ABSTRACT
BACKGROUND: Infection with the influenza A virus can cause severe disease and mortality. The effect of the different subtypes of influenza on morbidity and mortality is not yet known in Turkey. The aim of this study was to describe the predictors of fatality related to influenza A infection among hospitalized patients in Istanbul during the 2015-2016 influenza season, and to detail the differences between infections caused by H3N2 and H1N1. METHODS: This was a multicenter study performed by the Istanbul Respiratory Infections Study Group of The Turkish Society of Clinical Microbiology and Infectious Diseases (KLIMIK), among patients hospitalized for influenza in Istanbul during the 2015-2016 influenza season. RESULTS: A total of 222 patients hospitalized with laboratory-confirmed influenza during the 2015-2016 season were included in the study, of whom 25 (11.2%) died. The fatality rate was significantly higher among patients older than 65 years of age and those with chronic heart and kidney diseases (p<0.001), chronic neurological diseases (p=0.009), and malignancies (p=0.021). Thrombocyte counts were lower in those who died than in those who survived (p<0.004). The median alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase, and C-reactive protein levels were higher among fatal cases. In the multivariate analysis for the prediction of fatality, being >65years old (odds ratio (OR) 6.9, 95% confidence interval (CI) 2.07-23.08, p=0.002), being infected with influenza A(H3N2) (OR 4.2, 95% CI 1.27-14.38, p=0.019), and a 1-day delay in antiviral use (OR 1.28, 95% CI 1.01-1.63, p=0.036) were found to be associated with an increased likelihood of fatality. CONCLUSIONS: The case fatality rate of influenza A(H3N2) was significantly higher than that of influenza A(H1N1). Detection of the infection, allowing the opportunity for the early use of antiviral agents, was found to be important for the prevention of fatality. The vaccination should be prioritized for at-risk groups.
Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza A Virus, H3N2 Subtype , Influenza, Human/mortality , Influenza, Human/virology , Inpatients , Adult , Aged , Aging , Antiviral Agents/therapeutic use , Cardiovascular Diseases/complications , Child, Preschool , Female , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Kidney Diseases/complications , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Respiratory Tract Infections/drug therapy , Risk Factors , Seasons , Turkey/epidemiologyABSTRACT
The aim of this study was to identify the seroprevalance rate of tetanus and to determine missed opportunities for tetanus vaccination. Two hundred and twenty-seven female volunteers who were hospitalized following delivery participated in the study. Blood samples were analyzed using enzyme-linked immunoassay to measure tetanus antibody levels. In addition, a questionnaire was used to investigate the factors associated with vaccination status. Sixty-five percent of the study participants had safe protective levels of antibodies. Factors associated with antibody level were age, level of education and number of doses. Only 25.7% of women who received antenatal care (ANC) had received tetanus vaccinations. Women who received ANC from primary healthcare facilities were more likely to have been vaccinated than those who received ANC from hospitals or private practice (P < 0.05). Factors associated with both tetanus vaccination and immunizations in pregnant women should be further investigated by qualitative and quantitative studies. Knowledge, attitude and practice surveys of mothers and healthcare providers on provision of the tetanus vaccine to pregnant women need to be undertaken urgently.
