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This study aims to test the validity and reliability of the Turkish version of the HIV/AIDS-related Stigma Scale.The study has a methodological design. The sample included a total of 428 participants. of the participants, 198 were HIV/AIDS patients, 230 were HIV-negative individuals. The data were analyzed using the Exploratory and Confirmatory Factor Analysis.The Turkish version of the HIV/AIDS-related Stigma Scale was found to be valid and reliable for the Turkish society. Cronbach's α was 0.93 for the community perspectives subscale and 0.89 for the patient perspectives subscale, and all the model fit indices were acceptable.The level of stigmatization revealed by the scale helps gain an insight into the community and patient perspectives on HIV/AIDS.

Reducing invasive meningococcal disease (IMD) through MenACWY immunization is a critical healthcare strategy in the Kingdom of Saudi Arabia (KSA). Robust IMD surveillance is essential to help assess the need for additional immunization initiatives in target populations. This is particularly important in KSA, where mass gatherings accompanying Hajj/Umrah pilgrimages have been associated with IMD outbreaks within the local KSA population, and subsequent intercontinental spread via returning pilgrims. This narrative review of the published literature describes the changing epidemiology of IMD in KSA to provide a perspective on the impact of current immunization strategies and potential gaps. As recent published surveillance data are lacking, we also evaluated publicly reported data from the KSA Ministry of Health (MoH) for 2012–2019 to inform more recent IMD trends. Between 1995 and 2011, national surveillance data indicate that 1103 IMD cases were reported in KSA: 60% in 2000–2001, involving two (mainly MenW) outbreaks involving KSA citizens/residents and pilgrims focused in Mecca and Medina. Across 2002–2011, 184 cases of IMD were reported, with a higher proportion occurring in KSA citizens/residents, and with less focus within pilgrimage centers than apparent in previous years. Our analysis of MoH data found that, between 2012 and 2019, 44 IMD cases were reported, all in KSA citizens/residents, and chiefly in children or infants. No pilgrimage-associated outbreaks have occurred since 2001. Serogroup data were available for 62.5% of all cases for 2002–2011; MenW (40.0%), MenA (35.7%), and MenB (16.5%). Serogroup data for 2012–2019 remain incompletely reported, and the existing surveillance system could be improved, as some element of underestimation/underreporting of IMD may exist. While existing MenACWY immunization strategies for KSA citizens/residents and visiting pilgrims have been successful in reducing IMD due to specific serogroups, disease due to MenB remains a potential risk, and additional immunization strategies should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00467-x.

Introduction As of January 2021, rotavirus vaccination programs have been implemented in 109 countries and their use has resulted in a positive impact on rotavirus-related diarrheal hospitalizations and mortality in children below five years of age. Despite these successes, several countries in Africa and Asia where disease burden is high have not yet implemented rotavirus vaccination at all or at a scale sufficient enough to demonstrate impact. This could be, among other reasons, due to poor vaccine coverage and the modest levels of efficacy and effectiveness of the vaccines in these resource-limited settings. Areas covered We review various factors related to the human host (malnutrition, maternally-derived antibodies and breastfeeding, genetic factors, blood group and co-administration with oral polio vaccine), rotavirus pathogen (force of infection, strain diversity and coinfections) and the environment (related to the human microbiome) which reflect complex and interconnected processes leading to diminished vaccine performance in resource-limited settings. Expert opinion Addressing the limiting factors for vaccine efficacy is needed but likely to take a long time to be resolved. An immediate solution is to increase the immunization coverage to higher values generating an overall effect of adequate proportion of protected population to reduce the prevalence of rotavirus disease.

The reactivation of varicella zoster virus (VZV) in previously infected individuals can cause herpes zoster (HZ), which is characterized by a localized, painful dermatomal rash. While there is a global trend of increasing HZ cases, there is a lack of research examining the epidemiology of HZ within the Gulf Cooperation Council (GCC) countries. Therefore, we aimed to critically appraise evidence on VZV and HZ epidemiology in the GCC countries and identify gaps in the current literature.A literature review was conducted via a comprehensive appraisal of the literature. PubMed and local-language journals were searched to identify articles related to HZ and VZV published up until 31 January 2022, with a sole focus on the GCC countries. Included studies reported on surveillance data, seroepidemiology, and patient outcomes for HZ and VZV, and comprised primary data reports, case series, case reports, narrative and systematic literature reviews, studies reporting HZ incidence or prevalence, and Ministry of Health reports.Thirteen studies were found that reported on VZV seroprevalence in Saudi Arabia, the United Arab Emirates (UAE), and Qatar, ranging from 15.0% to 92.2%, while no data were identified for Bahrain, Kuwait, or Oman. There was very limited country-wide information on the incidence of HZ in GCC countries, and three identified studies reported HZ prevalence as seen in a single clinic, ranging from 0.62% to 2.3%. A single study from Saudi Arabia and government surveillance data reported on the impact of VZV vaccination on VZV infection, though there was no evidence on the impact of VZV vaccination on HZ.There is a clear gap in the literature regarding the incidence of HZ infection, and the impacts of HZ and VZV vaccinations in the GCC countries. Further research into the epidemiology of HZ is necessary to inform the implementation of vaccination programs in the GCC countries.

Günümüzdeki “aşı karşıtlığı” yeni olmamakla birlikte, özellikle dijital ortamda yayılan yanlış bilgiler önemli bir güven sorunu yaratmaktadır. Aşıların enfeksiyon hastalıkları ile mücadelede en etkili koruma yöntemi olduğunu vurgulayabiliriz; birçok ölümü engellediği gibi kimi coğrafyalarda ortadan kaldırılan hastalıklar da olmuştur. Aşılar konusunda olumsuzluklar büyük oradan bilimsel verilere dayanmamakta ve bu haberler bireyleri ve toplumları aşıdan soğutma riskini yaratmaktadır. Aşı karşıtlığını körükleyen etmenler arasında toplumsal hafıza zayıflığı, ebeveynlerin güvenlik ve etkinlik endişeleri, doğallık arayışı, bilime ve bilim süreçlerine güvensizlik ve komplo kuramları yer alır. İnanılan komplo kuramlarının mantığına ilişki soruların yöneltilmesi bu inançlarla mücadelede etkili olabilir.

Introduction Hepatitis A virus infection is more severe in adults than children. Although vaccination can protect adults, current childhood programs cover a large population more successfully. Childhood vaccination is, therefore, a solution to protecting adults if it induces lasting immunity. Fifteen-year protection has been demonstrated in children, but longer-term data are only available for adults. We aimed to predict long term persistence of antibody in children beyond 15 years and assess if immunological mechanisms triggered by vaccination support longer-term protection. Methods Long-term clinical studies using hepatitis A (HAV) or A/B vaccines (HAB) containing 720 or 1440 Enzyme-linked immunosorbent assay Units (EU) of hepatitis A virus antigen were identified. Duration of persistence of antibodies and possible protection was determined by descriptively comparing antibody geometric mean concentration (GMC) kinetics, as well as GMC (95% confidence interval) at 15 years post-vaccination across studies. Immunological mechanism studies describing hepatitis A vaccination were identified. Results One study in children 12–15 years (2-dose HAB 720) and four in adults (2-dose HAV 1440 and 3-dose HAB 720) showed comparable GMC kinetics and per year rates of change up to 15 years. At 15 years, the GMC in children [414.7 mEU/ml (336.9; 510.5)] was in the same range as in adults [range 282.6 (217.6; 367.0) to 550.1 (416.0; 727.4)]. Based on these data, mathematical model predictions from adult studies (showing > 85% protected at 50 years) were deemed likely to also apply to children. Studies identified, both humoral and cell-mediated responses are induced following vaccination. Conclusion Based on comparable antibody data in adults and children up to 15 years, similar longer-term antibody persistence is expected in children with 2-dose inactivated hepatitis A 720 containing vaccine at least up to 50 years. Accordingly, improving routine childhood hepatitis A vaccination coverage could protect against more severe disease in adulthood. Fig. 1 Plain language summary Trial Registration ClinicalTrials.gov identifiers, NCT00875485, NCT01000324, NCT01037114, NCT00289757, NCT00291876.

During the 20th century, the discovery of modern vaccines and ensuing mass vaccination dramatically decreased the incidence of many infectious diseases and in some cases eliminated them. Despite this, we are now witnessing a decrease in vaccine confidence that threatens to reverse the progress made. Considering the different extents of low vaccine confidence in different countries of the world, both developed and developing, we aim to contribute to the discussion of the reasons for this, and to propose some viable scientific solutions to build or help restore vaccine confidence worldwide.

Known since Hippocrates and of continuing public health importance, influenza remains a major cause of morbidity and mortality worldwide, and large segments of the human population are affected every year. Vaccination is the most effective means of preventing influenza infection. Today, many countries have implemented annual influenza vaccination programs, and there is increasing awareness of the potential societal and health benefits of vaccinating pregnant women, children aged 6 months to 5 years, older adults, and persons with underlying medical conditions that make them vulnerable to serious complications of influenza. In this non-systematic review, we summarize data on influenza epidemiology and influenza vaccine immunogenicity, efficacy/effectiveness, and safety in the main high-risk groups. We also discuss the optimal time to vaccinate and the effect of pre-existing immunity on vaccine response. Keywords: Influenza, Vaccine, Risk groups, Children, Pregnant women, Older adults, Chronic disease

Background In 2012, the World Health Organization recommended influenza vaccination for all pregnant women worldwide and the prioritisation of pregnant women in national influenza vaccination programmes. Nevertheless, vaccination rates in pregnant women often remain much lower than national targets. Objectives To assess the benefits and risks associated with influenza infection and vaccination during pregnancy, and to consider obstacles that work against influenza vaccine uptake during pregnancy. Results There is strong evidence that maternal and foetal outcomes can be compromised if women develop influenza infections during pregnancy. Influenza vaccines have been administered to millions of pregnant women and have demonstrated benefits in terms of disease prevention in mothers and their infants. There is a consensus amongst several recommending authorities that influenza vaccines may be safely administered during all stages of pregnancy. Healthcare professionals are recognised as the most important influencers of vaccine uptake, being well placed to recommend vaccination and directly address safety concerns. Conclusions Despite data supporting the value of influenza vaccination during pregnancy, vaccine uptake remains low globally. Low uptake appears to be largely due to ineffective communication with pregnant women about the risks and benefits of influenza vaccination. A graphical abstract is available online.

Invasive meningococcal disease (IMD) outbreaks associated with Hajj and Umrah pilgrimage events in the Kingdom of Saudi Arabia (KSA) are well recognized. Past outbreaks have been associated with substantial intercontinental spread of specific Neisseria meningitidis serogroups. The emergence of meningococcal serogroup W (MenW) was a global concern following the 2000/2001 Hajj outbreaks. Broader compulsory meningococcal serogroups A, C, W and Y (MenACWY) immunization strategies for pilgrims were introduced in response to these events and led to substantial declines in IMD cases associated with these mass gatherings. However, there remains potential for future outbreaks either within KSA during the Hajj or in local populations via pilgrim meningococcal transmission on their return. While the annual Hajj involves pilgrims from over 185 countries, two-thirds of these arrive from 13 countries, chiefly from across South-East Asia, the Middle East and North African (MENA) regions; for which we review the relevant epidemiology of IMD and meningococcal carriage. While disease surveillance is limited and data are often lacking, MenB is an important serogroup associated with IMD and carriage in a number of countries. Available literature suggests that most pilgrims receive polysaccharide MenACWY vaccines (which do not impact carriage and onward transmission) and incomplete compliance with visa/entry immunization regulations is reported. Existing preventative approaches for visiting pilgrims require continued oversight. More complete compliance and switching to the conjugated MenACWY vaccine can provide more robust and broader protection for pilgrims. Additional immunization options could also be considered.

The current COVID-19 global pandemic continues to impact healthcare services beyond those directly related to the management of SARS-CoV-2 transmission and disease. We reviewed the published literature to assess the pandemic impact on existing global immunization activities and how the impact may be addressed. Widespread global disruption in routine childhood immunization has impacted a majority of regions and countries, especially in the initial pandemic phases. While data indicate subsequent recovery in immunization rates, a substantial number of vulnerable people remain unvaccinated. The downstream impact may be even greater in resource-limited settings and economically poorer populations, and consequently there are growing concerns around the resurgence of vaccine-preventable diseases, particularly measles. Guidance on how to address immunization deficits are available and continue to evolve, emphasizing the importance of maintaining and restoring routine immunization and necessary mass vaccination campaigns during and after pandemics. In this, collaboration between a broad range of stakeholders (governments, industry, healthcare decision-makers and frontline healthcare professionals) and clear communication and engagement with the public can help achieve these goals.Key messagesThe COVID-19 pandemic has a substantial impact on essential immunization activities.Disruption to mass vaccination campaigns increase risk of VPD resurgence.Catch-up campaigns are necessary to limit existing shortfalls in vaccine uptake.Guidance to mitigate these effects continues to evolve.

Introduction and Objectives Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis. In recent years, its role in the development of chronic hepatitis and cirrhosis especially in immunosuppressed patients and its wide range of extrahepatic involvement have increased the amount of research on HEV. In this study we aimed to investigate the presence of HEV infection in individuals with cryptogenic cirrhosis. Materials and methods HEV antibodies were analysed using the Anti HEV enzyme-linked immunosorbent assay (ELISA) kit (anti-HEV ELISA; Diapro Prodiagnostic Bioprobes, Milan, Italy). HEV RNA was isolated with using QIAMP Viral RNA mini kit (QIAGEN, Hilden, Germany). The HEV RNA titre was detected with the Rotor Gene 3000 real time polymerase chain reaction (PCR) system using GenoSen's HEV (Rotor Gene) Quantitative Real Time PCR Kit (Genome Diagnostics Private Limited, the Netherlands). Results Our study included 21 healthy volunteers (12 males) and 35 cryptogenic cirrhosis patients (19 males). The ages of the patients and the controls were similar (46 ± 12.1 vs. 37.5 ± 9.7years). The mean Child–Pugh score was 8 ± 2.5. The anti HEV immunoglobulin G(IgG) positivity rate was 9.5% and 25.7% in the control and patient groups respectively (p > 0.05). HEV RNA positivity was not detected in the control group, but 3 cases (8.6%) in the patient group were positive (p > 0.05). The HEV RNA, aspartate aminotransferase (AST) and alanine aminotransferase(ALT) levels for these 3 cases were 326.461 copies/mL, 91 IU/L and 67 IU/L; 480 copies/mL, 68 IU/L and 36 IU/L and 72 copies/mL, 42 IU/L and 24 IU/L respectively. There were positive correlations between HEV RNA levels and AST and ALT levels (p Conclusions Anti HEVIgG and HEV RNA positivity rates are high in cryptogenic cirrhosis although it is not statistically significant and there is a positive correlation between HEV RNA and aminotransferases.

The diagnosis of influenza A virus is essential since it can be confused with influenza A like illness and lead to inaccurate drug prescription. In this study, the M2e peptide, a strategic antigen that is conserved in all virus subtypes, was used as a diagnostic marker of influenza A. For the first time, M2e-specific IgY antibody was covalently conjugated to alkaline phosphatase (ALP) enzyme in the presence of glutaraldehyde. The antibody-enzyme bioconjugate was characterized by fluorescence and Fourier-transform infrared spectroscopy. Subsequently, the diagnostic value of this bioconjugate was evaluated by direct sandwich ELISA using nasopharyngeal swab samples positive/negative for H1N1 and H3N2, which were previously analyzed by rRT-PCR for influenza. In conclusion, the M2e-specific IgY-ALP bioconjugate demonstrated positive results for Influenza A in samples that were diagnosed as Influenza A via the RT-PCR method.

In most countries of the Middle East and Northern African (MENA) region, a high hepatitis A virus (HAV) endemicity has been documented. Few others, such as Saudi Arabia and Turkey, are transitioning from high to intermediate endemicity. There is a paucity of recently published HAV disease burden that could be useful to inform or strengthen relevant national hepatitis A vaccination policy and other prevention strategies in the region. This review summarizes information on HAV epidemiology before and after the implementation of a childhood hepatitis A vaccination program in Saudi Arabia and Turkey. In both countries, a clear shift in the age of first HAV exposure has been documented, with more homogeneous trends across regions in Saudi Arabia compared to Turkey. Utilizing the experience of Saudi Arabia and Turkey with hepatitis A vaccination, countries in the region are encouraged to foster discussions on potential vaccination strategies suitable for their own setting.

Amaç: Aşı tereddüdü hem Türkiye hem de dünya için toplumsal tehdit oluşturan bir tutumdur. Bu konuda Türkçeye validasyonu yapılmış bir ölçek bulunmamaktadır. Bu çalışmanın amacı Opel ve ark. tarafından 2011 yılında geliştirilip 2013 yılında revize edilen ve ‘Parent Attitudes About Childhood Vaccines Survey ‘isimli ölçeğin Türkçeye dil validasyonunun yapılmasıdır. Gereç ve Yöntem : Çalışma bir dil validasyonu çalışması olarak gerçekleştirilmiştir. Opel DJ ve arkadaşları tarafından geliştirilen ölçek için ‘Seri yöntem’ kullanılarak dil validasyonu çalışması yapılmıştır. Ölçeğin çeviri, gözden geçirme, geri çeviri, açıklığın ve aynılığın değerlendirmesi ile çevirisi sağlanmış ve Modifiye Lawshe yöntemiyle kapsam geçerlilik analizi yapılarak son hali verilmiştir. Uzmanların ölçek maddelerine yönelik içerik uygunluğu yönünden belirtmiş oldukları görüşlere göre her madde için kapsam geçerlilik oranı ve kapsam geçerlilik indeksi hesaplanmıştır. Bulgular. Tüm ölçek soruları için kapsam geçerlilik oranı kritik değer olan 0,455’in üzerinde saptanmıştır. Ölçeğin kapsam geçerlilik indeksi değeri ise 0,630 olup ölçek sorularının kapsam geçerliliğinin istatistiksel olarak anlamlı olduğu tespit edilmiştir. Çıkarımlar: Çocukluk çağı aşılarına yönelik ebeveyn tutumları ölçeğinin dil validasyonunun tamamlanması ve kapsam geçerlilik testlerinden istatistik olarak anlamlı sonuçlar alınmış olması bu ölçeğin Türkçe anlaşılırlığının sağlandığını göstermektedir. Sonrasında yapılacak geçerlilik ve güvenilirlik çalışmaları ile ölçeğin Türkiye’de aşı tereddüdü konusunda ebeveyn tutumlarını ölçebilir hale gelmesi hedeflenmektedir. Böylece daha geniş kitlelerde çalışılarak aşı tereddüdü ve mücadelesi konusunda yapılacak çalışmalara katkı sağlayacağı düşünülmektedir.

The database of the Global Influenza B Study was created by collecting surveillance datasets from each of the participating countries. These national datasets are owned by the participating countries, and thus cannot be shared publicly. Researchers interested in obtaining the country-specific datasets may contact the individuals listed below for further details regarding data access.Argentina (Santa Fe Province): Gabriela Kusznierz (labconi@yahoo.com.ar)Australia: Kate Pennington (kate.pennington@health.gov.au)Bhutan: Sonam Wangchuk (swangchuk@health.gov.bt)Brazil: Cláudio Maierovitch Pessanha Henriques (claudio.henriques@saude.gov.br)Cameroon: Guy Vernet (vernet@pasteur-yaounde.org)Chile: Rodrigo Fasce (rfasce@ispch.cl)China: Feng Luzhao (fenglz@chinacdc.cn)Costa Rica: Alexey W. Clara (wclara@cdc.gov)Ecuador: Alfredo Bruno (alfredobruno@yahoo.es)El Salvador: Alexey W. Clara (wclara@cdc.gov)England: Maria Zambon (maria.zambon@phe.gov.uk)Guatemala: Alexey W. Clara (wclara@cdc.gov)Honduras: Alexey W. Clara (wclara@cdc.gov)Indonesia: Herman Kosasih (hermaninarespond@gmail.com)Italy: Caterina Rizzo (caterina.rizzo@iss.it)Ivory Coast: Herve A. Kadjo (hervekadjo@pasteur.ci)Kazakhstan: Gulzhan Muratbayeva (hnv2@cdc.gov)Kenya: Joshua Mott (zud9@cdc.gov)Madagascar: Jean-Michel Heraud (jmheraud@pasteur.mg)Morocco: Amal Barakat (amal.barakat@yahoo.fr)New Zealand: Sue Huang (sue.huang@esr.cri.nz)Nicaragua: Alexey W. Clara (wclara@cdc.gov)Panama: Alexey W. Clara (wclara@cdc.gov)Portugal: Ana Paula Rodrigues (ana.rodrigues@insa.min-saude.pt)Singapore: Vernon Lee (vernonljm@hotmail.com)South Africa: Cheryl Cohen (cherylc@nicd.ac.za)Turkey: Meral Akcay Ciblak (ciblakm@yahoo.com)Ukraine: Alla Mironenko (miralla@ukr.net)Viet Nam: Le Thi Quinh Mai (lom9@hotmail.com); International audience; BACKGROUND:Influenza disease burden varies by age and this has important public health implications. We compared the proportional distribution of different influenza virus types within age strata using surveillance data from twenty-nine countries during 1999-2014 (N=358,796 influenza cases).METHODS:For each virus, we calculated a Relative Illness Ratio (defined as the ratio of the percentage of cases in an age group to the percentage of the country population in the same age group) for young children (0-4 years), older children (5-17 years), young adults (18-39 years), older adults (40-64 years), and the elderly (65+ years). We used random-effects meta-analysis models to obtain summary relative illness ratios (sRIRs), and conducted meta-regression and sub-group analyses to explore causes of between-estimates heterogeneity.RESULTS:The influenza virus with highest sRIR was A(H1N1) for young children, B for older children, A(H1N1)pdm2009 for adults, and (A(H3N2) for the elderly. As expected, considering the diverse nature of the national surveillance datasets included in our analysis, between-estimates heterogeneity was high (I2>90%) for most sRIRs. The variations of countries' geographic, demographic and economic characteristics and the proportion of outpatients among reported influenza cases explained only part of the heterogeneity, suggesting that multiple factors were at play.CONCLUSIONS:These results highlight the importance of presenting burden of disease estimates by age group and virus (sub)type.

Introduction: The aim of this study was to asses the surveillance of influenza A/other respiratory viruses and risk factors in hospitalized children with the symptoms of influenza-like illness during two consecutive influenza seasons. Methodology: All children hospitalized with adiagnosis of influenza-like illness had been investigated for Influenza A and other respiratory antigens in pharengeal/nasopharyngeal secretions. Results: A total of 132 hospitalized children between December 2013-May 2014 and December 2014-May 2015 were enrolled in this study. At least one respiratory virus was found to be positive by RT-PCR in 78 (59%) patients, influenza A (H3N2) was detected in only 8 (6%) patients. In 54 (41%) patients samples no respiratory viral pathogen was detected and in 70 (53%) patients, one non- influenza A virus was detected. The respiratory viral pathogens detected in decreasing rates were:RSV (n = 46, 35%), HCoV (n = 10, 7.5%), adenovirüs (n = 7, 5%), rhinovirüs (n = 6, 4.5%), HMPV (n = 5, 4%), Influenza B (n = 4, 3%) ve human Bocavirus (n = 2, 1.5%). In 10 patients, coinfection was detected, however none was with H3N2. In the H3N2 (+) group, the following risk factors were identified: age older than three years (p < 0.05), asthma history (p < 0.05) and chronic lung diseases (p < 0.05). Conclusion: Influenza A virus was detected in 6% of hospitalized patients with influenza-like illness. Viruses other then Influenza, especially RSV, can cause similar symptoms compatible with Influenza-like-illness.

Objective: With a wide range of clinical presentations, respiratory tractinfections remain a significant cause of morbidity and mortality worldwide,particularly in infants. The aim of this cross-sectional descriptive study was to determine the frequency of respiratory virusesresponsible for upper respiratory tract infections during the 2013-2014influenza season in infants less than 6 months of age. Method: Nasal swabswere obtained from patients with symptoms suggestive of an influenza-likeillness (ILI) between January and April 2014. Specimens were evaluated byRT-PCR to help identify the causative viral pathogens. Results: A total of150 patients with ILI were enrolled in the study. A respiratory virus wassuccessfully detected in 126 (86%) infants; RSV in 41 (32.5%),rhinovirus in 17 (13.4%), metapneumovirus in 15 (11.9%), coronavirus in 11(8.7%), adenovirus in 5 (3.9%), parainfluenza virus in 2 (1.5%) and bocavirusin 2 (1.5%) infants. Thirty-three (26.1%) patients were found to be co-infectedwith both two viruses. Rhinorrhea and developing complications weresignificantly more frequently seen in RT-PCR positive patients (p=0.023 andp=0.019, respectively). All complications were seen in RT-PCR positive group,especially in metapneumovirus, RSV and multiple viruses positive patients.Conclusions: With an overall viral pathogen detection rate of 86%, findings ofour study present that influenza viruses were not seen in infants less than 6months of age in our study population, whether RSV and multiple viralinfections were the most common causes in this age group., Amaç: Solunum yolu enfeksiyonlarıtüm dünyada özellikle süt çocuklarında mortalite ve morbiditenin önemli birnedenidir. Bu kesitsel- tanımlayıcıçalışmanın amacı, 6 ay altındaki süt çocuklarında 2013-2014 influenza sezonuboyunca üst solunum yolu enfeksiyonlarından sorumlu olan solunum yoluviruslarının saptanmasıdır.Yöntem:Ocak - Nisan 2014 tarihleri arasında akut üst solunum yoluenfeksiyonu (ÜSYE) semptomları ile başvuran hastalardan nazofaringeal sürüntü(swab) alındı. Örneklerden solunum yoluvirusları için RT-PCR çalışıldı.Bulgular:150 hasta çalışmaya alındı. 126 (% 86) hastada solunumyolu virusları pozitif bulundu. Virus pozitif hastaların 41'inde (% 32.5) RSV,17'sinde (% 13.4) rinovirus, 15’inde (%11.9) metapnömovirus, 11’inde (% 8.7) koronavirus, beşinde (% 3.9) adenovirus,ikisinde (% 1.5) parainfluenza ve ikisinde (% 1.5) bokavirus saptandı. Otuz üç(% 26.1) hastanın iki virusle ko-enfeksiyonu olduğu tespit edildi. Burunakıntısı ve komplikasyon gelişimi RT-PCR pozitif hastalarda daha fazla idi(sırasıyla p = 0.023 ve p = 0.019). Tüm komplikasyonlar RT-PCR pozitif gruptaözellikle metapnömovirus, RSV ve çoklu virus pozitif hastalarda görüldü.Sonuç: Viralpatojen pozitifliği %86 saptanan çalışmamızda, 6 ay altındaki sütçocuklarında influenza virusugörülmediği, RSV ve çoklu viral enfeksiyonların bu yaş grubunda en sık neden olduğu ortaya konmuştur.

The knowledge about the viral etiologies causing respiratory disease in adults is limited. Viral respiratory diseases may lead deterioration in certain patient populations. The aim of this study was to determine the viral etiologies of influenza-like illness among patients requiring hospitalization and to document the risk factors for mortality. This prospective study was performed in one of the 7 centers in Turkey in the context of influenza surveillance by the Global Influenza Hospital Surveillance Network. A 35-bed Adult Emergency Service and 10-bed Acute Care Unit were screened for consequent recruitment of eligible patients daily, on weekdays only. ICD-10 codes in the electronic health records and direct patient encounters were used to screen for the following eligibility diagnoses: acute respiratory tract infection, asthma, heart failure, pneumonia, influenza, chronic obstructive lung disease, dyspnea/respiratory abnormality, respiratory symptoms, cough and fever. A total of 334 patients who were admitted with the eligible ICD-10 codes within the 24th and 48th hours were screened during the study period and of those eligible ones, 106 consented and were swabbed. Nasal or nasopharyngeal swabs were collected using Virocult (Medical Wire & Equipment, UK) and sent to the central laboratory in 1-3 days. Swabs were collected and specimens were introduced to real-time polymerase chain reaction based multiplex kits, as well as, ABI 7500 platform with CDC primers and probes. A total of 106 patients were swabbed. Hospital mortality was 12.2%. More than one fourth of the patients needed a sort of mechanical ventilation support and at least one organ failure developed in one third of the patients. One or more viral pathogens were detected in 56 (52.8%) of the swabbed patients, with influenza H3N2 being the most prevalent one. Having a lower body mass index (OR, 0.845, p= 0.034) was associated with mortality. Chronic lung diseases were shown to confer a survival advantage (OR, 0.127, p= 0.009). Community acquired viral respiratory infections might lead to significant compromise in adult patients. Prevention of malnutrition might result in better outcomes in patients who need acute admission. The survival advantage of those with chronic lung diseases warrants further investigation.

Buyukkapu-Bay S, Kebudi R, Gorgun O, Mese S, Zulfikar B, Badur S. Respiratory viral infection`s frequency and clinical outcome in symptomatic children with cancer: A single center experience from a middle-income country. Turk J Pediatr 2018; 60: 653-659. In developing countries, acute respiratory tract infections are a significant cause of morbidity and mortality in children, particularly in pediatric cancer patients. A majority of these illnesses are precipitated by viral infections. In our country, studies were conducted on the single respiratory viral infection in a pediatric hematology-oncology unit; however, the analysis of respiratory viral infections in children with cancer is lacking. The present study aimed to provide analysis of multiple respiratory viral infections and clinical outcome in children with cancer who receive chemotherapy and show signs and symptoms of respiratory tract infections. During January, 2014 and January, 2015 children with cancer under treatment who presented with respiratory tract infections were assessed for viruses by using multiplex real-time reverse transcription polymerase chain reaction (rRT-PCR). Specimens were collected by nasal swabbing at in-patient and out-patient clinics. Overall, 72 samples of respiratory tract infection episodes, collected from children with cancer were evaluated with the simultaneous detection of 20 respiratory viruses. A respiratory viral pathogen was obtained in 56.9% samples. Rhinovirus (24.3%) and co-infection with two viruses (19.5%) were the most frequently isolated pathogens. There were four (9.6%) samples of severe pneumonia. Patients with febrile neutropenic episodes and pneumonia were hospitalized and treated with broad-spectrum antibiotics. Other non-neutropenic and mild respiratory tract infections were treated with supportive care as outpatient procedures. There were no deaths. Because there are no effective antiviral agents for certain respiratory viruses, infection control and early diagnosis are crucial in preventing the spread of infection. Clinical findings and serological results of viral respiratory tract infections help us to accurately determine the treatment approach and avoid the unnecessary use of antibiotics.

Amaç: Hepatit A enfeksiyonu epidemiyolojisi yaşam koşullarına göre farklılık gösteren bir sorundur. Bu nedenle hastalığın değişen epidemiyolojisini değerlendirmek koruyucu hekimlik uygulamaları açısından önemlidir. Çalışmanın amacı anne ve bebek çiftlerinde hepatit A antikoru seropozitifliğinin belirlenmesi ve bunu etkileyen faktörlerin değerlendirilmesidir. Gereç ve Yöntem: Çalışmada 209 anne-bebek çiftinin verileri değerlendirilmiştir. Kan örnekleri annelerden doğumdan 1 ay sonra ve bebeklerinden ise 1. ve 6. aylarda alınmıştır. Hepatit A IgG antikor düzeyleri ELİSA yöntemi ile belirlenmiştir. Ailelerin sosyo-ekonomik ve demografik özelliklerine yönelik bilgiler yüz yüze uygulanan bir anket yolu ile toplanmıştır. Bulgular: Annelerde 1. ayda hepatit A seropozitifliği %67, bebeklerde 1. ayda %66,1, 6. ayda %68,9 olarak saptanmıştır. Ebeveynlerin eğitim süresinin, ailenin aylık gelirinin, gravida ve paritenin hepatit A seropozitiflik düzeyine istatistiksel açıdan ileri düzeyde anlamlı etkisi olduğu saptanmıştr. Eğitim düzeyi, aylık gelir arttıkça seropozitiflik oranı düşmekte; gravida ve parite artıkça yükselmektedir. Sonuç: Süt çocuklarında hepatit A seropozitiflik düzeyinin sosyo-ekonomik faktörlerden etkilendiği düşünülmüştür., Objective: Epidemiology of hepatitis A infection differs according to living conditions. Therefore, evaluating the changing epidemiology of the disease is important for preventive medicine. The aim of the study was to determine the seropositivity of hepatitis A antibody in mothers and their babies and to evaluate the factors affecting it. Materials and Methods: The data of 209 mother-infant pairs were evaluated. Blood samples were collected from mothers one month after birth and at 1 and 6 months of age from their babies. Hepatitis A IgG antibody levels were determined by ELISA method. The socio-economic and demographic characteristics of the families were collected by a questionnaire. Results: The seropositivity of the hepatitis A antibody was 67% in mothers at one month after birth, 66.1% and 68.9% in their babies at 1 and 6 months of age respectively. Parental education, family monthly income, gravity and parity were found to have a statistically significant effect on hepatitis A seropositivity. As the level of education and monthly income increased, hepatitis A seropositivity decreased. On the other hand as parity and gravida increased, seropositivity increased as well. Conclusion: Hepatitis A seropositivity in infants is thought to be affected by socio-economic factors.

Rotavirus gastroenteritis imposes a heavy burden on low- and middle-income countries. The World Health Organization defines the Eastern Mediterranean region (WHO-EMRO) as a diverse area in terms of socioeconomic status and health indicators. Rotavirus vaccination has been introduced, at least partially, in 19 out of the 22 EM countries; however, vaccine coverage remains low, and data on rotavirus disease burden is scarce. Available data on rotavirus prevalence, seasonality, vaccination status, and genotype evolution was systematically compiled following a literature review that identified 165 relevant WHO-EMRO epidemiology studies published between 1990 and 2017. Although the infectious agents responsible for acute gastroenteritis vary over time, rotavirus remained the leading cause of acute gastroenteritis in children, as seen in 76.3% of reviewed publications. Younger children (

Aim: The aim of this study was to determine the factors that influenced the decisions of family physicians working in primary care health services to receive influenza vaccines. Methods: This cross-sectional study was performed between June 2014 and September 2014. Physicians were reached electronically via e-mail. A self-reported questionnaire consisting of 50 items covering potential factors that may have influenced their decision to receive vaccination, including perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, cues to action, attitudes, social influences and personal efficacy, was administered to the study participants. Cronbach's alpha for the questionnaire was determined to be 0.92 in the pilot study. Results: The response rate was 27.5% (n = 596). Regularly vaccinated physicians accounted for 27.3% of the responses. The median age was 41.84 ± 7.80, and the median working duration of the group was 17.0 ± 7.8 years. The factors that led to increased vaccination compliance (p < 0.05) included working duration, age, chronic disease history and living with a person over 65 years. Nearly all major domains, i.e., perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, attitudes, social influences and personal efficacy, there were differences between the compliant and noncompliant groups. Multi-regression analyses revealed that risk perception, organizational factors such as time and convenient vaccination increased vaccine compliance. However, the perceived necessity to be vaccinated annually had a negative effect on vaccination behaviour (p < 0.05). Conclusion: Strategies aimed to increase the flu vaccination ratio among physicians that do not take different factors into account are more likely to be unsuccessful. In the planning and implementation of strategies aiming to increase the vaccination ratio among physicians, it is both necessary and important to take into account behavioural and organizational factors. © 2016 Elsevier Ltd.

Antibodies play an important role in combating and controlling viral diseases such as influenza. Immunoglobulin Y (IgY) antibodies have several advantages such as a less invasive manufacturing process, ease of isolation, higher affinity compared with IgG antibodies, and cost-effectiveness. To date, although specific IgY production has been performed for different strains of influenza A, to the best of our knowledge, an IgY against the M2e peptide has not been produced. In the current study, IgY antibodies are produced, purified, and characterized using the M2e peptide sequence for the first time with the intent to apply them for the diagnosis of influenza A virus. Anti-M2e IgY antibodies are obtained from eggs using a two-step purification method. The activity and characterization of the antibodies are determined using an enzyme-linked immunosorbent assay, a nano-spectrophotometer, an SDS-Page assay, and a Western Blot analysis. Finally, anti-M2e IgY antibodies are conjugated to the latex nanoparticles, and the reaction between the influenza A virus and the nanoparticles is demonstrated using light microscopy, transmission electron microscopy, and energy dispersive X-ray spectroscopy. In conclusion, this study shows that anti-M2e IgY antibodies can contribute to the diagnosis, treatment, and prevention of the influenza A virus.