Solunum Yolu Virüsleri: Aşı ile Korunabilen Grip Aramızda

Öz

Solunum yolu virüsleri özellikle yaşlı ve çocuklarda olmak üzere önemli mortalite ve morbidite nedeni olabilen akut solunum yolu enfeksiyonları olarak karşımıza çıkabilmektedir. Bu yazıda, bir üçüncü basamak eğitim araştırma üniversite hastanesi olan kurumumuzda akut solunum yolu enfeksiyonlarında solunum yolu virüslerinin rolü ile birlikte oseltamivir tedavisinin etkinliği, grip aşılanmasının önemini incelemek amaçlanmıştır. Toplam 103 hasta çalışmaya alınmıştır. Olguların 76’sında viral etken saptanmış (Rhinovirüs (25), Influenza A (23), Influenza B (14), Parainfluenza tip 1-2-3-4 (7), Bocavirus (6), Coronavirus (6), Adenovirüs (3), RSV-A(2), RSV-B(2), MPV (3)], olguların 15 tanesinde polimeraz zincir reaksiyonu ile birden fazla virüs tespit edilmiştir. Influenza aşısı olma oranı toplamda % 3.15 olarak saptanmıştır. Toplam sekiz hastada (% 7.7) mortalite gözlenmiş, iki olguda birden fazla virüs olmak üzere olguların beşinde Influenza [Influenza A (3) ve Influenza B (2)], ikisinde Bocavirus ve ikisinde de Rhinovirus pozitif saptanmıştır. Bu hastaların hiçbiri Influenza aşısı olmamıştır. Tedavi başlanmış olan 27/51 (% 52,9) hastada Influenza A/B pozitifliği belirlenmiştir. Oseltamivir tedavisi başlanmış olanlarla başlanmamış olanlar arasında mortalite oranlarındaki fark anlamlı (7/51’ye karşı 1/52, p=0,031) olarak daha yüksek bulunmuştur. Mortalite saptanan sekiz hastanın dördünde oseltamivir tedavisine, semptomların ortaya çıkmasından 48 saat sonra başlandığı görülmüştür. Sistemik inflamatuvar yanıt sendromu kriterlerine göre dört puan alan toplam on hastalık grupta mortalite anlamlı olarak daha fazla kaydedilmiştir (7/10 vs 1/93, p=0,000). Solunum yolu virüsleri, akut solunum yolu enfeksiyonlarında etken olarak sık karşımıza çıkmakla beraber özellikle aşı ile önlenebilen Influenza virüs tip A ve B başta olmak üzere bu etkenler ciddi mortalite ve morbiditeye neden olabilmektedirler. Bu nedenle özellikle risk grubunda bulunan kişilerin aşılanma ile korunması hayati önem arz etmektedir.

Anahtar Kelimeler

• influenza
• oseltamivir
• pnömoni
• solunum yolu virüsleri

Respiratory Viruses: Vaccine Preventable Influenza Is Among Us

Öz

Viruses are important causative agents for acute respiratory infections which can cause significant morbidity and mortality, especially in elderly and infants. In this report, we aimed to to evaluate the epidemiology of cases with acute viral respiratory infection in terms of mortality and effecting variables as well as the efficacy of oseltamivir treatment and influenza vaccination in a tertiary-care educational hospital. There were a total of 103 patients. Viral etiology was elucidated in 76 cases and, in 15 out of 76 cases, more than one virus were positive by polymerase chain reaction [(Rhinovirus (25), Influenza A (23), Influenza B (14), Parainfluenza type 1-2-3-4 (7), Bocavirus (6), Coronavirus (6), Adenovirus (3), RSV-A(2), RSV-B(2), MPV (3) respectively]. The influenza vaccination rate was 3.15 %. The mortality was seen in eight (7.7 %) cases (unvaccinated for influenza and more than one virus were detected in two cases) whose viral etiologies were Influenza [Influenza A (3) ve Influenza B (2)], Bocavirus (2) and Rhinovirus (2). Overall, empirical oseltamivir treatment was given 27 out of 50 (52.9 %) cases was positive for Influenza A or B. The mortality rate was significantly lower in the group given oseltamivir (7/51 vs 1/52, p=0.031). In four out of eight mortal cases, oseltamivir treatment could be initiated after the 48 hours of the onset of the symptoms. Mortality rate was significantly higher in the group of 10 patients whose systemic inflammatory response syndrome point were recorded as four (7/10 vs 1/93, p=0,000). Respiratory viruses are frequently seen as a pathogen of acute respiratory infections. Vaccinepreventable Influenza viruses A/B and the others can cause significant mortality and morbidity. Hence, influenza vaccination has vital importance, especially in the high-risk group of patients.

Anahtar Kelimeler

• influenza
• oseltamivir
• pneumonia
• respiratory viruses

Kaynakça

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