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Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları

Year 2014, Volume: 12 Issue: 1, 31 - 36, 01.06.2014

Abstract

Bu yazıda ülkemizde çocuk/adolesan gebeliklere genel bakış ile influenzanın klinik, bulaşma özelliklerinden ayrıca korunma ve tedavisinden bahsedilmesi amaçlanmıştır. Dünya Sağlık Örgütü DSÖ , 10-19 yaş grubunu ergen adolesan , olarak kabul eder. Türkiye’de 15-19 yaş arası evli çocuk/adolesan oranı %9,3 bildirilmiştir. Türkiye’de doğumların %9’u 15-19 yaşında olup, 15-19 yaş çocuk sahibi olma oranı ise 40/1000’dir. Çocuk/adolesan gebeliklerde doğum öncesi bakım, normal gebeliklere göre daha yetersiz olup doğum sonrası bebekte komplikasyon oranları da daha yüksek bulunmuştur. Çocuk/adolesan gebelerdeki influenza enfeksiyonları normal gebelerden esas olarak farklılık göstermez, ancak daha ağır hastalığa, daha fazla hastaneye yatışa ve daha yüksek oranda ölüme yol açar. Gebelerde influenza enfeksiyonu gebe annenin yanı sıra embriyo veya fetüsü ayrıca doğum sonrası yenidoğan bebeği de olumsuz etkileyebilir. Gebelikte influenza enfeksiyonunun embriyo ve fetüse etkileri iyi çalışılmamıştır. Aslında influenza virüsünün transplasental geçişi nadirdir, ancak doğum defektlerine yol açabilir. Gebede influenza enfeksiyonunun klinik bulguları ve tanısı diğer genel toplumda görülenlere benzerdir. Gebeye eğer endikasyon varsa influenzanın hem A, hem B profilaksi ve tedavisinde oseltamivir ve zanamivir verilir.Ancak aşılama influenza enfeksiyonundan korunmada tercih edilen en önemli korunma yoludur. Gebeye inaktif influenza aşısının gebe ve fetüs için artmış bir risk oluşturmadığı ve güvenli olduğu kabul edilir. Gebedeki grip aşılaması bir risk grubu olarak gebeyi, fetüsü ve ilk 6 aya kadar yenidoğan bebeği grip ve komplikasyonlarından koruyabilir. Ancak ülkemizde gebelerde aşılanma oranının %10’un altında olduğu tahmin edilmektedir

References

  • 1. Senanayake P.Adolescent fertility. In: Wallace HM, Giri K, (eds). Health Care of Women and children in Developing Countries, 3rd Party. Oakland, California, Publishing Company 1990:470-5.
  • 2. World Health Organization. The Health of Youth. A42/ Technical Discussions. Geneva, Switzerland; WHO 1989.
  • 3. Turkish Demographic Health Survey (TDHS-1998). Turkish Population and Health Research.Turkey: Hacettepe University Institute of Population Studies, Macro International Inc; 1998.
  • 4. Türkiye İstatistik Kurumu, http://www.TÜİK.gov.tr/VeriBilgi. do?alt_id=37, (Erişim tarihi 11.02.2013).
  • 5. Aksit S, Turpculu A. Trends in teenage pregnancy in Turkey. Int J Gynaecol Obstet 2003;81:55-6.
  • 6. Ozcebe H, Dervisoglu AA. (Is adolescent fertility a problem in Turkey?) Nufusbil 1993;15:33-53.
  • 7. Türk Hukuk Sitesi, Çocuk Hakları Sözleşmesi, http://www. turkhukuksitesi.com/showthread.php?t=5719, (Erişim tarihi 11.02.2013).
  • 8. Ventura SJ, Freedman MA. Teenage childbearing in the United States, 1960-1997. Am J Prev Med 2000;19:18-25.
  • 9. Singh S, Darroch JE. Adolescent pregnancy and childbearing: levels and trends in developed countries. Fam Plann Perspect 2000;32:14-23.
  • 10. Wang CS, Chou P. Risk factors for adolescent primigravida in Kaohsiung County, Taiwan. Am J Prev Med 1999;17:43-7.
  • 11. Bozkaya H, Mocan H, Usluca H, Beşer E, Gümüştekin D. A retrospective analysis of adolescent pregnancies. Gynecol Obstet Invest 1996;42:146-50.
  • 12. Canbaz S, SunterAT,CetinogluCE, PeksenY. Obstetric outcomes of adolescent pregnancies in Turkey. Adv Ther 2005;22:636-41.
  • 13. Edirne T, Can M, Kolusari A, Yildizhan R, Adali E, Akdag B. Trends, characteristics, and outcomes of adolescent pregnancy in eastern Turkey. Int J Gynaecol Obstet 2010;110:105-8.
  • 14. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451-8.
  • 15. Jamieson DJ, Rasmussen SA, Ramin SM, Hirsch MS, Barss VA. Influenza and pregnancy. http://www.uptodate.com/contents/influenza￾andpregnancy?source=search_result&search=Influenza +and+pregnancy.&selectedTitle=1%7E150, (Erişim tarihi 12 Eylül 2013).
  • 16. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA 2010;303:1517-25.
  • 17. Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol 2011;205:10-8.
  • 18. Irving WL, James DK, Stephenson T, Laing P, Jameson C, Oxford JS, et al.Influenza virusinfection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG 2000;107:1282-9.
  • 19. Acs N, Bánhidy F, Puhó E, CzeizelAE. Maternal influenza during pregnancy and risk of congenital abnormalities in offspring. Birth Defects Res A Clin Mol Teratol 2005;73:989-96.
  • 20. Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008;14:95-100.
  • 21. Moretti ME, Bar-Oz B, Fried S, Koren G. Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis. Epidemiology 2005;16:216-9.
  • 22. Edwards MJ.Review: Hyperthermia and fever during pregnancy. Birth Defects Res A Clin Mol Teratol 2006;76:507-16.
  • 23. Petrova A, Demissie K, Rhoads GG, Smulian JC, Marcella S, Ananth CV. Association of maternal fever during labor with neonatal and infant morbidity and mortality. Obstet Gynecol 2001;98:20-7.
  • 24. Centers for Disease Control and Prevention (CDC). Seasonal influenza and 2009 H1N1 influenza vaccination coverage among pregnant women 10 states, 2009-10 influenza season. MMWR Morb Mortal Wkly Rep 2010;59:1541-5.
  • 25. Influenza Vaccination Coverage Among Pregnant Women￾United States, 2010-11 Influenza season. MMWR Morb Mortal Wkly Rep 2011;60:1078-82.
  • 26. www.aifd.org.tr/ (Erişim tarihi 11.02.2013).
  • 27. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010;59:1-62.
  • 28. Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 2008;359:1555-64.
  • 29. Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ, et al. Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011;8:e1000441.
  • 30. Steinhoff MC, Omer SB, Roy E, El Arifeen S, Raqib R, Dodd C, et al. Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial. CMAJ 2012;184:645-53.
  • 31. Fell DB, Sprague AE, Liu N, Yasseen AS 3rd, Wen SW, Smith G, et al. H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. Am J Public Health 2012;102:33- 40.
  • 32. Haberg SE, Trogstad L, Gunnes N, Wilcox AJ, Gjessing HK, Samuelsen SO, et al. Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med 2013;368:333-40.
  • 33. De Wals P, Deceuninck G, Toth E, Boulianne N, Brunet D, Boucher RM, et al. Risk of Guillain-Barré syndrome following H1N1 influenza vaccination in Quebec. JAMA 2012;308: 175-81.
  • 34. Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol 2009;201:547-52.
  • 35. Pasternak B, Svanström H, Mølgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark. BMJ 2012;344:2794.
  • 36. Pasternak B, Svanström H, Mølgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Risk of adverse fetal outcomes following administration of a pandemic influenza A(H1N1) vaccine during pregnancy. JAMA 2012;308:165-74.
  • 37. Sheffield JS, Greer LG, Rogers VL, Roberts SW, Lytle H, McIntire DD, et al. Effect of influenza vaccination in the first trimester of pregnancy. Obstet Gynecol 2012;120:532-7.
  • 38. Jamieson DJ, Rasmussen SA. The safety of adjuvants in influenza vaccines during pregnancy: what do we know and why do we need them? Am J Obstet Gynecol 2012;207:145-6.
  • 39. Rasmussen SA, Kissin DM,Yeung LF, MacFarlane K, Chu SY, Turcios-Ruiz, et al. Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns. Am J Obstet Gynecol 2011;204:13-20.
  • 40. Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM, Antiviral agents for the treatment and chemoprophylaxis of influenza recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60:1-24.
  • 41. Oseltamivir: Pediatric drug information, http://www.uptodate. com/contents/oseltamivir-pediatric-drug-information (Erişim tarihi 27 Mayıs 2013).
  • 42. Wentges-van Holthe N, van Eijkeren M, van der Laan JW. Oseltamivir and breastfeeding. Int J Infect Dis 2008;12:451.
  • 43. Greer LG, Leff RD, Rogers VL, Roberts SW, McCracken GH Jr, Wendel GD Jr, Pharmacokinetics of oseltamivir according to trimester of pregnancy. Am J Obstet Gynecol 2011;204:89-93.
  • 44. Tamiflu oseltamivir phosphate) prescribing. www.gene.com/ download/pdf/tamiflu_prescribing.pdf (Erişim tarihi 2 Ocak 2013).

Childhood/Adolescent Pregnancies and Influenza Infections

Year 2014, Volume: 12 Issue: 1, 31 - 36, 01.06.2014

Abstract

In this article, we aimed to review child/adolescent pregnancies in general, and the clinical and epidemiological features including prevention and management of influenza in these patients in our country. World Health Organization WHO defines the children between 10-19 years as adolescents. In Turkey, the rate of marriage in adolescent children aged between 15-19 years is 9.3%. Of the births, 9% are in ages between 15-19 years and the rate of birth in ages between 15- 19 years is 40/1000. The pre-birth health care of child/adolescent pregnancies is inadequate and the birth complications are higher than the normal pregnancies. The influenza infections in child/adolescent pregnancies are not different from the influenza infectionsin normal pregnancies, however it causes more severe diseases, higher rates of hospitalizations and higher mortality in pregnant women. During the pregnancy, influenza can affect mother, embryo or fetus as well as the newborn baby after the delivery. In pregnancy, the effects of influenza on embryo and fetus have not so far been extensively investigated. Transplasental viral transmission of the influenza is rare however it may cause birth defects. The clinical findings and diagnostic approaches in pregnancy are similar to normal population. Chemoprophylaxis or chemotherapy oseltamivir or zanamivir can be given to pregnant women when they are indicated for both influenza A or B. Vaccination is the preferred way of preventing influenza in pregnancy. Inactive influenza vaccine is safe and effective in every stage of pregnancy. Vaccination in pregnancy can prevent the mother, the fetus and the newborn baby up to 6 months from the complication of influenza. In Turkey the estimated vaccination rate in pregnancy is very low, which is less than 10%

References

  • 1. Senanayake P.Adolescent fertility. In: Wallace HM, Giri K, (eds). Health Care of Women and children in Developing Countries, 3rd Party. Oakland, California, Publishing Company 1990:470-5.
  • 2. World Health Organization. The Health of Youth. A42/ Technical Discussions. Geneva, Switzerland; WHO 1989.
  • 3. Turkish Demographic Health Survey (TDHS-1998). Turkish Population and Health Research.Turkey: Hacettepe University Institute of Population Studies, Macro International Inc; 1998.
  • 4. Türkiye İstatistik Kurumu, http://www.TÜİK.gov.tr/VeriBilgi. do?alt_id=37, (Erişim tarihi 11.02.2013).
  • 5. Aksit S, Turpculu A. Trends in teenage pregnancy in Turkey. Int J Gynaecol Obstet 2003;81:55-6.
  • 6. Ozcebe H, Dervisoglu AA. (Is adolescent fertility a problem in Turkey?) Nufusbil 1993;15:33-53.
  • 7. Türk Hukuk Sitesi, Çocuk Hakları Sözleşmesi, http://www. turkhukuksitesi.com/showthread.php?t=5719, (Erişim tarihi 11.02.2013).
  • 8. Ventura SJ, Freedman MA. Teenage childbearing in the United States, 1960-1997. Am J Prev Med 2000;19:18-25.
  • 9. Singh S, Darroch JE. Adolescent pregnancy and childbearing: levels and trends in developed countries. Fam Plann Perspect 2000;32:14-23.
  • 10. Wang CS, Chou P. Risk factors for adolescent primigravida in Kaohsiung County, Taiwan. Am J Prev Med 1999;17:43-7.
  • 11. Bozkaya H, Mocan H, Usluca H, Beşer E, Gümüştekin D. A retrospective analysis of adolescent pregnancies. Gynecol Obstet Invest 1996;42:146-50.
  • 12. Canbaz S, SunterAT,CetinogluCE, PeksenY. Obstetric outcomes of adolescent pregnancies in Turkey. Adv Ther 2005;22:636-41.
  • 13. Edirne T, Can M, Kolusari A, Yildizhan R, Adali E, Akdag B. Trends, characteristics, and outcomes of adolescent pregnancy in eastern Turkey. Int J Gynaecol Obstet 2010;110:105-8.
  • 14. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451-8.
  • 15. Jamieson DJ, Rasmussen SA, Ramin SM, Hirsch MS, Barss VA. Influenza and pregnancy. http://www.uptodate.com/contents/influenza￾andpregnancy?source=search_result&search=Influenza +and+pregnancy.&selectedTitle=1%7E150, (Erişim tarihi 12 Eylül 2013).
  • 16. Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA 2010;303:1517-25.
  • 17. Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol 2011;205:10-8.
  • 18. Irving WL, James DK, Stephenson T, Laing P, Jameson C, Oxford JS, et al.Influenza virusinfection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study. BJOG 2000;107:1282-9.
  • 19. Acs N, Bánhidy F, Puhó E, CzeizelAE. Maternal influenza during pregnancy and risk of congenital abnormalities in offspring. Birth Defects Res A Clin Mol Teratol 2005;73:989-96.
  • 20. Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008;14:95-100.
  • 21. Moretti ME, Bar-Oz B, Fried S, Koren G. Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis. Epidemiology 2005;16:216-9.
  • 22. Edwards MJ.Review: Hyperthermia and fever during pregnancy. Birth Defects Res A Clin Mol Teratol 2006;76:507-16.
  • 23. Petrova A, Demissie K, Rhoads GG, Smulian JC, Marcella S, Ananth CV. Association of maternal fever during labor with neonatal and infant morbidity and mortality. Obstet Gynecol 2001;98:20-7.
  • 24. Centers for Disease Control and Prevention (CDC). Seasonal influenza and 2009 H1N1 influenza vaccination coverage among pregnant women 10 states, 2009-10 influenza season. MMWR Morb Mortal Wkly Rep 2010;59:1541-5.
  • 25. Influenza Vaccination Coverage Among Pregnant Women￾United States, 2010-11 Influenza season. MMWR Morb Mortal Wkly Rep 2011;60:1078-82.
  • 26. www.aifd.org.tr/ (Erişim tarihi 11.02.2013).
  • 27. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010;59:1-62.
  • 28. Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med 2008;359:1555-64.
  • 29. Omer SB, Goodman D, Steinhoff MC, Rochat R, Klugman KP, Stoll BJ, et al. Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: a retrospective cohort study. PLoS Med 2011;8:e1000441.
  • 30. Steinhoff MC, Omer SB, Roy E, El Arifeen S, Raqib R, Dodd C, et al. Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial. CMAJ 2012;184:645-53.
  • 31. Fell DB, Sprague AE, Liu N, Yasseen AS 3rd, Wen SW, Smith G, et al. H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. Am J Public Health 2012;102:33- 40.
  • 32. Haberg SE, Trogstad L, Gunnes N, Wilcox AJ, Gjessing HK, Samuelsen SO, et al. Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med 2013;368:333-40.
  • 33. De Wals P, Deceuninck G, Toth E, Boulianne N, Brunet D, Boucher RM, et al. Risk of Guillain-Barré syndrome following H1N1 influenza vaccination in Quebec. JAMA 2012;308: 175-81.
  • 34. Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol 2009;201:547-52.
  • 35. Pasternak B, Svanström H, Mølgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark. BMJ 2012;344:2794.
  • 36. Pasternak B, Svanström H, Mølgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Risk of adverse fetal outcomes following administration of a pandemic influenza A(H1N1) vaccine during pregnancy. JAMA 2012;308:165-74.
  • 37. Sheffield JS, Greer LG, Rogers VL, Roberts SW, Lytle H, McIntire DD, et al. Effect of influenza vaccination in the first trimester of pregnancy. Obstet Gynecol 2012;120:532-7.
  • 38. Jamieson DJ, Rasmussen SA. The safety of adjuvants in influenza vaccines during pregnancy: what do we know and why do we need them? Am J Obstet Gynecol 2012;207:145-6.
  • 39. Rasmussen SA, Kissin DM,Yeung LF, MacFarlane K, Chu SY, Turcios-Ruiz, et al. Preparing for influenza after 2009 H1N1: special considerations for pregnant women and newborns. Am J Obstet Gynecol 2011;204:13-20.
  • 40. Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM, Antiviral agents for the treatment and chemoprophylaxis of influenza recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60:1-24.
  • 41. Oseltamivir: Pediatric drug information, http://www.uptodate. com/contents/oseltamivir-pediatric-drug-information (Erişim tarihi 27 Mayıs 2013).
  • 42. Wentges-van Holthe N, van Eijkeren M, van der Laan JW. Oseltamivir and breastfeeding. Int J Infect Dis 2008;12:451.
  • 43. Greer LG, Leff RD, Rogers VL, Roberts SW, McCracken GH Jr, Wendel GD Jr, Pharmacokinetics of oseltamivir according to trimester of pregnancy. Am J Obstet Gynecol 2011;204:89-93.
  • 44. Tamiflu oseltamivir phosphate) prescribing. www.gene.com/ download/pdf/tamiflu_prescribing.pdf (Erişim tarihi 2 Ocak 2013).
There are 44 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Ahmet Gülen This is me

Mustafa Hacımustafaoğlu

Publication Date June 1, 2014
Published in Issue Year 2014 Volume: 12 Issue: 1

Cite

APA Gülen, A., & Hacımustafaoğlu, M. (2014). Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları. Güncel Pediatri, 12(1), 31-36. https://doi.org/10.4274/jcp.02411­
AMA Gülen A, Hacımustafaoğlu M. Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları. Güncel Pediatri. June 2014;12(1):31-36. doi:10.4274/jcp.02411­
Chicago Gülen, Ahmet, and Mustafa Hacımustafaoğlu. “Çocuk/Adolesan Gebelikler Ve İnfluenza Enfeksiyonları”. Güncel Pediatri 12, no. 1 (June 2014): 31-36. https://doi.org/10.4274/jcp.02411­.
EndNote Gülen A, Hacımustafaoğlu M (June 1, 2014) Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları. Güncel Pediatri 12 1 31–36.
IEEE A. Gülen and M. Hacımustafaoğlu, “Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları”, Güncel Pediatri, vol. 12, no. 1, pp. 31–36, 2014, doi: 10.4274/jcp.02411­.
ISNAD Gülen, Ahmet - Hacımustafaoğlu, Mustafa. “Çocuk/Adolesan Gebelikler Ve İnfluenza Enfeksiyonları”. Güncel Pediatri 12/1 (June 2014), 31-36. https://doi.org/10.4274/jcp.02411­.
JAMA Gülen A, Hacımustafaoğlu M. Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları. Güncel Pediatri. 2014;12:31–36.
MLA Gülen, Ahmet and Mustafa Hacımustafaoğlu. “Çocuk/Adolesan Gebelikler Ve İnfluenza Enfeksiyonları”. Güncel Pediatri, vol. 12, no. 1, 2014, pp. 31-36, doi:10.4274/jcp.02411­.
Vancouver Gülen A, Hacımustafaoğlu M. Çocuk/Adolesan Gebelikler ve İnfluenza Enfeksiyonları. Güncel Pediatri. 2014;12(1):31-6.