Pandemic Influenza situation update in Turkey

The first wave of pandemic influenza which began earlier than expected has been spreading rapidly in Turkey. Laboratory-confirmed cases are being reported from almost all regions of the country. As of 19 January 2010, a total of 627 persons including 40 pregnant women have died of confirmed H1N1v influenza. Most cases were under 65 years of age and 35% were previously healthy (Figure). 13,111 cases with confirmed H1N1v influenza were reported to be admitted to hospital, 2721 were treated in intensive care units and 1161 were artificially ventilated between 12 November and 31 December, 2009.The Ministry of Health (MoH) conducts H1N1v influenza surveillance and reports to the EUROFLU network. This surveillance includes collection of clinical samples that were randomly obtained from one patient with the diagnosis of influenza-like illness (ILI) at each of 150 outpatient clinics in 14 districts of the country; these samples have been tested in two national reference laboratories recognized by the World Health Organization. The pandemic advisory committe of the MoH recommended to continue this surveillance in addition to performing real time polymerase chain reaction (RT-PCR) diagnostic testing for cases with severe influenza. During the peak of the pandemic period, 40-50% of samples collected from patients with ILI were reported to be positive for influenza; 98% of those positive for influenza were H1N1v (personal communication with reference laboratories). The MoH has purchased 8 million doses of pandemic vaccine from Novartis, Glaxo Smith Kline, and Sanofi-Pasteur 2009-2010 influenza season. Four million doses were used for immunization of health care providers, Haj pilgrims, healthy people between 6 months and 24 years of age, and people between the ages of 6 months and 50 years with underlying conditions. Vaccination program was initiated on 16 November 2009, and depending on the availability of additional vaccine doses, vaccinations has been offered to schoolchildren. Additionally, non-adjuvanted vaccine from Sanofi-Pasteur has been offered to pregnant women.Due to the number of anti-vaccine campaigns in the media and on the Internet, the acceptance rate of vaccination among health care personnel and the general population is significantly less than expected. The pandemic advisory committe recommended that schools should be closed only when the level of absenteism makes education impossible. Although most patients diagnosed with H1N1v influenza have mild disease, the real burden of disease will become clear during the following months.