ABSTRACT
The aim of this study was to evaluate the epidemiological characteristics of tularemia outbreak and the effect of climate variability on this outbreak in Kayseri. The outbreak places, infection dates, source of infection, and the number of cases were recorded and analyzed. This information was obtained from the Regional Public Health Department. Climate data were supplied by the Regional Meteorological Service. The first case in Sariz was recorded in 2005. Thereafter, 2 cases were reported in 2006 and 1 case in 2007. During 2010, 21 cases were recorded in 7 towns, 62 cases in 2011 and 27 cases in 2012. A total number of 110 cases were recorded in 12 out of 16 towns in Kayseri Province between 2010 and 2012. The majority of cases were seen in the north-eastern, east and south-eastern parts of Kayseri Province; located in higher altitudes [over 1000 m from sea level]. It was accepted that the outbreak was originated from water sources and was confirmed by few number of water samples collected from outbreak areas. Considering climate variations, the outbreak occurred between 1988 and 2009 during a dry, low humid, high temperature period after rainy season. A tularemia outbreak was observed between 2010 and 2012 with the initiation of rainy years. High temperature for a long period accompanied by low rainfall and low humidity may affect the vector's biology and initiate a tularemia outbreak in high plateaus in Kayseri Province and around.
Subject(s)
Humans , Male , Female , Disease Outbreaks , Climate Change , Climate , Cross-Sectional StudiesABSTRACT
A structured questionnaire was administered to health-care workers [HCWs]. The HCWs were also screened for measles, rubella, mumps, and varicella [MMRV] using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive [cost difference: 24,385] for varicella, although vaccination without screening was cheap [cost difference: 5693] for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs [2-7%] would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable