{"id":5011,"date":"2021-09-22T14:54:52","date_gmt":"2021-09-22T11:54:52","guid":{"rendered":"https:\/\/www.klimik.org.tr\/koronavirus\/?p=5011"},"modified":"2021-10-19T07:55:54","modified_gmt":"2021-10-19T04:55:54","slug":"klimik-covid-19-simpozyumu-10-12-eylul-2021-istanbul-sonuc-bildirgesi-yayimlandi","status":"publish","type":"post","link":"https:\/\/www.klimik.org.tr\/koronavirus\/klimik-covid-19-simpozyumu-10-12-eylul-2021-istanbul-sonuc-bildirgesi-yayimlandi\/","title":{"rendered":"KL\u0130M\u0130K COVID-19 Simpozyumu (10-12 Eyl\u00fcl 2021, \u0130stanbul) Sonu\u00e7 Bildirgesi"},"content":{"rendered":"

SARS-CoV-2\u2019nin kayna\u011f\u0131, mutasyonlar\u0131, varyantlar\u0131<\/em><\/strong><\/span><\/p>\n

Mevcut veriler, SARS CoV-2\u2019nin do\u011fadan, \u00f6zellikle yarasalardan kaynakland\u0131\u011f\u0131n\u0131, bir ara konak yoluyla veya direkt olarak yarasadan insana bula\u015ft\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrmektedir. Bu virusun insana bula\u015fabilme adaptasyonununda bir ara konak olup olmad\u0131\u011f\u0131, varsa bu ara kona\u011f\u0131n hangi hayvan oldu\u011fu hen\u00fcz bilinmemekte ve bunlar\u0131n tan\u0131mlanmas\u0131n\u0131n uzun y\u0131llar s\u00fcren \u00e7al\u0131\u015fmalar gerektirebilece\u011fi ifade edilmektedir. Yarasalardan direkt olarak insana ge\u00e7i\u015f olas\u0131l\u0131\u011f\u0131n\u0131n daha k\u00fc\u00e7\u00fck bir olas\u0131l\u0131k oldu\u011fu s\u00f6ylenmekle birlikte, insandan insana bula\u015fma yetene\u011fi kazan\u0131p pandemik hale gelmeden \u00f6nce, adaptasyon s\u00fcrecini insanlarda ge\u00e7irmi\u015f olabilece\u011fini ileri s\u00fcren ara\u015ft\u0131rmalar da bulunmaktad\u0131r. Laboratuvar kaynakl\u0131 bir virus oldu\u011fu veya biyolojik silah olarak \u00fcretildi\u011fi konusunda herhangi bir veri bulunmamaktad\u0131r.<\/p>\n

Virusun \u00e7o\u011falmas\u0131 s\u0131ras\u0131nda mutasyonlar olu\u015fmas\u0131 ve bu mutasyonlar\u0131n daha kolay bula\u015fan ya da daha a\u011f\u0131r hastal\u0131k olu\u015fturan varyantlar olu\u015fturabilmesi son derece do\u011fal bir s\u00fcre\u00e7tir. Salg\u0131n ba\u015flang\u0131c\u0131nda, do\u011frulama okumas\u0131\/ekson\u00fckleaz aktivitesi bulunmas\u0131 nedeniyle daha d\u00fc\u015f\u00fck bir mutasyon h\u0131z\u0131 olaca\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclen SARS CoV-2\u2019de bu s\u00fcre\u00e7 beklenenden daha h\u0131zl\u0131 olarak ger\u00e7ekle\u015fmektedir. Bunun en olas\u0131 nedeni virusun \u00e7ok say\u0131da insana, h\u0131zla yay\u0131lmas\u0131 olabilir. Virusun h\u0131zl\u0131 yay\u0131l\u0131m\u0131 devam etti\u011fi i\u00e7in yeni mutasyonlar\u0131n ve varyantlar\u0131n ortaya \u00e7\u0131kmaya devam etmesi beklenmektedir. COVID-19 pandemisinin kontrol alt\u0131na al\u0131nabilmesinde yeterli genomik s\u00fcrveyans sistemleriyle varyantlar\u0131n yak\u0131ndan takip edilmesi olduk\u00e7a \u00f6nemli hale gelmi\u015ftir. Ancak \u00fclkemizdeki genomik s\u00fcrveyans sisteminin ve analiz say\u0131lar\u0131n\u0131n yeterli olmad\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. Bu sistemlerin yeterli hale getirilebilmesi i\u00e7in var olan \u00fclke kaynaklar\u0131n\u0131n t\u00fcm\u00fcn\u00fcn kullan\u0131lmas\u0131, \u00fcniversitelerden destek al\u0131nmas\u0131 gereklidir.<\/p>\n

En son ortaya \u00e7\u0131kan ve \u015fu anda d\u00fcnyada en yayg\u0131n varyant haline gelen \u201cdelta\u201d, \u00f6zellikle S genindeki mutasyonlar\u0131yla furin kesilme alan\u0131nda ortaya \u00e7\u0131kan de\u011fi\u015fiklik sayesinde, konak h\u00fccrelerine orijinal su\u015f ve di\u011fer varyantlardan \u00e7ok daha h\u0131zl\u0131 girebilmekte, konak ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131ndan daha kolay ka\u00e7abilmektedir. Bu da virusun \u00e7o\u011falma katsay\u0131s\u0131n\u0131n (R0) orijinal su\u015ftan en az 2 kat daha y\u00fcksek ve neden oldu\u011fu hastal\u0131\u011f\u0131n da daha a\u011f\u0131r olmas\u0131yla sonu\u00e7lanm\u0131\u015ft\u0131r.<\/p>\n

Ocak 2021\u2019de Kolombiya\u2019da tan\u0131mlanm\u0131\u015f ve hen\u00fcz \u201cizlenen varyant\u201d kategorisinde olan \u201cmu\u201d varyant\u0131n\u0131nsa yay\u0131lma konusunda deltaya g\u00f6re daha avantajl\u0131 olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

G\u00fcn\u00fcm\u00fczde S-geni mutasyonlar\u0131 \u00e7ok iyi izlenip etkileri ara\u015ft\u0131r\u0131l\u0131yorken di\u011fer gen b\u00f6lgelerinde ya\u015fanan mutasyonlar ve bunlar\u0131n etkileri konusunda veri son derece azd\u0131r. Ayr\u0131ca virusun genetik yap\u0131s\u0131n\u0131 de\u011fi\u015ftirme yetene\u011finde mutasyonlardan daha etkili olabilecek bir di\u011fer olay re-kombinasyondur. Farkl\u0131 \u00f6zellikteki varyantlar\u0131n ayn\u0131 konakta infeksiyon yapmalar\u0131 ve bu s\u0131rada birbirinden genetik al\u0131\u015fveri\u015fte bulunmalar\u0131 olarak tan\u0131mlanan re-kombinasyon olay\u0131 virusun \u00e7ok h\u0131zla de\u011fi\u015fmesine neden olabilecektir. Bu nedenlerle virus yay\u0131l\u0131m\u0131 \u00f6nlenemezse \u00f6n\u00fcm\u00fczdeki aylarda yeni ve \u00e7ok daha farkl\u0131 \u00f6zellikleri olan SARS CoV-2 ile kar\u015f\u0131la\u015fma olas\u0131l\u0131\u011f\u0131 da bulunmaktad\u0131r.<\/p>\n

A\u015f\u0131lar\u0131n virusun evrimine olan etkisi tam olarak bilinmemektedir. A\u015f\u0131lar, \u00f6zellikle eksik a\u015f\u0131lama ile ortaya \u00e7\u0131kan imm\u00fcn e\u015fik baz\u0131 varyantlar\u0131n yay\u0131lmas\u0131 i\u00e7in uygun ortam yaratabilir. Fakat yayg\u0131n ve etkili bir a\u015f\u0131lama ile virusun yay\u0131l\u0131m\u0131n\u0131n \u00f6nlenmesi varyantlar\u0131n ortaya \u00e7\u0131k\u0131\u015f\u0131n\u0131 \u00f6nlemek i\u00e7in en etkili y\u00f6ntem olarak g\u00f6r\u00fcnmektedir.<\/p>\n

Virusun kayna\u011f\u0131, yay\u0131l\u0131m\u0131, hayvanlara bula\u015fmas\u0131 konusunda yeni veriler ortaya \u00e7\u0131kmaktad\u0131r. Kaplan, kediler, k\u00f6pekler, primatlar, geyikler gibi hayvanlara SARS CoV-2 bula\u015fabildi\u011fi g\u00f6sterilmi\u015ftir. Vizon \u00e7iftliklerinde hem vizonlara insanlardan hem de vizonlardan insana bula\u015fma olabilece\u011fi belirlenmi\u015ftir. Di\u011fer hayvanlardan insanlara bula\u015fma oldu\u011fu konusunda veri bulunmamaktad\u0131r.<\/p>\n

SARS-CoV-2 ile birlikte d\u00fcnyada ilk kez viral evrimin anl\u0131k takibi yap\u0131lmaktad\u0131r, bu durum bilim \u00e7evrelerinde heyecanla kar\u015f\u0131lanmaktad\u0131r.<\/p>\n

T\u00fcm bu bilgiler \u0131\u015f\u0131\u011f\u0131nda \u00f6n\u00fcm\u00fczdeki d\u00f6nemde hem SARS CoV-2 ile ilgili \u00e7al\u0131\u015fmalarda hem de olas\u0131 yeni etkenlerin belirlenmesinde ba\u015far\u0131l\u0131 olunabilmesi i\u00e7in do\u011fan\u0131n \u00f6nemini kavrayarak, multidisipliner, etkin bir ulusal takip sistemi kurulmas\u0131 ya\u015famsal \u00f6neme sahiptir.<\/p>\n

COVID-19 Salg\u0131n\u0131n\u0131n Y\u00f6netimi<\/em><\/strong><\/span><\/p>\n

Pandemi y\u00f6netiminin ba\u015far\u0131s\u0131 i\u00e7in \u015feffafl\u0131k ve g\u00fcven \u015fartt\u0131r. D\u00fcnyada pandemi y\u00f6netimi i\u00e7in yap\u0131lan uygulamalar ve ba\u015far\u0131l\u0131 \u00fclke \u00f6rnekleri g\u00f6zden ge\u00e7irildi\u011finde salg\u0131n kontrol\u00fcnde farkl\u0131 k\u0131s\u0131tlama yakla\u015f\u0131mlar\u0131n\u0131n (seyahat k\u0131s\u0131tlamalar\u0131, test zorunlulu\u011fu, i\u015fletmelerin kapat\u0131lmas\u0131 vb.) hepsinin farkl\u0131 \u00f6l\u00e7\u00fclerde katk\u0131s\u0131 bulundu\u011fu g\u00f6r\u00fclmektedir. Tek ba\u015f\u0131na uygulanan hi\u00e7bir yakla\u015f\u0131m istenen etkiyi g\u00f6stermemektedir. Verilerin g\u00fcn\u00fc g\u00fcn\u00fcne takip edilmesi, pandemi seyrinin yerel \u00f6zellikleri ve de\u011fi\u015fen ihtiya\u00e7lara g\u00f6re dinamik bir y\u00f6netim sergilenmesi ve kararlar\u0131n bilimsel veriler \u0131\u015f\u0131\u011f\u0131nda \u015fekillendirilerek toplumla payla\u015f\u0131lmas\u0131 ba\u015far\u0131y\u0131 art\u0131rmaktad\u0131r. Salg\u0131n kontrol\u00fc i\u00e7in al\u0131nan \u00f6nlemlerin toplum taraf\u0131ndan kabul g\u00f6rmesini etkileyen en \u00f6nemli fakt\u00f6r\u00fcn, var olan t\u00fcm verilerin b\u00fct\u00fcn detaylar\u0131yla birlikte a\u00e7\u0131k bir \u015fekilde bilim \u00e7evreleri ve toplumla payla\u015f\u0131lmas\u0131 oldu\u011fu anla\u015f\u0131lmaktad\u0131r. \u00dclkemizde verilerin a\u00e7\u0131k bir \u015fekilde payla\u015f\u0131lm\u0131yor olmas\u0131, salg\u0131n\u0131n y\u00f6netimi ve kontrol\u00fcne b\u00fcy\u00fck zarar vermi\u015ftir. Epidemiyoloji biliminin gereklerinin uygulanmas\u0131 ve salg\u0131na ili\u015fkin verilerin \u015feffaf ve g\u00fcncel bir \u015fekilde payla\u015f\u0131lmas\u0131, g\u00fcven ortam\u0131n\u0131n tesisi ba\u015far\u0131l\u0131 pandemi y\u00f6netimi i\u00e7in \u015fartt\u0131r. Bu nedenle Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 salg\u0131n y\u00f6netimi i\u00e7in gerekli verileri a\u00e7\u0131k ve d\u00fczenli bir \u015fekilde payla\u015fmal\u0131, verilerden yola \u00e7\u0131karak do\u011fru stratejiler geli\u015ftirilmesini sa\u011flamal\u0131d\u0131r.<\/p>\n

COVID-19\u2019un Klinik \u00d6zellikleri<\/em><\/strong><\/span><\/p>\n

COVID-19 sadece solunum sistemini etkileyen bir infeksiyon de\u011fildir. Solunum sistemi d\u0131\u015f\u0131nda kardiyovask\u00fcler sistem, sinir sistemi ba\u015fta olmak \u00fczere t\u00fcm sistemlerde sorun olu\u015fturabilen bir sistemik infeksiyondur. Bulgular, virusun direkt etkileri yan\u0131nda imm\u00fcn sistemin dengesiz yan\u0131t\u0131n\u0131n bir sonucu olarak ortaya \u00e7\u0131kmaktad\u0131r.\u00a0 Virusun h\u00fccreye giri\u015fi ve h\u00fccrede \u00e7o\u011falmas\u0131 s\u00fcre\u00e7lerindeki ayr\u0131nt\u0131lar b\u00fcy\u00fck \u00f6l\u00e7\u00fcde anla\u015f\u0131lm\u0131\u015f olsa da virusa geli\u015fen imm\u00fcn yan\u0131t ve bu yan\u0131t\u0131n sonu\u00e7lar\u0131 konusundaki veriler hen\u00fcz yeterli de\u011fildir.<\/p>\n

COVID-19\u2019un klinik olarak akut d\u00f6nemde \u00f6zellikle solunum yolu bulgular\u0131 \u00f6n planda olsa da bir\u00e7ok farkl\u0131 klinik tablo olu\u015fturabilece\u011fi anla\u015f\u0131lmaktad\u0131r. Hastal\u0131\u011f\u0131n akut seyri s\u0131ras\u0131nda \u00f6zellikle tromboembolik sorunlar, kardiyak komplikasyonlar s\u0131k olarak ortaya \u00e7\u0131kmaktad\u0131r. Kronik etkileri zaman ge\u00e7tik\u00e7e daha iyi anla\u015f\u0131lmaktad\u0131r. \u00d6zellikle a\u011f\u0131r COVID-19 ge\u00e7iren hastalarda olmak \u00fczere, hastalar\u0131n %-50-90\u2019\u0131nda \u201cuzam\u0131\u015f COVID-19\u201ddenilen ve aylar boyu s\u00fcren bulgular olu\u015ftu\u011fu; \u00f6zellikle ya\u015fl\u0131, risk fakt\u00f6rlerine sahip hastalarda kardiyovask\u00fcler sorunlar\u0131n \u00e7ok y\u00fcksek oranlarda beklenebilece\u011fi, n\u00f6ropsikiyatrik bulgular\u0131n-nedenleri tam olarak tan\u0131mlanamasa da \u00e7ok yayg\u0131n saptand\u0131\u011f\u0131 belirtilmektedir.\u00a0 Bu nedenle COVID-19 hastalar\u0131n\u0131n iyile\u015fme s\u00fcreci sonras\u0131 multidisipliner bir ekibin sorumlulu\u011funda olu\u015fturulacak polikliniklerde takipleri gerekmektedir.<\/p>\n

COVID-19\u2019un Tedavisi<\/em><\/strong><\/span><\/p>\n

G\u00fcn\u00fcm\u00fczde COVID-19 tedavisinde hastal\u0131\u011f\u0131n ilk 7-10 g\u00fcn\u00fcnde virusun kendisi veya konak h\u00fccredeki \u00e7o\u011falma s\u00fcre\u00e7leri; 7-10 g\u00fcnden sonraysa virusa kar\u015f\u0131 kona\u011f\u0131n verdi\u011fi dengesiz do\u011fal ba\u011f\u0131\u015f\u0131k yan\u0131t ve bunun sonucunda geli\u015fen sitokin f\u0131rt\u0131nas\u0131 ve koag\u00fclasyon sistemleri hedeflenmektedir.<\/p>\n

Virusun kendisini veya konak h\u00fccresinde \u00e7o\u011falmas\u0131n\u0131 inhibe etmek amac\u0131yla \u00e7al\u0131\u015f\u0131lm\u0131\u015f veya halen \u00e7al\u0131\u015fmas\u0131 devam eden \u00e7ok say\u0131da ila\u00e7 bulunmaktad\u0131r. Virus ve virusun h\u00fccrede \u00e7o\u011falma s\u00fcreci daha iyi anla\u015f\u0131ld\u0131k\u00e7a etkili olabilecek ba\u015fka ila\u00e7 \u00e7al\u0131\u015fmalar\u0131 da g\u00fcndeme gelmektedir. Bu ila\u00e7lar esas olarak SARS-CoV-2 proteinlerini hedefleyenler ve SARS-CoV-2\u2019nin konak h\u00fccresinde \u00e7o\u011falmas\u0131na yard\u0131m eden konak proteinlerini hedefleyenler olarak iki gruba ayr\u0131labilir.<\/p>\n

G\u00fcn\u00fcm\u00fczde SARS-CoV-2\u2019yi hedefleyen tedaviler i\u00e7inde etkinli\u011fi, mortaliteyi ve hastane yat\u0131\u015f\u0131n\u0131 azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015f olan tek tedavi SARSCoV-2\u2019ye \u00f6zg\u00fc monoklonal antikorlard\u0131r. Kan\u0131ta dayal\u0131 \u00f6neri sunan rehberlerde hastal\u0131\u011f\u0131 a\u011f\u0131r ge\u00e7irme riski bulunan ya\u015fl\u0131, komorbiditeleri olan ki\u015filerde veya gebelerde, hastal\u0131\u011f\u0131n ilk 10 g\u00fcn\u00fcnde olmak \u00fczere, bulunulan \u00fclkedeki varyantlara etkinli\u011fi g\u00f6sterilmi\u015f kasirivimab-imdevimab, sotrovimab veya bamlanivimab-etesevimab gibi monoklonal antikorlar\u0131n intraven\u00f6z veya subkutan yoldan verilmesi \u00f6nerilmektedir. Ek olarak COVID-19\u2019lu bir hastayla yak\u0131n temas\u0131 olan ve hastal\u0131\u011f\u0131 a\u011f\u0131r ge\u00e7irme riski y\u00fcksek ki\u015filerde de profilaktik olarak monoklonal antikorlar\u0131n ayn\u0131 \u015fekilde kullan\u0131lmas\u0131 \u00f6nerilmektedir. \u00dclkemizde hen\u00fcz bulunmayan ve kullan\u0131lamayan monoklonal antikorlara ula\u015f\u0131labilmesi, \u00f6zellikle riskli gruplarda \u00f6l\u00fcm oranlar\u0131n\u0131n azalt\u0131lmas\u0131na katk\u0131 sa\u011flayacakt\u0131r.<\/p>\n

Virusu hedefleyen tedavi olarak yeniden konumland\u0131r\u0131larak kullan\u0131lm\u0131\u015f olan favipiravir ve remdesivirinse belirgin bir etkinlikleri oldu\u011fu kan\u0131tlanamam\u0131\u015ft\u0131r.\u00a0 Favipiravirin COVID-19\u2019daki etkinli\u011fi konusunda \u015fu ana kadar yap\u0131lm\u0131\u015f \u00e7al\u0131\u015fmalar\u0131n \u00e7ok say\u0131da eksikleri bulunmaktad\u0131r; olgu say\u0131lar\u0131 d\u00fc\u015f\u00fckt\u00fcr, plasebo kontrol\u00fc yoktur, hasta gruplar\u0131 heterojendir, primer sonlan\u0131m noktalar\u0131 ilac\u0131n kesin etkili oldu\u011funu g\u00f6sterecek \u015fekilde tan\u0131mlanmam\u0131\u015ft\u0131r ve sonu\u00e7lar\u0131 \u00e7eli\u015fkilidir. \u0130ngiliz PRINCIPLE sisteminin ve ABD\u2019de sorumlu firman\u0131n yapt\u0131\u011f\u0131 faz 3 \u00e7al\u0131\u015fmas\u0131 (PRESECO) sonu\u00e7lar\u0131n\u0131n y\u0131l sonunda a\u00e7\u0131klanmas\u0131 beklenmektedir. \u00a0\u00dclkemizde favipiravirle ilgili olarak yap\u0131lm\u0131\u015f olan iki randomize kontroll\u00fc \u00e7al\u0131\u015fma (RCT)\u2019 n\u0131n sonu\u00e7lar\u0131n\u0131n bir an \u00f6nce yay\u0131mlanmas\u0131 \u00e7ok \u00f6nemli ve gereklidir. Bu \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131 a\u00e7\u0131klanana kadar favipiravirin tedavide her hastaya rutin olarak verilmemesi ancak sonu\u00e7lar\u0131n yak\u0131n takip edildi\u011fi klinik \u00e7al\u0131\u015fmalar kapsam\u0131nda kullan\u0131lmas\u0131 uygun olacakt\u0131r. Remdesivirin COVID-19\u2019daki etkinli\u011fi konusunda yap\u0131lm\u0131\u015f be\u015f adet RCT\u2019n\u0131n \u00f6nemli eksikli\u011fi yoktur, bu \u00e7al\u0131\u015fmalar\u0131n meta-analizleri COVID-19\u2019da mortaliteyi azalt\u0131c\u0131 bir etkisinin olmad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir, D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) remdesivirin COVID-19\u2019da kullan\u0131lmamas\u0131n\u0131 \u00f6nermektedir.<\/p>\n

SARS-CoV-2\u2019yi hedefleyenlerden RdRp inhibit\u00f6r\u00fc molnupiravir ve AT-527 ve proteaz inhibit\u00f6r\u00fc PF- 07321332\u2019nin; SARS-CoV-2 \u00e7o\u011falmas\u0131n\u0131 destekleyen konak sistemlerini hedefleyen MEK-1 ve 2 kinazlar\u0131n \u00f6zg\u00fcn inhibit\u00f6r\u00fc ATR-00\u2019\u0131n faz 2\/3 klinik \u00e7al\u0131\u015fmalar\u0131 devam etmekte olup, y\u0131l sonuna kadar sonu\u00e7lar\u0131n\u0131n a\u00e7\u0131klanmas\u0131 beklenmektedir.<\/p>\n

Virusa kar\u015f\u0131 kona\u011f\u0131n verdi\u011fi a\u015f\u0131r\u0131 do\u011fal ba\u011f\u0131\u015f\u0131k yan\u0131t ve bunun sonucunda geli\u015fen sitokin f\u0131rt\u0131nas\u0131 ve koag\u00fclasyonun hedeflendi\u011fi imm\u00fcn sistemin etkin oldu\u011fu d\u00f6nemde kullan\u0131lan ila\u00e7lar steroidler, sitokin inhibit\u00f6rleri ve antikoag\u00fclanlard\u0131r. Kortikosteroidlerin, hastal\u0131\u011f\u0131n ilk d\u00f6neminde kullan\u0131lmamas\u0131 \u00f6nerilirken, imm\u00fcn d\u00f6nemde ve d\u00fc\u015f\u00fck dozlarda [10 g\u00fcn s\u00fcreyle g\u00fcnde 6 mg deksametazon veya e\u015fde\u011feri di\u011fer steroidlerin\u00a0 (40 mg prednizolon veya 32 mg metilprednizolon)] kullan\u0131m\u0131n\u0131n mortaliteyi azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Ancak y\u00fcksek dozlarda uygulana steroid tedavisinin etkinli\u011fi ve g\u00fcvenli\u011fi konusunda yeterli kan\u0131t yoktur. \u00d6zellikle 500 mg, 1000 mg gibi \u00e7ok y\u00fcksek g\u00fcnl\u00fck dozlar\u0131n f\u0131rsat\u00e7\u0131 k\u00fcf infeksiyonlar\u0131n\u0131 art\u0131rmak gibi ciddi sonu\u00e7lar\u0131 olabilece\u011fi unutulmamal\u0131d\u0131r. \u0130mm\u00fcn sistem \u00fczerine etkili tosilizumab, barisitinib gibi anti-sitokin tedavilerin de do\u011fru zamanda uyguland\u0131\u011f\u0131nda a\u011f\u0131r hastal\u0131kta mortaliteyi azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.<\/p>\n

COVID-19 tedavi \u00e7al\u0131\u015fmalar\u0131nda uygulanan yakla\u015f\u0131mlar hastalar\u0131 hastal\u0131\u011f\u0131n \u015fiddetini \u00f6n plana alarak grupland\u0131rmakta ve buna g\u00f6re tedavi vererek kar\u015f\u0131la\u015ft\u0131rma yapmaktad\u0131r. Bu y\u00f6ntem pratik uygulama a\u00e7\u0131s\u0131ndan makul g\u00f6r\u00fcnse de sonu\u00e7lar\u0131n do\u011fru yorumlanabilmesi i\u00e7in hasta alt gruplar\u0131nda farkl\u0131la\u015fan ve hastaya \u00f6zel de\u011fi\u015fik uygulamalar\u0131 \u00f6n plana alan bir yakla\u015f\u0131m gereklili\u011fi ortaya \u00e7\u0131kmaktad\u0131r.<\/p>\n

Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019n\u0131n halen y\u00fcr\u00fcrl\u00fckte olan hasta y\u00f6netimi ve tedavi rehberleri g\u00fcn\u00fcm\u00fcz verileri dikkate al\u0131nd\u0131\u011f\u0131nda ge\u00e7erlili\u011fini yitirmi\u015f \u00f6neriler i\u00e7ermektedir. \u00d6zellikle yayg\u0131n favipirapir uygulanmas\u0131 ve \u00a0y\u00fcksek doz steroid \u00a0\u00f6nerileri yeni veriler \u0131\u015f\u0131\u011f\u0131nda yanl\u0131\u015f olarak de\u011ferlendirilebilecek durumdad\u0131r. Bu rehberler h\u0131zla yeniden ele al\u0131narak g\u00fcncellenmeli ya da kald\u0131r\u0131lmal\u0131d\u0131r.<\/p>\n

COVID-19 Pandemisinde Gereksiz Antibiyotik Kullan\u0131m\u0131 ve Hastane \u0130nfeksiyonlar\u0131<\/em><\/strong><\/span><\/p>\n

Gerekmedi\u011fi halde antibiyotik kullan\u0131m\u0131 COVID-19 konusunda t\u00fcm d\u00fcnyada ya\u015fanan di\u011fer bir \u00f6nemli sorun olarak g\u00fcndeme gelmektedir. Ayaktan ba\u015fvuran COVID-19 hastalar\u0131nda antibiyotik gerektiren bakteriyel infeksiyon birlikteli\u011fi (ko-infeksiyon)\u00a0 %5\u2019ten az olsa da bu olgularda antibiyotik ba\u015flanma oran\u0131 % 70 seviyesinde bulunmaktad\u0131r. Gereksiz antibiyotik kullan\u0131m\u0131 \u00fclkemizin zaten \u00f6nemli bir sorunu olan antibiyotik direnci sorununu ileride daha da \u00f6nemli bir sorun haline getirebilecektir. Gerekli olmayan antibiyotik kullan\u0131m\u0131n\u0131n pandeminin bu d\u00f6neminde t\u00fcm verilerin ortaya konuldu\u011fu ve deneyim kazan\u0131ld\u0131\u011f\u0131 halde devam ediyor olmas\u0131 d\u00fc\u015f\u00fcnd\u00fcr\u00fcc\u00fcd\u00fcr.<\/p>\n

Di\u011fer yandan yo\u011fun bak\u0131mda yat\u0131r\u0131larak mekanik ventilasyon tedavisi uygulanan COVID-19 hastalar\u0131nda nozokomiyal sekonder bakteriyel infeksiyonlar artan oranlarda saptanmaktad\u0131r. Hastal\u0131\u011f\u0131n kendisi d\u0131\u015f\u0131nda uygulanan invazif i\u015flemlerin \u00e7oklu\u011fu, infeksiyon kontrol\u00fcnde ya\u015fanan sorunlar ve ba\u015fta y\u00fcksek doz steroidler olmak \u00fczere imm\u00fcn sistemi etkileyen ila\u00e7lar\u0131n kullan\u0131m\u0131n\u0131n bu infeksiyonlar i\u00e7in yatk\u0131nl\u0131k yaratt\u0131klar\u0131 g\u00f6r\u00fclmektedir. \u00d6zellikle \u00f6l\u00fcmc\u00fcl sonu\u00e7lar\u0131 olabilen f\u0131rsat\u00e7\u0131 k\u00fcf infeksiyonlar\u0131 (aspergilloz, mukormikoz) bu hasta grubunda akla gelmeli ve tan\u0131 konusunda zorluklar oldu\u011fundan tan\u0131 i\u00e7in \u00f6zel gayret g\u00f6stermek gerekti\u011fi hat\u0131rda tutulmal\u0131d\u0131r.<\/p>\n

COVID-19 seyrinde ya\u015fanan sa\u011fl\u0131k hizmeti sunumu sorunlar\u0131 (yo\u011fun bak\u0131mlar\u0131n yo\u011funlu\u011fu, personel eksiklikleri, \u00e7al\u0131\u015fanlar\u0131n ya\u015fad\u0131\u011f\u0131 kayg\u0131, vb) da hastane infeksiyonlar\u0131nda art\u0131\u015f ile sonu\u00e7lanm\u0131\u015f, bir\u00e7ok merkezde diren\u00e7li bakterilerin neden oldu\u011fu salg\u0131nlar ortaya \u00e7\u0131km\u0131\u015ft\u0131r. Ayr\u0131ca pandemide el hijyenine uyumda uzun vadede ya\u015fanan sorunlar, izolasyon \u00f6nlemlerine uyumun aksamas\u0131 ve \u00f6zellikle k\u00f6t\u00fc eldiven kullan\u0131m\u0131 ile s\u00fcrveyans sorunlar\u0131 hastanede infeksiyon kontrol\u00fcn\u00fc son derece olumsuz etkilemi\u015ftir. Bir di\u011fer yandan en temel infeksiyon kontrol uygulamalar\u0131n\u0131n (el hijyeni, uygun eldiven kullan\u0131m\u0131, izolasyon) asl\u0131nda ne kadar \u00f6nemli ve etkili oldu\u011fu da deneyimle ortaya \u00e7\u0131km\u0131\u015ft\u0131r. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n infeksiyon kontrol \u00f6nlemlerine azami d\u00fczeyde uymas\u0131 i\u00e7in hastanelerde e\u011fitim ve motivasyon \u00e7al\u0131\u015fmalar\u0131na yeniden ba\u015flanmal\u0131, eleman, ekipman ve di\u011fer altyap\u0131 eksikleri tamamlanmal\u0131d\u0131r.<\/p>\n

COVID-19\u2019da Ba\u011f\u0131\u015f\u0131kl\u0131k ve A\u015f\u0131lar<\/em><\/strong><\/span><\/p>\n

COVID-19 ge\u00e7iren ki\u015filerin >%80 oran\u0131nda ve >6 ay yeni bir SARS-CoV-2 infeksiyonuna kar\u015f\u0131 korundu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Mevcut COVID-19 a\u015f\u0131lar\u0131n\u0131n da hem faz \u00e7al\u0131\u015fmalar\u0131nda, hem de ger\u00e7ek ya\u015fam verilerinde hastal\u0131\u011fa kar\u015f\u0131, a\u015f\u0131 t\u00fcr\u00fcne g\u00f6re de\u011fi\u015fmek \u00fczere %50-95 aras\u0131nda etkili oldu\u011fu saptanm\u0131\u015ft\u0131r. \u00dclkemizde ve t\u00fcm d\u00fcnyada bask\u0131n su\u015f haline gelmi\u015f delta varyant\u0131n\u0131n mevcut a\u015f\u0131lar\u0131n etkinli\u011finde, orijinal etkinliklerinden %10-20\u2019lik bir\u00a0 azalmaya yol a\u00e7t\u0131\u011f\u0131, ancak a\u011f\u0131r hastal\u0131\u011f\u0131 ve \u00f6l\u00fcm\u00fc azaltmak konusunda a\u015f\u0131lar\u0131n hepsinin b\u00fcy\u00fck oranda etkili olmaya devam etti\u011fi belirlenmi\u015ftir.<\/p>\n

\u015eu ana kadar yap\u0131lan \u00e7al\u0131\u015fmalarda hastal\u0131\u011f\u0131 ge\u00e7irerek veya a\u015f\u0131larla COVID-19\u2019a kar\u015f\u0131 korunmay\u0131 en iyi g\u00f6steren belirtecin, SARS-CoV-2\u2019ye \u00f6zg\u00fc n\u00f6tralizan antikor seviyesi oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.\u00a0 T lenfosit yan\u0131t\u0131n\u0131n hastal\u0131ktan korunmadaki rol\u00fc halen tam olarak bilinmemektedir. A\u015f\u0131lar\u0131n Faz-1-2-3 \u00e7al\u0131\u015fmalar\u0131 de\u011ferlendirildi\u011finde, ilk fazlarda belirlenen n\u00f6tralizan antikor titrelerinin, faz-3\u2019te belirlenen a\u015f\u0131 etkinli\u011fiyle do\u011fru orant\u0131l\u0131 oldu\u011fu belirlenmi\u015f, a\u015f\u0131 etkinli\u011fiyle ilgili bildirilen ger\u00e7ek ya\u015fam verileri de bu bilgileri desteklemi\u015ftir. Faz \u00e7al\u0131\u015fmalar\u0131nda, var olan COVID-19 a\u015f\u0131lar\u0131 i\u00e7inde en etkili n\u00f6tralizan antikor yan\u0131t\u0131n\u0131, pref\u00fczyon stabilize, mod mRNA a\u015f\u0131lar\u0131n\u0131n sa\u011flad\u0131\u011f\u0131; onlar\u0131n ard\u0131ndan adenovirus viral vekt\u00f6r a\u015f\u0131lar\u0131n\u0131n geldi\u011fi ve inaktive virus a\u015f\u0131lar\u0131n\u0131n n\u00f6tralizan antikor yan\u0131t\u0131n\u0131nsa konvalesan (hastal\u0131\u011f\u0131 ge\u00e7irmi\u015f) hastalar\u0131n serumuyla geli\u015fenden daha d\u00fc\u015f\u00fck oldu\u011fu saptanm\u0131\u015ft\u0131r.<\/p>\n

Yayg\u0131n COVID-19 A\u015f\u0131lamas\u0131 ve Sorunlar <\/em><\/strong><\/span><\/p>\n

Hastal\u0131\u011f\u0131n etkin ve kesin bir tedavisinin olmamas\u0131 ve yeni mutasyon olas\u0131l\u0131\u011f\u0131n\u0131n varl\u0131\u011f\u0131, pandeminin gidi\u015fini durdurmak i\u00e7in korunman\u0131n \u00f6n plana \u00e7\u0131kmas\u0131na neden olmaktad\u0131r. SARS-CoV-2\u2019nin bula\u015fmas\u0131n\u0131 engellemek i\u00e7in salg\u0131n\u0131n ba\u015f\u0131ndan beri uygulanan \u201cmaske-mesafe-hijyen\u201d \u00fc\u00e7l\u00fcs\u00fc ile birlikte elimizi g\u00fc\u00e7lendiren en \u00f6nemli silah a\u015f\u0131d\u0131r. COVID-19 i\u00e7in 1 y\u0131l gibi bir s\u00fcrede, gerek hastal\u0131\u011f\u0131, gerekse hastane yat\u0131\u015f\u0131 ve \u00f6l\u00fcm\u00fc engellemek konusunda son derece etkili ve g\u00fcvenli a\u015f\u0131lar geli\u015ftirilmi\u015ftir. Onlarca y\u0131ld\u0131r devam eden ara\u015ft\u0131rmalar\u0131n ve \u00e7al\u0131\u015fmalar\u0131n sonucu olan bu durum, modern t\u0131bb\u0131n tarihteki en b\u00fcy\u00fck ba\u015far\u0131lar\u0131ndan biri olarak de\u011ferlendirilmektedir. \u015eu ana kadar yakla\u015f\u0131k 10 ayda t\u00fcm d\u00fcnyada toplam 6 milyar doz uygulanm\u0131\u015f olan COVID-19 a\u015f\u0131lar\u0131 sayesinde y\u00fczbinlerce insan\u0131n hayat\u0131 kurtar\u0131lm\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde yayg\u0131n a\u015f\u0131lama yap\u0131lan \u00fclkelerde COVID-19 nedeniyle hayat\u0131n\u0131 kaybeden ki\u015filerin %90\u2019dan fazlas\u0131n\u0131 a\u015f\u0131s\u0131z veya a\u015f\u0131lar\u0131n\u0131 tamamlamam\u0131\u015f ki\u015filer olu\u015fturmaktad\u0131r.<\/p>\n

T\u00fcm d\u00fcnyan\u0131n a\u015f\u0131lara ula\u015fabilir olmas\u0131 ve kitlelerin en h\u0131zl\u0131 \u015fekilde a\u015f\u0131lanmas\u0131 pandemiden kurtulmak i\u00e7in bir zorunluluktur. Ancak yeterli a\u015f\u0131 \u00fcretiminin olmamas\u0131 ve d\u00fcnyan\u0131n her yerinde a\u015f\u0131ya ula\u015fmak i\u00e7in ayn\u0131 olanaklar\u0131n bulunmamas\u0131 a\u015f\u0131lmas\u0131 gereken \u00f6nemli bir sorundur. Bunun yan\u0131nda hi\u00e7bir bilimsel temeli olmayan a\u015f\u0131 kar\u015f\u0131tl\u0131\u011f\u0131\/a\u015f\u0131 teredd\u00fct\u00fc de sorunun ba\u015fka bir boyutudur. \u00dclkemizde de uygulanan inaktive virus ve mRNA a\u015f\u0131lar\u0131, hastal\u0131\u011f\u0131n a\u011f\u0131r ge\u00e7irilmesi ve mortalite \u00fczerine olduk\u00e7a etkili olup, bug\u00fcne kadar a\u015f\u0131 yap\u0131lmas\u0131na engel olu\u015fturacak ciddi bir yan etkileri tan\u0131mlanmam\u0131\u015ft\u0131r. \u00dclkemizde a\u015f\u0131lama h\u0131z\u0131n\u0131n azami \u015fekilde art\u0131r\u0131lmas\u0131 ve bunun i\u00e7in de toplumun bu konuda \u015feffaf verilerle do\u011fru olarak bilgilendirilmesi pandemiden \u00e7\u0131k\u0131\u015f i\u00e7in b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n

\u00dclkemizde \u015fu ana kadar toplam n\u00fcfus i\u00e7inde COVID-19\u2019a kar\u015f\u0131 a\u015f\u0131lananlar\u0131n oran\u0131 %50\u2019ye ula\u015fabilmi\u015ftir. Bu oran\u0131n, infeksiyonun yay\u0131l\u0131m\u0131n\u0131 durdurmak i\u00e7in hedeflenen %70-80\u2019lik orandan halen olduk\u00e7a d\u00fc\u015f\u00fck oldu\u011fu dikkati \u00e7ekmektedir.\u00a0 \u00dclkemizde a\u015f\u0131ya ula\u015f\u0131mda hi\u00e7bir sorun olmamas\u0131 ve yeterli a\u015f\u0131 bulunmas\u0131na ra\u011fmen hedeflenen oranlara ula\u015f\u0131lamamas\u0131n\u0131n \u00f6nemli bir nedeninin yanl\u0131\u015f bilgilendirmeden kaynaklanan a\u015f\u0131 teredd\u00fcd\u00fc oldu\u011fu d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015ft\u00fcr. Bu teredd\u00fcd\u00fcn giderilebilmesi i\u00e7in daha aktif bir m\u00fccadele y\u00fcr\u00fct\u00fclmesi, teredd\u00fct ya\u015fayan ki\u015filere g\u00fcven duyduklar\u0131 kanallardan ve anlayabilecekleri \u015fekilde do\u011fru bilgilerin sunulmas\u0131 en b\u00fcy\u00fck \u00f6ncelik olmal\u0131d\u0131r.<\/p>\n

D\u00fcnyada a\u015f\u0131 da\u011f\u0131l\u0131m\u0131n\u0131n e\u015fitsiz olmas\u0131 nedeniyle baz\u0131 \u00fclkelerde a\u015f\u0131lar\u0131n \u00e7ok az uygulanabilmi\u015f olmas\u0131, a\u015f\u0131 uygulamas\u0131n\u0131n h\u0131zla devam etti\u011fi \u00fclkelerdeyse toplumda infeksiyonun yay\u0131lmas\u0131n\u0131 durdurmak i\u00e7in gereken %70-80 oran\u0131nda a\u015f\u0131lama sa\u011flanamad\u0131\u011f\u0131 i\u00e7in infeksiyon t\u00fcm d\u00fcnyada h\u0131zla yay\u0131lmaya devam etmekte, bu da yeni varyantlar\u0131n ortaya \u00e7\u0131kmas\u0131n\u0131 kolayla\u015ft\u0131rmaktad\u0131r.<\/p>\n

Bu nedenle COVID-19\u2019un toplumda kontrol alt\u0131na al\u0131nabilmesi i\u00e7in, bir yandan h\u0131zla ve n\u00fcfusun %70-80\u2019ini a\u015f\u0131layacak \u015fekilde a\u015f\u0131lama \u00e7al\u0131\u015fmalar\u0131na devam edilirken, di\u011fer taraftan infeksiyonun toplumda yay\u0131lmas\u0131n\u0131 engelleyecek farmakolojik olmayan \u00f6nlemlerin (maske, mesafelenme, kalabal\u0131klar\u0131n azalt\u0131lmas\u0131 gibi) de uygulanmas\u0131 gerekmektedir.<\/p>\n

A\u011f\u0131r COVID-19 geli\u015fmesi a\u00e7\u0131s\u0131ndan risk grubu olan gebelerin \u00fclkemizde hastanede yatan hastalar i\u00e7indeki oranlar\u0131n\u0131n artt\u0131\u011f\u0131, \u00e7ok say\u0131da gebenin COVID-19 nedeniyle a\u011f\u0131r \u015fekilde hastaland\u0131\u011f\u0131 ve \u00f6nemli say\u0131da gebenin COVID-19 nedeniyle hayat\u0131n\u0131 kaybetti\u011fi \u00fcz\u00fcnt\u00fcyle izlenmektedir. \u00dclkemizde kullan\u0131lmakta olan COVID-19 a\u015f\u0131lar\u0131n\u0131n gebelerde de g\u00fcvenle kullan\u0131labilece\u011fi bilinmektedir. Hastalanan veya hayat\u0131n\u0131 kaybeden gebelerin b\u00fcy\u00fck oranda a\u015f\u0131s\u0131z oldu\u011fu dikkate al\u0131nd\u0131\u011f\u0131nda, \u00fclkemizde gebe a\u015f\u0131lamas\u0131n\u0131n art\u0131r\u0131lmas\u0131n\u0131n acil bir durum oldu\u011fu ve bu konuya \u00f6zel \u00f6nem verilmesi gerekti\u011fi a\u00e7\u0131k\u00e7a ortaya \u00e7\u0131kmaktad\u0131r.<\/p>\n

Eri\u015fkinlerde a\u015f\u0131lama oran\u0131n\u0131n artmas\u0131 ve delta varyant\u0131 gibi daha bula\u015f\u0131c\u0131 bir varyant\u0131n ortaya \u00e7\u0131kmas\u0131yla t\u00fcm d\u00fcnyada, hastalananlarda \u00e7ocuklar\u0131n oran\u0131 \u00f6nemli art\u0131\u015f g\u00f6stermi\u015f, hastalanan \u00e7ocuk say\u0131s\u0131n\u0131n artmas\u0131, COVID-19 nedeniyle hastaneye yat\u0131r\u0131lan ve hayat\u0131n\u0131 kaybeden \u00e7ocuk say\u0131s\u0131n\u0131n da art\u0131\u015f\u0131na yol a\u00e7m\u0131\u015ft\u0131r. Bu nedenle ba\u015fta Avrupa \u00fclkeleri ve ABD olmak \u00fczere \u00e7ocuklar\u0131n a\u015f\u0131lanmas\u0131na ba\u015flanm\u0131\u015ft\u0131r. \u015eu anda var olan mRNA a\u015f\u0131s\u0131na bir\u00e7ok \u00fclkede 12 ya\u015f ve \u00fczeri i\u00e7in, inaktive virus a\u015f\u0131s\u0131naysa \u00c7in\u2019de >3 ya\u015f i\u00e7in acil kullan\u0131m onay\u0131 verilmi\u015ftir. \u00dclkemizde de \u00e7ocuklar\u0131n toplam hasta say\u0131s\u0131 i\u00e7indeki oran\u0131n\u0131n artmas\u0131 nedeniyle \u226512 ya\u015f \u00e7ocuklara a\u015f\u0131 uygulanmas\u0131,\u00a0 gerek hastane yat\u0131\u015f\u0131n\u0131, gerekse \u00f6l\u00fcm say\u0131s\u0131n\u0131 azaltarak \u00e7ocuklar\u0131n yarar\u0131na olacakt\u0131r.<\/p>\n

COVID-19 A\u015f\u0131lamas\u0131nda Rapel Dozlar<\/span> <\/em><\/strong><\/span><\/p>\n

Rapel dozlarla, a\u015f\u0131 yan\u0131t\u0131 zay\u0131f olabilen ya\u015fl\u0131\/ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f ki\u015filerdeki ek dozlar kar\u0131\u015ft\u0131r\u0131lmamal\u0131d\u0131r. Gerek mRNA, gerekse inaktive virus a\u015f\u0131lar\u0131n\u0131n ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f ki\u015filerdeki etkinlikleri daha d\u00fc\u015f\u00fckt\u00fcr ve bu ki\u015filerde primer a\u015f\u0131lamada 2 doz yerine daha fazla doz kullan\u0131lmas\u0131 gerekmektedir. Rapel a\u015f\u0131 ise primer a\u015f\u0131lamadan sonra koruyuculu\u011fun azalmas\u0131yla nedeniyle yap\u0131lan hat\u0131rlat\u0131c\u0131 dozlard\u0131r. A\u015f\u0131yla elde edilen n\u00f6tralizan antikor yan\u0131tlar\u0131n\u0131n d\u00fc\u015fme h\u0131z\u0131na g\u00f6re, rapel a\u015f\u0131 gereksinimini \u00f6ng\u00f6rmek amac\u0131yla delta varyant\u0131ndan \u00f6nceki d\u00f6nemde yap\u0131lm\u0131\u015f \u00e7al\u0131\u015fmalarda, inaktive virus a\u015f\u0131lar\u0131yla a\u015f\u0131lanm\u0131\u015f ki\u015filerde 2.dozdan 3 ay sonra, mRNA a\u015f\u0131lar\u0131nda ise 9 ay sonra ek dozlara gereksinim olaca\u011f\u0131 \u00f6ng\u00f6r\u00fclm\u00fc\u015ft\u00fcr. D\u00fcnyada hen\u00fcz bir doz a\u015f\u0131ya bile ula\u015famam\u0131\u015f ve a\u011f\u0131r hastal\u0131k a\u00e7\u0131s\u0131ndan risk grubunda bulunan \u00e7ok say\u0131da insan\u0131n bulundu\u011fu dikkate al\u0131nd\u0131\u011f\u0131nda DS\u00d6 rapel a\u015f\u0131 dozlar\u0131n\u0131n yap\u0131lmamas\u0131 i\u00e7in t\u00fcm d\u00fcnyaya \u00e7a\u011fr\u0131da bulunmu\u015ftur. Ancak kullan\u0131lan a\u015f\u0131ya g\u00f6re de\u011fi\u015fmek \u00fczere a\u015f\u0131dan belli bir s\u00fcre ge\u00e7tikten sonra azalan ba\u011f\u0131\u015f\u0131kl\u0131k nedeniyle a\u015f\u0131l\u0131 ki\u015filerde hastal\u0131k oranlar\u0131n\u0131n artmas\u0131 nedeniyle \u00fclkemizin de i\u00e7inde oldu\u011fu bir\u00e7ok \u00fclke, hastal\u0131k riski y\u00fcksek oldu\u011fu i\u00e7in sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na ve a\u011f\u0131r hastal\u0131k riski y\u00fcksek oldu\u011fu i\u00e7in >50 ya\u015f ve komorbiditeleri olan ki\u015filere ek doz uygulamas\u0131na ba\u015flam\u0131\u015ft\u0131r. Mevcut veriler de\u011ferlendirildi\u011finde, \u00fclkemizde ya\u015fl\u0131lar veya ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f ki\u015filerde, ba\u011f\u0131\u015f\u0131k yan\u0131tlar\u0131n\u0131n daha zay\u0131f olmas\u0131 nedeniyle daha imm\u00fcnojen oldu\u011fu g\u00f6sterilmi\u015f mRNA a\u015f\u0131s\u0131n\u0131n kullan\u0131lmas\u0131 ak\u0131lc\u0131d\u0131r. Bu ki\u015filerin ve sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n primer a\u015f\u0131lamas\u0131n\u0131n inaktive virus a\u015f\u0131s\u0131yla yap\u0131lm\u0131\u015f olmas\u0131 halinde, 2. a\u015f\u0131dan 3 ay sonra bir doz mRNA a\u015f\u0131s\u0131 yap\u0131lmas\u0131, hem heterolog a\u015f\u0131laman\u0131n daha iyi bir ba\u011f\u0131\u015f\u0131k yan\u0131t olu\u015fturmas\u0131, hem de mRNA a\u015f\u0131s\u0131n\u0131n daha imm\u00fcnojen olmas\u0131 nedeniyle tercih edilmelidir. Primer a\u015f\u0131lamas\u0131 2 doz mRNA a\u015f\u0131s\u0131yla yap\u0131lan ki\u015filerde rapel dozlar\u0131n ne kadar s\u00fcre sonra gerekece\u011fi konusunda var olan yay\u0131nlar ve ger\u00e7ek ya\u015fam verileri incelendi\u011finde, \u00f6zellikle >65 ya\u015fta ve ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f ki\u015filerde 6. aydan sonra ek dozlar\u0131n gerekebilece\u011fi g\u00f6r\u00fclmektedir.<\/p>\n

COVID-19 ve Sa\u011fl\u0131k \u00c7al\u0131\u015fanlar\u0131<\/em><\/strong><\/span><\/p>\n

\u0130\u00e7inde bulundu\u011fumuz 2021 y\u0131l\u0131 sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n y\u0131l\u0131 olarak tan\u0131mlanm\u0131\u015ft\u0131r. Pandemi ba\u015flang\u0131c\u0131ndan beri \u00fclkemizde en az 460 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 COVID-19 nedeniyle hayat\u0131n\u0131 kaybetmi\u015ftir. Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na \u015fiddet halen devam etmektedir. Bu olumsuz fakt\u00f6rlere artan i\u015f y\u00fck\u00fc ve pandeminin bir t\u00fcrl\u00fc kontrol alt\u0131na al\u0131namamas\u0131n\u0131n getirdi\u011fi \u00fcmitsizlik eklenmi\u015ftir. Simpozyum s\u0131ras\u0131nda derne\u011fimiz \u00fcyesi infeksiyon hastal\u0131klar\u0131 ve klinik mikrobiyoloji uzmanlar\u0131 bu olumsuz ko\u015fullara ra\u011fmen pandemi bitene kadar var g\u00fc\u00e7leriyle \u00e7al\u0131\u015fmaya devam etme kararl\u0131l\u0131\u011f\u0131nda olduklar\u0131n\u0131 ifade etmi\u015flerdir. Ancak idarecilerden pandemiyi bilimsel yakla\u015f\u0131mla y\u00f6netmelerini ve konunun uzman\u0131 olarak \u00f6nerilerinin dikkate al\u0131nmas\u0131n\u0131 beklemektedirler.<\/p>\n

COVID-19 ve Bilimsel \u00c7al\u0131\u015fmalar<\/em><\/strong><\/span><\/p>\n

T\u00fcrkiye d\u00fcnyada en \u00e7ok olgu g\u00f6r\u00fclen \u00fclkelerden biri olmas\u0131na ve g\u00fc\u00e7l\u00fc bir infeksiyon hastal\u0131klar\u0131 ve klinik mikrobiyoloji birikimi ve bilim gelene\u011fi olmas\u0131na ra\u011fmen d\u00fcnya literat\u00fcr\u00fcne istenilen d\u00fczeyde bilimsel katk\u0131da bulunamamaktad\u0131r. Bu durumun en ba\u015fta gelen sebebi salg\u0131n\u0131n ba\u015f\u0131ndan itibaren Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan \u00e7ok merkezli \u00e7al\u0131\u015fmalar i\u00e7in izin alma zorunlulu\u011fu getirilmi\u015f olmas\u0131d\u0131r. Daha \u00f6nce di\u011fer uzmanl\u0131k dernekleriyle birlikte yapt\u0131\u011f\u0131m\u0131z a\u00e7\u0131klamalarda belirtti\u011fimiz gibi bu zorunluluk bir an \u00f6nce kald\u0131r\u0131lmal\u0131 ve \u00fclkemizin bilimsel \u00fcretim alan\u0131nda \u00f6n\u00fc a\u00e7\u0131lmal\u0131d\u0131r.<\/p>\n

\u00d6zet olarak;<\/span><\/span> yakla\u015f\u0131k 2 y\u0131ld\u0131r devam eden COVID-19 pandemisiyle ilgili olarak, 10-12 Eyl\u00fcl 2021 tarihlerinde d\u00fczenlemi\u015f oldu\u011fumuz simpozyumda g\u00fcncel bilimsel veriler ve deneyimleri g\u00f6zden ge\u00e7irip tart\u0131\u015farak \u015fu sonu\u00e7lar\u0131 \u00e7\u0131karm\u0131\u015f bulunuyoruz:<\/span><\/strong><\/p>\n

\u00a01.\u00a0 Varyantlar\u0131n ve yeni zoonotik viruslar\u0131n izlenmesi i\u00e7in bir s\u00fcrveyans sistemi kurulmal\u0131, bu ama\u00e7la \u00fcniversitelerin olanaklar\u0131 de\u011ferlendirilmeli ve etkin bir bilimsel a\u011f olu\u015fturulmal\u0131d\u0131r.<\/strong><\/span><\/p>\n

\u00a02.\u00a0 Tedavi rehberi g\u00fcncellenmeli, g\u00fcncel bilimsel verilerle desteklenmeyen \u00f6neriler kald\u0131r\u0131lmal\u0131d\u0131r. \u00d6l\u00fcm\u00fc azaltmada etkili oldu\u011fu bildirilen monoklonal antikor tedavilerine, \u00f6zellikle riskli gruplar i\u00e7in olmak \u00fczere, \u00fclkemizde de eri\u015fim sa\u011flanmal\u0131d\u0131r.<\/strong><\/span><\/p>\n

\u00a03.\u00a0 Gereksiz antibiyotik, antikoag\u00fclan ve y\u00fcksek doz kortikosteroid kullan\u0131m\u0131 \u00f6nlenmelidir.<\/strong><\/span><\/p>\n

\u00a04.\u00a0 A\u015f\u0131lar\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 sa\u011flanmal\u0131 ve a\u015f\u0131lanma oran\u0131 \u00fclke genelinde h\u0131zla art\u0131r\u0131lmal\u0131d\u0131r. SA\u011eLIK VE E\u011e\u0130T\u0130M SEKT\u00d6R\u00dcNDE \u00c7ALI\u015eANLARA A\u015eI ZORUNLULU\u011eU GET\u0130R\u0130LMEL\u0130D\u0130R.<\/strong><\/span><\/p>\n

\u00a05.\u00a0 Gebelerin a\u015f\u0131lanmas\u0131 i\u00e7in acil \u00f6nlemler al\u0131nmal\u0131d\u0131r.<\/strong><\/span><\/p>\n

\u00a06.\u00a0 A\u015f\u0131 teredd\u00fcd\u00fc ya\u015fayan ki\u015filere, daha aktif bir \u015fekilde, etkili, do\u011fru bilgilendirme yap\u0131lmal\u0131d\u0131r.<\/strong><\/span><\/p>\n

\u00a07.\u00a0 A\u015f\u0131lama \u00e7al\u0131\u015fmalar\u0131 devam ederken toplumda infeksiyonun yay\u0131lmas\u0131n\u0131 azaltacak di\u011fer \u00f6nlemlere devam edilmelidir.<\/strong><\/span><\/p>\n

\u00a08.\u00a0 Salg\u0131nla ilgili veriler d\u00fczenli ve s\u0131k aral\u0131klarla, \u015feffaf bir \u015fekilde payla\u015f\u0131lmal\u0131d\u0131r. Verilerden \u00f6\u011frenerek strateji geli\u015ftirme yakla\u015f\u0131m\u0131 yerle\u015ftirilmelidir.<\/strong><\/span><\/p>\n

\u00a09.\u00a0 Bilimsel \u00e7al\u0131\u015fmalar i\u00e7in getirilen ek k\u0131s\u0131tlar acilen kald\u0131r\u0131lmal\u0131d\u0131r.<\/strong><\/span><\/p>\n

\u00a010.\u00a0 Pandeminin ba\u015f\u0131ndan beri var g\u00fc\u00e7leriyle \u00e7al\u0131\u015fmakta olan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n \u00e7al\u0131\u015fma ko\u015fullar\u0131 iyile\u015ftirilmeli, g\u00fcvenli \u00e7al\u0131\u015fma ortamlar\u0131 sa\u011flanmal\u0131, meslek \u00f6rg\u00fctleri arac\u0131l\u0131\u011f\u0131yla ilettikleri g\u00f6r\u00fc\u015f ve \u00f6nerilere kulak verilmelidir.<\/strong><\/span><\/p>\n

\"\"<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

SARS-CoV-2\u2019nin kayna\u011f\u0131, mutasyonlar\u0131, varyantlar\u0131 Mevcut veriler, SARS CoV-2\u2019nin do\u011fadan, \u00f6zellikle yarasalardan kaynakland\u0131\u011f\u0131n\u0131, bir ara konak yoluyla veya direkt olarak yarasadan insana bula\u015ft\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrmektedir. Bu virusun insana bula\u015fabilme adaptasyonununda bir ara konak olup olmad\u0131\u011f\u0131, varsa bu ara kona\u011f\u0131n hangi hayvan oldu\u011fu hen\u00fcz bilinmemekte ve bunlar\u0131n tan\u0131mlanmas\u0131n\u0131n uzun y\u0131llar s\u00fcren \u00e7al\u0131\u015fmalar gerektirebilece\u011fi ifade edilmektedir. Yarasalardan direkt olarak insana ge\u00e7i\u015f olas\u0131l\u0131\u011f\u0131n\u0131n daha k\u00fc\u00e7\u00fck bir olas\u0131l\u0131k oldu\u011fu s\u00f6ylenmekle birlikte, insandan insana bula\u015fma yetene\u011fi kazan\u0131p pandemik hale gelmeden \u00f6nce, adaptasyon s\u00fcrecini insanlarda ge\u00e7irmi\u015f olabilece\u011fini ileri s\u00fcren ara\u015ft\u0131rmalar da bulunmaktad\u0131r. Laboratuvar kaynakl\u0131 bir virus oldu\u011fu veya biyolojik silah olarak \u00fcretildi\u011fi konusunda herhangi bir veri bulunmamaktad\u0131r. Virusun […]<\/p>\n","protected":false},"author":4,"featured_media":5020,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[5],"tags":[],"_links":{"self":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/5011"}],"collection":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/comments?post=5011"}],"version-history":[{"count":5,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/5011\/revisions"}],"predecessor-version":[{"id":5016,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/posts\/5011\/revisions\/5016"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/media\/5020"}],"wp:attachment":[{"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/media?parent=5011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/categories?post=5011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimik.org.tr\/koronavirus\/wp-json\/wp\/v2\/tags?post=5011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}