[Pertussis seroprevalence and vaccination status in three selected provinces of Turkey]. / Seçilmis üç ilde bogmaca seroprevalansi ve asilanma durumu.

The aim of this community-based seroepidemiological survey was to assess the immune status against pertussis among the healthy population in three selected provinces with different geographical and socioeconomical status (Antalya, Diyarbakir and Samsun, located at Mediterrenean, Southeast Anatolia and Black Sea regions of Turkey, respectively) in relation with DwPT (whole cell pertussis vaccine combined with diphtheria and tetanus toxoids) vaccination status. A total of randomly selected 2085 subjects ages between 6 months to > 50 years were included to the study. Serum samples have been screened for the presence of pertussis antibodies by an in house ELISA method with the use of pertussis toxin (PT) and filamentous hemagglutinin (FHA) antigens. The levels of > or = 10 EU/mL was accepted as positive for anti-PT and anti-FHA. Vaccination rate with 3-4 doses among children under 15 years old was significantly lower in Diyarbakir compared to the other two provinces (p< 0.05). The antibody positivity was increased with age up to the 10-14 year group and was maintained among older groups. There was no statistically significant relationship between the vaccination rate and antibody prevalence (p> 0.05). Adult females showed a significantly higher antibody-positivity rate for anti-PT than the males (p< 0.05). Our study pointed out a high prevalence of pertussis infection in those selected provinces, suggesting that the adults play a role as potential reservoirs for B. pertussis. It can be concluded that adult immunization, especially of those who are likely to have close contact with infants, should be considered.

[A field survey carried out on the confirmation of a pertussis case in a village of Kirikkale Province, Turkey]. / Kirikkale'nin bir köyünde dogrulanmis bir bogmaca olgusu nedeniyle yapilan saha arastirmasi.

The aim of this study was to evaluate the existence and the rate of pertussis infection in December 2002 among the symptomatic contacts in Konurhaciobasi village of Kirikkale province (placed in middle Anatolia, Turkey, with a population of 500 people), where a laboratory-confirmed pertussis case was defined by culture positivity. Sixty contacts with cough history of more than two weeks have been interviewed and their nasopharyngeal swabs have been collected together with the serum samples from 47 of them. "Probable case" definition included cough lasting longer than two weeks together with at least one of the following symptoms: paroxysms of cough, inspiratory "whooping" and post-tussive vomiting without other apparent cause. The samples were inoculated onto cephalexin Bordet-Gengou agar (C-BGA), and following the growth of suspected colonies identification tests including slide agglutination by using Bordetella pertussis phase 1 and B.parapertussis specific antisera, were performed. IgG antibodies against B.pertussis were searched with an in-house ELISA method by using purified pertussis toxin, and titers of > or = 100 ELISA units (EU)/ml were considered as acute/recent infection. Among the subjects 80% were children and 75% were female. Thirty-six subjects (76.6%) had a history of immunization with 3-4 doses of diphtheria-pertussis-tetanus (DPT) vaccine. According to questionnaires the mean household number was calculated as 5.0 +/- 0.26. Fifteen contacts (age range: 4-12 years, 11 were female) were defined as "probable cases", however all of them were found to be culture negative. All these cases had been vaccinated with DPT vaccine. Among the probable cases 12 serum samples were available, and six of them were evaluated as acute/recent pertussis infection, since their antibody titers were found as > or = 100 EU/ml. In addition, the evaluation of ELISA results of 47 individuals indicated that 27 of them had antibody titers of > or = 100 EU/ml, who could be considered as acute or recent pertussis infection. The data of this field survey indicated a possible pertussis outbreak in this village.

Prevalence of high antibody titers of pertussis in Turkey: reflection of circulating microorganism and a threat to infants.

Acute pertussis infection among adults can cause its transmission to the larger population, especially to infants and young children, who can develop severe disease. In order to determine an age-dependent pertussis immune response, anti-pertussis toxin (PT) antibody was detected by the indirect enzyme-linked immunosorbent assay (ELISA) method in serum samples from 2,085 healthy subjects ranging in age from 6 months to > or = 60 years. Also included in the evaluation were responses to a questionnaire including sociodemographic characteristics, vaccination, and infection history. Titers of 50-99 ELISA units (EU)/mL and of > or = 100 EU/mL were accepted as indicative for recent exposure or infection. In addition, 30 EU/mL was estimated to be a sufficient titer in women of childbearing age to protect their newborns until administration of their first dose of pertussis vaccine. After the age of 4-5 years, presence of high-titered antibodies that increase with age might be a reflection of circulating infection and indicate the magnitude of the threat to infants. According to the questionnaires, in the groups younger than 15 years old, three to four doses of diphtheria toxoid-whole cell pertussis-tetanus toxoid (DwPT) were administered in 47.2 to 77.4%, 91.2 to 100.0%, and 83.5 to 100.0% of participants in Diyarbakir, Samsun, and Antalya, respectively. In addition, up to half of the expectant mothers we studied lacked a sufficient level of estimated antibody titers. To protect infants from life-threatening pertussis infection, improving vaccination coverage to ensure herd immunity and uniformly establishing coverage throughout the country are essential. Furthermore, revaccination with acellular vaccine for schoolchildren as well as for the households of pregnant women is recommended.

Tetanus immunization status among women of childbearing age in Turkey.

In order to assess the effect of the neonatal tetanus elimination program in Turkey, tetanus antibody prevalence among women of childbearing age from three selected provinces was evaluated in relation to vaccination doses of the single-type tetanus vaccine. A combined method of in-house enzyme-linked immunosorbent assay and particle agglutination test was used to determine tetanus antibody titers. Among 205 women aged 20-39 years, the tetanus antibody level was higher in women with 1-3 children than those without children. The geometric mean of the log antibody titer was increased proportionally with a slope of 0.405 +/- 0.174 per dose between 0 and 3 doses (P > 0.05). However, the proportion of 20-39-year-old women with the protective antibody in the provinces ranged from 54.8 to 86.6%. Diyarbakir had the lowest immunity with a larger number of children in the household, and a lower educational level. The results of our serological study demonstrated that the neonatal tetanus elimination program in Turkey is effectively promoting immunity against tetanus in pregnant women. However, the study also revealed that the tetanus immunity among women of childbearing age was still insufficient. Intensive implementation of the supplemental immunization activities and encouraging vaccinations through neonatal care services will improve the situation.

Immunity against tetanus and effect of vaccination in Turkey.

The immune status against tetanus in relation to vaccination was investigated among healthy populations in 3 selected provinces in Turkey (n=2094). In-house ELISA supplemented with the particle agglutination test was performed for this purpose. An exact correlation was found between vaccination status and immunity against tetanus. The immunity was high among children and sharply decreased with age among adults. The primary vaccination for children increased the immunity, reaching a geometric mean titer (GMT) of 6.2 IU/ml at the fourth dose. There was a reduction of immunity during the next y, followed by an increase with a booster injection at primary school age. Among adolescents and adults, the GMTs after the last vaccination fell off exponentially with a slope of -0.068 log10 IU/ml per y. Extrapolation of the regression line predicted that the minimum protective level (> or =0.01 IU/ml) would be maintained for approximately 30 y on average after the last vaccination. Diyarbakir, 1 of the selected provinces, had lower immunity than the other 2 provinces with poor immunization. Adult females tended to show slightly higher GMTs than males, probably due to the neonatal tetanus elimination program. Reinforcement of immunization against tetanus for adults is recommended.

Measles seroepidemiology in 3 cities in Turkey.

OBJECTIVE: To evaluate immunity against measles and its relation with some variables among healthy subjects in 3 cities in Turkey. METHODS: We carried out a cross-sectional study on measles antibody titers in the serum samples of 712 people from Antalya, 696 from Diyarbakir and 667 from Samsun, Turkey using particle agglutination test between February 2000 and October 2001. The study groups, informed and asked for their consent by midwives, consisted of randomly selected subjects of all ages older than 6 months. We implemented the study in 3 steps: physical examination, interview and blood collection. RESULTS: We considered titers of > or = 1:16 as positive and we observed lower seropositivity in Diyarbakir (90.8%) than Antalya (95.9%), and Samsun (94.9%) (p=0.040). We also observed that seropositivity was lower among preschool group than older groups (p=0.006). The number of doses of measles vaccine (p=0.001) and measles infection history (p=0.003) were found as a factor increasing the seropositivity ratio. There was no statistically significant between age groups (p=0.219), gender (p=0.148), residence (p=0.537), and number per household (p=0.983) among the provinces. CONCLUSION: Based on the findings, measles infection still has a high incidence in Turkey and the second dose of measles vaccine is extremely important in the prevention of measles transmission among school children and the community. Furthermore, we must improve our regional differences in routine vaccination services.

Seroprevalance of Bordetella pertussis antibodies among healthy adolescent girls in Edirne.

OBJECTIVE: Immune response against pertussis can be induced by infection and/or vaccination and vaccine induced immunity is known to wane within the decade following vaccination. Our aim was to assess the pertussis immune response among adolescent girls in the province of Edirne in Turkey. In addition we determined the relationship between the immune response and age, residence, and vaccination status. MATERIAL AND METHODS: Serum samples were collected from 359 adolescent girls, 12 to 17 years old. The subjects were selected by systematic randomisation from school rosters and sampled by age and urban-rural residence strata proportional to the corresponding distributions in the Edirne population. Pertussis immunity was determined by an in-house quantitative ELISA method for anti-PT and anti-FHA antibodies. RESULTS: Protective levels of antibody (>10 EU/ml) for anti-pertussis toxin and anti-filamentous heamagglutinin were found in 95.3% and 97.2% of the overall study group respectively. In 12- to 14-year-olds protective levels were shown in 94.1% and 97.0%, in 15- to 17-year-olds in 97.5% and 97.5%, in rural areas in 96.7% and 97.5%, and in urban areas in 94.5% and 97.5%, respectively (p >0.05). CONCLUSION: The high percentages of protective levels of antibodies in our study population might be an indicator of previous infections, which are a threat to infants who have not completed primary immunisation. In this respect, adult immunisation should be considered.

[Standardization of an in-house ELISA for pertussis serology and its application in a seroepidemiological study]. / Laboratuvarimizda hazirlanan ELISA testinin bogmaca serolojisinde standardizasyonu ve seroepidemiyolojik bir calismada kullanilmasi.

Seroepidemiological studies need sensitive, practicle and cost-effective methods. For pertussis serosurveillance, an in-house ELISA for antipertussis-toxin (PT) and anti-filamentous-hemagglutinin (FHA) were established in our laboratory and compared by a Ball-ELISA which had been reported to be reliable previously. Sixty sera with various antibody titers were tested by both of the methods. The correlation coefficients between two methods were 0.729 and 0.776 for anti-PT and anti-FHA, respectively, and regression coefficients were 0.623 and 0.693, respectively. The in-house ELISA was applied to a serosurvey including 373 healthy subjects (6 months-91 years old) in Turkey to observe the results. The moving averages of both antibodies were increased until 10 years old, reaching to 31 EU/ml for anti-PT and 65 EU/ml for anti-FHA and kept around this level in the older ages. The in-house ELISA was found to be reliable and the serosurvey results obtained by ELISA showed a characteristic distribution of antibody titers in each age group.

Oral findings and health status among hospitalized patients with physical disabilities, aged 60 or above.

The purpose of the study was to determine oral health status and the prevalence of oral mucosal lesions among hospitalized elderly patients with physical disabilities. The study group consisted of 111 (43 male and 68 female) elderly patients with physical disabilities. Clinical examination and interview methods were employed. Clinical examination revealed that 45.9% of the elderly patients had one or more oral mucosal lesions. Xerostomia (58.6%), coated-hairy tongue (54.1%) and halitosis (46.8%) were the most frequently encountered oral findings and mucosal lesions. As the most interesting finding discovered in elderly patients, macroglossia (30.6%) seems to depend on physical disability. Coated or hairy tongue was commonly related to poor oral hygiene, with both crude odds ratio (OR) of 3.25 (95% CI: 1.26-8.36) (P=0.021) and the logistic regression OR of 3.36 (95% CI: 1.21-9.33) (P=0.020). Halitosis and bruxism were commonly related to dentate patients [logistic regression OR of 0.29 (95% CI: 1.12-0.74) (P=0.009) and 0.21 (95% CI: 0.06-0.74) (P=0.016); respectively]. Increase in dental problems may have negative impacts on chewing, nutrition, aesthetics and phonation in elderly patients. It is particularly noteworthy that physical disability in elderly patients limits their ability to effectively follow oral hygiene procedures.

Tetanus antibody assay combining in-house ELISA and particle agglutination test and its serosurvey application in a province in Turkey.

In order to determine a practically useful quantitative assay method for tetanus antibody in a large-scale seroepidemiological study, a method combining an in-house ELISA with a particle agglutination test (KPA) was evaluated in comparison with the in vivo mouse neutralization test. Serum samples with mouse neutralization antibody titers 0.01 IU/ml (the minimum protective level) or below showed considerable overestimation of antitoxin titers up to 1.0 IU/ml when studied by in-house ELISA alone. On the other hand, the KPA values were highly correlated with the mouse test, even in cases of titers equal to 0.01 IU/ml or below. The combination of these two procedures, in which in-house ELISA values of 1.0 IU/ml or below were replaced by KPA values, provided a high correlation in antibody titers with the mouse test (r = 0.968). We applied this combined method to a tetanus seroepidemiological survey in a province in Turkey. The survey included 347 subjects from the healthy population, and the quantitative analyses showed high antibody levels in children and young adults and significantly low levels among adults aged 40 or over. A characteristic distribution of antibody titers in each age group was also demonstrated.

Community-based seroepidemiology of tetanus in three selected provinces in Turkey.

The aim of this study was to assess immunity levels against tetanus in the areas of 26 health centers in Samsun, Antalya, and Diyarbakir in Turkey in 2000 - 2001. The study group consisted of 2,465 healthy subjects aged 6 months old or above, randomly selected from each age group in the area. Of these, a total of 2,094 (85.0%) serum samples were assayed for tetanus antibody; 716 were from Antalya, 706 were from Diyarbakir, and 672 were from Samsun. The surveys were implemented in three steps: physical examination, interview, and blood collection. ELISA-in-house was used as a screening procedure and a particle agglutination test was used to reassess antibody titers of 1.0 IU/ml or below. It was revealed that 73.5% subjects had the full protection level (>/=0.1 IU/ml) of antibody in Antalya, 59.9% in Diyarbakir, and 75.0% in Samsun, indicating that protection against tetanus was significantly lower in Diyarbakir than in Antalya and Samsun. The results also showed that the percentage of protective levels decreased with increasing age in three provinces and was higher in rural areas than urban areas in Diyarbakir. The study indicates that the immunity levels against tetanus can be considered as satisfactory among children and adolescents but that it is necessary to increase immunity against tetanus among adults through effective vaccination of pregnant women and those in military service and also among people older than 40 years of age.

[Standardization of neutralization tests using the COBL cell line and comparison with the particle agglutination test for measles serology]. / Kizamik serolojisinde nötralizasyon testinin COBL Hücresi kullanilarak standardizasyonu ve partikül aglütinasyon testi ile karsilastirilmasi.

The aim of the present study was the detection and comparison of measles antibody titers with particle agglutination (PA) and neutralization (Nt) methods, in the sera samples of 364 subjects from different age groups. PA method was performed with a commercial test kit (Serodiameasles, Fujirebio Com. Japan), and Nt test which was standardized in this study, by using COBL (cord blood) cell lines, has been started to use in our laboratory as a reference method. As a result, antibody titers detected by PA were in parallel to the titers which detected by Nt test, and it was concluded that the differences in antibody titers would arise from the differences of test principles and viral antigens.