Outbreak In Turkey Research Articles

Epidemiological and Molecular Studies on Lumpy Skin Disease Outbreaks in Turkey during 2014-2015

This study was carried out to explore epidemiological and molecular features of lumpy skin disease virus (LSDV) in the Aegean, Central Anatolian and Mediterranean regions of Turkey, to evaluate the risk factors associated with LSDV infection and to investigate the financial impact of LSD and potential role of the Culicoides spp. in the transmission of LSDV. Samples were obtained from 611 cattle, each from different farms, and each clinically suspected to be infected with LSDV during the months of July 2014 and June 2015. Culicoides spp. were trapped from April to June 2015. Genetic characterization of the local LSDV field isolates was conducted by sequencing G-protein-coupled chemokine receptor gene segment. Real-time PCR high-resolution melting analysis was used for distinguishing each type of capripoxviruses. Viral DNA was detected in 448 of the 611 animals and Culicoides midges. Three hundred and ninety-three of the 448 affected farms were surveyed. The morbidity and mortality rates detected were 12.3% and 6.4%, respectively. Phylogenetic analysis showed that the field isolates in this study were clustered together with other Africa and Middle East isolates. Genotyping of isolates from infected cattle has revealed the presence of LSDV. A generalized mixed linear model showed that there were positive associations between LSDV infection, European breeds, small-sized family-type farms and nearness of farm to a lake. The financial cost of disease presence in surveyed cattle farms was estimated to be 72.75 GBP per head. The sequence analysis of the mitochondrial cytochrome oxidase subunit I gene showed that the species of Culicoides in LSDV-positive pools was Culicoides punctatus. Detection of LSDV in Culicoides punctatus suggests that it may have played a role in transmitting LSDV. Furthermore, movement of infected animals into disease-free areas increases the risk of the transmission of LSD. Control strategies for LSDV infection should include consideration of the risk factors identified in this study.

Oropharyngeal Tularemia Outbreak Associated with Drinking Contaminated Tap Water, Turkey, July-September 2013.

In 2013, an oropharyngeal tularemia outbreak in Turkey affected 55 persons. Drinking tap water during the likely exposure period was significantly associated with illness (attack rate 27% vs. 11% among non–tap water drinkers). Findings showed the tap water source had been contaminated by surface water, and the chlorination device malfunctioned.

Waterborne Tularemia Outbreaks in Turkey: From Past to Present

Waterborne Tularemia Outbreaks in Turkey: From Past to Present

The geographical distribution and first molecular analysis of Culicoides Latreille (Diptera: Ceratopogonidae) species in the Southern and Southeastern Turkey during the 2012 outbreak of bovine ephemeral fever.

This study investigated the geographical distribution and molecular analysis of Culicoides species in the Southern and Southeastern Turkey during the 2012 outbreak of bovine ephemeral fever (BEF). The midge specimens caught by Onderstepoort-type light traps from livestock farms were tested for molecular evidence of existence of viral genome. Blood specimens were collected from clinically BEF-suspected acute febrile cattle. Total nucleic acid samples obtained from field specimens were checked against the BEF virus G gene and Culicoides internal transcribed spacer 1 (ITS-1) gene. A total of 20,845 Culicoides specimens (20,569 ♀♀, 276 ♂♂) comprising 11 species (Culicoides badooshensis, Culicoides circumscriptus, Culicoides gejgelensis, Culicoides imicola, Culicoides kibunensis, Culicoides longipennis, Culicoides newsteadi, Culicoides nubeculosus, Culicoides odiatus, Culicoides punctatus, Culicoides schultzei, Culicoides spp.) were collected. C. schultzei (18,032) was found as the dominant species and followed by C. imicola (1,857), C. nubeculosus complex (545), and C. circumscriptus (259), respectively. C. kibunensis was identified as new species for this region. PCR positivity of BEF was found 37.14% (13/35) in blood samples whereas no viral genome was obtained from Culicoides specimens. Culicoides spp. ITS-1 gene sequences were analyzed phylogenetically with GenBank ITS-1 sequences. Molecular homology of Culicoides ITS-1 gene was ranged between 62.74 and 71.39%. The results described first molecular detection and phylogenetic analysis of Culicoides ITS-1 gene with reference to the 2012 BEF outbreak in Turkey.

Evaluation of 44 pediatric measles cases detected in Ankara, Turkey during 2012-2013 epidemic and molecular characterization of the viruses obtained from two cases

Elimination of measles and rubella until the end of 2015 in parallel with the "World Health Organization (WHO) Europe Region's Measles Elimination" work-up has been targetted and "Measles Elimination Program'' has been carried out since 2002 in Turkey. Due to the routine vaccination programmes the number of the vaccinated children have increased and epidemic incidences have been falling. However, imported measles cases from Europe and other neighboring countries have been observed in Turkey in the recent two years. Patients who applied to Dr. Sami Ulus Maternity and Children's Training and Research Hospital with a pre-diagnosis of measles between December 2012 and April 2013 were screened in this study. Seventy-eight patients who match the clinical definition of the disease (> 38°C fever and maculopapular rash and cough or nasal discharge or conjunctivitis) were evaluated. Forty-four children (25 male, 19 female; age range: 4-191 months, mean age: 58.6 ± 59.5 months) with a positive measles IgM test result were taken into consideration and the epidemiological and clinical features of these children were evaluated. In addition to fever and rash, cough, nasal discharge and conjunctivitis were seen in 36 (82%), 24 (55%), and 18 (41%) patients, respectively. Thirty five (80%) patients were diagnosed in December, 6 (14%) in January, 2 (4%) in February, and 1 (2%) in March. All patients included in the study were unvaccinated or too young to be vaccinated according to the routine vaccination calendar. The index case was a three-year old unvaccinated girl who had a history of contact with the Syrian neighborhoods. During the study period; following contact with the index case, two doctors (born in 1986 with a history of single dose of vaccination at ninth month) and three children (without vaccination) were also diagnosed as measles. Eight (18%) patients were hospitalized because of complications. Four (50%) of them had pneumonia and the other four (50%) had lack of oral feeding and dehydration. Average duration of hospitalization for patients was 4 ± 1.7 (range: 2-6) days and all patients were discharged with full recovery. For molecular typing, viral RNAs were isolated from urine samples of two of the measles IgM positive patients, subjected to sequence analysis of 450 nucleotides comprising the most variable C-terminal region of the nucleoprotein (N) gene. Phylogenetic analysis revealed that those two strains belonged to genotype D8. This study represented the involvement of measles virus genotype D8 in an outbreak in Turkey for the first time. During a measles epidemic, following the index case; medical personnel should be informed about possible, probable, and definite case definitions and should apply for appropriate triage or fast-track (rapidly examination) if necessary, and routine announcements should be made precisely and accurately at proper times and unvaccinated medical personnel and any people in touch with the patient should be vaccinated. In order to reach the elimination goal declared by European WHO for 2015, susceptible populations should be identified and vaccinated in Turkey to obtain sufficient herd immunity for preventing outbreaks.

Epidemiology of tularemia.

Tularemia is considered to have existed in Anatolia for several thousand years. There are suspicions regarding its use in biological warfare in the Neshite-Arzawan conflict. The causative agent of tularemia may have first been used as a biological weapon in 1320-1318 BC. The disease has recently become a significant re-emerging disease globally as well as in Turkey. In the period of 2001-2010, Kosovo had the highest annual incidence in Europe at a rate of 5.2 per 100,000. Sweden, Finland, Slovakia, Czech Republic, Norway, Serbia-Montenegro, Hungary, Bulgaria, and Croatia follow with rates of 2.80, 1.19, 1.0, 0.81, 0.42, 0.4, 0.36, 0.21, and 0.15 per 100,000 people, respectively. Tularemia in Turkey was first reported in the soldiers living in the region very close to the Kaynarca Stream of Thrace in 1936. It has started to gain more and more importance, especially in recent decades in Turkey, due to a very high number of cases and its spread throughout the country. A total of 431 tularemia cases were recorded in Turkey in 2005, but a significant reduction was observed in the number of the cases in the next three years; the number of patients decreased to 71 in 2008. The number of cases increased again in 2009 and continued in subsequent years. The number of cases reached 428, 1531, 2151, and 607 in 2009, 2010, 2011, and 2012, respectively. The number of cases peaked in 2011 in Turkey, and was in fact higher than the total number of cases in all European Union countries. The number of cases is higher in females than males in Turkey. In Turkey, 52% of cases of tularemia diagnoses occur from December to March and the most common clinical presentation is the oropharyngeal form caused by contaminated water. Rodents are the most likely sources of tularemia outbreaks in Turkey as well as in Kosovo. Organisms such as ticks, flies and mosquitoes are vectors of tularemia transmission to mammals. Because ticks can carry the bacteria by both transovarial and transstadial transmission, they play a role in the life cycle of tularemia as both reservoir and vector.

Willingness to Receive the Influenza A(H1N1) Vaccine and its Determinants among University Students during the 2009 Outbreak in Turkey.

The study aimed to determine the willingness to receive the Influenza A(H1N1) vaccine and its determinants in a large group of university students. This is a self-administered questionnairre based cross-sectional study. Students being educated at health and non-health faculties were invited to participate in this attitude survey. A total of 974 students were included in the study, of whom 51.3% (n=500) were in health related faculties. The rate of willingness to receive the Influenza A(H1N1) vaccine was 11.9 and 7.5% for health and non-health groups, respectively (p<0.05). For the health group, having been vaccined with seasonal influenza was a significant determinant of being willingness to receive the Influenza A(H1N1) vaccine (O.R [95% C.I.]), (O.R: 2.9 [1.5-5.6]) and to believe that the Influenza A(H1N1) vaccine prevents swine flu (O.R: 1.7 [1.09-2.8]). For the non-health group, the only determinant was to believe that Influenza A(H1N1) vaccine prevents from swine flu (O.R: 19.1 [5.7-64.1]) which found to be affected by confusing news in media. The public health professionals who will organize the efforts to improve the acceptability of Influenza A vaccines during influenza outbreaks should try to increase the vaccination rates of seasonal influenza. Information provided by the media should be organized in order not to cause fear and confusion, which was shown to decrease willingness and belief in the Influenza A(H1N1) vaccine.

Cotreatment of congenital measles with vitamin a and intravenous immunoglobulin.

Although the measles vaccine has been part of routine national childhood vaccination programs throughout Europe, measles remains a public health concern. High numbers of cases and outbreaks have occurred throughout the European continent since 2011, and an increasing number of cases have been reported in Turkey since 2012. During a recent measles outbreak in Turkey, 2 pregnant women contracted measles prior to delivering preterm infants at Hacettepe University Hospital. Measles virus genomic RNA and IgM antibodies against measles were detected in the cord blood of infants and mothers in both cases. The infants were treated with intravenous immunoglobulin (IVIG) and vitamin A. Transient thrombocytopenia was present in 1 infant and treated with an additional dose of IVIG and vitamin A. The infants were discharged, without complications, within 10 days of birth. The successful treatment of these cases suggests that infants who have been exposed to, or infected with, measles may benefit from cotreatment of vitamin A and IVIG.

Phylogenetic analysis of peste des petits ruminants virus from outbreaks in Turkey during 2008–2012

Peste des petits ruminants (PPR) is an important viral disease of sheep and goats and is endemic in all regions of Turkey. In this study, PPR virus infection was investigated by RT-PCR assay based on the fusion (F) gene in PPR-suspected sheep and goat samples. PPR virus RNA was detected in 65 small ruminants (51 sheep, 14 goats) from independent outbreaks during 2008-2012 in provinces in the central and Mediterranean regions and the central-west part of the Aegean region in Turkey. The virus was detected in an aborted sheep fetus sample by RT-PCR, and diagnosis was also confirmed by virus isolation. Vaccine strain Nigeria 75/1 was differentiated from field isolates by restriction fragment length polymorphism analysis of RT-PCR products using EcoRI. Phylogenetic analysis of 16 viruses indicated that all viruses, including the one from the aborted sheep fetus, belonged to lineage IV, as had the PPR viruses previously isolated in Turkey. Nucleotide sequence identity among 16 viruses was 99.1%-100%. Results showed that PPR virus lineage IV has been in circulation in Turkey since the first detection of the disease.

A Report on Bovine Ephemeral Fever Virus in Turkey: Antigenic Variations of Different Strains of EFV in the 1985 and 2012 Outbreaks Using Partial Glycoprotein Gene Sequences

We described the aetiological agents of outbreaks of bovine ephemeral fever (BEF) that occurred in 1985 and 2012 in Turkey, and identify mutations in the viruses from both outbreaks. Outbreaks have emerged periodically every 4-5 years in the same regions in Turkey. Because these regions are located in a subtropical climatic zone, good conditions for vector populations exist. The results of this study show that the BEFVs from outbreaks in Turkey vary significantly. Effective prevention will require a vaccine that contains BEFVs from different genetic clusters.

Molecular characterization of measles viruses in Turkey (2010–2011): First report of genotype D9 involved in an outbreak in 2011

Genetic characterization of measles viruses (MVs) combined with acquisition of epidemiologic information is essential for measles surveillance programs used in determining transmission pathways. This study describes the molecular characterization of 26 MV strains (3 from 2010, 23 from 2011) obtained from urine or throat swabs harvested from patients in Turkey. MV RNA samples (n = 26) were subjected to sequence analysis of 450 nucleotides comprising the most variable C-terminal region of the nucleoprotein (N) gene. Phylogenetic analysis revealed 20 strains from 2011 belonged to genotype D9, 3 to D4, 2 strains from 2010 to genotype D4 and 1 to genotype B3. This study represents the first report describing the involvement of MV genotype D9 in an outbreak in Turkey. The sequence of the majority of genotype D9 strains was identical to those identified in Russia, Malaysia, Japan, and the UK. Despite lack of sufficient epidemiologic information, the presence of variants observed following phylogenetic analysis suggested that exposure to genotype D9 might have occurred due to importation more than once. Phylogenetic analysis of five genotype D4 strains revealed the presence of four variants. Epidemiological information and phylogenetic analysis suggested that three genotype D4 strains and one genotype B3 strain were associated with importation. This study suggests the presence of pockets of unimmunized individuals making Turkey susceptible to outbreaks. Continuing molecular surveillance of measles strains in Turkey is essential as a means of acquiring epidemiologic information to define viral transmission patterns and determine the effectiveness of measles vaccination programs designed to eliminate this virus.

Molecular diagnostic and genetic characterization of highly pathogenic viruses: application during Crimean–Congo haemorrhagic fever virus outbreaks in Eastern Europe and the Middle East

Several haemorrhagic fevers are caused by highly pathogenic viruses that must be handled in Biosafety level 4 (BSL–4) containment. These zoonotic infections have an important impact on public health and the development of a rapid and differential diagnosis in case of outbreak in risk areas represents a critical priority. We have demonstrated the potential of a DNA resequencing microarray (PathogenID v2.0) for this purpose. The microarray was first validated in vitro using supernatants of cells infected with prototype strains from five different families of BSL-4 viruses (e.g. families Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae and Paramyxoviridae). RNA was amplified based on isothermal amplification by Phi29 polymerase before hybridization. We were able to detect and characterize Nipah virus and Crimean–Congo haemorrhagic fever virus (CCHFV) in the brains of experimentally infected animals. CCHFV was finally used as a paradigm for epidemics because of recent outbreaks in Turkey, Kosovo and Iran. Viral variants present in human sera were characterized by BLASTN analysis. Sensitivity was estimated to be 105–106 PFU/mL of hybridized cDNA. Detection specificity was limited to viral sequences having ˜13–14% of global divergence with the tiled sequence, or stretches of ˜20 identical nucleotides. These results highlight the benefits of using the PathogenID v2.0 resequencing microarray to characterize geographical variants in the follow-up of haemorrhagic fever epidemics; to manage patients and protect communities; and in cases of bioterrorism.

Molecular Evidence Indicates ThatPhlebotomus major sensu lato(Diptera: Psychodidae) Is the Vector Species of the Recently-Identified Sandfly Fever Sicilian Virus Variant: Sandfly Fever Turkey Virus

Sandfly fever turkey virus (SFTV) is a recently-discovered sandfly fever Sicilian virus (SFSV) variant (family Bunyaviridae, genus Phlebovirus), characterized during retrospective evaluation of febrile disease outbreaks in Turkey. In addition to causing sandfly fever, SFTV was observed to induce elevation of liver enzymes, and to cause thrombocytopenia in affected individuals. This study was conducted to identify vectors for phleboviruses including SFTV in Ankara province, Turkey, where evidence indicates ongoing circulation of SFTV, as well as Toscana virus. Sandfly sampling was performed in Ankara province in the vicinity or in animal housing facilities in 15 peri-domestic sites. Male sandflies were identified morphologically, whereas females were evaluated individually for Phlebovirus RNA via a nested-PCR assay with consensus primers. Selected individuals and PCR-positive sandflies were subjected to barcoding via cytochrome c oxidase sequence analyses. The source of blood meals in virus-infected sandflies was investigated using a multiplexed PCR targeting the mitochondrial cytochrome b gene of various vertebrates. A total of 667 sandflies were captured in 11 locations. Morphological identification of males (n=226) revealed Phlebotomus major sensu lato as the most abundant species (38.9%), followed by Phlebotomus sergenti (20.4%), Phlebotomus halepensis (17.7%), Phlebotomus papatasi (10.2%), Phlebotomus simici (3.98%), Larrousius spp. (3.53%), Phlebotomus tobbi (1.32%), Phlebotomus perfiliewi perfiliewi (1.32%), and others. Virus sequences were detected in 3 (3/441) sandflies, two of which were characterized as P. major s.l. via barcoding. The detected sequences in sandflies were identified as SFTV, and were identical or similar to sequences from patients from the same area and the prototype SFTV strain. Bovine and human blood meals were demonstrated in SFTV-infected sandflies. P. major s.l. has been identified as the vector species for SFTV. Bovidae need to be evaluated as probable amplifying hosts for SFTV.

Evaluation of the tick bites in a Crimean-Congo haemorrhagic fever (CCHF) endemic area in Turkey

After the first description of a CCHF outbreak in Turkey, tick bites became an increasing cause of visits to health-care facilities. In this study, we evaluated tick bites in a CCHF endemic region. Materials and methods: The study included cases of tick bites that were referred to 2 hospitals in Erzurum between June and October 2008. All cases were followed-up for 10 days for the results of CCHF. Results: During the study period, 161 patients were admitted for a tick bite. The majority (56.3%) were farmers and housewives. Children ≤ 13 years of age were bitten mostly on the head and neck (44.4%), while adults were bitten mostly on their legs (42.6%). Of the tick attachment sites, 18.3% were on non-visible regions of the body of the victims. In 39.1% of the cases, ticks were removed by medical staff. During a 10-day follow-up, CCHF occurred in 2 cases (1.2%). Conclusion: A tick bite poses an important problem for the resident population in CCHF endemic areas. A detailed body inspection after each outing in areas of possible contact with ticks, as well as the early removal of an attached tick, is important to prevent tick-borne diseases. An inspection of the non-visible regions of the body of the victim should be performed by another person. Education of public and medical staff is required for the prevention and management of tick bites.

Clinical Findings in Children with Cutaneous Anthrax in Eastern Turkey

Anthrax is a zoonosis produced by Bacillus anthracis. The aim of this study was to evaluate the clinical findings, therapy, and outcome in children with cutaneous anthrax (CA). Data on age, gender, occupation, clinical symptoms and findings, location and type of lesions, clinical history, laboratory findings, treatment, and outcome were recorded from patients' medical records, retrospectively. The study included 65 patients between 1 month and 18 years old (9.0±4.0 years), 37 patients (56.9%) were male and 28 (43.1%) were female. Most of the patients (89.1%) were admitted in summer and autumn (p<0.001). Of the 65 patients, 20 patients (30.8%) had received antibiotherapy before admission to our hospital. All patients except one had a contact history with infected animals. A 1-month-old patient had a contact history with his mother who had CA. On clinical examination, anthrax edema was noted in 36 (55.3%) patients, anthrax pustule in 27 (41.5%), and anthrax edema and anthrax pustule in two (3%) patients. Gram staining and culture was positive for B. anthracis in 35 (53.8%) patients, and only Gram staining was positive in 10 (15.4%) patients. In the remaining 20 (30.8%) patients, the diagnosis was made by clinical findings. Because the anthrax outbreak in Turkey was associated with slaughtering or milking of ill cows, sheep, or goats, and handling raw meat without taking any protective measures, persons in the community must be educated about using personal protective equipment during slaughtering of animals and handling of meat and skins.

Why were Turks unwilling to accept the A/H1N1 influenza-pandemic vaccination? People's beliefs and perceptions about the swine flu outbreak and vaccine in the later stage of the epidemic

This study investigated the acceptability of the A/H1N1 influenza vaccination and related factors among 1137 adults in the later stage of the A/H1N1 outbreak in Turkey. Having already been vaccinated or intending to get vaccinated were related to trust in the vaccine effectiveness, perceived risk of the side effects, and benefits of getting vaccinated. Perceived long term consequences of the A/H1N1 infection, perceptions of the A/H1N1 information in media, and barriers for getting vaccinated were related to intention whereas anticipated epidemic situation in Turkey, being chronically ill, and being not married were related to having already been vaccinated.

Knowledge and anticipated attitudes of the community about bird flu outbreak in Turkey, 2007–2008: a survey-based descriptive study

To determine factors associated with knowledge and anticipated attitudes to a foreseen avian influenza outbreak in a high-risk population from a Turkish remote region. A random, cross-sectional face-to-face survey of 1,046 Turkish adults. The proportion of participants concerned about contracting the virus was significantly lower amongst the less educated and rural located respondents. Significantly more rural than urban located participants declared not complying with quarantine policies and not handing out their poultry in case of an influenza outbreak. Factors associated with protective behaviours were higher level of education, urban location, not performing backyard farming of poultry, and preferring ready-to-eat products. Preparedness against bird flu endemic in remote regions could be hindered by factors, such as low levels of education and economic dependence on small-scale backyard farming. The baseline data collected in this survey will be useful in monitoring changes over time in the population's perceptions of threat, and its attitude towards compliance with specific public health recommendations.

Hospital Experience of an Avian Influenza a (H5N1) Outbreak in Turkey

This study reports the hospital experience of an avian influenza (H5N1) outbreak in Turkey. Out of a total of 602 cases, H5N1 infection was not suspected in 290, prophylactic therapy was given to 165 due to contact with poultry, and 147 were hospitalized, 10 of whom were confirmed as having H5N1 infection. Three peaks in the number of hospital applications were observed during the epidemic; all were related to particular items in the media. The proportion of confirmed H5N1 cases was 1.66% of all applications. The mean age was 10.4 years for confirmed cases and 16.3 years for both unconfirmed and confirmed H5N1 cases in contact with poultry. The mean hospitalization period was 5.0 and 12.2 days in suspected and confirmed cases, respectively. A total of 8 days of mechanical ventilator usage was required for the 10 confirmed cases. Four confirmed cases died during the outbreak. Efforts should be directed towards training health professionals, improving crisis management during an outbreak and, as children are prone to H5N1 infections, implementing school training programmes.

Impacts of site effects on losses of oriental spruce during Dendroctonus micans (Kug.) outbreaks in Turkey

The study showed some site and stand factors affecting host colonization, quantitative and qualitative losses in wood of oriental spruce as a source of raw material during the outbreak of Dendroctonus micans (Kug.). A total of 22.8 million m 3 standing trees were damaged. In 11.43 million m 3 standing trees infestations were observed and 6.96 million m 3 of trees were cut which occupied 120,000 ha of D. micans infestation areas. In pure spruce stands, 26.5% of the trees were infested. There was no statistically significant difference among the volume of crowns, crown base height and ages in infested and healthy trees. There was a positive correlation between stand density and number of D. micans , and number of attacks inversely correlated with altitude.

Combinatorial antibody libraries from survivors of the Turkish H5N1 avian influenza outbreak reveal virus neutralization strategies

The widespread incidence of H5N1 influenza viruses in bird populations poses risks to human health. Although the virus has not yet adapted for facile transmission between humans, it can cause severe disease and often death. Here we report the generation of combinatorial antibody libraries from the bone marrow of five survivors of the recent H5N1 avian influenza outbreak in Turkey. To date, these libraries have yielded >300 unique antibodies against H5N1 viral antigens. Among these antibodies, we have identified several broadly reactive neutralizing antibodies that could be used for passive immunization against H5N1 virus or as guides for vaccine design. The large number of antibodies obtained from these survivors provide a detailed immunochemical analysis of individual human solutions to virus neutralization in the setting of an actual virulent influenza outbreak. Remarkably, three of these antibodies neutralized both H1 and H5 subtype influenza viruses.