye’de pandemik influenza salgınını değerlendirmek amaçlanmıştır. Yöntem: Diyarbakır ’da 36 ve 53. haftalar arasında tüm sağlık kuruluşlarından influenza benzeri hastalık rapor edilmiştir. 731 nazofaringeal sürüntü alınmıştır. Bulgular: İlk H1N1 doğrulanmış vaka 36.haftada rapor edilmiştir ve vaka sayıları zaman içinde artış göstermiştir. 43. haftada salgın başlamış ve 53. haftada başlangıç düzeyine inmiştir.Salgın sırasında 31117 vaka grip benzeri hastalık olarak raporlanmış, 635 vaka hastaneye yatmış (hastaneye yatış hızı %2.0) ve laboratuvar olarak doğrulanmış 17 vaka ölmüştür (ölüm hızı milyonda 11.5). Laboratuvar olarak doğrulanmış vakaların semptomları mevsimsel influenza ile benzerlik  göstermiştir. Laboratuvar olarak doğrulanmış vakaların bazı semptomları öksürük (%90.9), ateş (%84.5), burun akıntısı (%69.5), baş ağrısı (%73.4) ve ishal (%17.5) olmuştur. Semptomların başlaması ile hastaneye başvuru suresi ortancası 3.5 gün (en az:1, en çok:11 gün), ölüm süresi ortancası ise 7.5 gündür. Sonuç: Diyarbakır’da 36 ve 53. haftalar arasında önemli bir grip benzeri hastalık salgını yaşanmıştır. Mortalite hızı beklenildiği kadar fazla olmamakla birlikte, bulaştırıcılık hızı yüksektir. Hastane başvurularındaki gecikme özellikle gebe kadınlarda ölüme yol açmış olabilir. Anahtar Kelimeler: Pandemik influenza; H1N1, vaka ölüm hızı, hastaneye yatma hızı</p

Serological response to influenza vaccine after hematopoetic stem cell transplantation

Vaccination is the best strategy to prevent influenza infection that is a potential cause of morbidity and mortality in immunosuppressed patients. Here, we evaluated the factors that may affect serological response to influenza vaccine in patients who have undergone hematopoetic stem cell transplantation (HSCT). Sixty-one HSCT recipients were included in the study during the 2007-2008 influenza season. Serum samples prior to vaccination and 6-10 weeks after vaccination were collected. Samples were assayed for antibodies to influenza virus A/H1N1, A/H3N2, and B strains by hemagglutination-inhibition assay. The patients were followed in terms of clinical symptoms up to the next influenza season and for adverse effects within a month after vaccination. Overall, pre-vaccine seroprotection rate against all vaccine antigens (A/H1N1, A/H3N2, and B antigens) was 45.1%, post-vaccine seroprotection rate 91% and seroconversion rate was 28.3%. Seroconversion rates were found to be low against B in patients who were vaccinated in the late influenza season (p = 0.018; respectively). Five patients (10.9%) had no immune response against H1N1. Adverse events were reported in 19.6% (n = 9/46) of the patients. In conclusion, the patients should be vaccinated as early as possible in the influenza season, before they are exposed to the virus

CASES OF INFLUENZA A(H1N1)V REPORTED IN TURKEY, MAY-JULY 2009

Following the declaration by the World Health Organization (WHO) of human cases of infection with a new influenza A(H1N1)v virus of swine origin, the Turkish Ministry of Health launched a case-based reporting of influenza A(H1N1)v throughout the country on 27 April 2009. The index case was detected on 15 May 2009. As of 17 July 2009 the number of laboratory-confirmed cases of influenza A(H1N1)v totalled 128 of whom 38 were indigenous cases

Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children