Did Financial Social Support for Tuberculosis Patients Lead to Better Treatment Outcomes in Türkiye during 2018-2019?

This study examined which factors, including the regular financial social support program, influence tuberculosis (TB) treatment outcomes and success rates. Patients with TB registered during 2018-2019 were included in this retrospective cohort study. We classified them into 2 groups: those who received financial support for at least one month, and those who did not. Of the 22,867 sampled patients, 5,033 received financial social support and 17,834 did not. The success rate was 11.9% higher among patients who received financial social support than among those who did not (97.34% versus 85.40%). After controlling for other factors, the success rate among all patients was 1.3 times higher for female, 2.6 times higher for those under 50 years, 1.5 times higher for extra-pulmonary TB, 1.5 times higher for a new case, 5.9 times higher for drug susceptible TB, and 5.8 times higher for those who received financial support. Crucially, this is the first study from Türkiye evaluating the effect of a regular financial social support program on TB treatment outcomes since the program began in 2018. We recommend regular financial support for patients with TB in all countries.

Analysis of participant-reported adverse events following the first dose of inactivated SARS-Cov-2 vaccine (TURKOVAC™) through telephone survey in Türkiye.

BACKGROUND/OBJECTIVE(S)/INTRODUCTION: TURKOVAC™ is a whole-virion inactivated COVID-19 vaccine, which was developed and recently granted emergency use authorization (conditional marketing authorization) in Türkiye. The objective of this study is to assess the spectrum and the distribution of adverse events reported following the administration of the first 150,000 doses as primary and booster vaccine doses in 22 state hospitals of 17 provinces in Türkiye. PATIENTS/MATERIALS AND METHODS: In this cohort study, a verbal survey was conducted via telephone calls between 10 January and 17 January 2022, utilizing a structured questionnaire algorithm on a sample group of 20,000 persons on the third- and seventh-days following vaccination. The algorithm consisted of two parts focusing on both systemic and local adverse effects. Other adverse events reported by the participants were also recorded. 6023 people and 5345 people agreed to participate in the telephone survey on the 3rd- and 7th- days of having received the first dose of the vaccine, respectively. RESULTS: Thirty-six-point-six percent of the participants on the 3rd day and 22.5% of the participants on the 7th day reported any adverse event following the first dose of the vaccine. On both follow-up days, the most commonly reported (29.7% for Day 3 and 13.1% for Day 7) adverse events were on the injection site. Among the local adverse events, the most frequently reported one was the pain on the injection site (27.9% for Day 3 and 12.4% for Day 7), induration (4.8% for Day 3 and 2.7% for Day 7) and swelling (3.5% for Day 3 and 2.0% for Day 7). Fatigue/weakness (9.6% for Day 3 and 8.3% for Day 7) and headache (7.9% for Day 3 and 8.0% for Day 7) were the most frequent systemic adverse events. Younger age, vaccine dose, and female sex were associated with having any adverse event and pain (on the injection site). Female sex was associated with more swelling (on the injection site), induration (on the injection site), fever, and a higher impact on daily living. CONCLUSION(S): In this study, we conducted a rapid assessment of adverse events following the first dose of the TURKOVAC vaccine. The vaccine appears to have a good safety profile in the first 7 days following vaccination. Younger age, vaccine dose, and female sex are associated with any adverse event and pain (on the injection site). These results present valuable information for the community and may contribute to increasing vaccine confidence.KEY MESSAGESAs a whole-virion inactivated SARS-CoV-2 vaccine, the TURKOVAC™ vaccine, which has a favorable safety profile, can be an alternative to other COVID-19 vaccines including mRNA and viral vector vaccines.

Self-Reported Allergic Adverse Events Following Inactivated SARS-CoV-2 Vaccine (TURKOVAC™) among General and High-Risk Population.

TURKOVAC™ is a whole-virion inactivated COVID-19 vaccine which was developed and granted emergency use and conditional marketing authorization in December 2021 in Türkiye. The objective of this study is to assess the distribution and the severity of allergic adverse events following the administration of the vaccine as the primary or the booster dose in 15 provinces in Türkiye. In this cohort study, between February and May 2022, in the selected 15 provinces having an adequate number of health care personnel in the community health centers to conduct the study, 32,300 people having the first, the second, or the booster dose of the vaccine were invited to the survey. A total of 29,584 people voluntarily agreed to participate to the survey and were given a structured questionnaire after a minimum of 10 days following the vaccination. In our study, only 0.5% of the participants (142 persons) reported to experience any allergic reaction, and 12 of them (8.5%) reported to be given medical treatment in a health center. Male predominance (55.6%) was observed among participants reported to experience any allergic reaction. No hospitalization was recorded. Of the participants, 4.4% (1315 people) reported to have a history of allergy. The most reported allergens were drugs. Among the participants without a known history of allergy (n = 28,269), 0.4% of them (110 people) reported to experience an allergic reaction following the vaccination, and 5.4% of the allergic reactions (six people) were reported to be treated in a health center. The percentage of the participants given any medical treatment among the participants without a known history of allergy is 0.02%. No immediate or anaphylactic reaction was reported. Among the participants with a known history of allergy (n = 1315), 32 people (2.4% of them) reported to experience an allergic reaction following the vaccination, and 18.7% of the allergic reactions (six people) were reported to be prescribed a medical treatment. The percentage of the participants given any medical treatment among the participants with a known history of allergy is 0.4%. A known history of allergy increased the risk of having an allergic experience by approximately six times following vaccination. As a whole-virion inactivated SARS-CoV-2 vaccine, the TURKOVAC™ vaccine, with a low allergic reaction-related adverse event profile, can be an alternative to other COVID-19 vaccines.

An acute gastroenteritis outbreak associated with a contaminated water supply system, Turkey, 2018.

Disruption of routine monitorization and chlorination of the water supply system during a week-long holiday led to a multi-organism gastroenteritis outbreak in a district with limited laboratory support. More than a 10-fold increase in patients with gastroenteritis was reported. Enteropathogenic Escherichia coli, Enteroaggregative E. coli, and norovirus were detected in human specimen samples. The main water tank and pipes were rusted; 13 out of the 19 water samples tested positive for total Coliform (1-920 colony-forming units (CFU)/100 ml) and E. coli (1-720 CFU/100 ml). Chlorine levels were below 0.2 ppm in seven of the nine samples. Information of 1,815 cases was obtained from the hospital records with a crude attack rate of 2.9%. Cases widespread in the district increased throughout the holiday, epidemic curve revealed a point-source outbreak. The case-control study revealed that consumption of drinking tap water and using it to clean vegetables/fruits were significantly associated with the illness. While drinking only bottled water had a protective effect against the illness. The culture technique showed that the water supply samples were positive for pathogenic bacteria. Upon decision in a multi-stakeholder meeting, the water tank was cleaned, and the Municipality initiated the renovation of the water supply system.

Effects of hydroxychloroquine and favipiravir on clinical course in outpatients with COVID-19

Background/aim: Due to the importance of early outpatient treatment to prevent hospitalization and disease progression, we examined the effects of hydroxychloroquine and favipiravir, which were initiated in early period, on the clinical course of COVID-19 outpatients. Materials and methods: Data of confirmed COVID-19 outpatients over a 4-month period were analyzed retrospectively. Public Health Management System (HSYS) was used for the case-based follow-up. Patients on antiviral therapy for at least five days, including hydroxychloroquine and / or favipiravir and patients who were followed-up for 30 days were included in this analysis. Results: We enrolled 1489 patients in this study. Overall, 775 (52%) patients were male and a mean age of patients was 38.9 ± 11.1 years. Of these patients, 537 of them were received favipiravir, 545 of them were received hydroxychloroquine and 407 of them were received both favipiravir and hydroxychloroquine. Symptoms improvement on the 14th day of follow-up was 1.8 times higher in the group of patients receiving hydroxychloroquine compared to patients who received favipiravir (p = 0.003). On the 3rd day of follow- up, PCR negativity rate was higher in patients who received hydroxychloroquine (p = 0.004). Hospitalization rates were similar in patients receiving favipiravir and hydroxychloroquine (p = 0.144). However, in the presence of pneumonia at the time of diagnosis, the hospitalization rate was 6.6 times higher in patients who received favipiravir than those who received hydroxychloroquine. Conclusion: The subgroups of patients treated with hydroxychloroquine and/or favipiravir did not have similar disease severities in our study. Therefore, further studies with homogeneous patient groups to be arranged prospectively are needed.

Prevalence of Protective Measles Virus Antibody Levels in Umbilical Cord Blood Samples and Sera of Mothers and Transplacental Transport Ratio in Turkey.

In Turkey, the Measles Elimination Program has been implemented since 2002. The aim of this study was to evaluate the measles-specific antibody levels of mothers admitted to a hospital for birth and their infants, to determine the factors influencing the antibody levels of both, and to evaluate the transplacental transport ratio. We selected healthy women who came to the hospital for birth and their healthy newborns. We collected blood samples from 1,547 mothers and 1,529 infants. The protective prevalence of measles antibody levels of mothers was 80% (95% confidence interval [CI]: 78-82%) and that of newborns was 85% (95% CI: 83-86%). The antibody levels of mothers and newborns were positively linearly correlated (R: 0.922, p < 0.001) and were associated with parity (p < 0.001). The ratio of neonatal to maternal antibody levels increased with gestational age. The protective levels were 1.6 times higher (95% CI: 1.1-2.4) in mothers ≥ 32 years of age and 2.1 times higher (95% CI: 1.4-3.3) in naturally immune mothers. Two factors affecting the antibody levels of newborns were the mothers' antibody levels and their immunization status. The antibody level of mother was the most significant factor that influenced the infant's antibody level. Vaccination of women before pregnancy could enhance passive antibody protection by increasing the level of transplacental transmission.

Epidemiological Study of Tetanus Seropositivity Levels in Different Age Groups in Ankara Province, Turkey, 2017.

The aim of this study was to determine the seropositivity levels of tetanus vaccine by age group in Ankara province, identify possible factors that affect immune status, and develop public health recommendations, especially for those 50 years and older. This cross-sectional epidemiological study covered individuals aged 3 years and older who are registered in the Family Medicine Information System. We received blood samples from 992 individuals and included 968 surveys in the analysis. Protective tetanus antibody levels were 80.5% in the 3-5 years age group, 92.0% in the 6-12 years age group, 94.3% in the 13-20 years age group, 95.2% in the 21-39 years age group, 84.4% in the 40-49 years age group, and 57.3% in the 50 years and older age group. Tetanus seropositivity decreased with age. Awareness of the importance of tetanus vaccine boosters for adults should be increased by providing training, ensuring booster vaccination against tetanus at 10-year intervals, and if necessary, considering mandatory tetanus vaccination for those 50 years and older.

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.

Lot quality survey: an appealing method for rapid evaluation of vaccine coverage in developing countries - experience in Turkey.

BACKGROUND: Vaccine-preventable diseases cause significant morbidity and mortality worldwide and in developing countries in particular. Information on coverage and reasons for non-vaccination is vital to enhance overall vaccination activities. Of the several survey techniques available for investigating vaccination coverage in a given setting, the Lot Quality Technique (LQT) remains appealing and could be used in developing countries by local health personnel of district or rural health authorities to evaluate their performance in vaccination and many other health-related programs. This study aimed to evaluate vaccination coverage using LQT in a selected semi-urban setting in Turkey. METHODS: A LQT-based cross-sectional study was conducted in Kecioren District on a representative sample of residents aged 12-23 months in order to evaluate coverage for routine childhood vaccines, to identify health units with coverage below 75%, and to investigate reasons for non-vaccination. RESULTS: Based on self-reports, coverage for BCG, diphtheria-pertussis-tetanus (DPT-3), oral polio-3, hepatitis-3, and measles vaccines ranged between 94-99%. Coverage for measles was below 75% in five lots. The relatively high educational and socioeconomic status of parents in the study group alone could not minimize the "considerable" risk of vaccine-preventable diseases in the District and dictates a continuity of efforts for improving vaccination rates, with special emphasis on measles. We believe that administrative methods should be backed up by household surveys to strengthen vaccination monitoring and that families should be trained and motivated to have their children fully vaccinated according to the recommended schedule and in a timely manner. CONCLUSION: This study identified vaccine coverage for seven routine vaccines completed before the age of 24 months as well as the areas requiring special attention in vaccination services. The LQT, years after its introduction to health-related research, remains an appealing technique for rapid evaluation of the extent of a variety of local health concerns in developing countries, in rural areas in particular, and is very efficient in determining performance of individual subunits in a given service area. Training of local health personnel on use of the LQT could expedite response to local health problems and could even motivate them in conducting their own surveys tailored to their professional interests.

What influences physical activity among elders? A Turkish experience from Ankara, Turkey.

Although the physical activity is a very basic lifestyle activity, the physical inactivity has been estimated to cause 1.9 million deaths worldwide annually, according to the 2002 World Health Organization (WHO) Report. In this cross-sectional study, we aimed to determine the frequency of and factors influencing regular exercise among elders living in the catchment area (CA) of a primary health care unit (PHCU) of a district in Ankara. The district has 7 subregions and 50 people were interviewed from each region. From the total number of elderly in the region, these 350 were selected for the study sample. Five of the authors collected data by a self-administered questionnaire. The dependent variable of the study was "doing physical activity", and there were various independent variables including sociodemographic characteristics and risky health behaviors, etc. Significantly positive associations were determined between "not doing regular exercise" and age of 65 years of older (odds ratio (OR)=1.059, 95% confidence interval (CI)=1.010-1.110; p=0.018), female gender (OR=1.992, 95% CI=1.245-3.185; p=0.004), presence of a chronic disease (OR=2.704, 95% CI=1.444-5.066; p=0.002), and lower/higher body mass index (BMI) (OR=2.568, 95% CI=1.573-4.192; p<0.001).