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    Multicenter hospital-based prospective surveillance study of bacterial agents causing meningitis and seroprevalence of different serogroups of Neisseria meningitidis, Haemophilus influenzae Type B, and Streptococcus pneumoniae during 2015 to 2018 in Turkey
    (American Society for Microbiology, 2020) Ceyhan, Mehmet; Özsürekçi, Yasemin; Başaranoglu, Sevgen Tanır; Gürler, Nezahat G.; Salı, Enes; Emiroglu, Melike; Öz, Fatma Nur; Belet, Nurşen M.; Duman, Murat; Ulusoy, Emel; Kurugöl, Zafer; Tezer, Hasan; Parlakay, Aslınur Özkaya; Dinleyici, Ener Cagri; Çelik, Ümit Sizmaz; Çelebi, Solmaz; Öner, Ahmet Faik; Solmaz, Mehmet Ali; Karbuz, Adem; Hatipoglu, Nevin; Devrim, İlker; Caglar, İlknur; Bozdemir, Şefika Elmas; Kocabaş, Emine; Gündeşli·oğlu, Özlem Özgür; Sütçü, Murat; Akcan, Özge Metin; Kuyucu, Necdet; Aktar, Fesih; Kara, Soner Sertan; Akışoğlu, Havva Özlem Altay; Tuygun, Nilden; Uslu, Zeynep Diyar Tamburaci; Öncel, Eda Karadag; Bayhan, Cihangül; Cengiz, Ali Bülent
    The etiology of bacterial meningitis in Turkey changed after the implementation of conjugated vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) in the Turkish National Immunization Program (NIP). Administration of Hib vaccine and PCV-7 (7-valent pneumococcal conjugate vaccine) was implemented in NIP in 2006 and 2009, respectively. In 2011, PCV-7 was replaced with PCV-13. Meningococcal vaccines have not yet been included in Turkish NIP. This prospective study comprised 27 hospitals located in seven regions of Turkey and represented 45% of the population. Children aged between 1 month and 18 years who were hospitalized with suspected meningitis were included. Cerebrospinal fluid (CSF) samples were collected, and bacterial identification was made according to the multiplex PCR assay results. During the study period, 994 children were hospitalized for suspected meningitis, and Hib (n = 3, 2.4%), S. pneumoniae (n = 33, 26.4%), and Neisseria meningitidis (n = 89, 71%) were detected in 125 samples. The most common meningococcal serogroup was MenB. Serogroup W comprised 13.9% (n = 5) and 7.5% (n = 4) of the meningococci in 2015 to 2016 and 2017 to 2018, respectively. Serogroup C was not detected. There were four deaths in the study; one was a pneumococcus case, and the others were serogroup B meningococcus cases. The epidemiology of meningococcal diseases has varied over time in Turkey. Differing from the previous surveillance periods, MenB was the most common serogroup in the 2015-to-2018 period. Meningococcal epidemiology is so dynamic that, for vaccination policies, close monitoring is crucial.
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    Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in Turkey: 2008–2014
    (Taylor and Francis Inc., 2016) Ceyhan, Mehmet; Özsürekçi, Yasemin; Gürler, Nezahat; Öksüz, Lütfiye; Aydemir, Şöhret; Özkan, Şengül; Akpolat, Nezahat
    Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008–2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008–2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008–2010 whereas was 37.6% in 2011–2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.
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    Serotype distribution of Streptococcus pneumoniain children with invasive disease in Turkey: 2015-2018
    (Taylor & Francis, 2020) Ceyhan, Mehmet; Aykaç, Kübra; Gürler, Nezahat; Özsürekçi, Yasemin; Öksüz, Lütfiye; Akisoğlu, Özlem Altay; Öz, Fatma Nur; Emiroğlu, Melike; TürkDağı, Hatice; Yaman, Akgün; Söyletir, Güner; Öztürk, Candan; Akpolat, Nezahat; Özakın, Cüneyt; Aydın, Faruk; Aydemir, Şöhret; Kiremitçi, Abdurrahman; Gültekin, Meral; Camcıoğlu, Yıldız; Zer, Yasemin; Güdücüoğlu, Hüseyin; Gülay, Zeynep; Birinci, Asuman; Arabacı, Çiğdem; Karbuz, Adem; Devrim, İlker; Sorguç, Yelda; Baysan, Betil Özhak; Öncel, Eda Karadağ; Yılmaz, Nisel; Altıntop, Yasemin Ay
    Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.