{"id":24743,"date":"2022-05-21T13:39:10","date_gmt":"2022-05-21T10:39:10","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=24743"},"modified":"2022-06-27T10:24:52","modified_gmt":"2022-06-27T07:24:52","slug":"yasli-populasyonda-inaktif-asinin-etkinligi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/05\/21\/yasli-populasyonda-inaktif-asinin-etkinligi\/","title":{"rendered":"SARS-CoV-2 PCR Pozitifli\u011fi Nedeniyle Hastaneye Yatan 65 Ya\u015f ve \u00dczeri Tam Doz \u0130naktif A\u015f\u0131l\u0131 ve A\u015f\u0131s\u0131z Olgular\u0131n \u0130rdelenmesi"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

T\u00fcrkiye\u2019de COVID-19 (koronavirus hastal\u0131\u011f\u0131 2019) pandemisinde ilk\u00a0tespit edilen\u00a0olgu T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan 11 Mart 2020 tarihinde a\u00e7\u0131kland\u0131. \u0130kinci dalgan\u0131n tamamland\u0131\u011f\u0131 2021\u2019in ba\u015flar\u0131nda \u00fclkemizde ilk a\u015f\u0131lamalara inaktif a\u015f\u0131larla ba\u015fland\u0131. Nisan ve May\u0131s aylar\u0131nda g\u00fcnl\u00fck olgu say\u0131lar\u0131n\u0131n en y\u00fcksek oldu\u011fu \u00fc\u00e7\u00fcnc\u00fc dalga ya\u015fand\u0131 ve bu d\u00f6nemde mRNA a\u015f\u0131lar\u0131yla (Pfizer\/BioNTech) a\u015f\u0131lama ba\u015flat\u0131ld\u0131. \u00dclkemizde yo\u011fun a\u015f\u0131lama \u00e7al\u0131\u015fmalar\u0131na ra\u011fmen t\u00fcm d\u00fcnyada oldu\u011fu gibi halen d\u00f6rd\u00fcnc\u00fc dalga s\u00fcrmektedir.<\/p>\n

Hastal\u0131\u011f\u0131n klini\u011fi; asemptomatik formdan, hafif \u00fcst solunum yolu infeksiyonu tablosuna veya hafif pn\u00f6moniden \u00f6l\u00fcmle sonu\u00e7lanabilen a\u011f\u0131r viral pn\u00f6monilere kadar de\u011fi\u015febilen formlarda seyir g\u00f6sterebilmektedir (1).\u00a0 <\/span>\u015eiddetli COVID-19 hastal\u0131\u011f\u0131 i\u00e7in ba\u015fl\u0131ca risk fakt\u00f6rleri aras\u0131nda ya\u015f, erkek cinsiyet, obezite, sigara kullan\u0131m\u0131n\u0131n yan\u0131 s\u0131ra hipertansiyon (HT) ve tip 2 diabetes mellitus (DM) gibi e\u015flik eden kronik hastal\u0131klar yer almaktad\u0131r. Pek \u00e7ok \u00e7al\u0131\u015fmada ya\u015f\u0131n tek ba\u015f\u0131na \u015fiddetli hastal\u0131k i\u00e7in en \u00f6nemli risk fakt\u00f6r\u00fc oldu\u011fu g\u00f6sterilmi\u015ftir (2, 3). Bu nedenle \u00fclkemizde a\u015f\u0131 uygulamas\u0131nda birinci a\u015famada s\u0131ras\u0131yla; sa\u011fl\u0131k kurumlar\u0131nda \u00e7al\u0131\u015fanlar, ya\u015fl\u0131 engelli koruma evleri gibi yerlerde kalan ve \u00e7al\u0131\u015fanlardan hemen sonra ya\u015fl\u0131 pop\u00fclasyonu temsil eden 65 ya\u015f \u00fcst\u00fc bireyler a\u015f\u0131lanm\u0131\u015ft\u0131r (4). \u0130lk a\u015f\u0131lama 13 Ocak 2021 tarihinde ba\u015flat\u0131lm\u0131\u015f olup uygulanan a\u015f\u0131 D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan ilk a\u015famada acil kullan\u0131m onay\u0131 verilen inaktive edilmi\u015f SARS-CoV-2 a\u015f\u0131s\u0131 CoronaVac (Sinovac Life Sciences, Pekin, \u00c7in)\u2019t\u0131r (5).<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, 65 ya\u015f ve \u00fcst\u00fc semptomatik hastalarda ger\u00e7ek zamanl\u0131 revers transkriptaz polimeraz zincir reaksiyonu (RT-PCR) tekni\u011fi ile SARS-CoV-2 pozitifli\u011fi saptanan ve hastaneye yat\u0131r\u0131lan olgular a\u015f\u0131lanma durumlar\u0131na g\u00f6re irdelendi.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fmam\u0131za, 10 Mart \u2013 30 Haziran 2021 tarihleri aras\u0131nda hastanemize yatan \u2265 65 ya\u015f, RT-PCR pozitifli\u011fi saptanm\u0131\u015f COVID-19 olgular\u0131 dahil edildi. Olgular a\u015f\u0131l\u0131 (Grup 1) ve a\u015f\u0131s\u0131z (Grup 2) olmak \u00fczere iki grupta incelendi. Grup 1, d\u00f6rt hafta ara ile iki doz inaktive a\u015f\u0131 olup a\u015f\u0131lar\u0131n\u0131n tamamlanmas\u0131ndan 15 g\u00fcn sonra hasta olanlardan olu\u015furken; Grup 2, hi\u00e7 a\u015f\u0131 olmayanlar, bir doz a\u015f\u0131 olanlar veya iki doz a\u015f\u0131 olan ancak ikinci dozun \u00fczerinden 15 g\u00fcn ge\u00e7meden hasta olanlardan olu\u015ftu. Grup 1\u2019de yer alan hastalar\u0131n hastal\u0131klar\u0131 i\u00e7in ge\u00e7en s\u00fcre en \u00e7ok 90 g\u00fcnd\u00fcr. Gruplar; demografik ve klinik \u00f6zelliklerinin yan\u0131 s\u0131ra laboratuvar verileri ve mortalite y\u00f6n\u00fcnden k\u0131yasland\u0131.<\/p>\n

Hastalar\u0131n epidemiyolojik, klinik (takipne, oksijen sat\u00fcrasyonu), laboratuvar [lenfosit, C-reaktif protein (CRP), D-dimer, ferritin] ve radyolojik verileri hastane bilgi y\u00f6netim sistemlerinden elde edildi. Solunum dakika say\u0131s\u0131n\u0131n \u226524 olmas\u0131 takipne, oda havas\u0131nda SpO\u00b2 <%93 olmas\u0131 desat\u00fcrasyon olarak de\u011ferlendirildi. Toraks BT g\u00f6r\u00fcnt\u00fclemeleri; kald\u0131r\u0131m ta\u015f\u0131 g\u00f6r\u00fcn\u00fcm\u00fc, konsolidasyon, infiltrasyon ve buzlu cam lezyonlar\u0131n\u0131n yayg\u0131nl\u0131\u011f\u0131na g\u00f6re hafif, orta ve a\u011f\u0131r olarak s\u0131n\u0131fland\u0131r\u0131ld\u0131. Akci\u011fer g\u00f6r\u00fcnt\u00fclemesinde tek tarafl\u0131 tutulumu olanlar hafif, bilateral <%50 tutulumu olanlar orta, >%50 tutulumu olanlar a\u011f\u0131r pn\u00f6moni olarak de\u011ferlendirildi. Demografik veriler, yak\u0131nmalar ve ek hastal\u0131klar olgu rapor formu ile de\u011ferlendirildi. Grup 2\u2019deki hastalar\u0131n a\u015f\u0131lanmama sebepleri soruldu.<\/p>\n

\u0130statistiksel Analizler<\/h3>\n

\u0130statistiksel analiz, SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 25.0 program\u0131 (IBM Corp., Armonk, NY, ABD) kullan\u0131larak ger\u00e7ekle\u015ftirildi.\u00a0Numerik de\u011fi\u015fkenler ortalama \u00b1 standart sapma (SS) olarak belirtildi. \u0130ki grup aras\u0131nda s\u00fcrekli de\u011fi\u015fkenlerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda t testi, kategorik de\u011fi\u015fkenlerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda \u03c72 testi kullan\u0131ld\u0131 ve p<\/i><\/span><0.05 istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n

BULGULAR<\/h2>\n

Olgular\u0131n Demografik ve Klinik \u00d6zellikleri<\/h3>\n

\u00c7al\u0131\u015fmaya toplam 151 olgu dahil edildi. Grup 1\u2019deki 78 hastan\u0131n 39 (%50)\u2019u, Grup 2\u2019deki 73 hastan\u0131n 38 (%52)\u2019i kad\u0131nd\u0131. Gruplar aras\u0131nda cinsiyet da\u011f\u0131l\u0131m\u0131 anlaml\u0131 farkl\u0131l\u0131k g\u00f6stermedi (p=0.80).<\/p>\n

Grup 2\u2019deki olgular\u0131n 49 (%67.1)\u2019u a\u015f\u0131ya kar\u015f\u0131 g\u00fcvensizlik, bilgisizlik, kimsesizlik, zamans\u0131zl\u0131k, hastaneye ula\u015famama ve randevu almay\u0131 becerememe gibi nedenlerle hi\u00e7 a\u015f\u0131 olmam\u0131\u015ft\u0131. Kalan 24 (%32.9) olgu ise bir kez a\u015f\u0131lanm\u0131\u015f, ikinci doz a\u015f\u0131 zaman\u0131 gelmeden veya bu zaman\u0131 ge\u00e7irdikten sonra hastal\u0131\u011fa yakalanm\u0131\u015ft\u0131. A\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z grubun ya\u015f ortalamalar\u0131 s\u0131ras\u0131yla 75.8\u00b17.4 ve 73.8\u00b18.0 y\u0131ld\u0131r (p<\/i>=0.10). K\u0131rk be\u015f (%29.8) olgu yo\u011fun bak\u0131m \u00fcnitesinde izlenmi\u015f olup 25 (%55.6)\u2019i a\u015f\u0131l\u0131, 20 (%44.4)\u2019si a\u015f\u0131s\u0131zd\u0131 (p<\/i>=0.32).<\/p>\n

Toplam mortalite oran\u0131 %21.9 (33 hasta) olup tamam\u0131 yo\u011fun bak\u0131m \u00fcnitesinde izlenen olgulard\u0131; 19 (% 57.6)\u2019u a\u015f\u0131l\u0131 ve 14 (% 42.4)\u2019\u00fc a\u015f\u0131s\u0131zd\u0131 (p<\/i>=0.44).<\/p>\n

Toplam 134 (%88.7) olguda komorbidite saptand\u0131. En s\u0131k g\u00f6r\u00fclen ek hastal\u0131klar s\u0131ras\u0131yla HT (%55.6), DM (%40.3), kardiyovask\u00fcler hastal\u0131k (%33.7), malignite (%12.5) ve KOAH (%12.5)\u2019d\u0131r. Ek hastal\u0131k say\u0131s\u0131 47 (%31.1) olguda bir, 47(%31.1) olguda iki, 27 (%17.9) olguda \u00fc\u00e7 ve 13 (%8.6) olguda ise \u00fc\u00e7ten fazla bulundu. Mortal seyreden olgular\u0131n 29 (%87.8)\u2019unda en az bir ek hastal\u0131k saptand\u0131. Ek hastal\u0131k say\u0131s\u0131 ile mortalite aras\u0131nda anlaml\u0131 d\u00fczeyde korelasyon saptand\u0131 (r=0.18, p<\/i>=0.02)<\/p>\n

A\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z grupta takipne saptanan olgu say\u0131s\u0131 s\u0131ras\u0131yla 25 (%32) ve 23 (%31.5)\u2019t\u00fc (p<\/i>=0.94). Desat\u00fcre olgu say\u0131lar\u0131 ise s\u0131ras\u0131yla 45 (%57.6) ve 43 (%58.9)\u2019t\u00fc (p<\/i>=0.88). Mortal seyreden olgular\u0131n 28 (%84.8)\u2019inin ba\u015fvuru an\u0131nda desat\u00fcre oldu\u011fu g\u00f6r\u00fcld\u00fc. Desat\u00fcrasyon ile mortalite aras\u0131nda anlaml\u0131 d\u00fczeyde korelasyon saptand\u0131 (r=0.28, p<\/i>=0.01).<\/p>\n

Laboratuvar ve G\u00f6r\u00fcnt\u00fcleme \u00d6zellikleri<\/h3>\n

Toplam 60 (%39.7) olguda mutlak lenfopeni (<800\/\u03bcl) saptand\u0131. Lenfopeninin a\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z grupta g\u00f6r\u00fclme oranlar\u0131 s\u0131ras\u0131yla 33 (%42.3) ve 27 (%36.9) idi (p<\/i><\/span>=0.51). CRP y\u00fcksekli\u011fi (>40 mg\/lt) toplam 107 (%70.8) olguda saptand\u0131. CRP y\u00fcksekli\u011finin a\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z grupta g\u00f6r\u00fclme oranlar\u0131 s\u0131ras\u0131yla 58 (%74.3)ve 49 (%67.1)\u2019du (p<\/i><\/span>=0.32). Ferritin y\u00fcksekli\u011fi (>500ng\/ml) toplam 52 (%34.4) olguda saptand\u0131. Ferritin y\u00fcksekli\u011finin a\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z grupta g\u00f6r\u00fclme oranlar\u0131 s\u0131ras\u0131yla 34 (%43.5) ve 18 (%24.6)\u2019di (p<\/i><\/span>=0.09). D-dimer y\u00fcksekli\u011fi (>1000 ng\/ml) toplam 90 (%59.6) olguda saptand\u0131. D-dimer y\u00fcksekli\u011finin a\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z grupta g\u00f6r\u00fclme oranlar\u0131 s\u0131ras\u0131yla 48 (%61.5) ve 42 (%57.5) idi (p<\/i><\/span>=0.61).<\/p>\n

A\u015f\u0131l\u0131 grupta; 19 (%24.3) olguda hafif, 26 (%33.3) olguda orta, 24 (%30.7) olguda a\u011f\u0131r tutulum saptand\u0131. A\u015f\u0131s\u0131z grupta ise 16 (%21.9) olguda hafif, 34 (%46.5) olguda orta, 20 (%27.3) olguda a\u011f\u0131r tutulum saptand\u0131. On iki olgu i\u00e7in BT istenmedi. Gruplar aras\u0131 radyolojik tutulum \u015fiddeti a\u00e7\u0131s\u0131ndan sonu\u00e7lar istatistiksel olarak anlaml\u0131 bulunmad\u0131 (p<\/i><\/span>=0.20).<\/p>\n

TARTI\u015eMA<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, 65 ya\u015f \u00fcst\u00fc ve kesin COVID-19 tan\u0131s\u0131 alm\u0131\u015f inaktif a\u015f\u0131l\u0131 olgular\u0131n a\u015f\u0131s\u0131z olgulara k\u0131yasla morbidite ve mortalite oranlar\u0131nda anlaml\u0131 farkl\u0131l\u0131k olmad\u0131\u011f\u0131 g\u00f6sterilmi\u015f olup inaktif a\u015f\u0131lar\u0131n faz \u00e7al\u0131\u015fmalar\u0131nda yer almayan ya\u015f grubunu i\u00e7ermesi nedeniyle literat\u00fcre katk\u0131da bulunmaktad\u0131r.<\/p>\n

T\u00fcm d\u00fcnyada yap\u0131lan \u00e7al\u0131\u015fmalarda a\u011f\u0131r COVID-19 hastal\u0131\u011f\u0131 i\u00e7in ileri ya\u015f\u0131n en \u00f6nemli risk fakt\u00f6r\u00fc oldu\u011fu bildirilmektedir. \u00c7in\u2019de yap\u0131lan bir \u00e7al\u0131\u015fmada mortalite oranlar\u0131; 40 ya\u015f ve alt\u0131nda %0.4, 50-60 ya\u015f grubunda %1.3, 60-70 ya\u015f grubunda %3.6, 70-80 ya\u015f grubunda %8 ve 80 ya\u015f ve \u00fcst\u00fcnde %14.8 olarak bulunmu\u015ftur (6). Pandemide, \u00c7in\u2019den sonra en \u00e7ok etkilenen \u00fclke olan \u0130talya\u2019da yap\u0131lan \u00e7al\u0131\u015fmada ise bu oranlar; 40 ya\u015f ve alt\u0131nda %0.4, 50-60 ya\u015f grubunda %1, 60-70 ya\u015f grubunda %3.5, 70-80 ya\u015f grubunda %12.8, 80 ya\u015f ve \u00fcst\u00fcnde %20.2 olarak tespit edilmi\u015ftir (7). Benzer \u015fekilde Fransa\u2019dan yap\u0131lan bir \u00e7al\u0131\u015fmada da COVID-19 nedeniyle yo\u011fun bak\u0131m \u00fcnitesine yatan hastalar\u0131n en \u00e7ok 60-80 ya\u015f aras\u0131nda oldu\u011fu, en s\u0131k 80 ya\u015f ve \u00fczerinde \u00f6l\u00fcmlerin oldu\u011fu bildirilmi\u015ftir (3). Pandeminin ilk dalgas\u0131nda \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada da a\u011f\u0131r seyirli olgular\u0131n anlaml\u0131 olarak ileri ya\u015f (ortalama 67.8\u00b117.5 y\u0131l) grubunda g\u00f6zlendi\u011fi bildirilmi\u015ftir (8).<\/p>\n

Di\u011fer risk fakt\u00f6rleri olarak; erkek cinsiyet, obezite, sigara kullan\u0131m\u0131, HT ve DM gibi kronik komorbid hastal\u0131klar g\u00f6sterilmektedir (1, 9-10). \u00c7al\u0131\u015fmam\u0131zda da ek hastal\u0131k say\u0131s\u0131 ile mortalite aras\u0131nda istatistiksel olarak anlaml\u0131 pozitif korelasyon saptand\u0131.<\/p>\n

Li ve arkada\u015flar\u0131n\u0131n (11), dokuz \u00e7al\u0131\u015fmay\u0131 dahil etti\u011fi meta-analiz sonu\u00e7lar\u0131nda erkeklerin kad\u0131nlara g\u00f6re hastal\u0131\u011fa daha fazla (%60) yakaland\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Zhang ve arkada\u015flar\u0131n\u0131n (12) yapt\u0131\u011f\u0131 140 olguyu i\u00e7eren ve medyan ya\u015f\u0131n 57 oldu\u011fu \u00e7al\u0131\u015fmada ise erkek hasta oran\u0131 %50.7 bulunmu\u015ftur. \u00c7al\u0131\u015fmam\u0131zda ise her iki grupta da ya\u015fl\u0131 pop\u00fclasyonda cinsiyet y\u00f6n\u00fcnden anlaml\u0131 bir fark bulunmad\u0131.<\/p>\n

Hastaneye ba\u015fvuru s\u0131ras\u0131nda gruplar aras\u0131nda takipne ve desat\u00fcre olma a\u00e7\u0131s\u0131ndan anlaml\u0131 fark saptamad\u0131k. Ancak hipoksi ile gelen olgular\u0131n mortalite ile anlaml\u0131 olarak ili\u015fkili oldu\u011fu saptand\u0131.\u00a0 <\/span>Xie ve arkada\u015flar\u0131n\u0131n (13) yapt\u0131\u011f\u0131 COVID-19\u2019lu hasta kohortunda da hipoksemi, hastane i\u00e7i mortalite ile ba\u011f\u0131ms\u0131z olarak ili\u015fkilendirilmi\u015ftir.<\/p>\n

Laboratuvar verilerinin de\u011ferlendirilmesi sonucunda, gruplar aras\u0131nda; lenfopeni, CRP, ferritin ve D-dimer y\u00fckseklikleri a\u00e7\u0131s\u0131ndan istatistiksel olarak anlaml\u0131 bir fark bulunmad\u0131. Benzer durum radyolojik g\u00f6r\u00fcnt\u00fcleme i\u00e7in de s\u00f6z konusudur. \u0130naktif a\u015f\u0131 sonras\u0131nda, Grup 1 ve Grup 2 aras\u0131nda benzer de\u011ferlerin g\u00f6r\u00fclmesi, inaktif a\u015f\u0131n\u0131n 65 ya\u015f \u00fczerinde hastal\u0131\u011f\u0131n seyrinde bir de\u011fi\u015fikli\u011fe neden olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrd\u00fc. Literat\u00fcrde, daha gen\u00e7 pop\u00fclasyonda yap\u0131lan bir \u00e7al\u0131\u015fmada da 18-59 ya\u015f aras\u0131ndaki sa\u011fl\u0131kl\u0131 bireylerde inaktive SARS-CoV-2 a\u015f\u0131s\u0131n\u0131n, antikor yan\u0131t\u0131n\u0131 ind\u00fckledi\u011fi ancak koruyucu etkinli\u011finin hen\u00fcz belirlenemedi\u011fi bildirilmi\u015ftir (14).<\/p>\n

Halen ABD Hastal\u0131k Kontrol ve Korunma Merkezleri (\u201cCenters for Disease Control and Prevention\u201d \u2013 CDC) taraf\u0131ndan monit\u00f6rize edilen \u00fc\u00e7 varyant bulunmaktad\u0131r: Birle\u015fik Krall\u0131k\u2019ta tespit edilen Alfa varyant\u0131 (B.1.1.7), G\u00fcney Afrika\u2019da tespit edilen Beta varyant\u0131 (B.1.351) ve Brezilya\u2019da tespit edilen Gama varyant\u0131 (P.1).\u00a0 <\/span>Endi\u015fe d\u00fczeyinde izlenen ise iki varyant bulunmaktad\u0131r. Bunlar Hindistan\u2019da bulunan Delta varyant\u0131 (B.1.617.2) ve G\u00fcney Afrika\u2019daki ara\u015ft\u0131r\u0131c\u0131lar taraf\u0131ndan ortaya \u00e7\u0131kar\u0131lan Omicron varyant\u0131 (B.1.1.529)\u2019d\u0131r (15). Fiolet ve arkada\u015flar\u0131n\u0131n (16) yapt\u0131\u011f\u0131 derlemede: mRNA, AZD1222 (Oxford-AstraZeneca) ve CoronaVac a\u015f\u0131lar\u0131n\u0131n Alfa, Beta, Gama veya Delta varyantlar\u0131na kar\u015f\u0131 semptomatik COVID-19 ve ciddi infeksiyonlar\u0131n \u00f6nlenmesinde etkili oldu\u011fu; g\u00f6zlemsel ger\u00e7ek ya\u015fam verileriyle ilgili olarak ise mRNA ve AZD1222 a\u015f\u0131lar\u0131 ile tam ba\u011f\u0131\u015f\u0131klaman\u0131n orijinal su\u015f, Alfa ve Beta varyantlar\u0131n\u0131n neden oldu\u011fu SARS-CoV-2 infeksiyonunu etkili bir \u015fekilde \u00f6nledi\u011fi ancak Delta su\u015funa kar\u015f\u0131 etkinli\u011fin azald\u0131\u011f\u0131 bildirilmi\u015ftir. Ayn\u0131 \u00e7al\u0131\u015fmada, azalan ba\u011f\u0131\u015f\u0131kl\u0131\u011fa kar\u015f\u0131 destek dozu ve heterolog a\u015f\u0131lama ile ilgili sorunlar\u0131n devam etti\u011fine y\u00f6nelik g\u00f6r\u00fc\u015f bildirilmi\u015ftir. Fakat bu geni\u015f derlemede de a\u015f\u0131lar\u0131n ileri ya\u015f etkinli\u011fi ile ilgili bilgi bulunmamaktad\u0131r.<\/p>\n

G\u00fcn\u00fcm\u00fczde tart\u0131\u015fmalar, ileri ya\u015f olgular\u0131n onay alm\u0131\u015f hangi a\u015f\u0131lar taraf\u0131ndan yeterince korundu\u011funa odaklanmaktad\u0131r. \u0130naktif a\u015f\u0131lar\u0131n bu pop\u00fclasyonda etkinli\u011fi ile ilgili \u00e7al\u0131\u015fmalar s\u0131n\u0131rl\u0131d\u0131r (17-18). DS\u00d6, CoronaVac a\u015f\u0131s\u0131n\u0131, 60 ya\u015f ve \u00fczeri yeti\u015fkinlerde etkinli\u011fine dair bir kan\u0131t bo\u015flu\u011fu bulunmas\u0131na ra\u011fmen, \u015eili\u2019de yap\u0131lan ve 60 ya\u015f \u00fczerinde ikinci dozdan 14 g\u00fcn ge\u00e7tikten sonra CoronaVac a\u015f\u0131s\u0131n\u0131n d\u00fczeltilmi\u015f etkinli\u011finin %66.6 oldu\u011funu bulan g\u00f6zlemsel bir \u00e7al\u0131\u015fmaya at\u0131fta bulunarak Haziran 2021\u2019in ba\u015flar\u0131nda onaylad\u0131 (19). A\u011fustos 2021\u2019de Brezilya\u2019da yap\u0131lan bir di\u011fer \u00e7al\u0131\u015fmada 70 ya\u015f ve \u00fczeri olgularda CoronoVac\u2019\u0131n koruyuculu\u011funun iki doz tamamlan\u0131ncaya kadar azald\u0131\u011f\u0131 ve ya\u015f artt\u0131k\u00e7a etkinli\u011finin de d\u00fc\u015ft\u00fc\u011f\u00fc bildirildi (20). \u0130naktif CoronaVac a\u015f\u0131s\u0131n\u0131n, BNT162b2 (Pfizer-BioNTech) ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 ba\u015fka bir \u00e7al\u0131\u015fmada, ya\u015f ile n\u00f6tralizan antikor olu\u015fumu aras\u0131nda negatif korelasyon saptanm\u0131\u015f olup CoronaVac ile a\u015f\u0131lanan grupta BNT162b2 a\u015f\u0131s\u0131 olanlara g\u00f6re n\u00f6tralizan antikor titresi anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck saptanm\u0131\u015ft\u0131r (21).<\/p>\n

\u00c7al\u0131\u015fmalar mRNA ve vekt\u00f6r bazl\u0131 a\u015f\u0131lar\u0131n ya\u015fl\u0131 pop\u00fclasyonda etkin koruma sa\u011flad\u0131\u011f\u0131n\u0131 ileri s\u00fcrmektedir (22-23). Mhawish ve arkada\u015flar\u0131n\u0131n (24) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, Suudi Arabistan\u2019da yo\u011fun bak\u0131m \u00fcnitesinde yatan ve onaylanm\u0131\u015f COVID-19 a\u015f\u0131lar\u0131 (Pfizer-BioNTech ve Oxford-AstraZeneca) ile en az bir doz a\u015f\u0131lanm\u0131\u015f ve hi\u00e7 a\u015f\u0131lanmam\u0131\u015f hastalarda, hastal\u0131\u011f\u0131n ciddiyetinin kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 \u00e7al\u0131\u015fmada; en az bir doz ba\u011f\u0131\u015f\u0131klaman\u0131n hastal\u0131\u011f\u0131n \u015fiddetini \u00f6nemli \u00f6l\u00e7\u00fcde azaltt\u0131\u011f\u0131 ve 30 g\u00fcnl\u00fck t\u00fcm nedenlere ba\u011fl\u0131 \u00f6l\u00fcm oranlar\u0131nda azalma ile anlaml\u0131 ili\u015fkili oldu\u011fu saptanm\u0131\u015ft\u0131r. Vasileiou ve arkada\u015flar\u0131n\u0131n (25) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, \u0130sko\u00e7ya\u2019da BNT162b2 ve AZD1222 vekt\u00f6r a\u015f\u0131lar\u0131n\u0131n uyguland\u0131\u011f\u0131 1 331 993 ki\u015finin (ortalama ya\u015f 65) a\u015f\u0131lamadan 28-34 g\u00fcn sonra hastaneye yat\u0131\u015f oranlar\u0131na bak\u0131ld\u0131\u011f\u0131nda; BNT162b2 ile a\u015f\u0131lananlarda %91, AZD1222 ile a\u015f\u0131lananlarda ise %88 oran\u0131nda azalma oldu\u011fu saptanm\u0131\u015ft\u0131r. S\u00f6z konusu \u00e7al\u0131\u015fmada 80 ya\u015f ve \u00fcst\u00fc i\u00e7in de benzer sonu\u00e7lar oldu\u011fu bildirilmi\u015ftir (25). Bizim \u00e7al\u0131\u015fmam\u0131zda ise a\u015f\u0131l\u0131 ve a\u015f\u0131s\u0131z gruplar aras\u0131nda yo\u011fun bak\u0131ma yat\u0131\u015f ve yo\u011fun bak\u0131m mortalite oranlar\u0131 a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde bir farkl\u0131l\u0131k saptanmam\u0131\u015ft\u0131r.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n k\u0131s\u0131tl\u0131l\u0131klar\u0131; geriye d\u00f6n\u00fck bir \u00e7al\u0131\u015fma olmas\u0131, tek merkezde y\u00fcr\u00fct\u00fclmesi ve sadece hastaneye yat\u0131\u015f\u0131 olan olgular\u0131n de\u011ferlendirilerek, asemptomatik ve hastaneye yat\u0131\u015f olmayan semptomatik olgular\u0131n \u00e7al\u0131\u015fmaya al\u0131nmamas\u0131d\u0131r.<\/p>\n

Sonu\u00e7 olarak; g\u00fcncel veriler e\u015fli\u011finde ve bu \u00e7al\u0131\u015fmada g\u00f6zlemledi\u011fimiz 65 ya\u015f ve \u00fcst\u00fc kesin COVID-19 tan\u0131s\u0131 alm\u0131\u015f inaktif a\u015f\u0131l\u0131 olgular\u0131n a\u015f\u0131s\u0131z olgulara k\u0131yasla morbidite ve mortalite oranlar\u0131nda anlaml\u0131 d\u00fczeyde farkl\u0131l\u0131k bulunmamas\u0131 sebebiyle, ya\u015fl\u0131 pop\u00fclasyonda inaktif a\u015f\u0131n\u0131n tercih edilmemesi \u00f6nerilmektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e T\u00fcrkiye\u2019de COVID-19 (koronavirus hastal\u0131\u011f\u0131 2019) pandemisinde ilk\u00a0tespit edilen\u00a0olgu T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan 11 Mart 2020 tarihinde a\u00e7\u0131kland\u0131. \u0130kinci dalgan\u0131n tamamland\u0131\u011f\u0131 2021\u2019in ba\u015flar\u0131nda \u00fclkemizde ilk a\u015f\u0131lamalara inaktif a\u015f\u0131larla ba\u015fland\u0131. Nisan ve May\u0131s aylar\u0131nda g\u00fcnl\u00fck olgu say\u0131lar\u0131n\u0131n en y\u00fcksek oldu\u011fu \u00fc\u00e7\u00fcnc\u00fc dalga ya\u015fand\u0131 ve bu d\u00f6nemde mRNA a\u015f\u0131lar\u0131yla (Pfizer\/BioNTech) a\u015f\u0131lama ba\u015flat\u0131ld\u0131. \u00dclkemizde yo\u011fun a\u015f\u0131lama \u00e7al\u0131\u015fmalar\u0131na ra\u011fmen […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5174,5428,5427],"class_list":["post-24743","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-covid-19","tag-inaktive-covid-19-asisi","tag-yasli-populasyon"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24743","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=24743"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24743\/revisions"}],"predecessor-version":[{"id":25046,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24743\/revisions\/25046"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=24743"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=24743"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=24743"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}