Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review

Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC infectious diseases. 2011;11(1): 337.BACKGROUND: To provide a clear picture of the current hepatitis B situation, the authors performed a systematic review to estimate the age- and region-specific prevalence of chronic hepatitis B (CHB) in Turkey. METHODS: A total of 339 studies with original data on the prevalence of hepatitis B surface antigen (HBsAg) in Turkey and published between 1999 and 2009 were identified through a search of electronic databases, by reviewing citations, and by writing to authors. After a critical assessment, the authors included 129 studies, divided into categories: 'age-specific'; 'region-specific'; and 'specific population group'. To account for the differences among the studies, a generalized linear mixed model was used to estimate the overall prevalence across all age groups and regions. For specific population groups, the authors calculated the weighted mean prevalence. RESULTS: The estimated overall population prevalence was 4.57, 95% confidence interval (CI): 3.58, 5.76, and the estimated total number of CHB cases was about 3.3 million. The outcomes of the age-specific groups varied from 2.84, (95% CI: 2.60, 3.10) for the 0-14-year olds to 6.36 (95% CI: 5.83, 6.90) in the 25-34-year-old group. CONCLUSION: There are large age-group and regional differences in CHB prevalence in Turkey, where CHB remains a serious health problem

Nasal Carriage of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus in Nursing Home Residents in Bolu,Turkey

Background: This study aimed (a) to provide information on methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus colonization ratio in residents of nursing homes; (b) to determine the effect of hand-washing education given to nursing home residents and employees on nasal carriage of Staphylococcus aureus (NCSA) and (c) to obtain probable risk factors for MRSA colonization of residents in two nursing homes. Methods: Seventy-nine volunteers (24 females and 55 males) from Bolu nursing homes were included in the study. Nasal samples were taken with sterile swabs from the anterior nares. Staphylococcus aureus strains were identified using classical methods and genotyping of methicillin resistant strains was done using Arbitrary Primed PCR (AP-PCR). Antibiotic susceptibilities were determined by disk diffusion methods according to NCCLS standards. After first nasal samples were taken, all employees and residents of nursing homes were educated about the methods of hand hygiene over two days. Results: With hand-washing education, the decrease of NCSA rate (initially 43%; after education, 21%) was significant (p 0.05). MRSA carriage was significantly correlated with presence of skin lesions, prior hospitalization within the last six months, and antibiotics usage within the last six months. AP PCR results suggested that residents’ carriage of MRSA was the result of the same source. Conclusion: MSSA and MRSA colonization rates were found to be 38% and 5% in nursing homes, respectively. These ratios can decrease with simple precautions like hand-washing after a short education period. "Portación Nasal de Staphylococcus Aureus Resistentes a la Meticilina y Susceptible a la Meticilina en los Residentes del Hogar de Ancianos en Bolu, Turquía" RESUMEN Antecedentes: Este estudio tiene como propósito: (a) ofrecer información sobre la tasa de colonización Staphylococcus aureus resistentes a la meticilina (SARM) y el de Staphylococcus aureus susceptibles a la meticilina (SASM) de residentes en hogares de ancianos; (b) determinar el efecto de la educación del lavado de manos brindada a los residentes y empleados, sobre la portación nasal de Staphylococcus aureus (PNSA); y (c) obtener los factores de riesgo probables por la colonización de SARM en los residentes de dos hogares de ancianos. Métodos: Setenta y nueve voluntarios (24 hembras y 55 varones) de los hogares de ancianos Bolu fueron incluidos en el estudio. Se tomaron muestras nasales con hisopos estériles, de 1/3 orificios nasales anteriores. Se identificaron cepas de Staphylococcus aureus usando métodos clásicos; y la genotipificación de las cepas resistentes a la meticilina se realizó por medio de la técnica de la reacción en cadena de la polimerasa con iniciadores arbitrarios (AP-PCR). Las susceptibilidades antibióticas se determinaron mediante métodos de difusión por disco de acuerdo con los estándares del NCCLS. Después que se tomaron las primeras muestras nasales, todos los empleados y los residentes de los hogares de ancianos recibieron instrucción sobre métodos de higiene de las manos durante dos días. Resultados: Con la educación del lavado de manos, la disminución de la tasa de PNSA (inicialmente 43%; después del entrenamiento 21%) fue significativa (p 0.05)

An outbreak of tularemia in western Black Sea Region of Turkey

Gurcan, Saban/0000-0002-5052-481XWOS: 000220224200003PubMed: 15004863The aim of this study was to investigate the source and the size of a tularemia outbreak in a village located in a non-endemic area. Five patients from the same village were admitted to hospital with the same complaints all within one week of September 2001. Tularemia was suspected and a diagnosis was made after physical and anamnesis examinations. The village was visited the same week that the patients were admitted to the hospital, in the January and April 2002. The villagers were examined and screened serologically by microagglutination method and the water sources were investigated bacteriologically. A total of 14 people were found to be infected from the outbreak and the oropharyngeal form was the only clinical presentation. Antibody titers ranged between 1 : 80 and 1 : 640. The patients responded well to the aminoglycoside plus tetracycline therapy. Examination of the pipewater and three springs revealed that all the water sources were contaminated by coliforrns, however, Francisella tularensis could not be isolated in glucose-cystine. medium. Antibody levels stayed stable or decreased seven months after. Tularemia had not been reported in this area before, so the first patients were misdiagnosed. In conclusion tularemia should be considered in differential diagnosis of patients with fever, sore throat and cervical lymphadenopaties

Exposure time to hepatitis B virus and associated risk factors among children in Edirne, Turkey

Hepatitis B virus (HBV) infection is endemic in Turkey, but the main routes of transmission were not well established. This study aims to detect the exposure time to HBV and associated risk factors among children. In a sampling group of children aged 0-19 years living in Edirne, antiHBc, antiHBs and HBsAg were screened by the microELISA method. A questionnaire was also completed for each child. In 717 children that were included in the study, the total antiHBc seropositivity was 5.4% and was 1.8, 0.8, 1.7, 6.8, 11.8% in 0-1, 2-5, 6-10, 11-14, 15-19 years age groups respectively. The overall HBsAg seropositivity was 1.7%. The risk of HBV infection increased after the age of 10 years (OR 7.79, 95% CI 3.01-20.16). Collective circumcision was the only independent factor according to regression analysis. Children living in Edirne should be vaccinated against HBV before reaching 11 years of age

hospitals

Background: This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs).Methods: An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country.Results: The respondent group included 41.3% nurses. 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least I occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P =.000), being a doctor (P =.000), being a nurse (P=.000). young age (P =.025), and living in a poor region (P =.005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P =.000) and working at a university hospital (P =.003) were significant predictors of less occupational exposure, Overall, the mean number of PME incidents was 2.16/person/year.Conclusion: Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs (Am J Infect Control 2009:37:65-9.

Healthcare workers' compliance with universal precautions in Turkey

Blood-borne pathogens (BBP) represent remarkable occupational risks for healthcare workers (HCWs). Avoiding occupational blood exposure is a basis of prevention of the blood-borne pathogens (BBP). The effectiveness of the prevention strategies depends on the compliance and adherence to the program by healthcare-facility personnel. The aim of this study was to evaluate Turkish HCWs' compliance with Universal Precautions (UP). An analytic, cross-sectional, countrywide survey study was performed in hospital settings, (n = 5145) in 30 hospitals in 19 cities. In total, 1726 of the 5143 (33.6%) participants' behaviors were accepted as satisfactory for compliance with UP. The hepatitis knowledge levels of 2,650 (51.5%) participants were found to be satisfactory. In the multivariate analysis, working at a surgical site (P = 0.004), living in a rich region (P =.007) and the existence of a health office for HCWs (p =.000) were found to be contributor factors for HCWs' compliance with UP. Conversely, being a nurse (P =.000) and HBV/HCV carrier status (P =.039) were significant preventing predictors for HCWs' compliance with UP. Along with the other well-known predictive factors, regional economic status and a health office for HCWs are contributors for compliance with UP. © 2011 Elsevier Ltd

Widespread detection of PER-1-type extended-spectrum beta-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide multicenter study

We studied the prevalence and molecular epidemiology of PER-1-type beta-lactamases among Acinetobacter, Klebsiella, and Pseudomonas aeruginosa strains isolated over a 3-month period id eight university hospitals from distinct regions of Turkey, A total of 72, 92, and 367 Acinetobacter, Klebsiella, and P. aeruginosa isolates were studied, respectively, The presence of bla(PER) aas determined by the colony hybridization method and later confirmed by isoelectric focusing, We detected PER-1-type beta-lactamases in 46% (33/72) of Acinetobacter strains and in 11% (40/367) of P. aeruginosa strains but not in klebsiella strains. PER-1-type enzyme producers were highly resistant to ceftazidime and gentamicin, intermediately resistant to amikaein, and susceptible or moderately susceptible to imipenem and meropenem, Among PER-1-type-beta-lactamase-positive isolates, five Acinetobacter isolates and six P, aeruginosa isolates from different hospitals were selected for ribosomal DNA fingerprinting with EcoRI and SalI, The EcoRI-digested DNAs were later hybridized with a digoxigenin-labelled PER-1 probe, The ribotypes and the lengths of bla(PER)-carrying fragments were identical in four Acinetobacter strains. A single isolate (Ac3) harbored a PER gene on a different fragment (approximately 4.2 kbp) than the others (approximately 3.4 kbp) and showed a clearly distinguishable ribotype, Ribotypes of P. aeruginosa strains obtained with EcoRI showed three patterns. Similarly, in Pseudomonas strains two different EcoRI fragments harbored bla(PER) (approximately 4.2 kbp in five isolates and 3.4 kbp in one isolate), PER-1-type beta-lactamases appear to be restricted to Turkey, However, their clonal diversity and high prevalence indicate a high spreading potential

Widespread detection of PER-1-type extended-spectrum beta-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide multicenter study.

We studied the prevalence and molecular epidemiology of PER-1-type beta-lactamases among Acinetobacter, Klebsiella, and Pseudomonas aeruginosa strains isolated over a 3-month period in eight university hospitals from distinct regions of Turkey. A total of 72, 92, and 367 Acinetobacter, Klebsiella, and P. aeruginosa isolates were studied, respectively. The presence of blaPER was determined by the colony hybridization method and later confirmed by isoelectric focusing. We detected PER-1-type beta-lactamases in 46% (33/72) of Acinetobacter strains and in 11% (40/367) of P. aeruginosa strains but not in Klebsiella strains. PER-1-type enzyme producers were highly resistant to ceftazidime and gentamicin, intermediately resistant to amikacin, and susceptible or moderately susceptible to imipenem and meropenem. Among PER-1-type-beta-lactamase-positive isolates, five Acinetobacter isolates and six P. aeruginosa isolates from different hospitals were selected for ribosomal DNA fingerprinting with EcoRI and SalI. The EcoRI-digested DNAs were later hybridized with a digoxigenin-labelled PER-1 probe. The ribotypes and the lengths of blaPER-carrying fragments were identical in four Acinetobacter strains. A single isolate (Ac3) harbored a PER gene on a different fragment (approximately 4.2 kbp) than the others (approximately 3.4 kbp) and showed a clearly distinguishable ribotype. Ribotypes of P. aeruginosa strains obtained with EcoRI showed three patterns. Similarly, in Pseudomonas strains two different EcoRI fragments harbored blaPER (approximately 4.2 kbp in five isolates and 3.4 kbp in one isolate). PER-1-type beta-lactamases appear to be restricted to Turkey. However, their clonal diversity and high prevalence indicate a high spreading potential