The seroprevalence of Crimean-Congo haemorrhagic fever among inhabitants living in the endemic regions of Western Anatolia.

BACKGROUND: In Turkey, Crimean-Congo haemorrhagic fever (CCHF) is seen particularly in the north-eastern part of Anatolia. Aydin was thought to be a non-endemic area, however the first case was reported from Aydin in 2006 and a total of 39 cases were reported between 2006 and 2010. METHODS: Four hundred and twenty-nine volunteers from 3 endemic regions of Aydin were enrolled in this study. We determined the IgG seropositivity against the virus by enzyme-linked immunosorbent assay (ELISA) method. RESULTS: IgG seropositivity in the study group was found to be 19.6% (n = 84). Chi-squared automatic interaction detector (CHAID) analysis was performed and a significant relationship between IgG seropositivity and tick-bite was found. The IgG seropositivity rate was 13% in cases without a history of tick-bite, while it was 41.1% in those with a tick-bite history (p < 0.001). In cases without a history of tick-bite (n = 339), the most important factor related to seropositivity was cattle-dealing. The seropositivity rate was higher in women than in men in the group dealing with cattle without a history of tick-bite (p = 0.013). In cases with a tick-bite history, the most important factor related to IgG seropositivity was age; the rate was 81% in cases younger than 34 y old, while it was 29% in cases older than 34 y. CONCLUSIONS: This study indicates that people suffering from the disease did not ask for any professional healthcare or that the healthcare providers could not diagnose these cases.

Unintended pregnancy and prenatal care: a study from a maternity hospital in Turkey.

OBJECTIVES: To evaluate factors associated with pregnancy intention and its effects on source, content and adequacy of prenatal care for women who delivered in a large maternity hospital in Izmir, Turkey. METHODS: This cross-sectional survey was carried out using a questionnaire administered face-to-face to 351 women who had given birth in Konak Maternity Hospital in May 2002. RESULTS: Nearly half (47.3%) of the pregnancies were unintended: 31.3% were mistimed, and 16.0% unwanted. Women's and husbands' older age and lower education, lower social class, women's recent migration to Izmir, lower household income and absence of social security had a negative impact on pregnancy intention. Women with unwanted pregnancies had started procreating earlier; they had more pregnancies, deliveries, children and intentional abortions (p < 0.05). Number and contents of prenatal visits increased as intention status improved. When controlled for socio-demographic variables, women with unwanted pregnancies had less prenatal care, received less education during prenatal visits and had less iron and vitamin supplementation (p < 0.05) whereas mistimed pregnancies did not significantly differ from intended pregnancies. CONCLUSION: Unwanted pregnancies constitute a risk group that should be identified early in pregnancy. Ensuring an adequate and satisfactory prenatal care for all requires appropriate measures to be taken by public health authorities.

An outbreak of Crimean-Congo hemorrhagic fever in western Anatolia, Turkey.

OBJECTIVE: Sporadic Crimean-Congo hemorrhagic fever (CCHF) cases were first reported in Turkey in 2002, arising particularly in northeastern Anatolia. Epidemics have been reported in neighboring countries since the 1970s. With the increase in number of CCHF virus infected or suspected cases in the Aydin region of western Anatolia by 2006, we decided to focus attention on this disease. METHODS: Twenty-six patients with an acute febrile syndrome characterized by malaise, bleeding, leukopenia, and thrombocytopenia were admitted to various hospitals in Aydin between May 2007 and June 2008. CCHF diagnosis was established by measuring IgM in a blood sample and/or detecting viral genome by real-time polymerase chain reaction (real-time PCR) or by clinical findings of the disease, even if IgM was negative (real-time PCR was not performed). RESULTS: Twenty-five patients (22 of the patients with cases confirmed by laboratory findings) matched the criteria for CCHF defined by the European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD); one patient did not match suspected-case criteria, however he was also included in the study as his blood sample was positive according to real-time PCR. The most common signs and symptoms encountered were fever, myalgia, nausea, and vomiting. The overall case-fatality rate was 5.5% (one patient) in 2007. Patients showed hemorrhagic manifestations (35%), while complete blood counts revealed thrombocytopenia and leukopenia in 17 patients (65%), and raised levels of aspartate aminotransferase (77%), alanine aminotransferase (77%), lactate dehydrogenase (69%), and creatinine phosphokinase (42%). CONCLUSIONS: To date, western Anatolia has been accepted as a non-endemic area for this disease, with only sporadic cases. These non-endemic CCHF cases in Aydin province of the Aegean region should alert other non-endemic regions of the world to be mindful of this disease.