GRİP VE AŞI

Yıl 2018, Cilt: 20 Sayı: 3, 329 - 344, 30.12.2018

Sedat Kaygusuz Serdar Gül

https://doi.org/10.24938/kutfd.500424

Cited By: 2

Öz

Grip, influenza virüsleri tarafından gelişen, akut, ciddi
ve salgınlara yol açabilen bir enfeksiyon hastalığıdır. Üç tip (A, B ve C)
influenza virüsü tanımlanmış olup, İnfluenza A bu tipler içerisinde en ağır
seyirli olandır. Hastalık solunum yoluyla bulaşır ve kış aylarında daha sıktır.
Pnömoni, en önemli komplikasyonu olmakla birlikte, kardiyak ve merkezi sinir
sistemi komplikasyonları da görülebilir. Tanı genellikle klinik olarak
konulmakla birlikte, tanıyı desteklemek için moleküler testler de
kullanılabilir. Oseltemivir ve zanamivir tedavide kullanılabilecek
antivirallerden olup, hastalığın erken evrelerinde kullanıldıklarında
hastalığın süresini ve komplikasyon riskini azaltırlar.

Aşı, risk faktörü bulunan kişilerde altta yatan
hastalığın daha da kötüleşmesinin, morbiditenin ve mortalitenin önündeki en
önemli önleyici seçenektir. Kontrendikasyonu olmayan ≥6 aylık tüm kişiler için
rutin yıllık influenza aşısı önerilmektedir. 2018-19 sezonunda da standart
dozda, adjuvanlanmamış, inaktif influenza aşıları, üçlü (Trivalan) (IIV3) ve
dörtlü (Tetravalan) (IIV4) formülasyonlarda piyasaya sunulmuştur. Üçlü
influenza aşılarında A/Michigan/45/2015 (H1N1) pdm09 benzeri virüs,
A/Singapur/INFIMH-16-0019/2016 (H3N2) benzeri virüs ve B/Colorado/06/2017
benzeri virüs (Victoria soyu) bulunurken, dörtlü influenza aşıları, bu üç virüs
suşuna ek olarak bir influenza B aşı virüsü olan B/Phuket/3073/2013-benzeri
virüs (Yamagata soyu) ile sunulmuştur. Aşıların endikasyonları,
kontrendikasyonları ve alınacak önlemler yazıda tartışılmaktadır. 

Anahtar Kelimeler

Grip, aşılama, trivalan aşı, tetravalan aşı

Influenza and Vaccine

Öz

 

Influenza is an
acute, severe infectious disease caused by influenza viruses and it can lead to
pandemics. Three types of Influenza viruses (A, B and C) are determined and
type A causes the most severe infection. The disease spreads via respiratory
route and occurs commonly in winter. While pneumonia is the most important
complication, central nervous system complications can also be seen. The
diagnosis is usually established by clinical findings but molecular techniques
can also be used for supporting the diagnosis. Oseltamivir and Zanamivir are
the antivirals used for treatment and they shorten the duration of the disease
and decrease the complication risk. Vaccination is the most important tool  for protecting the patients with
comorbidities from worsening of the underlying disease as well as mortality and
morbidity. The vaccine is also recommended annually for everyone ≥6 months of
age without contraindications. In the 2018-2019 season, vaccines without
adjuvants, inactive influenza vaccines, quadrivalent (IIV4) and trivalent (IIV3) formulations were also
launched. While the trivalent vaccine contains, A/Michigan/45/2015 (H1N1) pdm09
like virus, A/Singapur/INFIMH-16-0019/2016 (H3N2) like virus and
B/Colorado/06/2017 like virus (Victoria strain), the quadrivalent vaccine contains one more B/Phuket/3073/2013-like virus
(Yamagata strain), which is an influenza B virus, in addition to these three
viruses. The indications, contraindications of the vaccines and the precautions
to be taken are discussed in this article.

Anahtar Kelimeler

Influenza, prophylaxy, trivalent vaccine, quadrivalent vaccine

Kaynakça

• 1. Treanor JJ. Influenza (including avian influenza and swine influenza). In: Bennett JE, Dolin R, Blaser MJ, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia. Elsevier Saunders, 2015:2020-24.
• 2. Hirsch A. Handbook of Geographical and Historical Pathology. 2nd ed. London. New Sydenham Society, 1883.
• 3. Crosby AW. Epidemic and Peace 1918. Part IV. Westport CT. Greenwood Press, 1976.
• 4. Simonsen l, Clarke MJ, Williamson DW, Stroup DF, Arden NH, Schonberger LB. The impact of influenza epidemics on mortality; introducing a severity index. Am J Pub Health. 1997;(12)87:1944-50.
• 5. Kavet J. A perspective on the significance of pandemic influenza. Am J Pub Health. 1977;67(11):1063-70.
• 6. Glezen WP, Keitel WA, Taber LH, Piedra PA, Clover RD, Couch RB. Age distribution of patients with medically-attended illnesses caused by sequantial variants of influenza A/H1N1: comparison to age-spesific infection rates, 1978-1989. Am J Epidemiol. 1991;133(3):296-304.
• 7. Bhat N, Wright JG, Broder KR, Murray EL, Greenberg ME, Glover MJ et al. Influenza-associated deaths among children in the United States, 2003-2004. N Eng J Med. 2005;353(24):2559-67.
• 8. 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(15):1517-25.
• 9. Forbes RL, Wark PAB, Murphy VE, Gibson PG. Pregnant woman have attenuated innate interferon responses to 2009 pandemic influenza A virus subtype H1N1. J Infect Dis. 2012;206(5):646-53.
• 10. Louie JK, Acosta M, Samuel MC, Schechter R, Vugia DJ, Harriman K et al. A novel risc factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1). Clin Infect Dis. 2011;52(3):301-12.
• 11. CDC. 2010-2011 Influenza (Flu) Season. Accessed date, 7 June 2011: https://www.cdc.gov/flu/pastseasons/1011season.htm
• 12. Yan J, Grantham M, Pantelic J, Bueno de Mesquita PJ, Albert B, Liu F et al. Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci USA. 2018;115(5):1081-86.
• 13. Bischoff WE, Reid T, Russell GB, Peters TR. Transocular entry of seasonal influenza-attenuated virus aerosols and the efficacy of N95 respirators, surgical masks, and eye protection in humans. J Infect Dis. 2011;204(2):193-9.
• 14. World Health Organization Writing Group, Bell D, Nicoll A, Fukuda K, Horby P, Monto A, Hayden F et al. Non-pharmaceutical interventions for pandemic influenza, international measures. Emerg Infect Dis. 2006;12(1):81-7.
• 15. Ip DK, Lau LL, Leung NH, Fang VJ, Chan KH, Chu DK et al. Viral shedding and transmission potential of asymptomatic and paucisymptomatic influenza virus infections in the community. Clin Infect Dis. 2017;64(6):736-42.
• 16. Lau LL, Cowling BJ, Fang VJ, Chan KH, Lau EH, Lipstich M et al. Viral shedding and clinical illness in naturally acquired influenza virus infections. J Infect Dis. 2010;201(10):1509-16.
• 17. Leekha S, Zitterkopf NL, Espy MJ, Smith TF, Thompson RL, Sampathkumar P. Duration of influenza A virus shedding in hospitalized patients and implications for infection control. Infect Control Hosp Epidemiol. 2007;28(9):1071-6.
• 18. Klimov AI, Rocha E, Hayden FG, Shult PA, Roumillat LF, Cox NJ. Prolonged shedding of amantadine-resistant influenzae A viruses by immunodeficient patients: detection by polymerase chain reaction-restriction analysis. J Infect Dis. 1995;172(5):1352-55.
• 19. Memoli MJ, Athota R, Reed S, Czajkowsky L, Bristol T, Proudfoot K et al. The natural history of influenza infection in the severely immunocompromised vs nonimmunocompromised hosts. Clin Infect Dis. 2014;58(2):214-24.
• 20. Lee N, Chan PK, Hui DS, Rainer TH, Wong E, Choi KW et al. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis. 2009;200(4):492-500.
• 21. Cohen YZ, Dolin R. Influenza. In: Kasper DL, Fauci AS, Hauser SL et al, eds. Harrison’s Principles of Internal Medicine. 19th ed. New York. McGraw Hill Book Company, 2015:1209-14.
• 22. Martin CM, Kunin CM, Gottlieb LS, Barnes MW, Lui C. Asian influenza A in Boston, 1957-1958. Observations in thirty-two influenza-associated fatal cases. AMA Arch Intern Med. 1959;103(4):515-31.
• 23. Chertow DS, Memoli MJ. Bacterial coinfection in influenza: a grand rounds review. JAMA 2013;309(3):275-82.
• 24. Peltola VT, Murti KG, McCullers JA. Influenza virus neuraminidase contributes to secondary bacterial pneumonia. J Infect Dis 2005;192(2):249-57.
• 25. Schwarzmann SW, Adler JL, Sullivan RJ Jr, Marine WM. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969. Arch Intern Med. 1971;127(6):1037-41.
• 26. Warren-Gash C, Hayward AC, Hemingway H, Denaxas S, Thomas SL, Timmis AD et al. Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study. J Infect Dis. 2012;206(11):1652-9.
• 27. Lichenstein R, Magder LS, King RE, King JC Jr. The relationship between influenza outbreaks and acute ischemic heart disease in Maryland residents over a 7-year period. J Infect Dis. 2012;206(6):821-7.
• 28. Paddock CD, Liu L, Denison AM, Bartlett JH, Holman RC, Deleon-Carnes M et al. Myocardial injury and bacterial pneumonia contribute to the pathogenesis of fatal influenza B virus infection. J Infect Dis. 2012;205(6):895-05.
• 29. Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med. 2000;160(21):3243-7.
• 30. Nicholson KG, Kent J, Hammersley V, Cancio E. Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden. BMJ. 1997;315(7115):1060-4.
• 31. CDC. Information on rapid molecular assays, RT-PCR, and other molecular assays for diagnosis of influenza virus infection. Accessed date, 25 September 2018: http://www.cdc.gov/flu/professionals/diagnosis/molecular-assays.htm
• 32. Bruning AHL, Leeflang MMG, Vos JMBW, Spijker R, de Jong MD, Wolthers KC et al. Rapid Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review and Meta-analysis. Clin Infect Dis. 2017;65(6):1026-32.
• 33. CDC. Evaluation of 11 commercially available rapid influenza diagnostic tests-United States, 2011-12. MMWR. 2012;61(43):873-76. 34. CDC. Rapid influenza diagnostic tests. Accessed date, 6 September 2017: https://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm.
• 35. Landry ML, Cohen S, Ferguson D. Real-time PCR compared to Binax NOW and cytospin-immunofluorescence for detection of influenza in hospitalized patients. J Clin Virol. 2008;43(2):148-51.
• 36. Covalciuc KA, Webb KH, Carlson CA. Comparison of four clinical specimen types for detection of influenza A and B viruses by optical immunoassay (FLU OIA test) and cell culture methods. J Clin Microbiol. 1999;37(12):3971-4.
• 37. Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG et al. Seasonal influenza in adults and children-diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(8):1003-32.
• 38. CDC. Rapid diagnostic testing for influenza: Information for health care professionals. Accessed date, 6 September 2017: http://www.cdc.gov/flu/professionals/diagnosis/rapidclin.htm.
• 39. Fiore AE, Fry A, Shay D, Gudareva L, Bresee JS, Uyeki TM et al. Antiviral agents for the treatment and chemoprophylaxis of influenza- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(1):1-24.
• 40. Marty FM, Vidal-Puigserver J, Clark C, Gupta SK, Merino E, Garot D et al. Intravenous zanamivir or oral oseltamivir for hospitalised patients with influenza: an international, randomised, double-blind, double-dummy, phase 3 trial. Lancet Respir Med. 2017;5(2):135-46.
• 41. CDC. Update: Influenza activity-United States, October 3-December 11, 2010. MMWR. 2010;59(50):1651-5.
• 42. Beigel JH, Bao Y, Beeler J, Manosuthi W, Slandzicki A, Dar SM et al. Oseltamivir, amantadine, and ribavirin combination antiviral therapy versus oseltamivir monotherapy for the treatment of influenza: a multicentre, double-blind, randomised phase 2 trial. Lancet Infect Dis. 2017;17(12):1255-65.
• 43. Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev. 2016;3:CD010406.
• 44. Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W et al. Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med. 2009;151(7):437-46.
• 45. Grohskopf LA, Sokolow LZ, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices-United States, 2018-19 Influenza Season. MMWR. 2018;67(3):1-20.
• 46. WHO. Accessed date, 22 February 2018. http://www.who.int/influenza/vaccines/virus/recommendations/201802_recommendation.pdf
• 47. Erişkin Bağışıklama Rehberi. Türkiye EKMUD, Erişim tarihi: 1 Mayıs 2016: http://ekmud.org.tr/emek/rehberler/1-ekmud-rehberleri
• 48. CDC. Influenza Activity-United States, 2012–13 Season and Composition of the 2013-14 Influenza Vaccine. MMWR. 2013;62(23);473-9.
• 49. Kroger AT, Duchin J, Vázquez M. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
• 50. Havers FP, Chung JR, Belongia EA, McLean HQ, Gaglani M, Murthy K et al. Influenza vaccine effectiveness and statin use among adults in the United States, 2011-2017. Clin Infect Dis. 2018 Oct 27. doi: 10.1093/cid/ciy780.
• 51. CDC. The flu season. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. Accessed date, 12 Jully 2018. https://www.cdc.gov/flu/about/season/flu-season.htm
• 52. Thompsona MG, Pierseb N, Huang QS, Prasad N, Duquea J, Newbernb EC et al. Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012–2015. Vaccine. 2018;36(39):5916-25.
• 53. Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza. Clinical Infectious Diseases. 2018. Accessed date, 19 December 2018, ciy866, https://doi.org/10.1093/cid/ciy866.
• 54. Udell JA, Zawi R, Bhatt DL, Keshtkar-Jahromi M, Gaughran F, Phrommintikul A et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013:310(16):1711-20. doi: 10.1001/jama.2013.279206.
• 55. Sosyal Güvenlik Kurumu. http://www.sgk.gov.tr/wps/portal/sgk/tr/kurumsal/merkez-teskilati/ana_hizmet_birimleri/gss_genel_mudurlugu/anasayfa_duyurular/18062016_guncel_sut