Cutaneous reactions after COVID-19 vaccination in Turkey: A multicenter study

Objectives In this study covering all of Turkey, we aimed to define cutaneous and systemic adverse reactions in our patient population after COVID-19 vaccination with the Sinovac/CoronaVac (inactivated SARS-CoV-2) and Pfizer/BioNTech (BNT162b2) vaccines. Methods This prospective, cross-sectional study included individuals presenting to the dermatology or emergency outpatient clinics of a total of 19 centers after having been vaccinated with the COVID-19 vaccines. Systemic, local injection site, and non-local cutaneous reactions after vaccination were identified, and their rates were determined. Results Of the 2290 individuals vaccinated between April 15 and July 15, 2021, 2097 (91.6%) received the CoronaVac vaccine and 183 (8%) BioNTech. Systemic reactions were observed at a rate of 31.0% after the first CoronaVac dose, 31.1% after the second CoronaVac dose, 46.4% after the first BioNTech dose, and 46.2% after the second BioNTech dose. Local injection site reactions were detected at a rate of 35.6% after the first CoronaVac dose, 35.7% after the second CoronaVac dose, 86.9% after the first BioNTech dose, and 94.1% after the second BioNTech dose. A total of 133 non-local cutaneous reactions were identified after the CoronaVac vaccine (2.9% after the first dose and 3.5% after the second dose), with the most common being urticaria/angioedema, pityriasis rosea, herpes zoster, and maculopapular rash. After BioNTech, 39 non-local cutaneous reactions were observed to have developed (24.8% after the first dose and 5% after the second dose), and the most common were herpes zoster, delayed large local reaction, pityriasis rosea, and urticaria/angioedema in order of frequency. Existing autoimmune diseases were triggered in 2.1% of the patients vaccinated with CoronaVac and 8.2% of those vaccinated with BioNTech. Conclusions There are no comprehensive data on cutaneous adverse reactions specific to the CoronaVac vaccine. We determined the frequency of adverse reactions from the dermatologist's point of view after CoronaVac and BioNTech vaccination and identified a wide spectrum of non-local cutaneous reactions. Our data show that CoronaVac is associated with less harmful reactions while BioNTech may result in more serious reactions, such as herpes zoster, anaphylaxis, and triggering of autoimmunity. However, most of these reactions were self-limiting or required little therapeutic intervention

Investigation the effect of mycobacterium tuberculosis man-lam antigen on fibroblast macrophage coculture model to the macrophage

Makrofajlar Mycobacterium tuberculosis enfeksiyonuna karşı korunmada ana bileşendir. M. tuberculosis mannoz-kaplı lipoarabinomannanı (Man-LAM) ile makrofaj reseptörlerinin etkileşimi, makrofaj işlevini düzenlemektedir. Bu çalışmada, granülom formasyonunda enfeksiyonu sınırlama işlevi olan fibroblastların Man-LAM ile uyarımı takiben makrofaj polarizasyonuna etkisinin kokültür modelinde araştırılması amaçlanmıştır. Man-LAM M. tuberculosis H37Rv standart suşundan izole edildi. 3T3 fare fibroblast ve J774.1 fare makrofaj hücre dizinleri kokültür çalışmalarında kullanıldı. 3T3 ve J774.1 hücreleri üç farklı şekilde Man-LAM ile uyarıldı; tek başlarına, temas halinde ve 0,4 µm por çaplı naylon membran filtre ile temassız olarak. Ayrıca hücreler tüm bu üç konfigürasyonda TLR-2 antagonistleri ile bloklandı. İnkübasyonun 18'inci saatinde süpernatant sitokin analizi için toplandı. Yirmidördüncü saatte toplanan hücrelerden akım sitometri ile CD11b, CD80, CD86, MHC sınıf II, CD103, CD44, CD62L, CD107b yüzey molekül ekspresyonlarınının analizi yapıldı. Man-LAM ile uyarılan makrofajların, fibroblast varlığında M1 makrofaj fenotipi ile ilişkili İL-12 ve TNF-α sitokinlerini oluşturduğu gözlendi. Bu etkinin tümüyle hücre hücre temasına bağlı olmadığı saptandı. Ayrıca Man-LAM ile uyarımın M2 makrofaj fenotipi ile ilişkili TGF-β ve İL-10 üretiminde azalmaya neden olduğu saptandı. Ek olarak, immün düzenleyici sitokin İL-33 üretiminin fibroblast ve makrofaj kokültür modellerinde arttığı tespit edildi. Akım sitometri analizi için makrofaj hücreleri ilk önce CD11b ile karakterize edildi. Man-LAM ile uyarımı takiben CD11b+ makrofaj hücrelerinin MHC sınıf II ve CD86 ekspresyonlarının fibroblast varlığında devam ettiği gösterildi. Bulgular, fibroblastların Man-LAM ile uyarılması sonucu makrofajların M1 fenotipine farklılaştığını ve fibroblastın makrofajı aktive ederek yanıt verdiğini gösterdi. Ayrıca bu etkinin TLR-2'nin bloklanmasından sonra arttığı saptandı. Fibroblastların granülom formasyonunda makrofajların polarizasyonunu ve aktivasyonunu etkileyerek immünolojik olarak aktif rol aldığı, TLR-2'nin Man-LAM ile uyarımı takiben immün modülatör etkiye sahip olduğu kanısına varılmıştır.Macrophages play an essantial role in protection to Mycobacterium tuberculosis infection. Interactions between M. tuberculosis mannose-capped lipoarabinomannan (Man-LAM) and macrophage receptors modulate macrophage functions. In this study, we aimed to evaluate the effect of the fibroblast, the cells play restrictive function in granuloma formation, effects on the macrophage polarisation in a coculture model after stimulation with Man-LAM. Man-LAM were isolated from M. tuberculosis H37Rv standart strain. 3T3 mouse fibroblast cell line and J774.1 mouse macrophage cell line were used in the coculture studies. The cells treated with Man-LAM in three different conditions; alone, together and together with an 0.4 µm pore size nylon membrane filter. And, cells also treated with TLR-2 antagonist in all conditions with and without Man-LAM. After 18 hour incubation, supernatant collected for cytokine analysis, and after 24 hour incubation the cells measured for CD11b, CD80, CD86, MHC class II, CD103, CD44, CD62L, CD107b cell surface receptor with flow cytometry. Macrophages incubated with Man-LAM in the presence of fibroblast after a period of cell incubation produced IL-12 and TNF-α cytokines that are the markers of the M1 macrophages. This effect is not fully in a cell contact dependent manner. Also the M2 macrophage marker TGF-β decreased after stimulation of the coculters induced by Man-LAM in both coculture situation. In addition, the immonomodulatory cytokine IL-33 increased in the coculture models after treatment with Man-LAM. After treatment with Man-LAM, CD11b+ macrophage cells MHC class II and CD86 expression were maintained in the presence of fibroblast. The results demonstrated that, the fibroblasts had an effect on the macrophage M1 polarization and macrophage activation. And also the proinflamatory effect of Man-LAM increased after blocking the TLR-2. It is suggested that, fibroblasts had a very important and immunologically active role in the granuloma formation by leading the macropage polarisation, and activation and TLR-2 had an immunomodularory function on macrophages after stimulation of fibroblast and macrophages with Man-LAM

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

Clinical Analysis in Influenza A (H1N1) Virus Patients

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Clinical analysis in influenza A (H1N1) virus patients İnfluenza a (H1N1) virus enfeksiyonlu hastalari{dotless}n klinik analizi

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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