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Introduction: The aim of this study was to asses the surveillance of influenza A/other respiratory viruses and risk factors in hospitalized children with the symptoms of influenza-like illness during two consecutive influenza seasons. Methodology: All children hospitalized with adiagnosis of influenza-like illness had been investigated for Influenza A and other respiratory antigens in pharengeal/nasopharyngeal secretions. Results: A total of 132 hospitalized children between December 2013-May 2014 and December 2014-May 2015 were enrolled in this study. At least one respiratory virus was found to be positive by RT-PCR in 78 (59%) patients, influenza A (H3N2) was detected in only 8 (6%) patients. In 54 (41%) patients samples no respiratory viral pathogen was detected and in 70 (53%) patients, one non- influenza A virus was detected. The respiratory viral pathogens detected in decreasing rates were:RSV (n = 46, 35%), HCoV (n = 10, 7.5%), adenovirüs (n = 7, 5%), rhinovirüs (n = 6, 4.5%), HMPV (n = 5, 4%), Influenza B (n = 4, 3%) ve human Bocavirus (n = 2, 1.5%). In 10 patients, coinfection was detected, however none was with H3N2. In the H3N2 (+) group, the following risk factors were identified: age older than three years (p < 0.05), asthma history (p < 0.05) and chronic lung diseases (p < 0.05). Conclusion: Influenza A virus was detected in 6% of hospitalized patients with influenza-like illness. Viruses other then Influenza, especially RSV, can cause similar symptoms compatible with Influenza-like-illness.

Objective: With a wide range of clinical presentations, respiratory tractinfections remain a significant cause of morbidity and mortality worldwide,particularly in infants. The aim of this cross-sectional descriptive study was to determine the frequency of respiratory virusesresponsible for upper respiratory tract infections during the 2013-2014influenza season in infants less than 6 months of age. Method: Nasal swabswere obtained from patients with symptoms suggestive of an influenza-likeillness (ILI) between January and April 2014. Specimens were evaluated byRT-PCR to help identify the causative viral pathogens. Results: A total of150 patients with ILI were enrolled in the study. A respiratory virus wassuccessfully detected in 126 (86%) infants; RSV in 41 (32.5%),rhinovirus in 17 (13.4%), metapneumovirus in 15 (11.9%), coronavirus in 11(8.7%), adenovirus in 5 (3.9%), parainfluenza virus in 2 (1.5%) and bocavirusin 2 (1.5%) infants. Thirty-three (26.1%) patients were found to be co-infectedwith both two viruses. Rhinorrhea and developing complications weresignificantly more frequently seen in RT-PCR positive patients (p=0.023 andp=0.019, respectively). All complications were seen in RT-PCR positive group,especially in metapneumovirus, RSV and multiple viruses positive patients.Conclusions: With an overall viral pathogen detection rate of 86%, findings ofour study present that influenza viruses were not seen in infants less than 6months of age in our study population, whether RSV and multiple viralinfections were the most common causes in this age group., Amaç: Solunum yolu enfeksiyonlarıtüm dünyada özellikle süt çocuklarında mortalite ve morbiditenin önemli birnedenidir. Bu kesitsel- tanımlayıcıçalışmanın amacı, 6 ay altındaki süt çocuklarında 2013-2014 influenza sezonuboyunca üst solunum yolu enfeksiyonlarından sorumlu olan solunum yoluviruslarının saptanmasıdır.Yöntem:Ocak - Nisan 2014 tarihleri arasında akut üst solunum yoluenfeksiyonu (ÜSYE) semptomları ile başvuran hastalardan nazofaringeal sürüntü(swab) alındı. Örneklerden solunum yoluvirusları için RT-PCR çalışıldı.Bulgular:150 hasta çalışmaya alındı. 126 (% 86) hastada solunumyolu virusları pozitif bulundu. Virus pozitif hastaların 41'inde (% 32.5) RSV,17'sinde (% 13.4) rinovirus, 15’inde (%11.9) metapnömovirus, 11’inde (% 8.7) koronavirus, beşinde (% 3.9) adenovirus,ikisinde (% 1.5) parainfluenza ve ikisinde (% 1.5) bokavirus saptandı. Otuz üç(% 26.1) hastanın iki virusle ko-enfeksiyonu olduğu tespit edildi. Burunakıntısı ve komplikasyon gelişimi RT-PCR pozitif hastalarda daha fazla idi(sırasıyla p = 0.023 ve p = 0.019). Tüm komplikasyonlar RT-PCR pozitif gruptaözellikle metapnömovirus, RSV ve çoklu virus pozitif hastalarda görüldü.Sonuç: Viralpatojen pozitifliği %86 saptanan çalışmamızda, 6 ay altındaki sütçocuklarında influenza virusugörülmediği, RSV ve çoklu viral enfeksiyonların bu yaş grubunda en sık neden olduğu ortaya konmuştur.

Background There is a limited knowledge regarding the epidemiology of influenza in Middle East and North Africa. Objectives We described the patterns of influenza circulation and the timing of seasonal epidemics in countries of Middle East and North Africa. Methods We used virological surveillance data for 2010-2016 from the WHO FluNet database. In each country, we calculated the median proportion of cases that were caused by each virus type and subtype; determined the timing and amplitude of the primary and secondary peaks; and used linear regression models to test for spatial trends in the timing of epidemics. Results We included 70 532 influenza cases from seventeen countries. Influenza A and B accounted for a median 76.5% and 23.5% of cases in a season and were the dominant type in 86.8% and 13.2% of seasons. The proportion of influenza A cases that were subtyped was 85.9%, while only 4.4% of influenza B cases were characterized. For most countries, influenza seasonality was similar to the Northern Hemisphere, with a single large peak between January and March; exceptions were the countries in the Arabian Peninsula and Jordan, all of which showed clear secondary peaks, and some countries had an earlier primary peak (in November-December in Bahrain and Qatar). The direction of the timing of influenza activity was east to west and south to north in 2012-2013 and 2015-2016, and west to east in 2014-2015. Conclusions The epidemiology of influenza is generally uniform in countries of Middle East and North Africa, with influenza B playing an important role in the seasonal disease burden.

The aim of this study was to determine the frequency of respiratory viruses responsible for respiratory tract infections in Turkish children during the 2011-2012 influenza season. Nasal swabs were obtained from patients with symptoms suggestive of an influenza-like illness between December 2011 and April 2012. Samples were analyzed with multiplex real-time polymerase chain reaction (RT-PCR) to help identify the causative viral pathogen. A total of 200 patients were enrolled in the study. A respiratory virus was detected successfully in 102 (51%) children; influenza A (H3N2) in 39.2%, influenza B in 23.5%, RSV in 15.6%, rhinovirus in 13.7%, bocavirus in 2.9%, coronavirus in 2.9%, and metapneumovirus in 0.9% of patients. Only one patient was co-infected with bocavirus and influenza A virus. A statistically significant difference in the mean age of presentation was observed between the various viral pathogens (P

Influenza infections cause considerable morbidity and mortality not only during the pandemics but also during annual epidemics. Vaccines are the most effective tools for preventing the infection. Although World Health Organization (WHO) and Ministry of Health (MoH) recommends vaccination for people at increased risk, sales data indicate that vaccination rate remains low in Turkey. Vaccine recommended groups are well defined and reimbursed in Turkey. However, the prevalence of people in risk groups, current vaccination rates and factors influencing vaccine uptake which are essential in order to develop and sustain effective strategies to increase vaccination rate are not documented. A thorough literature review was performed to determine the estimated number of people in risk groups, vaccination rates, factors influencing vaccine uptake in Turkey. Actions taken by the health authorities in order to increase the vaccine uptake among specified risk groups are also summarized. Based on the published prevalence rates, current study calculated that there are approximately 27 to 33 million people in risk groups. In addition, there are 428,000 health care providers serving in the public sector who are at increased risk for influenza infections. The lowest reported vaccination rate (5.9%) was in the elderly ≥65 years of age and the highest (27.3%) in patients with COPD. Finally, survey results indicated that leading factor negatively influencing vaccine uptake was disbelief in the effectiveness of vaccine. In order to increase vaccination coverage, vaccines are provided to health care providers free of charge and reimbursed for those in the risk groups. Realizing the fact that combating flu requires multidisciplinary collaboration, a stakeholder network, Grip Platformu, has been established in 2011 with the endorsement of the MoH to increase influenza awareness and vaccine coverage rates among risk groups in accordance with WHO recommendations.

Influenza virus is associated with a variety of neurological complications, of which the most commonly encountered are seizures and encephalopathy. Acute encephalitis and postinfectious encephalopathy have been reported infrequently in association with influenza A and B virus infections. We describe two previously healthy adults who presented with encephalopathy with a virologically documented influenza B infection.

We aimed to investigate serum and gingival crevicular fluid levels of myeloperoxidase, interleukin-17, and interleukin-23 before and after nonsurgical periodontal therapy in generalized aggressive periodontitis patients and compare to those in healthy controls. Interleukin-17, interleukin-23, and myeloperoxidase levels were measured by enzyme-linked immunosorbent assay in gingival crevicular fluid and serum samples taken from 19 systemically healthy generalized aggressive periodontitis patients and 22 healthy controls. In addition, the levels of IL-17, IL-23, and myeloperoxidase were reassessed at 3 months after periodontal therapy in the generalized aggressive periodontitis (GAP) group. Periodontal clinical parameters were also evaluated at baseline and 3 months post-therapy. The investigated molecule levels in serum decreased significantly at 3 months as a result of the therapy (p = 0.014 for IL-17, p = 0.000 for IL-23, and p = 0.001 for myeloperoxidase (MPO)). Significant reductions were also observed in gingival crevicular fluid (GCF) IL-17, IL-23, and MPO levels at 3 months after therapy (p = 0.000 for all molecules). However, the GCF levels of IL-17, IL-23, and MPO in GAP patients were still higher than those in the controls at 3 months (p = 0.001). A significant decrease in the local and systemic levels of IL-17, IL-23, and MPO based on the therapy might indicate the role of these mediators for tissue destruction in periodontal tissues.

The objective of this study was to determine the phenotypic profile of blood mononuclear cells, specifically CD8+/CD28+ cells, in patients with generalized aggressive periodontitis (GAgP) and chronic periodontitis (CP) in peripheral blood and in blood obtained from periodontal defect site which might contribute to tissue damage. 13 GAgP, 11 chronic periodontitis (CP) and 5 healthy controls (H) were included in the study. Plaque index (PI), bleeding on probing (BoP), periodontal probing depth (PPD) and clinical attachment level (CAL) were recorded. Blood from the base of periodontal defect site and peripheral blood from the antecubital vein were obtained. Relative counts of CD45+, CD3+, CD4+, CD8+/CD28+, CD8+/CD28−, CD19+, CD16+/CD56+/CD3, CD3+/CD16+/CD56+ receptors were determined with two color flow cytometry using monoclonal antibodies. BoP, PPD and CAL were significantly higher in both periodontitis groups than healthy controls (p +/CD28+ cells, were significantly elevated in GAgP and CP groups compared to HC both in blood obtained from defect site and blood obtained from systemic circulation (p

The aim of this study was to determine the frequency of respiratory viruses responsible for respiratory tract infections in Turkish children during the 2011–2012 influenza season. Nasal swabs were obtained from patients with symptoms suggestive of an influenza‐like illness between December 2011 and April 2012. Samples were analyzed with multiplex real‐time polymerase chain reaction (RT‐PCR) to help identify the causative viral pathogen. A total of 200 patients were enrolled in the study. A respiratory virus was detected successfully in 102 (51%) children; influenza A (H3N2) in 39.2%, influenza B in 23.5%, RSV in 15.6%, rhinovirus in 13.7%, bocavirus in 2.9%, coronavirus in 2.9%, and metapneumovirus in 0.9% of patients. Only one patient was co‐infected with bocavirus and influenza A virus. A statistically significant difference in the mean age of presentation was observed between the various viral pathogens (P

Intense research has been conducted on influenza A(H1N1)pdm09 virus to determine the virulence markers. Limited information on characteristics of pandemic virus has become available in Turkey since the pandemic. In this first report from Turkey, we investigated the molecular markers that have been associated with increased virulence and oseltamivir resistance. We also conducted serological studies in people after infection, vaccination, exposure, and no-exposure controls to determine the level of protection against the pandemic H1N1 influenza virus. Thirteen rRT-PCR positive samples were analyzed for presence of mutations that have been associated with host range, virulence, and antiviral resistance: substitution D222G in the HA, E627K in the PB2, and H275Y in the neuraminidase (NA). In addition, 135 serum samples from vaccinated, recovered, asymptomatic contacts, and control individuals were tested using hemagglutination inhibition (HI) assay. D222G was detected in nasal samples from two severe cases. No specified mutations in the PB2 and NA were identified. Additional substitutions, I216V, V321I, E374K, S203T in HA, V655I in PB2, and I163V in NA, were detected. HI testing from vaccinated individuals, recovered patients, asymptomatic contacts, and control individuals showed that 97.9, 99.7, 88.2, and 44.2 % had HI titers ≥40, respectively. Molecular markers promoting influenza A(H1N1)pdm09 to become a pandemic virus are still under investigation. Serological results confirm that younger, un-exposed individuals are at increased risk of pandemic virus infections. Influenza A(H1N1)pdm09 viruses are still in circulation around the globe. Therefore, these viruses need to be monitored closely for development of new markers including antiviral resistance mutations.

The real-time reverse transcription polymerase chain reaction (rRT-PCR) technique has been used as the reference technique for the diagnosis of pandemic (H1N1)2009 virus infections. However, rapid influenza diagnostics tests (RIDTs) have been considered in the diagnosis of pandemic (H1N1)2009 by some healthcare institutions in Turkey due to their ease of use and generation of fast results. Nevertheless, their low sensitivity has caused concern during the control of the pandemic. This study aimed to determine the sensitivity of 4 different rapid tests available on the market in Turkey in the diagnosis of pandemic (H1N1)2009 infections compared to the reference rRT-PCR technique. One hundred and four patient samples that tested positive and 88 samples that tested negative for pandemic (H1N1)2009 by rRT-PCR were tested with RIDTs available on the market. The sensitivity of the rapid tests ranged from 31.7% to 50% depending on the brand of RIDT. Specificity ranged from 97.7% to 100%. Currently available RIDTs are not sensitive enough and could lead physicians to delay the treatment of patients, adversely affecting control efforts to mitigate the pandemic. Therefore, these tests should only be used for screening, and negative results should not rule out influenza. More sensitive and rapid point-of-care techniques are needed to meet the demands of point-of-care testing.

Monitoring the activity of influenza viruses is important for establishing the circulating types and for detection of the emergence of novel sub-types and antiviral resistant strains. This is the first report from Turkey on the surveillance and oseltamivir resistance of influenza viruses in 2007–2008. Five hundred twenty-four nasal swabs were tested from different geographical regions in Turkey during November 2007–April 2008. One hundred sixty-three (31%) samples were positive for influenza viruses of which 111 (68%) were influenza A, 52 (31%) influenza B using an immuno-capture ELISA. Forty isolates were selected at random from influenza A positive samples and grown in MDCK cell cultures. The supernatant of the cell cultures was used for RNA extraction followed by RT-PCR to detect the sub-types. Sub-typing revealed all samples as A/H1N1. The N1 gene segment of 30 A/H1N1 samples was sequenced in part, from the 201st to 365th residue, which included the critical region for oseltamivir resistance. Then resulting sequences were analyzed with oseltamivir sensitive and resistant strains obtained from National Center for Biotechnology Information (NCBI) GenBank by CLC Main Workbench Software. H275Y (H274Y according to N2 numbering) mutation, which is known to confer resistance to oseltamivir, was detected in 6 out of 30 (20%) H1N1 isolates from four cities (Istanbul, Bursa, Ankara, and Izmir). The D354G mutation was observed in all oseltamivir resistant H1N1 isolates but not in the oseltamivir sensitive isolates. Assay of neuraminidase activity revealed that these isolates were resistant to oseltamivir, but sensitive to zanamivir. J. Med. Virol. 81:1645–1651, 2009. © 2009 Wiley-Liss, Inc.

Influenza associated myositis has generally a clearly defined clinical picture. However, it may cause diagnostic confusion and unnecessary work up due to unfamiliarity with this condition by the medical staff. In this report, retrospective clinical and laboratory data about 10 children with influenza associated myositis diagnosed among all admissions to emergency room of a tertiary referral centre during the cold season of 2013-2014 was presented to increase awareness of this clinical issue. (Hong Kong j.emerg.med. 2016;23:186-191)

Following the declaration by the World Health Organization (WHO) of human cases of infection with a new influenza A(H1N1)v virus of swine origin, the Turkish Ministry of Health launched a case-based reporting of influenza A(H1N1)v throughout the country on 27 April 2009. The index case was detected on 15 May 2009. As of 17 July 2009 the number of laboratory-confirmed cases of influenza A(H1N1)v totaled 128 of whom 38 were indigenous cases.