Research Article
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Bir ilçedeki gebelerde TORCH seroprevalansının araştırılması

Year 2022, Volume: 19 Issue: 3, 1373 - 1379, 30.09.2022
https://doi.org/10.38136/jgon.1021475

Abstract

Amaç: Bir ilçedeki gebelerde ilk trimesterde toksoplazma, rubella, CMV, sifiliz, HIV ve hepatit B&C seroprevalansının belirlenmesini ve gebelik takibinde bu enfeksiyonların taranmasının gerekli olup olmadığını tartışmayı amaçladık.
Gereçler ve Yöntem: Çalışmaya bir ilçedeki mevcut olan tek kadın hastalıkları ve doğum polikliniğine bir yıl içinde başvuran 259 gebe dahil edilmiştir. Gebelerden ilk trimesterde alınan venöz kanda; rubella IgM&IgG, toksoplazma IgM&IgG, CMV IgM&IgG, HBsAg, anti-HCV, anti-HIV ve sifiliz (VDRL-RPR) serolojileri değerlendirilmiştir.
Bulgular: Hastaların seroloji sonuçlarında rubella IgG 255 (%98.5), CMV IgG 254 (%98.1), toksoplazma IgG 58(%22.4) hastada pozitif olarak bulundu. Bir hastada toksoplazma IgM ve IgG pozitif saptandı. Rubella IgM, CMV IgM, anti-HCV ve anti-HIV hiçbir hastada pozitif saptanmadı. Hastaların 2’sinde (%0.8) HBsAg, başka 2 (%0.8) hastada da VDRL-RPR pozitif saptandı. İki hastada HBV DNA testi ile Hepatit B hastalığı, bir hastada TPHA testi ile sifiliz hastalığı doğrulandı.
Sonuç: Bölgemizde rubella enfeksiyonunun aşılama programı sayesinde, CMV enfeksiyonun da gebelik öncesi dönemde geçirilerek bağışıklıklarının yüksek olması gebelikte taranmalarının uygun olmadığını göstermektedir. Bölgemizdeki toksoplazma için tespit edilen yüksek seronegatiflik oranları gebelik takibinde ilk muayenede toksoplazma yönünden bağışıklık durumunun belirlenmesinin yararlı olacağını göstermektedir. Hepatit B için gerekli taramalar yapıldıktan sonra mümkünse prekonsepsiyonel dönemde aşılama önerilmelidir. Hepatit C, HIV ve sifiliz taramasının maliyeti ve bölgemizdeki düşük prevelansı göz önüne alındığında riskli grupların taranması daha uygun gözükmektedir. Ancak ülkemiz Sağlık Bakanlığı, Birleşmiş Milletlerin belirlediği hedefler doğrultusunda tüm gebelerin özellikle HIV ve sifiliz açısından taranmasını önermektedir.

References

  • 1. Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol 2015; 42:77-103.
  • 2. Reef SE, Plotkin S, Cordero JF, Katz M, Cooper L, Schwartz B, et al. Preparing for elimination of congenital rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000; 31:85-95.
  • 3. Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982; 2:781-4.
  • 4. Reef SE, Redd SB, Abernathy E, Zimmerman L, Icenogle JP. The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998-2004: the evidence for absence of endemic transmission. Clin Infect Dis 2006; 43:126-32.
  • 5. Gülseren YD, Taþbent FE, Ozdemir M. Investigation of CMV and rubella seroprevalence and age related distribution in pregnant women. Turk Mikrobiyol Cem Derg 2019; 49:154-61.
  • 6. Nazik S, Duran I, Nazik H, Duran Ş. Gebelikte toksoplazma ve rubella seropozitifliğinin değerlendirilmesi. Balıkesir Medical Journal 2017; 1:22-5.
  • 7. Sirin MC, Agus N, Yilmaz N, Bayram A, Derici YK, Samlioglu P, et al. Seroprevalence of toxoplasma gondii, rubella virus and cytomegalovirus among pregnant women and the importance of avidity assays. Saudi Med J 2017; 38:727.
  • 8. Şevki Ç, Ayla S, Ayşe Ç, Sibel S, Serpil Ü, Nuri D, et al. Seroprevalence of toxoplasma gondii and rubella among pregnant women in central Turkey. Afr J Microbiol Res 2013; 7:2524-9.
  • 9. Pass RF, Arav-Boger R. Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention. F1000 Res 2018; 7:255.
  • 10. Sahiner F, Cekmez F, Cetinkaya M, Kaya G, Kalayci T, Gunes O, et al. Congenital cytomegalovirus infections and glycoprotein B genotypes in live-born infants: a prevalence study in Turkey. Infect Dis (Lond) 2015; 47:465-71.
  • 11. Picone O, Vauloup-Fellous C, Cordier AG, Guitton S, Senat MV, Fuchs F, et al. A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 2013; 33:751-8.
  • 12. Akpınar O, Akpınar H. Gebe kadınlarda rubella ve sitomegalovirus seroprevelansının ELISA yöntemi ile Araştırılması. Balıkesir Sağlık Bil Derg 2017; 6:11-5.
  • 13. Varıcı BF, Arslan A, Sertöz R, Altuğlu İ. Rubella and cytomegalovirus seroprevalance among pregnant women admitted to Ege University Hospital. ETD 2014; 53(4):179-83.
  • 14. Maldonado YA, Read JS. Diagnosis, Treatment, and Prevention of congenital toxoplasmosis in the United States. Pediatrics 2017; 2:139. 15. Prusa AR, Kasper DC, Sawers L, Walter E, Hayde M, Stillwaggon E. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving. PLoS Negl Trop Dis 2017; 11:e0005648.
  • 16. Jones JL, Kruszon-Moran D, Rivera HN, Price C, Wilkins PP. Toxoplasma gondii seroprevalence in the United States 2009-2010 and comparison with the past two decades. Am J Trop Med Hyg 2014; 90:1135-9.
  • 17. Doğan Y, Yücesoy G. Fetal enfeksiyonların prenatal tanısı. Turkiye Klinikleri J Gynecol Obst-Special Topics 2017; 10:68-81.
  • 18. Obut M, Doğan Y, Bademkıran MH, Akgöl S, Kahveci B, Peker N, et al. Diyarbakır ilindeki gebe kadınlarda toksoplazma, rubella ve sitomegalovirus seroprevalansı. Dicle Tıp Dergisi 2019; 46:23-8.
  • 19. Sert UY, Ozgu-Erdinc AS, Gokay S, Engin-Ustun Y. Toxoplasma screening results of 84587 pregnant women in a tertiary referral center in Turkey. Fetal Pediatr Pathol 2019 ;38:307-16.
  • 20. Tanriverdi EC, Ozkurt Z, Cayir Y, Uslu H. Pregnancy and toxoplasmosis: should screening be a routine practice? Fam Pract Palliat Care. 2019; 4:74-8.
  • 21. Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiane SG, et al. Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLOS ONE 2019; 14:e0219613.
  • 22. Braxton J, Davis DW, Emerson B, Flagg EW, Grey J, Grier L, et al. Sexually transmitted disease surveillance 2017. 2018.
  • 23. Sifiliz İstatistik. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Bulaşıcı Hastalıklar Dairesi Başkanlığı. Erişim Tarihi: 01.05.2019. Available from:https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar,
  • 24. Nas T, Taner MZ, Yildiz A. Seroprevalence of syphilis, human immunodeficiency virus type-1, and hepatitis B virus infections among pregnant women in Turkey. Int J Gynaecol Obstet1999; 66:171-2.
  • 25. Dogan K, Guraslan H, Ozel G, Aydan Z, Yasar L. Seroprevalence rates of toxoplasma gondii, rubella, cytomegalovirus, syphilis, and hepatitis b, seroprevalences rate in the pregnant population in istanbul. Turkiye Parazitol Derg 2014; 38:228-33.
  • 26. Ensari T, Kirbas A, Ozgu-Erdinc AS, Gokay Saygan S, Erkaya S, Uygur D, et al. An eight-year retrospective analysis of antenatal screening results for syphilis: is it still cost effective? J Infect Dev Ctries 2015; 9:1011-5.
  • 27. World Health Organization. Global health observatory data: summary of the global HIV epidemic. Erişim tarihi: 10 Kasım 2021. Available from: https://www.who.int/data/gho/data/themes/hiv-aids
  • 28. Cooper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002; 29:484-94.
  • 29. Irmak H, Yardım N, Keklik K, Temel F. Türkiye HIV/AIDS Kontrol programı 2019–2024. Ankara: Arti6 Medya Tanıtım Matbaa, 2019: 1131.
  • 30. Yalcin Bahat P, Turan G, Yuksel Ozgor B, Bagci Cakmak K. Comparison of hepatitis B, hepatitis C, and HIV seropositivity of Syrian and Turkish pregnant women. Turk J Obstet Gynecol 2019; 16:95-9.
  • 31. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29:133-9.
  • 32. T.C. Sağlık Bakanlığı Doğum Öncesi Bakım Yönetim Rehberi. Yayın No: 924. Ankara: TC Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Kadın ve Üreme Sağlığı Daire Başkanlığı, 2014.
  • 33. Toy M, Önder FO, Wörmann T, Bozdayi AM, Schalm SW, Borsboom GJ, et al. Age-and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis 2011; 11:337.
  • 34. Bakar RZ, Dane B. Hepatitis B seropositivity of pregnant women and the review of Turkish literature. Perinatal Journal 2016; 24:83-8.
  • 35. Madendağ Y, Çöl İ, Çelen Ş, Ünlü S, Danişman N. Seroprevalence of Hepatitis B, Hepatitis C and HIV at whole obstetric and gynecologic patients who applied our hospital. Turkiye Klinikleri J Gynecol Obst 2007; 17:442.
  • 36. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis 2014; 59:765-73.
  • 37. Ghany MG, Morgan TR; AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis C Guidance 2019 update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology. 2020; 71:686-721.
  • 38. Hofmeister MG, Rosenthal EM, Barker LK, Rosenberg ES, Barranco MA, Hall EW, et al. Estimating prevalence of Hepatitis C virus infection in the United States, 2013-2016. Hepatology 2019; 69:1020-31.
  • 39. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect 2015; 21:1020-6.

Investigation of TORCH seroprevalence among pregnant women in a district

Year 2022, Volume: 19 Issue: 3, 1373 - 1379, 30.09.2022
https://doi.org/10.38136/jgon.1021475

Abstract

Aim: The aim of this study to evaluate the seroprevalence of toxoplasmosis, rubella, CMV, syphilis, HIV and hepatitis B&C infections among pregnant women at the first trimester in a district and to discuss whether it is necessary to screen for these infections during routine pregnancy follow -up.
Materials and Method: This study included 259 pregnant women who applied to the single Obstetrics and Gynecology outpatient clinic in a district within one year. Rubella IgM&IgG, toxoplasma IgM&IgG, CMV IgM&IgG, HBsAg, anti-HCV, anti-HIV and syphilis (VDRL-RPR) serologies were examined from the venous blood sample taken in the first trimester of pregnancy.
Results: Rubella IgG antibodies detected in 255 (98.5%) patients, CMV IgG antibodies in 254 (98.1%) patients, toxoplasma IgG antibodies in 58 (22.4%) patients. Only one patient was positive for Anti-Toxoplasma IgM and IgG antibodies. None of the patients were positive for Rubella IgM, CMV IgM, anti-HCV and anti-HIV antibodies. HBsAg positivity was detected in 2 (0.8%) patients and VDRL-RPR positivity in other 2 patients. Positive results for Hepatitis B disease was confirmed by HBV DNA test in two patients and syphilis disease was confirmed by TPHA test in one patient.
Conclusion: Due to the protective effects of rubella vaccination and acquired immunity in the pre-pregnancy period of CMV infection, screening for these infections during pregnancy may not be appropriate. The high seronegativity rates determined for toxoplasmosis in our region indicate that it will be useful to screen for toxoplasmosis in the first antenatal visit. If possible, in the preconceptional period, vaccination should be recommended after the routine screening for hepatitis B infection done. Considering the cost of the screening for hepatitis C, HIV and syphilis infections and low prevalence in our region, screening of high-risk groups seems more convenient. However, the Ministry of Health recommends that all pregnant women be screened for HIV and syphilis infections in line with the goals set by the United Nations.

References

  • 1. Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol 2015; 42:77-103.
  • 2. Reef SE, Plotkin S, Cordero JF, Katz M, Cooper L, Schwartz B, et al. Preparing for elimination of congenital rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000; 31:85-95.
  • 3. Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982; 2:781-4.
  • 4. Reef SE, Redd SB, Abernathy E, Zimmerman L, Icenogle JP. The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998-2004: the evidence for absence of endemic transmission. Clin Infect Dis 2006; 43:126-32.
  • 5. Gülseren YD, Taþbent FE, Ozdemir M. Investigation of CMV and rubella seroprevalence and age related distribution in pregnant women. Turk Mikrobiyol Cem Derg 2019; 49:154-61.
  • 6. Nazik S, Duran I, Nazik H, Duran Ş. Gebelikte toksoplazma ve rubella seropozitifliğinin değerlendirilmesi. Balıkesir Medical Journal 2017; 1:22-5.
  • 7. Sirin MC, Agus N, Yilmaz N, Bayram A, Derici YK, Samlioglu P, et al. Seroprevalence of toxoplasma gondii, rubella virus and cytomegalovirus among pregnant women and the importance of avidity assays. Saudi Med J 2017; 38:727.
  • 8. Şevki Ç, Ayla S, Ayşe Ç, Sibel S, Serpil Ü, Nuri D, et al. Seroprevalence of toxoplasma gondii and rubella among pregnant women in central Turkey. Afr J Microbiol Res 2013; 7:2524-9.
  • 9. Pass RF, Arav-Boger R. Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention. F1000 Res 2018; 7:255.
  • 10. Sahiner F, Cekmez F, Cetinkaya M, Kaya G, Kalayci T, Gunes O, et al. Congenital cytomegalovirus infections and glycoprotein B genotypes in live-born infants: a prevalence study in Turkey. Infect Dis (Lond) 2015; 47:465-71.
  • 11. Picone O, Vauloup-Fellous C, Cordier AG, Guitton S, Senat MV, Fuchs F, et al. A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 2013; 33:751-8.
  • 12. Akpınar O, Akpınar H. Gebe kadınlarda rubella ve sitomegalovirus seroprevelansının ELISA yöntemi ile Araştırılması. Balıkesir Sağlık Bil Derg 2017; 6:11-5.
  • 13. Varıcı BF, Arslan A, Sertöz R, Altuğlu İ. Rubella and cytomegalovirus seroprevalance among pregnant women admitted to Ege University Hospital. ETD 2014; 53(4):179-83.
  • 14. Maldonado YA, Read JS. Diagnosis, Treatment, and Prevention of congenital toxoplasmosis in the United States. Pediatrics 2017; 2:139. 15. Prusa AR, Kasper DC, Sawers L, Walter E, Hayde M, Stillwaggon E. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving. PLoS Negl Trop Dis 2017; 11:e0005648.
  • 16. Jones JL, Kruszon-Moran D, Rivera HN, Price C, Wilkins PP. Toxoplasma gondii seroprevalence in the United States 2009-2010 and comparison with the past two decades. Am J Trop Med Hyg 2014; 90:1135-9.
  • 17. Doğan Y, Yücesoy G. Fetal enfeksiyonların prenatal tanısı. Turkiye Klinikleri J Gynecol Obst-Special Topics 2017; 10:68-81.
  • 18. Obut M, Doğan Y, Bademkıran MH, Akgöl S, Kahveci B, Peker N, et al. Diyarbakır ilindeki gebe kadınlarda toksoplazma, rubella ve sitomegalovirus seroprevalansı. Dicle Tıp Dergisi 2019; 46:23-8.
  • 19. Sert UY, Ozgu-Erdinc AS, Gokay S, Engin-Ustun Y. Toxoplasma screening results of 84587 pregnant women in a tertiary referral center in Turkey. Fetal Pediatr Pathol 2019 ;38:307-16.
  • 20. Tanriverdi EC, Ozkurt Z, Cayir Y, Uslu H. Pregnancy and toxoplasmosis: should screening be a routine practice? Fam Pract Palliat Care. 2019; 4:74-8.
  • 21. Korenromp EL, Rowley J, Alonso M, Mello MB, Wijesooriya NS, Mahiane SG, et al. Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012. PLOS ONE 2019; 14:e0219613.
  • 22. Braxton J, Davis DW, Emerson B, Flagg EW, Grey J, Grier L, et al. Sexually transmitted disease surveillance 2017. 2018.
  • 23. Sifiliz İstatistik. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Bulaşıcı Hastalıklar Dairesi Başkanlığı. Erişim Tarihi: 01.05.2019. Available from:https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar,
  • 24. Nas T, Taner MZ, Yildiz A. Seroprevalence of syphilis, human immunodeficiency virus type-1, and hepatitis B virus infections among pregnant women in Turkey. Int J Gynaecol Obstet1999; 66:171-2.
  • 25. Dogan K, Guraslan H, Ozel G, Aydan Z, Yasar L. Seroprevalence rates of toxoplasma gondii, rubella, cytomegalovirus, syphilis, and hepatitis b, seroprevalences rate in the pregnant population in istanbul. Turkiye Parazitol Derg 2014; 38:228-33.
  • 26. Ensari T, Kirbas A, Ozgu-Erdinc AS, Gokay Saygan S, Erkaya S, Uygur D, et al. An eight-year retrospective analysis of antenatal screening results for syphilis: is it still cost effective? J Infect Dev Ctries 2015; 9:1011-5.
  • 27. World Health Organization. Global health observatory data: summary of the global HIV epidemic. Erişim tarihi: 10 Kasım 2021. Available from: https://www.who.int/data/gho/data/themes/hiv-aids
  • 28. Cooper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002; 29:484-94.
  • 29. Irmak H, Yardım N, Keklik K, Temel F. Türkiye HIV/AIDS Kontrol programı 2019–2024. Ankara: Arti6 Medya Tanıtım Matbaa, 2019: 1131.
  • 30. Yalcin Bahat P, Turan G, Yuksel Ozgor B, Bagci Cakmak K. Comparison of hepatitis B, hepatitis C, and HIV seropositivity of Syrian and Turkish pregnant women. Turk J Obstet Gynecol 2019; 16:95-9.
  • 31. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29:133-9.
  • 32. T.C. Sağlık Bakanlığı Doğum Öncesi Bakım Yönetim Rehberi. Yayın No: 924. Ankara: TC Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Kadın ve Üreme Sağlığı Daire Başkanlığı, 2014.
  • 33. Toy M, Önder FO, Wörmann T, Bozdayi AM, Schalm SW, Borsboom GJ, et al. Age-and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis 2011; 11:337.
  • 34. Bakar RZ, Dane B. Hepatitis B seropositivity of pregnant women and the review of Turkish literature. Perinatal Journal 2016; 24:83-8.
  • 35. Madendağ Y, Çöl İ, Çelen Ş, Ünlü S, Danişman N. Seroprevalence of Hepatitis B, Hepatitis C and HIV at whole obstetric and gynecologic patients who applied our hospital. Turkiye Klinikleri J Gynecol Obst 2007; 17:442.
  • 36. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical transmission of hepatitis C virus: systematic review and meta-analysis. Clin Infect Dis 2014; 59:765-73.
  • 37. Ghany MG, Morgan TR; AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis C Guidance 2019 update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology. 2020; 71:686-721.
  • 38. Hofmeister MG, Rosenthal EM, Barker LK, Rosenberg ES, Barranco MA, Hall EW, et al. Estimating prevalence of Hepatitis C virus infection in the United States, 2013-2016. Hepatology 2019; 69:1020-31.
  • 39. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect 2015; 21:1020-6.
There are 38 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Fatih Kılıç 0000-0002-7333-4883

Burak Ersak 0000-0003-3301-062X

Adem Yalçınkaya This is me 0000-0002-2255-1394

Publication Date September 30, 2022
Submission Date November 10, 2021
Acceptance Date December 20, 2021
Published in Issue Year 2022 Volume: 19 Issue: 3

Cite

Vancouver Kılıç F, Ersak B, Yalçınkaya A. Bir ilçedeki gebelerde TORCH seroprevalansının araştırılması. JGON. 2022;19(3):1373-9.