{"id":25848,"date":"2022-11-17T11:57:49","date_gmt":"2022-11-17T08:57:49","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=25848"},"modified":"2022-12-26T17:59:45","modified_gmt":"2022-12-26T14:59:45","slug":"saglik-calisanlarinda-tetanos-seropozitifligi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/11\/17\/saglik-calisanlarinda-tetanos-seropozitifligi\/","title":{"rendered":"Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131nda Tetanos Seropozitifli\u011finin Ya\u015f ve Meslek Gruplar\u0131na G\u00f6re De\u011ferlendirilmesi"},"content":{"rendered":"

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

Tetanos, <\/i>deri b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn bozulmas\u0131 sonucunda (yaralanma, t\u0131rmalanma, yan\u0131k vs.) Clostridium<\/i> tetani <\/i>bakterisi sporlar\u0131n\u0131n v\u00fccuda girmesi ile ortaya \u00e7\u0131kan, mortalite ve morbiditesi olduk\u00e7a y\u00fcksek bir infeksiyon hastal\u0131\u011f\u0131d\u0131r (1). C. tetani<\/i> sporlar\u0131 do\u011fada olduk\u00e7a yayg\u0131n olarak bulunmakta ve y\u0131llarca canl\u0131l\u0131\u011f\u0131n\u0131 s\u00fcrd\u00fcrebilmektedir.\u00a0<\/span><\/p>\n

A\u015f\u0131 ile \u00f6nlenebilir bir infeksiyon hastal\u0131\u011f\u0131 olmas\u0131na ra\u011fmen 2019 y\u0131l\u0131 i\u00e7erisinde d\u00fcnyada 73 000\u2019den fazla insan tetanos hastal\u0131\u011f\u0131na yakalanm\u0131\u015f ve bunlar\u0131n yakla\u015f\u0131k 27 000\u2019i neonatal tetanos olgusu olarak bildirilmi\u015ftir (2). Tetanosa kar\u015f\u0131 farkl\u0131 ulusal a\u015f\u0131lama politika ve programlar\u0131n\u0131n uygulanmas\u0131 sonucunda ba\u011f\u0131\u015f\u0131kl\u0131k oranlar\u0131 \u00fclkelere g\u00f6re de\u011fi\u015fmektedir. Ba\u011f\u0131\u015f\u0131klama ve hijyen ko\u015fullar\u0131n\u0131n yetersiz oldu\u011fu geli\u015fmemi\u015f \u00fclkelerde tetanos kaynakl\u0131 yenido\u011fan ve anne \u00f6l\u00fcm oranlar\u0131 y\u00fcksek seyretmektedir; Avrupa \u00fclkelerinde ise \u00e7ocuk ba\u011f\u0131\u015f\u0131klama oranlar\u0131 y\u00fcksektir ve tetanos kaynakl\u0131 \u00f6l\u00fcmlerin \u00e7o\u011funlu\u011funu a\u015f\u0131s\u0131z veya yetersiz a\u015f\u0131lanan ya\u015fl\u0131 bireyler olu\u015fturmaktad\u0131r (3). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6)\u2019n\u00fcn verilerine g\u00f6re \u00fclkemizde 2018 y\u0131l\u0131nda tetanos olgusu bildirilmezken, 2019 y\u0131l\u0131nda 18 olgu bildirimi yap\u0131lm\u0131\u015f; 2011 y\u0131l\u0131ndan itibaren sadece bir neonatal tetanos olgusu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (4).\u00a0<\/span><\/span><\/p>\n

Tetanos a\u015f\u0131s\u0131 toksoid bir a\u015f\u0131d\u0131r; tetanos ile difteri toksoid kombinasyonu olan pediatrik (DT) veya eri\u015fkin (Td) formu bulunmaktad\u0131r. Td formu DT formuna g\u00f6re daha d\u00fc\u015f\u00fck miktarda difteri toksoidi i\u00e7ermektedir. Ayr\u0131ca bo\u011fmaca ile kombine pediatrik DaBT ve eri\u015fkin Tdap a\u015f\u0131 formu da mevcuttur. Her iki a\u015f\u0131 asel\u00fcler bo\u011fmaca antijeni i\u00e7erir; Tdap daha d\u00fc\u015f\u00fck dozlarda difteri toksoidi ve bo\u011fmaca antijeni i\u00e7ermektedir (5). \u00dclkemizde Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019n\u0131n Temmuz 2020\u2019de g\u00fcncellemi\u015f oldu\u011fu rutin a\u015f\u0131 takvimine g\u00f6re bebekler, 2., 4. ve 6. ay\u0131n sonunda olmak \u00fczere \u00fc\u00e7 kez be\u015fli karma a\u015f\u0131 (DaBT-IPA-Hib) ile a\u015f\u0131lanmakta; rapel dozlar 18. ay\u0131n sonunda DaBT-IPA-Hib, 48. ay\u0131n sonunda d\u00f6rtl\u00fc karma a\u015f\u0131 (DaBT-IPA) ve 13 ya\u015f\u0131nda Td \u015feklinde uygulanmaktad\u0131r. Eri\u015fkinlerde ise \u00fc\u00e7 doz primer a\u015f\u0131lama \u00f6nerilmektedir. D\u00f6rt hafta ara ile iki doz; 2. dozdan 6-12 ay sonra 3. doz olmak \u00fczere, primer a\u015f\u0131 \u015femas\u0131n\u0131 tamamlayanlara her 10 y\u0131lda bir Td rapel doz ile a\u015f\u0131lama (rapellerden birinin Tdap olarak uygulanmas\u0131) \u00f6nerilmektedir (6). Gebelerde daha \u00f6nce \u00fc\u00e7 doz primer a\u015f\u0131 uygulanm\u0131\u015fsa; her gebelikte, tercihen 27-36. haftada bir doz Tdap; daha \u00f6nce primer a\u015f\u0131lama yap\u0131lmam\u0131\u015f, eksik yap\u0131lm\u0131\u015f veya bilinmiyorsa \u00fc\u00e7 doz tetanos a\u015f\u0131s\u0131 yap\u0131lmas\u0131 ve bu a\u015f\u0131lardan birinin Tdap olmas\u0131 \u00f6nerilmektedir (7).<\/p>\n

Bununla birlikte \u00e7ocukluk d\u00f6nemi sonras\u0131nda \u00fclkemizde yaln\u0131zca askerlik d\u00f6neminde veya kad\u0131nlarda gebelik takipleri s\u0131ras\u0131nda tetanos a\u015f\u0131s\u0131 uygulanmaktad\u0131r. \u00dclkemizde yeti\u015fkinlerde tetanos a\u015f\u0131s\u0131na ait s\u00fcrveyans sistemi bulunmamakta olup bu ya\u015f grubunda tetanos ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131na ait veriler bilinmemektedir. A\u015f\u0131yla olu\u015fan koruyucu antitoksin d\u00fczeyleri \u00f6zellikle 50 ya\u015f ve \u00fczerinde belirgin olarak azalmakta hatta 65 ya\u015f ve \u00fczerinde negatifle\u015febilmektedir; s\u00f6z konusu ya\u015f grubu tetanos kaynakl\u0131 \u00f6l\u00fcm a\u00e7\u0131s\u0131ndan en y\u00fcksek risk grubunu olu\u015fturmaktad\u0131r (8).\u00a0 <\/span>Bu sebeple primer a\u015f\u0131 \u015femas\u0131 sonras\u0131nda eri\u015fkinlerde 10 y\u0131lda bir rapel doz uygulanmas\u0131 b\u00fcy\u00fck \u00f6nem arz etmektedir.<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ise meslek grubu olarak tetanos a\u00e7\u0131s\u0131ndan y\u00fcksek bir risk grubu kabul edilmemekle birlikte, daha \u00f6nce Tdap uygulanmayan ki\u015filere ve son Td dozu \u00fcst\u00fcnden ge\u00e7en s\u00fcreye bak\u0131lmaks\u0131z\u0131n t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na tek doz Tdap ile tetanos ba\u011f\u0131\u015f\u0131klamas\u0131 \u00f6nerilmektedir (9). \u00c7al\u0131\u015fmam\u0131zda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda tetanos antikor yeterlili\u011finin ya\u015f ve meslek gruplar\u0131 i\u00e7inde de\u011ferlendirilmesini ama\u00e7lad\u0131k.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Bu \u00e7al\u0131\u015fma, hastanemizde \u00e7al\u0131\u015fmakta olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n tetanos antikor d\u00fczeylerinin incelendi\u011fi retrospektif ve g\u00f6zlemsel bir \u00e7al\u0131\u015fmad\u0131r. \u015eubat 2018 – Mart 2019 aras\u0131nda tetanos antikor d\u00fczeyi bak\u0131lm\u0131\u015f olan 18 ya\u015f ve \u00fczeri sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 \u00e7al\u0131\u015fmaya dahil edildi. \u00c7al\u0131\u015fmaya dahil edilen 2082 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131; mesleklerine g\u00f6re doktor, hem\u015fire ve di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 olarak \u00fc\u00e7 gruba ayr\u0131ld\u0131 ve ya\u015flar\u0131na g\u00f6re <20 ya\u015f, 20-29 ya\u015f, 30-39 ya\u015f, 40-49 ya\u015f ve ><\/span> 50 ya\u015f olmak \u00fczere 6 dekadda incelendi.\u00a0<\/span><\/p>\n

Tetanos antikor d\u00fczeyi bir d\u0131\u015f laboratuvarda \u201cenzyme-linked immunosorbent assay\u201d ELISA y\u00f6ntemi ile \u00e7al\u0131\u015f\u0131lm\u0131\u015f olup antikor \u00f6l\u00e7\u00fcm\u00fcnde tetanos toksoid Ig G antikor test kiti (Immunolab GmbH, Kassel, Almanya) kullan\u0131lm\u0131\u015ft\u0131r. S\u00f6z konusu test \u00e7al\u0131\u015f\u0131l\u0131rken mikro-titre striplerinin y\u00fczeyine ba\u011fl\u0131 tetanos antijeninin \u00fczerine seyreltilmi\u015f hasta serumu eklenmi\u015ftir. Serumdaki Ig G antikorlar\u0131yla tetanos toksoid antijeni aras\u0131nda ba\u011flanma sa\u011flanm\u0131\u015f ve oda s\u0131cakl\u0131\u011f\u0131nda bir saat ink\u00fcbe edildikten sonra fazla materyali uzakla\u015ft\u0131rmak amac\u0131yla y\u0131kama sol\u00fcsyonu ile y\u0131kanm\u0131\u015ft\u0131r. Anti-human Ig G peroksidaz konjugat\u0131 eklenip 30 dakika bekletilmi\u015f sonra tekrar y\u0131kama sol\u00fcsyonu ile y\u0131kanm\u0131\u015f ve TMB sol\u00fcsyonu eklenip 20 dakika ink\u00fcbe edildikten sonra mavi renk olu\u015fumu izlenmi\u015ftir. Mavi renk olu\u015ftuktan sonra durdurma sol\u00fcsyonu eklenerek rengin sar\u0131ya d\u00f6nmesi sa\u011flanm\u0131\u015f ve elde edilen renk 450 nm dalga boyunda spektrofotometrik olarak \u00f6l\u00e7\u00fclm\u00fc\u015ft\u00fcr. Bulunan tetanos antikor d\u00fczeyleri, kullan\u0131lan kitin \u00fcretici y\u00f6nergeleri do\u011frultusunda ve testin referans aral\u0131\u011f\u0131 baz al\u0131narak seropozitif (\u22650.5 IU\/ml) veya seronegatif (<0.5 IU\/ml) olarak kabul edilmi\u015ftir.<\/p>\n

\u00c7al\u0131\u015fma i\u00e7in \u00dcmraniye E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Etik Kurulu\u2019ndan 20 Kas\u0131m 2019 tarih ve 2019\/214 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n

\u0130statistiksel Analiz<\/h3>\n

Verilerin analizi SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 25.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile ger\u00e7ekle\u015ftirildi. Tan\u0131mlay\u0131c\u0131 \u00f6l\u00e7\u00fctler olarak ortalama, standart sapma ve y\u00fczde da\u011f\u0131l\u0131mlar\u0131 kullan\u0131ld\u0131. Gruplar aras\u0131nda seropozitif ve seronegatiflik kar\u015f\u0131la\u015ft\u0131rmas\u0131 ki-kare testi ile de\u011ferlendirildi. Tetanos antikor d\u00fczeyleri ile di\u011fer de\u011fi\u015fkenler aras\u0131ndaki (cinsiyet, ya\u015f ve meslek grubu) ili\u015fki lojistik regresyon analizi ile de\u011ferlendirildi.\u00a0 <\/span>\u0130statistiksel olarak p<\/i><0.05 anlaml\u0131 d\u00fczey olarak kabul edildi.<\/p>\n

BULGULAR<\/h2>\n

\u00c7al\u0131\u015fmaya toplam 2082 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 dahil edilmi\u015f olup 877 (%43)\u2019si erkek; 1191 (%57)\u2019i kad\u0131nd\u0131r. Ya\u015f ortalamas\u0131 33\u00b18 (minimum-maksimum=18-66)\u2019dir; \u00e7al\u0131\u015fanlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funu %94.8 oran\u0131yla 20-49 ya\u015f aras\u0131 bireyler olu\u015fturmaktad\u0131r. Meslek da\u011f\u0131l\u0131mlar\u0131; 446 (%22.4)\u2019s\u0131 doktor, 513 (%24.6)\u2019\u00fc hem\u015fire ve 1013 (%53)\u2019\u00fc yard\u0131mc\u0131 sa\u011fl\u0131k personeli \u015feklindedir.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> Tetanos Antikor D\u00fczeylerinin Dekadlara G\u00f6re Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\u0130ncelenen 2082 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n 1615 (%77.5)\u2019i seropozitif, 467 (%22.5)\u2019si seronegatif olarak tespit edildi. Ya\u015f gruplar\u0131na g\u00f6re de\u011ferlendirildi\u011finde; 18-19 ya\u015f aras\u0131nda olan 7 kat\u0131l\u0131mc\u0131n\u0131n 5 (%71.4)\u2019i, 20-29 ya\u015f aras\u0131 865 kat\u0131l\u0131mc\u0131n\u0131n 688 (%79.1)\u2019i, 30-39 ya\u015f aras\u0131ndaki 693 kat\u0131l\u0131mc\u0131n\u0131n 588 (%78.6)\u2019i ve 40-49 ya\u015f aras\u0131 416 kat\u0131l\u0131mc\u0131n\u0131n 310 (%74.5)\u2019u seropozitif olarak tespit edildi. En d\u00fc\u015f\u00fck seropozitiflik oran\u0131 \u226550 ya\u015f \u00fczeri bireylerde tespit edilmi\u015f olup 101 kat\u0131l\u0131mc\u0131n\u0131n 67 (%66.3)\u2019si seropozitifti. Tetanos antikor koruyuculu\u011funun ya\u015f art\u0131\u015f\u0131 ile azald\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (p=<\/i>0.03) (Tablo 1).<\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> Tetanos Antikor D\u00fczeylerinin Meslek Gruplar\u0131na G\u00f6re De\u011ferlendirilmesi<\/p><\/div>\n

Tetanos antikor d\u00fczeyleri meslek gruplar\u0131na g\u00f6re de\u011ferlendirildi\u011finde; 466 doktorun 362 (%77.7)\u2019sinin, 513 hem\u015firenin 406 (%79.1)\u2019s\u0131n\u0131n ve 1103 yard\u0131mc\u0131 sa\u011fl\u0131k personelinin 847 (%76.8)\u2019sinin seropozitif oldu\u011fu g\u00f6r\u00fcld\u00fc. Meslek gruplar\u0131 aras\u0131nda seropozitiflik oranlar\u0131 aras\u0131nda anlaml\u0131 d\u00fczeyde bir fark saptanmad\u0131 (p<\/i>=0.57) (Tablo 2).\u00a0<\/span><\/p>\n

\u0130RDELEME<\/h2>\n

\u00dclkemizde geni\u015fletilmi\u015f ba\u011f\u0131\u015f\u0131klama programlar\u0131na ra\u011fmen a\u015f\u0131 ile \u00f6nlenebilir bir hastal\u0131k olan ve \u00f6l\u00fcmc\u00fcl seyreden tetanos hastal\u0131\u011f\u0131 halen varl\u0131\u011f\u0131n\u0131 s\u00fcrd\u00fcrmektedir. \u00c7ocuklar\u0131n rutin ba\u011f\u0131\u015f\u0131klama program\u0131 kapsam\u0131nda tetanos a\u015f\u0131s\u0131 uygulanmakta ve kay\u0131t alt\u0131na al\u0131nmaktad\u0131r; yeti\u015fkinlerde ise erkeklerde askerlik s\u0131ras\u0131nda, kad\u0131nlarda gebelikte tetanos hat\u0131rlatma dozu uygulanmaktad\u0131r. Fakat eri\u015fkin tetanos s\u00fcrveyans sistemi olmad\u0131\u011f\u0131 i\u00e7in eri\u015fkin a\u015f\u0131lanma oranlar\u0131na ula\u015f\u0131lamamaktad\u0131r. Ayr\u0131ca sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na ait tetanos ba\u011f\u0131\u015f\u0131klama durumu ve koruyucu antikor seviyeleri ile ilgili yeterli bilgi de yoktur.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda hem toplumun bir kesimi olarak hem de meslek gurubu olarak tetanos antikor d\u00fczeyleri de\u011ferlendirildi. Toplam 2082 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n 1615 (%77.5)\u2019inde seropozitiflik tespit edildi. Ya\u015fa g\u00f6re de\u011ferlendirildi\u011finde en y\u00fcksek seropozitiflik oran\u0131n\u0131n 20-29 ya\u015f grubunda (%79.1) oldu\u011fu g\u00f6r\u00fcld\u00fc; ya\u015fla birlikte koruyucu antikor d\u00fczeyinin azald\u0131\u011f\u0131 ve en d\u00fc\u015f\u00fck seropozitifli\u011fin\u00a0 <\/span>\u226550 ya\u015f grubunda (%66.3) oldu\u011fu saptand\u0131.<\/p>\n

\u0130leri ya\u015f ile azalan antikor d\u00fczeyi de\u011ferlendirildi\u011finde, \u00e7al\u0131\u015fmam\u0131zda tespit edilen 50 ya\u015f ve \u00fczeri seropozitiflik d\u00fczeyi literat\u00fcre g\u00f6re y\u00fcksektir (10-13). Sahan ve arkada\u015flar\u0131n\u0131n (10) Ankara\u2019da aile hekimli\u011fi sistemine kay\u0131tl\u0131 bir pop\u00fclasyon \u00fczerine yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, tetanos seropozitifli\u011finin ya\u015fla birlikte azald\u0131\u011f\u0131, t\u00fcm ya\u015f gruplar\u0131 i\u00e7inde koruyuculuk oran\u0131n\u0131n %79 oldu\u011fu ve 50 ya\u015f\u0131n \u00fczerinde %57\u2019ye d\u00fc\u015ft\u00fc\u011f\u00fc g\u00f6sterilmi\u015ftir. Alkan ve arkada\u015flar\u0131n\u0131n (14) \u00e7al\u0131\u015fmas\u0131nda, 30-40 ya\u015f aral\u0131\u011f\u0131nda %70 civar\u0131nda olan tetanos seropozitiflik d\u00fczeyinin her dekadda azald\u0131\u011f\u0131 ve 70 ya\u015fa do\u011fru %19 civar\u0131na geriledi\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (p<\/i>=0.01). Her iki \u00e7al\u0131\u015fmada \u00e7ocuk hastalar\u0131n da dahil edilmesi nedeniyle genel pop\u00fclasyon i\u00e7indeki koruyuculu\u011fun, \u00e7al\u0131\u015fmam\u0131za g\u00f6re daha y\u00fcksek oldu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc. Erg\u00f6n\u00fcl ve arkada\u015flar\u0131n\u0131n (13) \u00e7al\u0131\u015fmas\u0131nda da ya\u015fla birlikte seropozitifli\u011fin azald\u0131\u011f\u0131, 50 ya\u015f ve \u00fczerinde bu oran\u0131n %35 civar\u0131na geriledi\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. \u00d6nc\u00fc ve arkada\u015flar\u0131n\u0131n (12) Ayd\u0131n\u2019da 50 ya\u015f \u00fcst\u00fc 293 \u00e7ift\u00e7i aras\u0131nda tetanos seroepidemiyolojisi ve imm\u00fcnitesini etkileyen fakt\u00f6rleri ara\u015ft\u0131rd\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, tetanos seropozitiflik oran\u0131 %33.9 olarak tespit edilmi\u015ftir; ya\u015f gruplar\u0131 incelendi\u011finde bu oran 50-59 ya\u015f aras\u0131nda %51.5; 60-69 ya\u015f aras\u0131nda %36.4 ve 70 ya\u015f ve \u00fczerinde %9.5\u2019tur. S\u00f6z konusu \u00e7al\u0131\u015fmada tespit edilen tetanos koruyuculuk oranlar\u0131 \u00e7al\u0131\u015fmam\u0131zdaki 50 ya\u015f ve \u00fcst\u00fc bireylere g\u00f6re daha d\u00fc\u015f\u00fckt\u00fcr. Bu durum pop\u00fclasyonun \u00e7ift\u00e7ilikle u\u011fra\u015fan bireylerden olu\u015fmas\u0131, %37\u2019sinin hi\u00e7 e\u011fitim almam\u0131\u015f olmas\u0131 ve a\u015f\u0131 ile ilgili bilgi d\u00fczeyinin yetersizli\u011fi ile a\u00e7\u0131klanabilir. Sung ve arkada\u015flar\u0131n\u0131n (11) yeti\u015fkin ve ad\u00f6lesanlarda tetanos seropozitifli\u011finin ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 1193 bireyin dahil edildi\u011fi \u00e7al\u0131\u015fmas\u0131nda, tetanos antikor titresi \u2265 0.1 IU\/ml seropozitif kabul edilmi\u015f ve tetanos seroprevalans\u0131 %56.4 bulunmu\u015f; ya\u015fla birlikte seropozitifli\u011fin azald\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Literat\u00fcrle uyumlu olarak \u00e7al\u0131\u015fmam\u0131zda da ya\u015f ile tetanos seropozitifli\u011finin azald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir ancak 50 ya\u015f ve \u00fczerinde seropozitiflik oran\u0131 biraz daha y\u00fcksektir. Bu durum, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015f\u0131ya eri\u015fim kolayl\u0131\u011f\u0131 ve rapel doz uygulamas\u0131ndaki \u00f6nemin fark\u0131ndal\u0131\u011f\u0131 ile a\u00e7\u0131klanabilir.<\/p>\n

D\u00fcnyada ve \u00fclkemizde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n tetanos antikor d\u00fczeyi ile ilgili az say\u0131da \u00e7al\u0131\u015fma mevcuttur. C\u0131l\u0131z ve arkada\u015flar\u0131 (15) \u00e7al\u0131\u015fmalar\u0131nda, 309 sa\u011fl\u0131k personelinde tetanos antikor pozitifli\u011fini %93.5 olarak tespit etmi\u015f ve seropozitifli\u011fin ya\u015f ilerledik\u00e7e azald\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir (p<\/i><0.05). Dos Santos ve arkada\u015flar\u0131n\u0131n (16) ABD\u2019li sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda yapm\u0131\u015f oldu\u011fu bir \u00e7al\u0131\u015fmada ise %93.9 tetanos seropozitifli\u011fi bildirilmi\u015ftir. Esteve ve arkada\u015flar\u0131n\u0131n (17) 2010 y\u0131l\u0131nda Katalonya\u2019da yapt\u0131klar\u0131 difteri ve tetanos antikor prevalans\u0131n\u0131n ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, tetanos seropozitifli\u011fi \u2265 0.1 IU\/ml kabul edilmi\u015f, 537 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 aras\u0131nda seropozitiflik oran\u0131 %93.9 olarak bulunmu\u015ftur. Esteve ve arkada\u015flar\u0131n\u0131n \u00e7al\u0131\u015fmas\u0131 de\u011ferlendirildi\u011finde, 35 ya\u015f alt\u0131ndaki bireylerde seropozitiflik oran\u0131 %100 iken, 55 ya\u015f ve \u00fczerinde bu oran %87\u2019ye d\u00fc\u015fmektedir. S\u00f6z konusu oran \u00e7al\u0131\u015fmam\u0131za g\u00f6re y\u00fcksek olup yine yeterli kabul edilen antikor d\u00fczeyinin \u00e7al\u0131\u015fmam\u0131za g\u00f6re daha d\u00fc\u015f\u00fck olmas\u0131 ile a\u00e7\u0131klanabilir (>0.1 IU\/ml; >0.5 IU\/ml). Yine ayn\u0131 \u00e7al\u0131\u015fmada, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 mesleklerine g\u00f6re doktor, hem\u015fire, di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ve sa\u011fl\u0131k bak\u0131m\u0131 sunmayan \u00e7al\u0131\u015fanlar olarak d\u00f6rt gruba ayr\u0131lm\u0131\u015f ve meslek gruplar\u0131 ile seropozitiflik aras\u0131nda anlaml\u0131 bir fark bulunmam\u0131\u015ft\u0131r. Doktor ve hem\u015firelerin sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n yakla\u015f\u0131k yar\u0131s\u0131n\u0131 olu\u015fturdu\u011fu \u00e7al\u0131\u015fmam\u0131zda da meslek gruplar\u0131 aras\u0131nda seropozitif bireylerin oran\u0131n\u0131n (doktorlar %77.7, hem\u015fireler %79.1 ve di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 %76.8) benzer oldu\u011fu ve meslek gruplar\u0131 ile seropozitiflik aras\u0131nda anlaml\u0131 d\u00fczeyde bir fark olmad\u0131\u011f\u0131 tespit edildi (p=<\/i>0.572) (Tablo 2).<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n %95\u2019inin 20-49 ya\u015f aras\u0131nda oldu\u011fu \u00e7al\u0131\u015fmam\u0131zda, her dekaddaki \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fcn\u00fcn e\u015fit veya benzer olmas\u0131 ile daha anlaml\u0131 sonu\u00e7lar elde edilebilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir. \u00c7al\u0131\u015fmam\u0131zda baz\u0131 k\u0131s\u0131tl\u0131l\u0131klar da mevcuttur; \u00e7al\u0131\u015fmaya dahil edilen sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n son 10 y\u0131lda yaralanma durumu, sa\u011fl\u0131k merkezine ba\u015fvuru durumu, tetanos a\u015f\u0131s\u0131 \u00f6yk\u00fcs\u00fc, 10 y\u0131lda bir hat\u0131rlatma dozu yapt\u0131rma durumu, gebelik veya askerlik gibi tetanos antikor d\u00fczeyini etkileyebilecek fakt\u00f6rler de\u011ferlendirilememi\u015ftir. Ayr\u0131ca \u00e7al\u0131\u015fmam\u0131zda kullan\u0131lan test kitinin ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 yeterli kabul etti\u011fi referans de\u011fer \u2265 0.5 IU\/ml olup bir\u00e7ok \u00e7al\u0131\u015fmada koruyucu tetanos antikor d\u00fczeyi \u2265 0.1 IU\/ml olarak kabul edilmektedir. \u00dclkemizde tetanos ba\u011f\u0131\u015f\u0131kl\u0131k ve a\u015f\u0131lama durumu i\u00e7in s\u00fcrveyans sistemi ve yeterli veri bulunmamaktad\u0131r. Primer a\u015f\u0131 \u015femas\u0131n\u0131 takiben kad\u0131nlarda gebelikte, erkeklerde ise askerlik d\u00f6neminde hat\u0131rlatma dozu ile tetanos ba\u011f\u0131\u015f\u0131klamas\u0131 yap\u0131ld\u0131\u011f\u0131 bilinmekle birlikte bu bireylerin sonras\u0131nda 10 y\u0131lda bir a\u015f\u0131lanmaya devam etti\u011fi d\u00fc\u015f\u00fcn\u00fclmemektedir.\u00a0<\/span><\/p>\n

Sonu\u00e7 olarak; bu konuda fark\u0131ndal\u0131\u011f\u0131 art\u0131rmak i\u00e7in t\u00fcm eri\u015fkin bireylere e\u011fitimler verilmesinin, a\u015f\u0131ya eri\u015fim kolayl\u0131\u011f\u0131n\u0131n sa\u011flanmas\u0131n\u0131n, uygulanan tetanos ba\u011f\u0131\u015f\u0131klamas\u0131n\u0131n kay\u0131t alt\u0131na al\u0131nmas\u0131n\u0131n ve s\u00fcrveyans \u00e7al\u0131\u015fmalar\u0131n\u0131n ba\u015flat\u0131lmas\u0131n\u0131n faydal\u0131 olaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcn\u00fcyoruz.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Tetanos, deri b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn bozulmas\u0131 sonucunda (yaralanma, t\u0131rmalanma, yan\u0131k vs.) Clostridium tetani bakterisi sporlar\u0131n\u0131n v\u00fccuda girmesi ile ortaya \u00e7\u0131kan, mortalite ve morbiditesi olduk\u00e7a y\u00fcksek bir infeksiyon hastal\u0131\u011f\u0131d\u0131r (1). C. tetani sporlar\u0131 do\u011fada olduk\u00e7a yayg\u0131n olarak bulunmakta ve y\u0131llarca canl\u0131l\u0131\u011f\u0131n\u0131 s\u00fcrd\u00fcrebilmektedir.\u00a0 A\u015f\u0131 ile \u00f6nlenebilir bir infeksiyon hastal\u0131\u011f\u0131 olmas\u0131na ra\u011fmen 2019 y\u0131l\u0131 i\u00e7erisinde d\u00fcnyada 73 000\u2019den fazla […]<\/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":[5554,5552,3675,5553],"class_list":["post-25848","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-asiyla-onlenebilir-hastalik","tag-eriskin-asilama","tag-saglik-calisanlari","tag-tetanos-seropozitifligi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25848","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=25848"}],"version-history":[{"count":5,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25848\/revisions"}],"predecessor-version":[{"id":26231,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25848\/revisions\/26231"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=25848"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=25848"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=25848"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}