{"id":27722,"date":"2023-10-29T17:59:58","date_gmt":"2023-10-29T14:59:58","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=27722"},"modified":"2024-06-25T14:31:35","modified_gmt":"2024-06-25T11:31:35","slug":"kizamik-seroprevalansi-kesitsel-bir-calisma","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/10\/29\/kizamik-seroprevalansi-kesitsel-bir-calisma\/","title":{"rendered":"K\u0131zam\u0131k Eliminasyon Program\u0131 S\u00fcrecinde Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131n\u0131n K\u0131zam\u0131k Seroprevalans\u0131: Kesitsel Bir \u00c7al\u0131\u015fma"},"content":{"rendered":"

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

K\u0131zam\u0131k; y\u00fcksek ate\u015f, g\u00f6zlerde k\u0131zar\u0131kl\u0131k, burun ak\u0131nt\u0131s\u0131, \u00f6ks\u00fcr\u00fck ve mak\u00fclopap\u00fcler d\u00f6k\u00fcnt\u00fc ile karakterize olan olduk\u00e7a bula\u015f\u0131c\u0131 bir hastal\u0131kt\u0131r. D\u00f6k\u00fcnt\u00fcler tipik olarak kulak arkas\u0131nda ve al\u0131n sa\u00e7 \u00e7izgisinde ba\u015flar, 2-3 g\u00fcn i\u00e7inde ense, g\u00f6vde, kol ve bacaklara yay\u0131l\u0131r. Hastal\u0131k, d\u00f6k\u00fcnt\u00fc \u00f6ncesi ve sonras\u0131nda d\u00f6rt g\u00fcn bula\u015f\u0131c\u0131d\u0131r (1). Be\u015f ya\u015f alt\u0131 \u00e7ocuklar ve 30 ya\u015f \u00fczeri yeti\u015fkinler, gebeler, ba\u011f\u0131\u015f\u0131kl\u0131k sistemi zay\u0131flam\u0131\u015f ki\u015filer, pn\u00f6moni ve santral sinir sistemi tutulumu gibi komplikasyonlar a\u00e7\u0131s\u0131ndan \u00f6zellikle risk alt\u0131ndad\u0131r (1)<\/p>\n

Tek kona\u011f\u0131n\u0131n insan olmas\u0131, tek serotipinin olmas\u0131, a\u015f\u0131laman\u0131n g\u00fcvenli ve etkin olmas\u0131 ve h\u0131zl\u0131 tan\u0131 koydurucu y\u00f6ntemlerin varl\u0131\u011f\u0131 nedeniyle hastal\u0131\u011f\u0131n eradikasyonu olas\u0131d\u0131r (2). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan k\u0131zam\u0131k eliminasyon program\u0131 ba\u015flat\u0131lm\u0131\u015f ve eradikasyonu hedeflenmi\u015ftir (3). Ba\u011f\u0131\u015f\u0131klama faaliyetleri sayesinde k\u0131zam\u0131\u011fa ba\u011fl\u0131 \u00f6l\u00fcmler b\u00fcy\u00fck oranda azalm\u0131\u015f olup 2000-2021 y\u0131llar\u0131 aras\u0131nda k\u0131zam\u0131k a\u015f\u0131s\u0131n\u0131n 56 milyon \u00f6l\u00fcm\u00fc \u00f6nledi\u011fi tahmin edilmi\u015ftir (1). Ancak son y\u0131llarda k\u0131zam\u0131\u011f\u0131n yeniden ortaya \u00e7\u0131kt\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc verilerine g\u00f6re Avrupa b\u00f6lgesinde 2019 y\u0131l\u0131nda olgu say\u0131s\u0131 104 248\u2019e y\u00fckselmi\u015ftir (4). Eliminasyon sonras\u0131 Amerika Birle\u015fik Devletleri\u2019nde de importe olgular nedeniyle salg\u0131nlar ya\u015fanm\u0131\u015f ve 2019 y\u0131l\u0131nda 1274 olgu ile 1992\u2019den beri en y\u00fcksek olgu say\u0131s\u0131na ula\u015f\u0131ld\u0131\u011f\u0131 bildirilmi\u015ftir (5).<\/p>\n

T\u00fcrkiye\u2019de kapsaml\u0131 k\u0131zam\u0131k a\u015f\u0131lamas\u0131 1980\u2019li y\u0131llarda ba\u015flam\u0131\u015f ve uzun y\u0131llar dokuzuncu ayda tek doz olarak uygulanm\u0131\u015ft\u0131r. \u0130kinci doz a\u015f\u0131 1998 y\u0131l\u0131nda ilkokul birinci s\u0131n\u0131flara uygulanmaya ba\u015flam\u0131\u015ft\u0131r.\u00a0 <\/span>Olgu say\u0131s\u0131 1998\u2019de 27 120 iken iki doz a\u015f\u0131lamaya ge\u00e7ilmesi ve k\u00fcresel eliminasyon hedefi kapsam\u0131nda yap\u0131lan kampanyalarla 2010\u2019da yediye gerilemi\u015ftir. Ancak Avrupa\u2019da ya\u015fanan salg\u0131nlar\u0131n etkisiyle 2012-2013 k\u0131\u015f d\u00f6neminde \u00fclke genelinde toplam 7000\u2019den fazla ki\u015fiyi etkileyen bir salg\u0131n ya\u015fanm\u0131\u015ft\u0131r (6). Yo\u011fun ba\u011f\u0131\u015f\u0131klama ve kontrol \u00e7al\u0131\u015fmalar\u0131 ile olgu say\u0131s\u0131 2016\u2019da dokuza d\u00fc\u015f\u00fcr\u00fclm\u00fc\u015f, 2019\u2019da ise 2904\u2019e y\u00fckselmi\u015ftir (7). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc\u2019n\u00fcn 2023 May\u0131s ay\u0131nda yay\u0131mlad\u0131\u011f\u0131 rapora g\u00f6re; May\u0131s 2022-Nisan 2023 d\u00f6neminde, T\u00fcrkiye 1543 olgu ile DS\u00d6 Avrupa B\u00f6lgesi\u2019nde en \u00e7ok olgu bildirilen \u00fclke olmu\u015ftur (8).<\/p>\n

Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n k\u0131zam\u0131k hastal\u0131\u011f\u0131n\u0131n bula\u015fmas\u0131 a\u00e7\u0131s\u0131ndan toplumdaki di\u011fer bireylerden 2-19 kat daha fazla risk alt\u0131nda oldu\u011fu ve 30 ya\u015f alt\u0131ndaki gen\u00e7 sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda riskin daha y\u00fcksek oldu\u011fu bildirilmi\u015ftir (9). Hastal\u0131\u011f\u0131n d\u00f6k\u00fcnt\u00fc \u00f6ncesinde de bula\u015f\u0131c\u0131 olmas\u0131, hemen tan\u0131namamas\u0131 ve uygun izolasyon \u00f6nlemlerinin al\u0131nmamas\u0131 nozokomiyal bula\u015fmalara neden olmaktad\u0131r (10). Bulgaristan\u2019da 2010 y\u0131l\u0131ndaki salg\u0131n s\u0131ras\u0131nda, 326 olgunun sa\u011fl\u0131k kurulu\u015flar\u0131 kaynakl\u0131 oldu\u011fu bildirilmi\u015ftir (11). 2017 y\u0131l\u0131nda \u0130talya\u2019da bir hastanede 35 olgunun g\u00f6r\u00fcld\u00fc\u011f\u00fc bir nozokomiyal salg\u0131n ya\u015fanm\u0131\u015ft\u0131r (12). \u00dclkemizde 2012-2013 k\u0131\u015f d\u00f6neminde eri\u015fkin ya\u015f grubundaki olgular\u0131n %7.6\u2019s\u0131n\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 olu\u015fturmu\u015ftur (13). Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n k\u0131zam\u0131k ba\u011f\u0131\u015f\u0131klamalar\u0131n\u0131n tamamlanmas\u0131n\u0131 ve serolojik durumlar\u0131na bak\u0131lmaks\u0131z\u0131n bir ay ara ile iki doz k\u0131zam\u0131k, kabakulak ve k\u0131zam\u0131k\u00e7\u0131k (KKK) a\u015f\u0131s\u0131 yap\u0131lmas\u0131n\u0131 \u00f6nermektedir (14). \u00dclkemiz a\u015f\u0131lama takvimine g\u00f6re 1980-1991 y\u0131llar\u0131 aras\u0131nda do\u011fan ki\u015filerin tek doz a\u015f\u0131 olmalar\u0131 nedeniyle k\u0131zam\u0131k ba\u011f\u0131\u015f\u0131klamalar\u0131n\u0131n yetersiz oldu\u011fu bilinmektedir (14). Bu nedenle \u00f6zellikle bu ya\u015f grubu sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015f\u0131lar\u0131n\u0131n tamamlanmas\u0131 hem kendi sa\u011fl\u0131klar\u0131 hem de di\u011fer hastalar ve meslekta\u015flar\u0131 i\u00e7in kritik \u00f6neme sehiptir. G\u00fcn\u00fcm\u00fczde, Ba\u011f\u0131\u015f\u0131klama Uygulamalar\u0131 Dan\u0131\u015fma Komitesi (Advisory Committee on Immunization Practices -ACIP) taraf\u0131ndan da t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n k\u0131zam\u0131k a\u015f\u0131lar\u0131n\u0131n tamamlanmas\u0131 ve ba\u011f\u0131\u015f\u0131kl\u0131k durumlar\u0131n\u0131n rutin olarak de\u011ferlendirilmesi \u00f6nerilmektedir (15). Bu \u00e7al\u0131\u015fma ile hastanemizde k\u0131zam\u0131k olgusu ile kar\u015f\u0131la\u015fma olas\u0131l\u0131\u011f\u0131 y\u00fcksek olan b\u00f6l\u00fcmlerde g\u00f6rev yapan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda k\u0131zam\u0131k seroprevalans\u0131n\u0131n ve ili\u015fkili etmenlerin belirlenmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Bu kesitsel \u00e7al\u0131\u015fma Dokuz Eyl\u00fcl \u00dcniversitesi Hastanesi\u2019nde Haziran 2018-Eyl\u00fcl 2019 tarihleri aras\u0131nda y\u00fcr\u00fct\u00fcld\u00fc. Ara\u015ft\u0131rma evrenini; k\u0131zam\u0131k i\u00e7in riskli b\u00f6l\u00fcmler olarak de\u011ferlendirilen \u00c7ocuk Hastal\u0131klar\u0131 Hastanesi (\u00c7ocuk Acil Servis ve \u00c7ocuk \u0130nfeksiyon Hastal\u0131klar\u0131 klinikleri de dahil olmak \u00fczere t\u00fcm bran\u015flar), Eri\u015fkin Acil Servis, \u0130nfeksiyon Hastal\u0131klar\u0131 ve Klinik Mikrobiyoloji, Aile Hekimli\u011fi ve Dermatoloji kliniklerinde g\u00f6rev yapmakta olan 368 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olu\u015fturdu. \u00d6rneklem belirlenmeyip t\u00fcm \u00e7al\u0131\u015fanlara ula\u015f\u0131lmas\u0131 hedeflendi. Bu b\u00f6l\u00fcmlerde \u00e7al\u0131\u015fan ve kat\u0131l\u0131mc\u0131 olmay\u0131 kabul eden 326 (%88.5) sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n bilgilendirilmi\u015f onamlar\u0131 al\u0131nd\u0131ktan sonra cinsiyet, ya\u015f, meslek, \u00e7al\u0131\u015f\u0131lan b\u00f6l\u00fcm ve hastal\u0131k ge\u00e7irme \u00f6yk\u00fcs\u00fcn\u00fc sorgulayan veri kay\u0131t formlar\u0131 y\u00fcz y\u00fcze g\u00f6r\u00fc\u015fme yoluyla dolduruldu. Ba\u011f\u0131ml\u0131 de\u011fi\u015fken seropozitif\/seronegatif olma durumu olup ba\u011f\u0131ms\u0131z de\u011fi\u015fkenler ya\u015f, cinsiyet, meslek, \u00e7al\u0131\u015f\u0131lan birim ve hastal\u0131k ge\u00e7irme \u00f6yk\u00fcs\u00fcn\u00fcn varl\u0131\u011f\u0131 idi. Ya\u015f fakt\u00f6r\u00fc, 20-29, 30-39, 40-49, 50 y\u0131l ve \u00fczeri olmak \u00fczere ya\u015f gruplar\u0131na g\u00f6re s\u0131n\u0131fland\u0131r\u0131larak sunuldu. Ayr\u0131ca T\u00fcrkiye\u2019de tek doz a\u015f\u0131lama \u015femas\u0131n\u0131n uyguland\u0131\u011f\u0131 1980 sonras\u0131 do\u011fan 21-38 ya\u015f grubu ile a\u015f\u0131laman\u0131n daha az yayg\u0131n oldu\u011fu 1980 \u00f6ncesi d\u00f6nemde do\u011fmu\u015f olan 30-54 ya\u015f grubu da seropozitiflik a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131.<\/p>\n

\u00c7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul eden ki\u015filere bilgilendirilmi\u015f g\u00f6n\u00fcll\u00fc onam formu imzalat\u0131ld\u0131. \u00c7al\u0131\u015fma i\u00e7in Dokuz Eyl\u00fcl \u00dcniversitesi T\u0131p Fak\u00fcltesi Giri\u015fimsel Olmayan Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 2018\/13-36 karar numaras\u0131 ile onay al\u0131nd\u0131.<\/p>\n

Serolojik Ara\u015ft\u0131rma<\/h3>\n

Onamlar\u0131 al\u0131nan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131ndan 10 ml kan \u00f6rne\u011fi al\u0131nd\u0131. Al\u0131nan \u00f6rnekler santrif\u00fcj edildi ve serumlar \u00e7al\u0131\u015fman\u0131n yap\u0131laca\u011f\u0131 g\u00fcne kadar -20\u02daC\u2019de sakland\u0131. Kantitatif anti-k\u0131zam\u0131k IgG antikor d\u00fczeyi, serum \u00f6rneklerinden \u201cenzyme linked immunosorbent assay\u201d (ELISA) ticari kiti (EUROIMMUN Medizinische Labordiagnostika AG, L\u00fcbeck, Almanya) ile \u00fcretici firma \u00f6nerileri do\u011frultusunda belirlendi. Anti-k\u0131zam\u0131k-IgG d\u00fczeyi olarak; <200 \u0130\u00dc\/lt seronegatif, \u2265200 ve <275 \u0130\u00dc\/lt ara de\u011fer, \u2265275 \u0130\u00dc\/lt ise seropozitif olarak de\u011ferlendirildi.<\/p>\n

\u0130statistiksel Analiz<\/h3>\n

Verilerin analizi, SPSS (Statistical Package for the Social Sciences) versiyon 15.0 program\u0131 (IBM Corp., Armonk, NY, ABD) ile yap\u0131ld\u0131. Tan\u0131mlay\u0131c\u0131 \u00f6l\u00e7\u00fctler, ortalama, standart sapma, ortanca ve y\u00fczde da\u011f\u0131l\u0131m\u0131 olarak sunuldu. \u0130kili gruplar aras\u0131ndaki ortalama farklar\u0131n saptanmas\u0131 i\u00e7in parametrik ko\u015fullar\u0131n sa\u011fland\u0131\u011f\u0131 durumlarda Student t testi, sa\u011flanamad\u0131\u011f\u0131 durumlarda ise Mann-Whitney U testi kullan\u0131ld\u0131. Gruplar aras\u0131nda y\u00fczde da\u011f\u0131l\u0131mlar\u0131n\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 i\u00e7in \u03c7\u00b2 testi\u00a0kullan\u0131ld\u0131. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.\u00a0Anti-k\u0131zam\u0131k IgG ara de\u011ferler seronegatif olarak kabul edildi.<\/p>\n

BULGULAR<\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Kat\u0131l\u0131mc\u0131lar\u0131n Sosyodemografik \u00d6zelliklerine G\u00f6re K\u0131zam\u0131k Seropozitiflik Oranlar\u0131n\u0131n Da\u011f\u0131l\u0131m\u0131 (N=326)<\/p><\/div>\n

K\u0131zam\u0131k olgusu ile kar\u015f\u0131la\u015fma riski y\u00fcksek olan birimlerde \u00e7al\u0131\u015fmakta olan toplam 368 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n 326 (% 88.5)\u2019s\u0131 \u00e7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul etti. Kat\u0131l\u0131mc\u0131lar\u0131n ya\u015f ortalamas\u0131 30.6\u00b15.9 (21-54) y\u0131l olup cinsiyet da\u011f\u0131l\u0131m\u0131 227 (% 69.6) kad\u0131n ve 99 (%30.4) erkek olarak belirlendi. Kat\u0131l\u0131mc\u0131lar\u0131n sosyodemografik \u00f6zellikleri ve seropozitiflik oranlar\u0131n\u0131n da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de sunuldu.<\/p>\n

\"\"<\/a>Kat\u0131l\u0131mc\u0131lar\u0131n 79 (%24.2)\u2019u seronegatif ve 247 (%75.8)\u2019si seropozitif olarak saptand\u0131. Ya\u015f gruplar\u0131na g\u00f6re de\u011ferlendirildi\u011finde ya\u015f azald\u0131k\u00e7a seronegatifli\u011fin artt\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (p<\/i>=0.036) (\u015eekil 1). Ayr\u0131ca tek doz a\u015f\u0131lama \u015femas\u0131n\u0131n uyguland\u0131\u011f\u0131 1980 sonras\u0131 do\u011fan 21-38 ya\u015f grubunda seronegatiflik oran\u0131 %26.3 (76\/289) iken a\u015f\u0131laman\u0131n daha az yayg\u0131n oldu\u011fu 1980 \u00f6ncesi d\u00f6nemde do\u011fmu\u015f olan 39-54 ya\u015f grubunda bu oran %9.1 (3\/37) olarak saptand\u0131. 1980 sonras\u0131 do\u011fanlar\u0131n daha duyarl\u0131 oldu\u011fu istatistiksel olarak anlaml\u0131 bulundu (p<\/i>=0.015).<\/p>\n

\"\"<\/a>\u00c7al\u0131\u015fmam\u0131zda seroprevalans\u0131n, cinsiyet, meslek gruplar\u0131 ve \u00e7al\u0131\u015f\u0131lan birimlerden etkilenmedi\u011fi g\u00f6r\u00fcld\u00fc. K\u0131zam\u0131k ge\u00e7irme \u00f6yk\u00fcs\u00fc olanlar ise daha fazla oranda seropozitif saptand\u0131 (Tablo 1). Kat\u0131l\u0131mc\u0131lar\u0131n 223 (%68.4)\u2019\u00fc do\u011furganl\u0131k \u00e7a\u011f\u0131ndaki (15-49 ya\u015f grubu) kad\u0131nlard\u0131. Bu grupta 51(% 22.9) ki\u015fi seronegatif saptand\u0131.<\/p>\n

\u00c7al\u0131\u015fma grubunun anti-k\u0131zam\u0131k IgG antikor d\u00fczey ortancas\u0131 654 \u0130\u00dc\/ml (65-5000 \u0130\u00dc\/ml) idi. Antikor d\u00fczey ortancalar\u0131 21-29 ya\u015f grubunda 591 \u0130\u00dc\/ml, 30-39 ya\u015f grubunda 690 \u0130\u00dc\/ml, 40-49 ya\u015f grubunda 1914 \u0130\u00dc\/ml ve 50-59 ya\u015f grubunda 3280 \u0130\u00dc\/ml olarak saptand\u0131. Ya\u015f gruplar\u0131na g\u00f6re kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda ya\u015f grubu artt\u0131k\u00e7a antikor d\u00fczey ortancalar\u0131n\u0131n da anlaml\u0131 d\u00fczeyde artt\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (p<\/i><0.001) (\u015eekil 2). Ayr\u0131ca 1980 \u00f6ncesi do\u011fanlar\u0131n antikor d\u00fczey ortancalar\u0131n\u0131n (2313 \u0130\u00dc\/ml) 1980 sonras\u0131 do\u011fanlara g\u00f6re (603 \u0130\u00dc\/ml) anlaml\u0131 d\u00fczeyde daha y\u00fcksek oldu\u011fu saptand\u0131 (p<\/i><0.001). <\/span><\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda risk alt\u0131ndaki sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n k\u0131zam\u0131k seroprevalans\u0131n\u0131n belirlenmesi hedeflendi ve 326 kat\u0131l\u0131mc\u0131n\u0131n 79 (%24.2)\u2019u seronegatif, 247 (%75.8)\u2019si seropozitif olarak tespit edildi. Literat\u00fcrdeki \u00e7al\u0131\u015fmalarda, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda k\u0131zam\u0131k seroprevalans\u0131n\u0131n %86-%98 oranlar\u0131 aras\u0131nda \u00fclkeden \u00fclkeye de\u011fi\u015fti\u011fi bildirilmi\u015ftir (16-20). Bu farkl\u0131l\u0131klar; \u00fclkelerdeki a\u015f\u0131 politikalar\u0131, a\u015f\u0131n\u0131n yayg\u0131n kullan\u0131ma girme zaman\u0131, a\u015f\u0131ya eri\u015fim ve a\u015f\u0131lama sonras\u0131 olu\u015fan primer ya da sekonder a\u015f\u0131 yan\u0131ts\u0131zl\u0131\u011f\u0131 gibi durumlardan kaynaklanabilmektedir.<\/p>\n

Ara\u015ft\u0131rma kapsam\u0131nda kat\u0131l\u0131mc\u0131lar\u0131n k\u0131zam\u0131k seropozitiflik durumunun ya\u015f ile ili\u015fkisi ara\u015ft\u0131r\u0131ld\u0131 ve k\u0131zam\u0131k seropozitifli\u011finin ya\u015fla birlikte artt\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. Tek doz a\u015f\u0131 olan 1980 sonras\u0131 do\u011fumlu 21-38 ya\u015f grubunda seropozitiflik %73.7 iken 39-54 ya\u015f grubunda %91.9 olarak saptand\u0131. \u0130spanya\u2019da yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada Urbiztondo ve arkada\u015flar\u0131 (20), seropozitiflik oran\u0131n\u0131 %98 bulduklar\u0131n\u0131 ve 1981\u2019den sonra do\u011fanlarda duyarl\u0131l\u0131\u011f\u0131n daha y\u00fcksek oldu\u011funu bildirmi\u015ftir. Ledda ve arkada\u015flar\u0131n\u0131n (16) \u0130talya\u2019da yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, seropozitiflik oran\u0131 %86 olup gen\u00e7 ya\u015flarda duyarl\u0131l\u0131\u011f\u0131n daha fazla oldu\u011fu belirtilmi\u015ftir. K\u00f6se ve arkada\u015flar\u0131n\u0131n (21) Tokat\u2019ta yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, ya\u015f gruplar\u0131na g\u00f6re de\u011ferlendirilen seropozitifli\u011fin; 18-25 ya\u015f grubunda %72.1 ile en d\u00fc\u015f\u00fck, 26-35 ya\u015f grubunda\u00a0 <\/span>%88.8 ve 36-45 ya\u015f grubunda ise\u00a0 <\/span>%95.2 ile en y\u00fcksek oranda bulundu\u011fu, ya\u015f artt\u0131k\u00e7a k\u0131zam\u0131k ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n\u0131n da artt\u0131\u011f\u0131 bildirilmi\u015ftir. T\u00fcm bu \u00e7al\u0131\u015fmalar de\u011ferlendirildi\u011finde, ileri ya\u015flarda ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n fazla olmas\u0131n\u0131n, a\u015f\u0131lama \u00f6ncesindeki d\u00f6nemde k\u0131zam\u0131k insidans\u0131n\u0131n y\u00fcksek olmas\u0131 nedeniyle do\u011fal ba\u011f\u0131\u015f\u0131kl\u0131k kazan\u0131lmas\u0131ndan kaynakland\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclmektedir. Ayr\u0131ca 1980 sonras\u0131 do\u011fanlarda duyarl\u0131l\u0131\u011f\u0131n fazla olmas\u0131, tek doz a\u015f\u0131laman\u0131n yetersiz oldu\u011funu ve a\u015f\u0131 iki doz uygulanm\u0131\u015f olsa da primer ya da sekonder a\u015f\u0131 yan\u0131ts\u0131zl\u0131\u011f\u0131n\u0131n g\u00f6z \u00f6n\u00fcnde bulundurulmas\u0131 gerekti\u011fini g\u00f6stermektedir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, seronegatiflik oran\u0131 kad\u0131nlarda %22.5 ve erkeklerde %28.3 olup seroprevalans\u0131n cinsiyetten etkilenmedi\u011fi g\u00f6r\u00fcld\u00fc. Avustralya\u2019dan Andrew ve arkada\u015flar\u0131 (18), Fransa\u2019dan Freund ve arkada\u015flar\u0131 (19) taraf\u0131ndan yap\u0131lan \u00e7al\u0131\u015fmalarda da cinsiyetle k\u0131zam\u0131k seroprevalans\u0131 aras\u0131nda ili\u015fki saptanmad\u0131\u011f\u0131 bildirilmi\u015ftir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, meslekler aras\u0131nda k\u0131zam\u0131k seroprevalans\u0131 a\u00e7\u0131s\u0131ndan anlaml\u0131 fark saptanmad\u0131. Benzer olarak Urbiztondo ve arkada\u015flar\u0131n\u0131n (20) ve Fransa\u2019dan Botelho ve arkada\u015flar\u0131n\u0131n (22) \u00e7al\u0131\u015fmalar\u0131nda da fark saptanmad\u0131\u011f\u0131 bildirilmi\u015ftir.<\/p>\n

Kat\u0131l\u0131mc\u0131lar \u00e7al\u0131\u015ft\u0131klar\u0131 b\u00f6l\u00fcmlere g\u00f6re de\u011ferlendirildi\u011finde, k\u0131zam\u0131k ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde bir fark saptanmad\u0131. Benzer \u015fekilde Freund ve arkada\u015flar\u0131n\u0131n (19) ve T\u00fcrkiye\u2019de Alp ve arkada\u015flar\u0131n\u0131n (23) \u00e7al\u0131\u015fmalar\u0131nda da seroprevalans\u0131n \u00e7al\u0131\u015f\u0131lan b\u00f6l\u00fcmlere g\u00f6re de\u011fi\u015fmedi\u011fi bildirilmi\u015ftir. <\/span><\/p>\n

Kat\u0131l\u0131mc\u0131lar k\u0131zam\u0131k ge\u00e7irme \u00f6yk\u00fclerine g\u00f6re de\u011ferlendirildi\u011finde, hastal\u0131\u011f\u0131 ge\u00e7irdi\u011fini belirtenlerin tamam\u0131 seropozitif saptand\u0131 ve hastal\u0131k \u00f6yk\u00fcs\u00fc olanlar ile seroprevalans ili\u015fkisi istatistiksel olarak anlaml\u0131 bulundu.\u00a0 <\/span>Hatipo\u011flu ve arkada\u015flar\u0131n\u0131n (24) \u00e7al\u0131\u015fmas\u0131nda seropozitiflik oran\u0131 %97.5 olup hastal\u0131\u011f\u0131 ge\u00e7irme \u00f6yk\u00fcs\u00fc verenlerin tamam\u0131n\u0131n seropozitif saptand\u0131\u011f\u0131 bildirilmi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fmada, hastal\u0131\u011f\u0131 ge\u00e7irme \u00f6yk\u00fcs\u00fcn\u00fcn k\u0131zam\u0131\u011fa kar\u015f\u0131 imm\u00fcniteyi tahmin ettirmede g\u00fcvenilir oldu\u011fu, hastal\u0131\u011f\u0131 ge\u00e7irme \u00f6yk\u00fcs\u00fc olan sa\u011fl\u0131k personelinin a\u015f\u0131lanmas\u0131n\u0131n gerekmedi\u011fi sonucuna var\u0131ld\u0131\u011f\u0131 bildirilmi\u015ftir. Avustralya\u2019dan Andrew ve arkada\u015flar\u0131n\u0131n \u00e7al\u0131\u015fmas\u0131nda (18), hastal\u0131k \u00f6yk\u00fcs\u00fc olanlarda seropozitiflik oran\u0131 %99 iken olmayanlarda %93 saptand\u0131\u011f\u0131, hastal\u0131\u011f\u0131 ge\u00e7irenlerin daha fazla ba\u011f\u0131\u015f\u0131k oldu\u011fu bildirilmi\u015ftir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda ya\u015f grubu artt\u0131k\u00e7a antikor d\u00fczey ortancalar\u0131n\u0131n artt\u0131\u011f\u0131 belirlendi ve 1980 \u00f6ncesi do\u011fumlu 39-54 ya\u015f grubunun antikor d\u00fczey ortancalar\u0131n\u0131n, 21-38 ya\u015f grubundakilerin antikor d\u00fczey ortancalar\u0131ndan daha y\u00fcksek oldu\u011fu saptand\u0131. 1980 \u00f6ncesi do\u011fan kat\u0131l\u0131mc\u0131lar\u0131n hastal\u0131\u011f\u0131 ge\u00e7irme \u00f6yk\u00fcs\u00fcn\u00fcn daha y\u00fcksek olmas\u0131 antikor d\u00fczey ortancalar\u0131n\u0131n bu grupta y\u00fcksek olmas\u0131n\u0131n do\u011fal ba\u011f\u0131\u015f\u0131kl\u0131k nedeniyle oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir. Sasaki ve arkada\u015flar\u0131n\u0131n (25) Japonya\u2019da gen\u00e7 eri\u015fkinlerde yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, k\u0131zam\u0131k antikor titrelerinin k\u0131zam\u0131k ge\u00e7irme \u00f6yk\u00fcs\u00fc verenlerde anlaml\u0131 derecede daha y\u00fcksek saptand\u0131\u011f\u0131 bildirilmi\u015ftir. A\u015f\u0131lama ile olu\u015fan ba\u011f\u0131\u015f\u0131kl\u0131kta antikor d\u00fczeylerinin d\u00fc\u015f\u00fck olmas\u0131 nedeniyle \u00f6zellikle do\u011furganl\u0131k \u00e7a\u011f\u0131ndaki kad\u0131nlar\u0131n bebeklerine yeterli antikor ge\u00e7ebilmesi i\u00e7in ikinci doz a\u015f\u0131lar\u0131n\u0131 tamamlam\u0131\u015f olmalar\u0131 \u00f6nemlidir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda baz\u0131 k\u0131s\u0131tl\u0131l\u0131klar mevcuttur. Kat\u0131l\u0131mc\u0131lar g\u00f6n\u00fcll\u00fcl\u00fck esas\u0131na g\u00f6re \u00e7al\u0131\u015fmaya dahil edildi\u011fi i\u00e7in ba\u011f\u0131\u015f\u0131kl\u0131k durumunu bilenler \u00e7al\u0131\u015fmaya kat\u0131lmam\u0131\u015f olabilir. \u00c7al\u0131\u015fmam\u0131z \u0130zmir\u2019de tek merkezde y\u00fcr\u00fct\u00fclm\u00fc\u015f olup T\u00fcrkiye genelinde sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda k\u0131zam\u0131k seroprevalans\u0131 i\u00e7in yorum yap\u0131lamamaktad\u0131r. Ayr\u0131ca kat\u0131l\u0131mc\u0131lar\u0131n a\u015f\u0131 kay\u0131tlar\u0131na ula\u015f\u0131lamad\u0131 ve k\u0131zam\u0131k a\u015f\u0131lanma \u00f6yk\u00fcleri sorguland\u0131; ancak b\u00fcy\u00fck bir k\u0131sm\u0131 hat\u0131rlamad\u0131\u011f\u0131 i\u00e7in de\u011ferlendirme yap\u0131lamad\u0131.<\/p>\n

Bu \u00e7al\u0131\u015fma ile hastanemiz sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00f6nemli bir k\u0131sm\u0131n\u0131n k\u0131zam\u0131\u011fa duyarl\u0131 oldu\u011fu belirlendi. \u00d6zellikle 1980 sonras\u0131 do\u011fanlarda seropozitifli\u011fin daha d\u00fc\u015f\u00fck oldu\u011fu saptand\u0131. Ayr\u0131ca hastal\u0131\u011f\u0131 ge\u00e7irme \u00f6yk\u00fcs\u00fc olanlar\u0131n tamam\u0131n\u0131n seropozitif oldu\u011fu g\u00f6r\u00fcld\u00fc. Sonu\u00e7 olarak; 1980-1991 aras\u0131nda do\u011fup tek doz a\u015f\u0131 olanlar ba\u015fta olmak \u00fczere hastal\u0131k ge\u00e7irme \u00f6yk\u00fcs\u00fcn\u00fc bilmeyen t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ba\u011f\u0131\u015f\u0131klamalar\u0131n\u0131n tamamlanmas\u0131 gerekmektedir. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n gerek \u00f6\u011frencilik d\u00f6nemlerinde gerekse sonras\u0131nda i\u015fe ilk giri\u015fleri s\u0131ras\u0131nda a\u015f\u0131 kay\u0131tlar\u0131n\u0131n ve ba\u011f\u0131\u015f\u0131kl\u0131k durumlar\u0131n\u0131n de\u011ferlendirilmesi eksik a\u015f\u0131lar\u0131n tamamlanmas\u0131 i\u00e7in f\u0131rsat olabilir. Eliminasyon hedeflerine ula\u015fabilmek i\u00e7inse \u00f6zellikle salg\u0131nlar\u0131n g\u00f6r\u00fcld\u00fc\u011f\u00fc d\u00f6nemlerde serolojik durumlar\u0131na bak\u0131lmaks\u0131z\u0131n t\u00fcm sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015f\u0131lanmas\u0131 hem kendilerinin korunmas\u0131 hem de olas\u0131 nozokomiyal salg\u0131nlar\u0131n \u00f6nlenmesi bak\u0131m\u0131ndan uygulanacak yol olmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e K\u0131zam\u0131k; y\u00fcksek ate\u015f, g\u00f6zlerde k\u0131zar\u0131kl\u0131k, burun ak\u0131nt\u0131s\u0131, \u00f6ks\u00fcr\u00fck ve mak\u00fclopap\u00fcler d\u00f6k\u00fcnt\u00fc ile karakterize olan olduk\u00e7a bula\u015f\u0131c\u0131 bir hastal\u0131kt\u0131r. D\u00f6k\u00fcnt\u00fcler tipik olarak kulak arkas\u0131nda ve al\u0131n sa\u00e7 \u00e7izgisinde ba\u015flar, 2-3 g\u00fcn i\u00e7inde ense, g\u00f6vde, kol ve bacaklara yay\u0131l\u0131r. Hastal\u0131k, d\u00f6k\u00fcnt\u00fc \u00f6ncesi ve sonras\u0131nda d\u00f6rt g\u00fcn bula\u015f\u0131c\u0131d\u0131r (1). Be\u015f ya\u015f alt\u0131 \u00e7ocuklar ve 30 ya\u015f \u00fczeri […]<\/p>\n","protected":false},"author":4,"featured_media":28226,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[3377,5805,5804,3682],"class_list":["post-27722","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-kizamik","tag-kizamik-asisi","tag-kizamik-seroprevalansi","tag-saglik-calisani"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27722","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=27722"}],"version-history":[{"count":5,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27722\/revisions"}],"predecessor-version":[{"id":28767,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27722\/revisions\/28767"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/28226"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27722"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27722"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27722"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}