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Son günlerde gündem konusu olan Domuz Gribi ile ilgili Eczacıbaşı Holding İşyeri Sağlık Birimi’ nin hazırlamış olduğu mail’i sizlerle paylaşmak istedim.

Herkese sağlıklı günler dileğimle ,
Kevser AYDIN


Pandemik Grip
(Yeni İnfluenza A / (H1N1)v)


Yeni İnfluenza A (H1N1)v Gribi nedir ?

—Yeni İnfluenza A (H1N1)v tipi virüsten kaynaklanan, insanlarda hastalığa yol açan viral bir hastalıktır. Pandemik (salgın yapan) Grip’de denmektedir.
—Hastalık ilk kez Meksika’da sonra ABD’de (Nisan 2009) görülmüş ve daha sonra birçok ülkeye yayılmıştır.
—Alarm düzeyini Dünya Sağlık Örgütü (DSÖ) Pandemik Faz 6 olarak açıklamıştır. (11 Haziran 2009)
—Virüs, halen dünyanın bütün bölgelerinde görülmektedir

Virüsün Yapısı

Bu virüse “ domuz gribi” denmesinin sebebi, domuzlar arasında görülen grip virüslerine çok benzediğinin gösterilmiş olmasıdır. Bu yeni virüs insan, domuz ve kuş virüslerinin bir karışımıdır ve yeni bazı özelliklere sahiptir.

Mevsimsel Grip / Pandemik Grip Arasındaki Farklar ;

—Hastaneye yatışlarda farklı bir yaş dağılımı var.
—İleri yaşlarda daha az vaka. (> 60 yaş)
—Daha önceden sağlıklı olan, genç erişkin ve çocuklarda ağır hastalık ve ölümler daha fazladır.

Hastalığın Bazı Klinik Özellikleri

—En çok 5 - 45 yaş aralığında görülür.
—Beklenen grip mevsiminin dışında da süren bulaş ve viral dolaşımı vardır.
—Etkin ve hızlı insandan insana bulaşma görülmektedir.
—Hastalık spektrumu ateşsiz, hafif üst solunum yolu hastalığından ağır hatta ölümcül zatürreye kadar değişmektedir.

Hastalığın Bazı Klinik Özellikleri

—Hastaneye yatırılan hastalarda daha çok, alt solunum yolu hastalığı görülmektedir.
—Eşlik eden ikincil enfeksiyonlar olabilmektedir.
—Ortalama hastanede yatış süresi 5 - 7 gündür.
—Hastalık hamilelerde daha ağır seyretmektedir.


—Yeni İnfluenza A/(H1N1)v virüsü bulaşıcıdır ve insandan insana kolaylıkla geçebilmektedir.
—Yeni İnfluenza A/(H1N1)v’ de mevsimsel grip etkenleri gibi bulaşmaktadır.
——Kişiden kişiye genellikle öksürme, aksırma esnasında ortama yayılan ve virüs içeren damlacıklarla bulaşır.
Bu damlacıklar, vücuda direkt solunum yolu ile alınabileceği gibi ortamdaki kapı kolu, masa, sandalye, telefon, elektrik düğmesi v.b. gibi cansız yüzeylerden eller vasıtasıyla da alınabilir.
Tokalaşma, öpüşme, sarılma v.b. yakın temasla da bulaşma olmaktadır
—İçme, kullanma ve havuz sularıyla herhangi bir bulaşma gösterilmemiştir.

Bulaşmayı önlemek için ne yapmalı ?

—Virüsün iş ortamında masa, sandalye v.b. yüzeylerdeki canlılığını ortamın ısısı, nem oranı ve temizlenme sıklığı etkiler. Buraların sık sık temizlenmesi ve ellerin sık sık yıkanması, bulaşma riskini de en aza indirecektir.
—Öksürme ve hapşırma sırasında ağız ve burundan ortama damlacıklar yayılır. Bunlar yaklaşık 1.5 metre içinde ki diğer insanlarca soluk yolu ile alınabilir. Yayılmayı önlemek için, ağız ve burnun bir mendil ile kapatılması iyi olur. Yok ise ağız kol ile kapatılmalıdır.
—Öksürdükten ve hapşırdıktan sonra eller bol sabun ve suyla yıkanmalıdır. Alkol içeren el yıkama antiseptikleri de kullanılabilinir.
—Kirli ellerle, gözlere, burna ve ağza dokunulmamalıdır. Kağıt mendil kullanılmalıdır
—Eller sık sık, en az 15-20 saniye süreyle su ve sabunla yıkanmalıdır.
—Su ve sabuna ulaşılamayan yerlerde (sokakta, toplu taşıma araçlarında,AVM’lerde v.b.) alkol içeren el antiseptikleri dezenfektanları kullanabilinir.
—Hastalık tanısı konulursa, belirtilerin başlamasından 7 gün sonrasına ya da belirtilerin tamamen geçmesinden bir gün sonrasına kadar evde istirahat edilmelidir.
—Hastalığın bulaşmaması için çevredeki kişilerden uzak durulmalıdır.
—Bulunulan mekan sık, sık havalandırılmalıdır.
—Hasta insanlar, belirtilerin başlamasından bir gün öncesi ve 7 gün sonrasına kadar bulaştırıcıdırlar. Bu süre boyunca temas sınırlandırılmalıdır.
—Gereklilik halinde maske (cerrahi maske) takılmalıdır.

Belirtileri nelerdir ?

Bu gribin belirtileri, insanlarda görülen mevsimsel grip belirtilerine benzerdir.
1.Ateş (38 derece ve üstü)
3.Boğaz ağrısı,
4.Yaygın vücut ağrısı,
5.Baş ağrısı,
6.Üşüme - titreme
7.Yorgunluk, halsizlik hissi
8.Kusma ve ishal görülebilmektedir

Acil Durumlar

—Erişkinlerde acil müdahale gerektiren belirtiler nelerdir?
—Nefes darlığı veya zor nefes almak
—Bilinç bulanıklığı
—Sık ve uzun süreli kusma
—Çocuklardaki acil müdahale gerektiren belirtiler nelerdir?
—Hızlı veya zor nefes alma
—Vücutta solgunluk ya da morarma
—Uyarılara cevapta azalma ve uykuya meyil
—Ateşle beraber döküntü görülmesi

Tanı Koyma

—Yeni İnfluenza A (H1N1)v’in laboratuar teyidi vakaya yaklaşım, antiviral tedavi ve gereksiz antibiyotik kullanımının önlenmesi açısından önemlidir !
—Gerçek zamanlı PCR (Polymerase Chain Reaction-polimeraz zincir reaksiyonu) testi en önemli tanı aracıdır.


Genel Tedavi Prensipleri :

—Antibiyotikler profilaksi amacıyla kullanılmamalı
—Vakaların çoğunda hastane yatışı ya da antiviral tedavi gerekmemektedir. —Destekleyici tedavi: Ateş düşürücü - ağrı kesici, sıvı alımının artırılması ve dinlenme önerilmektedir.
—Hamileler, hem mevsimsel, hem H5N1 (kuş gribi) hem de pandemik grip için yüksek risk grubu.
—Yatan hastada yakın gözlem ve erken antiviral tedavi öneriliyor.

İlaç Tedavisi;

—Özellikle kullanılması gereken gruplar;
1.Hamile kadınlar.
2.Hastalığı hızla ve şiddetli olarak ilerleyenler.
3.Pnömonisi olan/gelişen kişiler.
4.Altta yatan başka hastalıkları olanlar
—Yeni İnfluenza A (H1N1)v virüsü halen,
1.Oseltamivir ve zanamivire duyarlıdır.
2.Amantadin ve rimantadine dirençlidir.—Klinik etkinlik sonuçlarını gösteren veriler henüz yoktur !!!
—Oseltamivir ve zanamivir hastalığın şiddet ve süresini azaltıp ilerlemesini ve ölümleri engelleyebilir.
DSÖ İlaç Tedavisi Önerileri;
—Ciddi veya komplikasyonlu vakaların tedavisinde;
—Tercihan oseltamivir, alternatif olarak zanamivir kullanılır.
—Tedavi mümkün olduğunca erken başlanmalı, fakat herhangi bir zamanda da başlanabilir.
—Hamile ve yenidoğan dahil olmak üzere bütün hastalarda başlanabilir
—Yüksek riskli hastaların hafif veya komplikasyonsuz tedavisinde;
Oseltamivir veya zanamivir kullanılabilinir.
—Önceden sağlıklı, hafif veya komplikasyonsuz hastaların tedavisi için antiviral kullanımı gereksiz.
—Kemoprofilaksi önerilmez.

Aşı Tedavisi

—Aşı hazırlama çalışmaları tamamlanmış ve aşı üretimi çalışmalarına başlanmıştır.
—Mevsimsel Grip için hazırlanmış olan ve uygulanan aşılardan farklıdır.
—Sadece Yeni İnfluenza A /Californiya/2009/(H1N1)v adı verilen ve pandemik Grip yapması beklenen virüse etkili olacak bir aşıdır.

—Çin’de üretilen ilk domuz gribi (A-H1N1) aşısının denemesi başarılı oldu.
—Avustralya'da domuz gribi aşısı vurulmaya başlandı.

Türkiye’de Durum

1.Sağlık Bakanlığı 6. faz çalışmalarını yapıyor.
2.Türkiye afet planı içerisinde Pandemi planlaması yapıldı. İl koordinatörlükleri oluşturuldu.
3.İlaç stokları ve aşılar Sağlık Bakanlığınca takip (depolanması ve takibi)ediliyor.
4.Türkiye yaklaşık 26 milyon doz aşı alacak.(Yeni İnfluenza A /(H1N1)v virüsüne karşı hazırlanan aşıdan)
Türkiye’de Vaka sayısı (1 Eylül 2009)—Pandemik grip vaka sayısı toplam 423 e ulaşmıştır. Bu vakaların 137 si yerli vakadır.
—Halen 18 vaka ayaktan 2 vaka ise hastanede takip edilmektedir.

Dünya’da Durum

1.DSÖ tarafından 6. Faza geçildi,
2.Bildirilen vaka sayısı hergeçen gün artmakta,
3.Virüs insandan insana bulaşıyor,
4.Ülkelerin kendi pandemi planları hazırlama çalışmaları devam ediyor,
5.Aşı üretimi gerçekleşti, gelecek bir yıl içerisinde yaklaşık 5 milyar aşı üretilebilecek

İstanbul’da Başvurulacak Hastaneler

—Avrupa yakası

1.Haseki EAH
2.Şişli Etfal EAH*
3.Okmeydanı EAH
4.İstanbul EAH

—Asya yakası

1.Kartal EAH
2.Göztepe EAH*
3.Haydarpaşa Numune EAH


—Genel temizlik ve beslenme kurallarına uyulmalı,
—Hastalık şüphesi var ise ortamdan uzaklaşılmalı gereklilik halinde maske takılmalı,
—Maskeler bir kere kullanılıp atılmalı.
—İzole edilen hastayla temaslarda maske takılarak yaklaşılmalı ve temas sonrası eller hemen bol su, sabun ve/veya alkollü dezenfektanlarla temizlenmeli,
—Çalışma ve yaşam alanları sık sık temizlenmeli, masa, sandalye, telefon v.b. aletler sık sık silinmeli,
—Toplu olarak kullanılan alanlarda mümkün olduğunca ortama (kapı kolları, asansörler, elektrik düğmeleri v.b.) el ile temas edilmemeli temas sonrası eller yıkanmalı ve/veya dezenfektanlarla temizlenmeli,
—Sık sık, el ve yüz yıkanmalı,
—Korunmak amaçlı herhangi bir Antibiyotik ve/veya Antiviral ilaç kullanılmamalı,
—Şüpheli bir durumda doktora danışılmalı

** Yorum için üyelik şart -- Yorum yapmak istiyorsan siteye giriş yap.


# admin 19-10-2009 10:19
Bu güncel sorunu ve bilgileri bizlerle paylaştığın için teşekkür ederim.

Hüseyi n


Hüseyin Dinçer
Mehmet Karaaslan
Kevser Aydın
Hasan Aksoy
İsmet Avşar
Süleyman Kılıç
Hueseyin Aksoy
Hakan Dinçer

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