Mercury exposure via breast-milk in infants from a suburban area of Ankara, Turkey.

The objective of this study was to evaluate mercury (Hg) levels in breast-milk in the postpartum 2nd month and to determine the relationship between Hg levels and sociodemographic parameters, maternal nutritional habits, presence of dental amalgam, maternal depression, maternal anemia, and growth status of infants. One hundred forty-four mothers residing in a suburban area in Ankara were invited at the 2nd month postpartum. A questionnaire concerning sociodemographic characteristics, vitamin intake during pregnancy and in the 2nd month postpartum, consumption of fish and viscera, smoking habits, and presence of dental fillings was applied. Hg could be detected in samples of 18% of the mothers, all levels of which were higher than the Hg limit in breast-milk reported by the World Health Organization. The Hg levels were higher in mothers who consumed viscera than in those who did not. Turkish women can still safely breastfeed their children, but Hg contamination in breast-milk should be monitored during the lactation period.

Breast milk lead and cadmium levels from suburban areas of Ankara.

The objectives of this study were (1) to evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk at 2 months postpartum, (2) to investigate the relationship between Pb and Cd levels in breast milk and some sociodemographic parameters and (3) to detect whether these levels have any influence on the infant's physical status or on postpartum depression in the mothers. Pb and Cd levels in breast milk were determined by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The median breast milk concentrations of Pb and Cd were 20.59 and 0.67 µg/l, respectively. In 125 (87%) of 144 samples, Pb levels were higher than the limit in breast milk reported by the World Health Organization (WHO) (> 5 µg/l). Breast milk Cd levels were > 1 µg/l in 52 (36%) mothers. The mothers with a history of anemia at any time had higher breast milk Pb levels than those without a history of anemia (21.1 versus 17.9 µg/l; p=0.0052). The median breast milk Cd levels in active and passive smokers during pregnancy were significantly higher than in non-smokers (0.89, 0.00 µg/l, respectively; p=0.023). The breast milk Cd levels of the mothers who did not use iron and vitamin supplements for 2 months postpartum were found to be higher than in those who did use the supplements (iron: 0.73, 0.00 µg/l, p=0.023; vitamin: 0.78, 0.00 µg/l, p=0.004, respectively). Breast milk Cd levels at the 2nd month were correlated negatively with the z scores of head circumference and the weight for age at birth (r=-0.257, p=0.041 and r=-0.251, p=0.026, respectively) in girls. We found no correlation between the breast milk Pb and Cd levels and the Edinburgh Postpartum Depression Scale scores. Breast milk monitoring programs should be conducted that have tested considerable numbers of women over time in view of the high levels of Pb in breast milk in this study.

Efficacy of oral ribavirin treatment in Crimean-Congo haemorrhagic fever: a quasi-experimental study from Turkey.

OBJECTIVE: The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF). METHODS: In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n=126) were compared with ribavirin-untreated CCHF patients (n=92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study. RESULTS: There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P>0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality. CONCLUSION: Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed.

The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a serious disease caused by the CCHF virus of the Bunyaviridae family. The disease has been reported in 30 countries in Africa, Asia, Eastern Europe, and the Middle East. It has been present in Turkey since 2002. In this study we present and discuss the epidemiological features, clinical and laboratory findings, treatment, and outcome of cases diagnosed with CCHF between 2002 and 2007 from the surveillance results of the Turkish Ministry of Health (MoH). METHODS: According to the surveillance system of the MoH, data for patients with clinical, laboratory, and epidemiological findings compatible with CCHF are recorded on case reporting forms. These forms are submitted to the General Directorate of Primary Health Care of the MoH by the city health directorates. All the surveillance data regarding CCHF were recorded on a database (SSPS 11.0) established in the Communicable Diseases Department of the MoH. RESULTS: According to the surveillance reports of the Turkish MoH, between 2002 and 2007, 1820 CCHF cases occurred (150 in 2002-2003, 249 in 2004, 266 in 2005, 438 in 2006, and 717 in 2007). The crude fatality rate was calculated to be 5% (92/1820). Two thirds of the CCHF cases were reported from five cities located in the Mid-Eastern Anatolia region; 69.4% of the cases were from rural areas. The male to female ratio was 1.13:1. Of all the reported cases, 68.9% had a history of tick-bite or tick contact and 84.1% were seen in the months of May, June, and July. Of 1820 CCHF cases, three (0.16%) were nosocomial infections. CONCLUSIONS: CCHF appears to be a seasonal problem in the Mid-Eastern Anatolia region of Turkey. The possible risk factors for transmission and the clinical and laboratory findings of patients with a diagnosis of CCHF were found to be similar to those reported in the literature. The mean fatality rate for Turkey is lower than the rate reported for other series from other parts of the world.

The presence of tick-borne encephalitis in an endemic area for tick-borne diseases, Turkey.

The aim of this study was to indicate the presence of tick-borne encephalitis (TBE) in an endemic area for Crimean-Congo haemorrhagic fever (CCHF) in Turkey. Of 39 CCHF suspected cases, one was found to be TBE virus immunoglobulin M positive and seven were TBE virus immunoglobulin G positive. It is important to report this first appearance of the TBE virus in Turkey since 1967.

Modeling the spatial distribution of crimean-congo hemorrhagic fever outbreaks in Turkey.

The more than 1100 human cases of Crimean-Congo Hemorrhagic Fever (CCHF) reported in a continuing series of outbreaks that started in 2003 in Turkey constitute the largest epidemic of the disease since CCHF was first recognized in 1944. The spatial distribution of CCHF case reporting rates in Turkey was studied to look for clusters of disease. We applied the spatial scan analysis to test the hypothesis of whether there were areas with a higher than expected number of CCHF cases. The analysis was conducted through windows of 10, 20, 40 and 80 km in diameter[SR1] to determine whether clustering of cases was dependent on the size of the scanning window. At the largest window size, consistent patterns of significantly higher than expected numbers of CCHF cases were found in a total of 40 administrative districts. A predictive model to map the habitat suitability for the vector tick was developed from satellite-based climate data and high-resolution features of the vegetation from Landsat images covering the whole country. It was found that areas of higher risk (higher CCHF reporting) were correlated (p<0.05) with zones of high climate suitability for the tick together with a high rate of fragmentation of agricultural land interspersed between forest and shrub-type vegetation.

Crimean-Congo haemorrhagic fever cases in Turkey.

Crimean-Congo haemorrhagic fever (CCHF) is an arbovirus infection, which is transmitted through ticks or via blood and secretions. Until recently, human cases of CCHF were unknown in Turkey; however, several acute disease cases were reported in 2002. We report on the investigation of a cluster of suspected CCHF cases in the middle part of the Black Sea from May 2002 to October 2003. The medical charts that we reviewed were obtained from all local physicians and our field investigations. 'Suspected case' was defined with regard to time, place, and both clinical and laboratory characteristics. A total of 108 patients were defined as suspected case. Among them 36 patients were reached and blood samples taken for examination for CCHF by using ELISA and RT-PCR. According to the laboratory analysis, 80.6% (29/36) were acute cases and 8.3% (3/36) were past CCHF infections. The overall mortality rate was 5.6%. There was no nosocomial infection; however, there were 2 family clusters. Tick exposure was the most prevalent risk factor (74.2%). A multidisciplinary collaboration should be developed in order to understand the magnitude of the disease and also to keep it under control.