Herd Immunity and Measles

The term “herd immunity” is an immunization concept that refers to a means of protecting a whole population from an infectious disease by immunizing a certain percent of a population. Measles is a highly contagious infectious disease. Measles vaccine failure may lead to outbreaks. In this article, basic herd immunity concepts and measles immunization practices are reviewed

Differential Diagnosis of Crimean-Congo Hemorrhagic Fever: Six Cases

Crimean-Congo hemorrhagic fever (CCHF) is a viral hemorrhagic disease that has been reported in Turkey since 2002. Although pathogenesis of the disease has not yet been clearly explained, it has been found that CCHF disease damages the reticuloendothelial system. Many diseases, such as brucella, leptospira, B12 deficiency, and malignancies that damage the reticuloendothelial system, have similar clinical features with CCHF. In the current study, 6 cases that were dispatched with CCHF pre-diagnosis to the Infectious Diseases and Clinical Microbiology Clinic of Diskapi Yildirim Beyazit Training and Research Hospital between 2008 and 2009 are discussed herein. Afterwards, patients were hospitalized with different diagnoses. This study is presented to highlight the differential diagnoses of CCHF

TNF-Α, IL-1Β and IL-6 Levels in Pandemic Influenza A (H1N1) 2009 Patients and Effect on Mortality

Introduction: Throughout history, influenza virus pandemics have led to the death of millions of people. The virus sometimes causes pathological changes that can lead to severe illness and death. Inflammatory cytokines and chemokines have been shown to be involved in the pathogenesis of tissue damage in the lungs of animals and humans infected with influenza viruses. Materials and Methods: The serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin- 6 (IL-6) were determined with enzyme immunoassay (EIA) in 57 patients who were hospitalized with confirmed influenza and a control group. Results: Fifty-seven patients with confirmed influenza A (H1N1) 2009 and 62 healthy subjects as the control group were included in this study. Of these patients with influenza, 51 (89.4%) were discharged, and 6 (10.5%) died of influenza-related illness. TNF-α levels were found to be 43.0 pg/mL in fatal patients, 20.9 pg/mL in non-fatal patients, and 4.1 pg/mL in the control group. IL-6 levels were found to be 1074.12 pg/mL in fatal patients, 191.0 pg/mL in non-fatal patients, and 36.1 pg/mL in the control group. The differences between groups were statistically significant (p= 0.003 and p< 0.001, respectively). IL-1β levels were found to be 2.1 pg/mL in fatal patients, 7.1 pg/mL in non-fatal patients, and 7.5 pg/mL in the control group, and the difference was not statistically significant (p= 0.657). Conclusion: We found that TNF-α and IL-6 levels were significantly higher in patients who died. We suggest that higher levels of pro-inflammatory cytokines may be used as an important marker of mortality

Adherence to Nucleoside/Nucleotide Analogue Treatment in Patients with Chronic Hepatitis B

Background: Adherence to medication is an important aspect of preventing drug resistance and treatment failure in patients receiving nucleos(t)ide analogues for chronic hepatitis B. Aims: To assess adherence to nucleoside/nucleotide analogues in chronic hepatitis B treatment and to determine factors associated with non-adherence. Study Design: Cross-sectional study. Methods: The study enrolled 85 chronic hepatitis B patients who had been receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was completed by patients themselves, and adherence was evaluated based on patients’ self-reporting. The use of at least 95% of the drugs in the previous month was considered as adequate adherence. Results: Adherence was adequate in 82.4% of patients. Female gender (p=0.003), unemployment (p=0.041) and lower monthly family income (p=0.001) were related to lower adherence. Better adherence was significantly linked to adequate basic knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than 12 months (p<0.001), previous use of other medications for chronic hepatitis B (p=0.014) and regular follow-up by the same physician (p<0.001). Conclusion: Counselling patients about their disease state and the consequences of non-adherence is an important intervention for enhancing adherence. Naïve patients should be followed up more frequently to reinforce adherenc

Reactivation rates in patients using biological agents, with resolved HBV infection or isolated anti-HBc IgG positivity

Background/Aims: Tumor necrosis factor-? (TNF-?) inhibitors and ustekunimab are widely used in autoimmune diseases. It is known that these biological agents cause the reactivation of hepatitis B virus (HBV). There is no standardized strategy to prevent the reactiva- tion in patients with evidence of a previous HBV infection. In our study, anti-HBc IgG-positive patients who received a biological agent were evaluated in terms of HBV reactivation. Materials and Methods: Patients who were followed up for the use of biological agents in our clinic were evaluated retrospectively. Pa- tients with isolated anti-HBc IgG positivity were included in the study. The HBV reactivation data were recorded from the patients’ files retrospectively. Results: Two hundred and seventy-eight patients who received biological treatment were evaluated. Twenty-nine patients with isolated anti-HBc IgG positivity or resolved HBV infection were included in the study. The HBV reactivation was seen in 5 patients (17.2%). Of these patients, 3 were using adalimumab, 1 infliximab, and 1 ustekunimab. It was controlled by antiviral therapy that was started in the early period. Conclusion: Drugs that block TNF-? and ustekunimab cause an increase in viral replication. In literature, the HBV reactivation rate was approximately 1% in HBsAg-negative, anti-HBC IgG-positive cases, whereas it was found to be as high as 17.2% in our study. Patients receiving the immunomodulator therapy should be evaluated for HBV serology before treatment and carefully monitored for HBV reac- tivation during and after treatment

Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study

Background: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients’ data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient’s demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients