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ABSTRACTPregnant women and infants are at relatively high risk for influenza- and pertussis-related morbidity and mortality. Vaccination is the most important prevention strategy for both diseases. We evaluated knowledge and acceptance of influenza and pertussis vaccinations among pregnant women. We performed a cross-sectional survey of 465 pregnant women receiving prenatal care at the obstetric outpatient clinic in a tertiary medical center in Turkey between November 2015 and May 2016. We used a questionnaire investigating the knowledge of pertussis and influenza to evaluate potential influences on the acceptance or rejection of pertussis or influenza vaccinations. The acceptance rates of pertussis and influenza vaccinations were 11.2% and 19.8%, respectively. Maternal age, education level, employment status, number of gestations, and gestational age did not affect the rate of acceptance of these vaccinations. On the other hand, pregnant women who had a history of vaccination during their adolescence and in previous pregnancies were significantly more likely to accept pertussis vaccination. Knowledge about the risks of pertussis and influenza diseases for pregnant women and their children has a significant effect on vaccination acceptance. Even in low socioeconomic status groups, a recommendation for vaccinations by the primary obstetrician was significantly predictive of acceptance of both pertussis and influenza vaccination. This study revealed that the acceptance rates of pertussis and influenza vaccination among pregnant women are very low in Turkey. Healthcare worker recommendations and increased awareness about pertussis and influenza morbidity and mortality in pregnant women and infants are essential to improve the rates of vaccination acceptance during pregnancy.

ABSTRACTDeveloping an effective and safe vaccine against Covid-19 will facilitate return to normal. Due to hesitation toward the vaccine, it is crucial to explore the acceptability of the COVID-19 vaccine to the public and healthcare workers. In this cross-sectional survey, we invited 2251 pediatricians and 506 (22%) of them responded survey and 424 (84%) gave either nasopharyngeal swap or antibody assay for COVID-19 and 71 (14%) of them got diagnosis of COVID-19. If the effective and safe COVID-19 vaccine was launched on market, 420 (83%) of pediatrician accepted to get vaccine shot, 422 (83%) of them recommended vaccination to their family members, 380 (75%) of them accepted to vaccine their children and 445 (85%) of them offered vaccination to their pediatric patients. Among the participated pediatricians 304 (60%) of them thought COVID-19 vaccine should be mandatory. We found that there are high COVID-19 vaccine willingness rates for pediatricians for themselves, their own children, family members and their pediatric patients. We also found that being a pediatric subspecialist, believing in achieving an effective vaccine, willingness to participate in the phase 1–2 clinical vaccine trial, willingness to get an influenza shot this season, believing a vaccine and vaccine passport should be mandatory were significant factors in accepting the vaccine. It is important to share all information about COVID-19 vaccines, especially effectiveness and safety, with the public in a clear communication and transparency. The opposite will contribute to vaccine hesitancy and anti-vaccine movement.

ABSTRACTThe aim of the study was to investigate changes in the incidences of Varicella and Herpes Zoster (HZ) following introduction of single dose Varicella vaccine (VV) in Turkey. Changes in the incidences of varicella and HZ per 100,000 population were compared with pre (2011–2012) and post-VV period (2018–2019) throughout years between years 2011 and 2019 both for children and adults. In children ≤5 years of age, the annual incidences of varicella significantly decreased from 290 per 100000 children in 2011 to 24 per 100000 children in 2019 [p= .0001]. Also, for children ≤5 years the mean annual incidence of varicella decreased significantly [326/100000 ±51/100000 vs 23/100000 ± 1/100000; p= .014] between pre- and post-VV period. Moreover, the annual incidences of varicella significantly decreased from 43 per 100000 children in 2011 to 26 per 100000 children in 2019 in children age between 6 and 17 years. On the other hand, incidence of varicella in adult population (age >17 years) did not change significantly. Besides, the annual incidences of Herpes Zoster did not change significantly in children age stratas but significant increment observed in adult population. This increment was significant in adult age strata of 18–44 years, but non-significant in age strata of 45–64 years and >64 years. Thus, our study showed a significant reduction in the incidences of Varicella in children age stratas whereas significant increment in the incidence of HZ in adult population after the implementation of VV into the NIP of Turkey.

ABSTRACTRotavirus (RV) vaccines have been available in Turkey since 2006. These vaccines are not funded by the National Health System, so consequently their coverage rate in children has reached only 13–18%. We conducted a retrospective record review including all children ≤60 months of age presenting to study hospitals with suspected or clinical acute gastroenteritis (AGE) between 2012 and 2018. During the study, 109,605 children ≤60 months of age were admitted to pediatric out-patient clinics and pediatric emergency room, of which 15,501 (14%) were diagnosed with AGE. Incidence of RV-positive AGE decreased from 4.47 per 1,000 children in 2012 to 2.48 per 1,000 in 2018. A total of 4,805 (31%) such children were hospitalized with RV-positive AGE, a decrease from 1.9 per 1,000 children in 2012 to 0,45 per 1,000 in 2018. The length of hospital stays (LOS) of RV-positive AGE was 2.47 ± 1.15 days compared to LOS of RV-negative AGE 1.59 ± 1.17 days (p< .001). The overall cost of RV-positive AGE ($335 ± 200) was higher than that for RV-negative AGE ($280 ± 148) cases (p= .015). Vaccine effectiveness against any case of RV-positive AGE was 75,1% (95% CI: 65–86%). Despite the low level of vaccine coverage, the introduction of RV vaccination had a positive impact on the incidence of RV-positive AGE and related hospitalizations in young children.

ABSTRACTThe aim of the study was to investigate changes in the incidences of community-acquired pneumonia (CAP) and CAP-related hospitalizations following introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in children ≤5 years of age into the national immunization programme (NIP) of Turkey. PCV7 was included in the NIP of Turkey in November 2008 and was replaced by PCV13 in late 2011. Changes in the incidences of CAP and CAP-related hospitalizations per 100,000 children admissions were investigated from 2011 to 2017. A total of 225,963 children visits were recorded; CAP was diagnosed in 4863 (2.15%) children and 1086 (22%) of them hospitalized between 2011 and 2017. The incidence of CAP declined from 5448 to 1144/100,000 from 2011 to 2017 (p= .001, r = −0.965). When the mean annual incidence of CAP between the transition period of PCV13 (2011/2012) was compared with a post-PCV13 period (2016/2017), CAP incidence was found to be 22% lower (p= .009). Also, the incidence of CAP-related hospitalization decreased significantly from 943 to 335/100,000 from 2011 to 2017 (p= .004 r = −0.91). Moreover, the mean incidence of CAP hospitalization declined 35% (p= .01) between the transition period of PCV13 and a post-PCV13 period. Thus, our study showed a significant reductions in the incidences of CAP and CAP-related hospitalization in children ≤5 years-old after the implementation of PCV13 into the NIP of Turkey.

ABSTRACTThe aim of this study was to investigate changes in the incidences of acute otitis media (AOM), recurrent AOM (rAOM) and tympanostomy tube (TT) insertion in children following the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the national immunization program (NIP) of Turkey in April 2011. National coverage for the PCV7 was 97% in 2009, 93% in 2010, 96% in 2011 and for the PVC13 was 97% in 2012, 97% in 2013, 96% in 2014, 97% in 2015, 98% in 2016, and 96% in 2017 for Turkish children younger than 12 months of age. A total of 499932 pediatric visits were recorded, and AOM was diagnosed in 23005 (4.6%) children. The incidence of AOM in children ≤5 years of age decreased from 10700/100000 (2011) to 4712/100000 (2017), with a significant decreasing trend (p< .001, r = −0.965). When the mean annual incidences of AOM between the transition period of PCV13 (years 2011/2012) were compared with those of a post-PCV13 period (years 2016/2017) for children ≤5 years of age, the incidence of AOM was found to be decreased by 54% (p= 0.013). The mean incidence of TT insertion was found to be decreased by 65% (p= 0.003) between the transition period of PCV13 and a post-PCV13 period for children ≤5 years of age. On the other hand, rAOM incidence was found to be increased in whole pediatric age groups. Our study showed a significant decrease in the incidences of AOM and TT insertion in children ≤5 years old after implementation of PCV13 in the NIP in Turkey.

ABSTRACTMaternal vaccination with SARS-CoV-2 vaccines has not been well studied yet in terms of safety and efficacy for protecting the newborn by the placental passage of antibodies. We reported 34 years of old health care worker (HCW) without any known SARS-CoV-2 infection. She had the first dose of SARS-CoV-2 inactivated virus vaccine (CoronaVac, Sinovac Life Science Co, Ltd, Beijing, China) at a gestational age of 28 weeks. The second dose of vaccine was given four weeks later at a gestational age of 32 weeks. HCW did not report any vaccine-related adverse events after either the first or second dose of the vaccine. Three weeks after the second dose of the vaccine, her anti-receptor-binding domain (RBD) of SARS-CoV-2 spike protein antibody was 779 arbitrary units (AU) per ml. She gave a birth of 38 weeks three days gestation age of healthy, full-term girl with a birth weight of 2770 gr. The mother’s anti-RBD antibody was 734 AU/ml, the infant’s cord blood anti-RBD antibody level was 764 AU/ml, respectively, cord sera/maternal sera transfer ratio was 1,04. This infant is the first identified case of SARS-CoV-2 IgG antibodies detectable in cord blood after maternal vaccination with CoronaVac.

ABSTRACTThe effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15–136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202–10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8–15547 AU/mL, p= .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals.

ABSTRACTWe are happy to answer to the Letter from Ozkaya-Parlakay et al. to the Editor commenting on our recent paper, 1  investigated impact of the 13-valent pneumococcal conjugate vaccine (PCV13)  on the incidences of community-acquired pneumonia and pneumonia-related hospitalizations in children ≤5 years after its implementation into the national immunization program (NIP) of Turkey.   Ozkaya-Parlakay et al. draw attention to vaccine failure and importance of continuous  surveillance of relevant disease especially in the perspective of  Streptococcus pneumoniae serotype 19A. They supported their opinion by their clinical observation of seven children who were vaccinated with PCV13 developed empyema and meningitidis caused by Streptococcus pneumoniae  serotype 19A 
 in Turkey.