{"id":460,"date":"2022-12-24T14:55:08","date_gmt":"2022-12-24T11:55:08","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=460"},"modified":"2022-12-24T14:55:10","modified_gmt":"2022-12-24T11:55:10","slug":"covid-19-caginda-yaslilar-zaturre-asisi-olmali-mi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/covid-19-caginda-yaslilar-zaturre-asisi-olmali-mi\/","title":{"rendered":"COVID-19 \u00c7a\u011f\u0131nda Ya\u015fl\u0131lar Zat\u00fcrre A\u015f\u0131s\u0131 Olmal\u0131 M\u0131?\u00a0"},"content":{"rendered":"\n<p>Pn\u00f6mokok hastal\u0131\u011f\u0131na yak\u0131n temas yoluyla ki\u015fiden ki\u015fiye yay\u0131labilen streptokoklar neden olur. Pn\u00f6mokokal menenjit sa\u011f\u0131rl\u0131\u011fa ve beyin hasar\u0131na neden olabilir ve %10 civar\u0131nda \u00f6l\u00fcme yol a\u00e7ar. \u0130nfluenza salg\u0131nlar\u0131nda ise %25-50 aras\u0131nda pn\u00f6mokoklar ile birliktelik, yani koenfeksiyon oldu\u011fu bilinmektedir. Ya\u015fl\u0131larda komorbid hastal\u0131klar s\u0131k oldu\u011fundan \u00f6l\u00fcm oranlar\u0131 da y\u00fckselmektedir. Yine COVID-19 ve \u0130nfluenza vir\u00fcs enfeksiyonlar\u0131n\u0131n mevsimsel ve co\u011frafi dalgalanma g\u00f6sterdi\u011fi bir d\u00f6nemde ya\u015fl\u0131 hastalar\u0131n pn\u00f6moniye yakalanmas\u0131 bu enfeksiyonlar \u00fczerinden de \u00f6l\u00fcm riskini art\u0131rmaktad\u0131r. Ara\u015ft\u0131rmalar \u0130nfluenza ile koenfeksiyon varl\u0131\u011f\u0131n\u0131n yo\u011fun bak\u0131m yat\u0131\u015f e\u011filimini iki kata kadar art\u0131rd\u0131\u011f\u0131n\u0131 ortaya koymu\u015ftur (1). \u00c7ok yeni bir meta-analitik \u00e7al\u0131\u015fmada COVID-19 enfeksiyon riskinin&nbsp;Influenza ve pn\u00f6mokok a\u015f\u0131lanmas\u0131 olan ki\u015filerde belirgin \u015fekilde azald\u0131\u011f\u0131 bildirilmi\u015ftir (OR: 0.80, 95% CI: 0.75-0.86 ve OR: 0.70, 95% CI: 0.57-0.88, s\u0131ras\u0131yla) (2).&nbsp;<\/p>\n\n\n\n<p>Hastalar\u0131n \u00f6nemli b\u00f6l\u00fcm\u00fc hafif ge\u00e7irse de, bir b\u00f6l\u00fcm\u00fc invaziv pn\u00f6mokok hastal\u0131\u011f\u0131 (\u0130PH) denen \u015fiddetli formu nedeniyle ciddi tedavi almas\u0131 gerekecektir.<\/p>\n\n\n\n<p><strong>IPH i\u00e7in y\u00fcksek riskli gruplar&nbsp;<\/strong><\/p>\n\n\n\n<p>\u2022 HIV enfeksiyonu&nbsp;<\/p>\n\n\n\n<p>\u2022 Kronik b\u00f6brek yetmezli\u011fi, nefrotik sendrom&nbsp;<\/p>\n\n\n\n<p>\u2022 Kanser (solid ve hematolojik)&nbsp;<\/p>\n\n\n\n<p>\u2022 Transplantasyon ge\u00e7irenler (b\u00f6brek, karaci\u011fer vb)<\/p>\n\n\n\n<p>\u2022 Otoimm\u00fcn hastal\u0131klar&nbsp;<\/p>\n\n\n\n<p>\u2022 \u0130mm\u00fcns\u00fcpresif tedavi ve uzun s\u00fcreli kortikosteroid kullananlar&nbsp;<\/p>\n\n\n\n<p>\u2022 Primer imm\u00fcn yetmezlikler<\/p>\n\n\n\n<p>Bu gruplar\u0131n d\u0131\u015f\u0131nda diyabetliler, dala\u011f\u0131 olmayanlar (aspleni), siroz gibi kronik karaci\u011fer hastalar\u0131, kalp hastalar\u0131, alkolizm tan\u0131l\u0131lar da riskli gruptad\u0131r. Bunun yan\u0131nda huzurevi, ya\u015fl\u0131 bak\u0131mevi, k\u0131\u015fla gibi ortamlarda kalanlar ve zaman ge\u00e7irenler, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 da riskli kabul edilir.&nbsp;<\/p>\n\n\n\n<p><strong>Pn\u00f6mokok enfeksiyonu sonras\u0131nda beklenen komplikasyonlar \u015funlard\u0131r:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Akut otit<\/li>\n\n\n\n<li>Pn\u00f6moni&nbsp;<\/li>\n\n\n\n<li>Bakteriyemi&nbsp;<\/li>\n\n\n\n<li>Meningoansefalit<\/li>\n\n\n\n<li>Sepsis ve septik \u015fok<\/li>\n<\/ul>\n\n\n\n<p><strong>Bu a\u015f\u0131 neden gerekli?&nbsp;<\/strong><\/p>\n\n\n\n<p><strong>A\u015f\u0131lama hem \u00e7ocuklar\u0131 hem de yeti\u015fkinleri ve ya\u015fl\u0131lar\u0131 pn\u00f6mokok hastal\u0131\u011f\u0131ndan koruyabilir. Pn\u00f6mokok enfeksiyonlar\u0131n\u0131n penisilin ve di\u011fer ila\u00e7larla tedavisi diren\u00e7 geli\u015fimi nedeniyle art\u0131k eskisi kadar etkili de\u011fildir.&nbsp;<\/strong>Bu nedenle a\u015f\u0131lama yoluyla hastal\u0131\u011f\u0131n \u00f6nlenmesi daha da \u00f6nemli olmu\u015ftur. Ortalama 63 ya\u015f\u0131nda bir erke\u011fin 10 y\u0131ll\u0131k sa\u011fkal\u0131m\u0131 pn\u00f6mokok pn\u00f6monisi olmas\u0131yla %30 kadar azalmaktad\u0131r (3).&nbsp;<\/p>\n\n\n\n<p><strong>Zat\u00fcrre a\u015f\u0131s\u0131 kimlere yap\u0131lmal\u0131d\u0131r?&nbsp;<\/strong>(\u015eekil -1)<strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>65 ya\u015f ve \u00fczeri olanlar,<\/li>\n\n\n\n<li>65 ya\u015f\u0131n\u0131n alt\u0131nda oldu\u011fu halde b\u00f6brek, karaci\u011fer, kalp, akci\u011fer ve diyabet (\u015feker) gibi kronik hastal\u0131\u011f\u0131 olanlar,<\/li>\n\n\n\n<li>Ge\u00e7mi\u015fte tekrarlayan pn\u00f6moni ge\u00e7irenler,<\/li>\n\n\n\n<li>Kanser tedavisi olanlar,<\/li>\n\n\n\n<li>Sigara i\u00e7enler ve alkolizm tan\u0131s\u0131 olanlar,<\/li>\n\n\n\n<li>Organ nakli ge\u00e7irenler (kohlear implant dahil),<\/li>\n\n\n\n<li>Dala\u011f\u0131 al\u0131nan veya i\u015flevsiz olan ki\u015filer,<\/li>\n\n\n\n<li>Ba\u011f\u0131\u015f\u0131kl\u0131k yetmezli\u011fi olan veya bask\u0131lay\u0131c\u0131 tedavi kullanan hastalar,<\/li>\n\n\n\n<li>Pn\u00f6moni ile s\u0131k kar\u015f\u0131la\u015fan huzurevi \u00e7al\u0131\u015fanlar\u0131 ve sa\u011fl\u0131k personelleri ya\u015fa bak\u0131lmaks\u0131z\u0131n pn\u00f6mokok a\u015f\u0131s\u0131 yapt\u0131rmal\u0131d\u0131r.<\/li>\n<\/ul>\n\n\n\n<p><strong>A\u015f\u0131lama \u015femas\u0131 nas\u0131ld\u0131r?&nbsp;<\/strong><\/p>\n\n\n\n<p>KPA13\/PCV13 rutin olarak 2, 4, 6 ve 12-15 ayl\u0131k \u00e7ocuklara yap\u0131l\u0131r.&nbsp;Rutin 4 dozdan eksik a\u015f\u0131lama varsa 5 ya\u015f\u0131na kadar 1 ek doz a\u015f\u0131lama ile tamamlanabilir.<\/p>\n\n\n\n<p>Y\u00fcksek risk grubuna girmeye neden olan sa\u011fl\u0131k sorunlar\u0131 bulunan 2 &#8211; 64 ya\u015f aras\u0131ndaki ki\u015filere, 65 ya\u015f ve \u00fczeri t\u00fcm yeti\u015fkinlere KPA13\/PCV13 \u00f6nerilir.&nbsp;<\/p>\n\n\n\n<p><strong>Kontrendikasyonlar ve dikkat edilmesi gereken noktalar&nbsp;<\/strong><\/p>\n\n\n\n<p>Ba\u015fka a\u015f\u0131lara, \u00f6zellikle pn\u00f6mokok a\u015f\u0131lar\u0131na allerjisi olmu\u015f, anafilaksi ve di\u011fer reaksiyon \u00f6yk\u00fcs\u00fc olan ki\u015filere dikkatli olunmal\u0131 veya hi\u00e7 yap\u0131lmamal\u0131d\u0131r. A\u015f\u0131lanacak ki\u015finin o anda ate\u015fli, grip enfeksiyonlu olmas\u0131 durumunda da a\u015f\u0131 ertelenir.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" src=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2022\/12\/a348c686fc5dbfb29d82c426e4b898c1.png\" alt=\"\" class=\"wp-image-461\" width=\"675\" height=\"675\" srcset=\"https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2022\/12\/a348c686fc5dbfb29d82c426e4b898c1.png 675w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2022\/12\/a348c686fc5dbfb29d82c426e4b898c1-300x300.png 300w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2022\/12\/a348c686fc5dbfb29d82c426e4b898c1-150x150.png 150w, https:\/\/tatd.org.tr\/geriatri\/wp-content\/uploads\/sites\/14\/2022\/12\/a348c686fc5dbfb29d82c426e4b898c1-630x630.png 630w\" sizes=\"(max-width: 675px) 100vw, 675px\" \/><figcaption class=\"wp-element-caption\"><strong>\u015eekil-1:&nbsp;<\/strong>Pn\u00f6mokok a\u015f\u0131s\u0131 endikasyonlar\u0131.<\/figcaption><\/figure>\n\n\n\n<p><strong>A\u015f\u0131 uygulamas\u0131 i\u00e7in notlar:<\/strong>&nbsp;Her iki a\u015f\u0131 da 0.5 mL doz olarak kas i\u00e7ine (IM) uygulanabilir, ek olarak PPSV23 cilt alt\u0131 (subkutan) da verilebilir. Di\u011fer a\u015f\u0131larla birlikte kullan\u0131m\u0131 gerekirse, farkl\u0131 enjekt\u00f6r ile farkl\u0131 b\u00f6lgelere uygulan\u0131r. \u0130nfluenza ve\/veya COVID-19 a\u015f\u0131lar\u0131yla birlikte kullan\u0131labilir, birlikte uygulama ile etkinli\u011fi de\u011fi\u015fmez.<\/p>\n\n\n\n<p><strong>A\u015f\u0131dan sonra yan etki beklenir mi?<\/strong><\/p>\n\n\n\n<p>Evet, hafif yan etkiler beklenebilir. Bildirilen en yayg\u0131n sorunlar, uyku hali, ge\u00e7ici bir i\u015ftahs\u0131zl\u0131k, ba\u015f a\u011fr\u0131s\u0131, titreme veya kas a\u011fr\u0131s\u0131, enjeksiyonun yap\u0131ld\u0131\u011f\u0131 yerde k\u0131zar\u0131kl\u0131k veya duyarl\u0131l\u0131k ve enjeksiyonun yap\u0131ld\u0131\u011f\u0131 yerde \u015fi\u015flik ile birlikte hafif ate\u015ftir. 2-3 g\u00fcnden sonra devam etmesi beklenmez.<\/p>\n\n\n\n<p><strong>\u00d6zet<\/strong><\/p>\n\n\n\n<p>\u0130nfluenza, COVID-19 ve pn\u00f6mokok a\u015f\u0131lanmalar\u0131 birbirinden etkilenen ve birbirini destekleyen ba\u011f\u0131\u015f\u0131klama pratikleridir. K\u0131r\u0131lgan n\u00fcfus i\u00e7inde en \u00f6n s\u0131rada yer alan ya\u015fl\u0131 grubun her \u00fc\u00e7 hastal\u0131kla ilgili a\u015f\u0131lanmas\u0131 \u00f6l\u00fcm ve \u015fiddetli hastal\u0131k oranlar\u0131n\u0131 d\u00fc\u015f\u00fcrme y\u00f6n\u00fcnde etkileme olas\u0131l\u0131\u011f\u0131 net olarak ortaya konmu\u015ftur. Hem devlet kurulu\u015flar\u0131 hem de sivil toplum \u00f6rg\u00fctleri, meslek\/uzmanl\u0131k dernekleri bu y\u00f6nde a\u00e7\u0131k ve y\u00fcksek vol\u00fcml\u00fc bir kampanya y\u00fcr\u00fctmelidir.&nbsp;<\/p>\n\n\n\n<p><strong>Kaynaklar<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\">\n<li>Cong B, Deng S, Wang X, Li Y. The role of respiratory co-infection with influenza or respiratory syncytial virus in the clinical severity of COVID-19 patients: A systematic review and meta-analysis. J Glob Health. 2022;12:05040. doi: 10.7189\/jogh.12.05040.&nbsp;<\/li>\n\n\n\n<li>Kapoula GV, Vennou KE, Bagos PG. Influenza and Pneumococcal Vaccination and the Risk of COVID-19: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022;12(12): 3086. doi: 10.3390\/diagnostics12123086.&nbsp;<\/li>\n\n\n\n<li>Sandvall B, Rueda AM, Musher DM. Long-term survival following pneumococcal pneumonia. Clin Infect Dis. 2013 Apr;56(8):1145-6. doi: 10.1093\/cid\/cis1207. Epub 2013 Jan 8. PMID: 23300240.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Pn\u00f6mokok hastal\u0131\u011f\u0131na yak\u0131n temas yoluyla ki\u015fiden ki\u015fiye yay\u0131labilen streptokoklar neden olur. Pn\u00f6mokokal menenjit sa\u011f\u0131rl\u0131\u011fa ve beyin hasar\u0131na neden olabilir ve %10 civar\u0131nda&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":463,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[],"class_list":["post-460","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/460","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=460"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/460\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/463"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=460"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=460"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=460"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}