Rotavirus infeksiyonları ve aşılar

Rotaviruslar, tüm dünyada 5 yaş altı çocuklarda görülen ishallerin, özellikle ağır gastroenteritin en önde gelen etkenidir. Rotaviruslar, her yıl 2 milyondan fazla hastane yatışına ve yaklaşık 600 bin ölüme sebep olmaktadır. Morbidite ve mortaliteye yol açmasının yanında, önemli bir ekonomik yüke de neden olmaktadır. Rotavirus ishalinin önlenmesinde tek yöntem rotavirus aşılamasıdır. İlk reassortant rotavirus aşısı, tetravalan maymun-insan reassortant rotavirus aşısı (RRTV, Rota-shield) ABD’de 1998’de ruhsat almıştır. Ancak, aşı ile invajinasyon arasında ilişki olduğu gerekçesiyle kısa bir süre içinde kullanımdan kaldırılmıştır. Sonraki yıllarda, iki yeni rotavirus aşısının [monovalan human rotavirus aşısı (HRV, Rotarix) ve pentavalan human-bovine reassortant rotavirus aşısı (PRV, RotaTeq)] etkinliği ve güvenirliliği yaklaşık 130,000 bebekte yapılan geniş çalışmalarla değerlendirilmiştir. Bu çalışmaların sonuçları, her iki yeni rotavirus aşısının, ishale, özellikle ciddi ishale karşı etkin ve güvenli bir korunma sağladığını göstermiştir. Rotavirus aşılarının, rotavirus olgularını (% 74), ağır olguları (% 98) ve hastane yatışlarını (% 96) azaltması beklenmektedir. Rotavirus aşıları ile invaginasyon riskinin artmadığı, gerek ruhsat öncesi çalışmalar, gerekse ruhsat aldıktan sonra yapılan surveyans çalışmaları ile gösterilmiştir. Günümüzde, bu iki yeni rotavirus aşısı ülkemizin de dahil olduğu 90’dan fazla ülkede lisans alarak kullanıma girmiştir. ABD yanında Venezüella, Brezilya, Panama, Meksika ve Avusturya gibi ülkelerde rutin aşı takvimine dahil edilmiştir. Dünya Sağlık Örgütü, rotavirus aşısının yapıldığı ülkelerde etkin ve güvenilir olduğunu rapor etmektedir. Aşı oral yolla 2 ve 4. ayda olmak üzere 2 dozda (HRV için) veya 2, 4 ve 6. ayda olmak üzere 3 dozda (PRV için) uygulanır. İlk doz bebek 6-12 haftalık iken uygulanmalı ve aşılamaya 12-14 haftadan sonra başlanılmamalıdır ve aşılama 24. haftadan (HRV için) veya 32. haftadan önce (HRV için) tamamlanmalıdır.

Anahtar Kelimeler:

Çocuk, Rotavirus enfeksiyonları, Aşılar, Rotavirus, Epidemiyoloji, Rotavirüs aşıları, Reassortant virüs

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1. Altındiş M, Yavru S, şimşek A, Özkul A, Çeri A, Koç H: Rotavirus infection in children with acute diarrhea as detected by latex agglutination, ELISA and polyacrylamide gel electrophoresis, Indian Pediatr 2004;41(6):590-4.

2. AAP: Prevention of Rotavirus Disease: Guidelines for Use of Rotavirus Vaccine. Committee on Infectious Diseases, Pediatrics 2007;119:171-82.

3. Bernstein DI, Sack DA, Rothstein E et al: Efficacy of live, attenuated, human rotavirus vaccine 89-12 in infants: a randomised placebo-controlled trial, Lancet 1999;354(9175):287-90.

4. Bernstein DI, Smith VE, Sander DS, Pax KA, Schiff GM, Ward RI: Evaluation of WC3 rotavirus vaccine and correlates of protection in healthy infants, J Infect Dis 1990;162(5):1055-62.

5. Bozdayı G, Doğan B, Dalgıç B et al: Diversity of human rotavirus G9 among children in Turkey, J Med Virol 2008;80(4):733-40.

6. Centers for Disease Control and Prevention: Postmarketing Monitoring of Intussusception after RotaTeq™ Vaccination – United States, February 1, 2006 – February 15, 2007, MMWR 2007;56:218-22.

7. Centers for Disease Control and Prevention: Press release of the February 21, (2006). http://www. cdc.gov/od/oc/media/pressrel/r060221.htm.

8. Ceyhan M, Kanra G, Yeniay I, Ciliv G, Vesikari T: Rotaviruses in infants with diarrhea studied by viral RNA electrophoresis in Ankara, Turkey, Turk J Pediatr 1987;29(3):145-9.

9. Clark HF, Burke CJ, Volkin DB et al: Safety, immunogenicity and efficacy in healthy infants of G1 and G2 human reassortant rotavirus vaccine in a new stabilizer/buffer liquid formulation, Pediatr Infect Dis J 2003;22(10):914-20.

10. Constenla D, O’Ryan M, Navarette MS, Antil L, Rheingans RD: Potential cost effectiveness of a rotavirus vaccine in Chile, Rev Med Chil 2006;134(6):679-88.

11. Cunliffe NA, Nakagomi O: A critical time for rotavirus vaccines: a review, Expert Rev Vaccines 2005;4(4):521-32.

12. Çataloluk O, Itturiza M, Gray J: Molecular characterization of rotaviruses circulating in the population in Turkey, Epidemiol Infect 2005;133(4):673-8.

13. Çiçek C, Karataş T, Altuğlu I, Koturoğlu G, Kurugöl Z, Bilgiç A: Comparison of elisa with shell vial cell culture method for the detection of human rotavirus in fecal specimens, New Microbiol 2007;30(2):113-8.

14. De Vos B, Vesikari T, Linhares AJ et al: A rotavirus vaccine for prophylaxis of infants against rotavirus gastroenteritis, Pediatr Infect Dis J 2004;23(Suppl 10):S179-82.

15. Desselberger U, Wolleswinkel-van den Bosh J, Mrukowicz J et al: Rotavirus types in Europe and their significance for vaccination, Pediatr Infect Dis J 2006;25(1 Suppl):30-41.

16. Friedland L: Developing a startegic roadmap for rotavirus vaccine introduction, World Vaccine Congress, Washington (2008).

17. Fu C, Wang M, Liang J, He T, Wang D, Xu J: Effectiveness of Lanzhou lamb rotavirus vaccine against rotavirus gastroenteritis requiring hospitalization: a matched case-control study, Vaccine 2007;25(52):8756-61.

18. Glass RI, Kilgore PE, Holman RC et al: The epidemiology of rotavirus diarrhoea in the United States: surveillance and of disease burden, J Infect Dis 1996;174(Suppl 1):5-11.

19. Goossens LM, Standaert B, Hartwig M, Hövels AM, Al MJ: The cost-utility of rotavirus vaccination with Rotarix (RIX4414) in the Netherlands, Vaccine 2008;26(8):1118-27.

20. Goveia MG, Rodriguez ZM, Dallas MJ et al: Safety and efficacy of the pentavalent human-bovine (WC3) reassortant rotavirus vaccine in healthy premature infants, Pediatr Infect Dis 2007;26(12):1099-104.

21. http://www.who.int/immunization_standards/ vaccinequality/pq_system/en/index.html).

22. Karadağ A, Açıkgöz ZC, Avcı Z et al: Childhood diarrhoea in Ankara, Turkey: epidemiological and clinical features of rotavirus-positive versus rotavirus-negative cases, Scand J Infect Dis 2005;37(4):269-75.

23. Kilbourne ED: Inactivated influenza vaccines, “Plotkin SA, Mortimer EA (eds): Vaccines” kitabı nda s.531-52, W.B. Saunders, Philadelphia(1999).

24. Kurugöl Z, Geylani S, Karaca Y et al: Rotavirus gastroenteritis among children under five years of age in izmir, Turkey, Türk J Pediatr 2003;45(4):290-4.

25. Lepage P: Rotavirus. Evidence for vaccination, Pediatr Infect Dis J 2008;27(1):1-2.

26. Linhares AC, Ruiz-Palacios GM, Guerrero ML et al: A short report on highlights of world-wide development of RIX4414: a Latin American experience, Vaccine 2006;24(18):3784-5.

27. Ministry of Health of Turkey: Burden of Disease, Final Report 2004, Refik Saydam Hygiene Center, School of Public Health, Ankara (2004).

28. Parashar UD, Gibson CJ, Bresee JS, Glass RI: Rotavirus and severe childhood diarrhea, Emerg Infect Dis 2006;12:304-6.

29. Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI: Global illness and deaths caused by rotavirus disease in children, Emerg Infect Dis 2003;9(5):565-72.

30. Rheingans RD, Costenla D, Antil L, Innis BL, Breuer T: Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries, Rev Panam Salud Publica 2007;21(4):205-16.

31. Rodriguez ZM, Goveia MG, Stek JE et al: Concomitant use of an oral live pentavalent human-bovine reassortant rotavirus vaccine with licensed parenteral pediatric vaccines in the United States, Pediatr Infect Dis J 2007;26(3):221-7.

32. Ruiz Palacios G, Perez Schael I, Velazquez FR et al: Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis, N Engl J Med 2006;354(1):11-22.

33. Salinas B, Perez Schael I, Linhares AC et al: Evaluation of safety, immunogenicity and efficacy of an attenuated rotavirus vaccine, RIX4414: A randomized, placebo-controlled trial in Latin American infants, Pediatr Infect Dis J 2005;24(9):807-16.

34. Saronio-Gabarro MS, Mrukowicz J, Vesikari T, Verstraeten T: Burden of rotavirus disease in European Union countries, Pediatr Infect Dis J 2006;25(Suppl 1):7-11.

35. Senturia YD, Peckham CS, Cordery M, Chrystie IA, Banatvala JE, André FE: Live attenuated oral rotavirus vaccine, Lancet 1987;2(8567):1091-2.

36. Steele D: Alternative upstream rotavirus vaccines, 7th International Rotavirus Symposium, Lisbon, 12-13 June (2006).

37. Velazquez FR, Matson DO, Calva JJ et al: Rotavirus infections in infants as protection against subsequent infections, N Engl J Med 1996;335(14):1022-8.

38. Velazquez FR, Matson DO, Guerrero ML et al: Serum antibody as a marker of protection against natural rotavirus infection and disease, J Infect Dis 2000;182(6):1602-9.

39. Vesikari T: Immune protection against rotavirus, 25th Annual Meeting of the European Society for Paediatric Infectious Diseases, Porto, 2-4 May(2007).

40. Vesikari T, Clark HF, Offit PA et al: Effects of the potency and composition of the multivalent human- bovine (WC3) reassortant rotavirus vaccine on efficacy, safety and immunogenicity in healthy infants, Vaccine 2006;24(22):4821-9.

41. Vesikari T, Giaquinto C, Huppertz HI: Clinical trials of rotavirus vaccines in Europe, Pediatr Infect Dis J 2006;25(Suppl 1):42-7.

42. Vesikari T, Karvonen A, Puustinen L et al: Efficacy of RIX4414 live attenuated human rotavirus vaccine in Finnish infants, Pediatr Infect Dis J 2004;23(10):937-43.

43. Vesikari T, Matson DO, Dennehy P et al: Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine, N Engl J Med 2006;354(1):23-40.

44. Ward RL, Bernstein DI: Protection against rotavirus disease after natural rotavirus infection. US Rotavirus Vaccine Efficacy Group, J Infect Dis 1994;169(4):900-4.

45. Widdowson MA, Meltzer MI, Zhang X, Bresee JS, Parashar UD, Glass RI: Cost-effectiveness and potential impact of rotavirus vaccination in the United States, Pediatrics 2007;119(4):684-97.

46. World Health Organization: State of the Art of New Vaccines Research and Development, WHO, Geneva, April (2003).