{"id":40370,"date":"2020-02-29T00:00:17","date_gmt":"2020-02-28T21:00:17","guid":{"rendered":"https:\/\/bilimvegelecek.com.tr\/?p=40370"},"modified":"2020-03-21T17:25:47","modified_gmt":"2020-03-21T14:25:47","slug":"influenza-virusunun-evrimi-yayilimi-ve-salgin-riski","status":"publish","type":"post","link":"https:\/\/bilimvegelecek.com.tr\/index.php\/2020\/02\/29\/influenza-virusunun-evrimi-yayilimi-ve-salgin-riski","title":{"rendered":"\u0130nfluenza vir\u00fcs\u00fcn\u00fcn evrimi, yay\u0131l\u0131m\u0131 ve salg\u0131n riski"},"content":{"rendered":"

Genetik yap\u0131s\u0131 dolay\u0131s\u0131yla s\u0131kl\u0131kla de\u011fi\u015fime u\u011frayabilen ve do\u011fal rezervuar\u0131n\u0131n yan\u0131 s\u0131ra bir\u00e7ok konak organizmay\u0131 enfekte edebilen influenza A vir\u00fcsleri, her daim salg\u0131n riski ta\u015f\u0131rlar. T\u00fcm influenza vir\u00fcslerine kar\u015f\u0131 mevcutta etkin bir a\u015f\u0131n\u0131n olmamas\u0131 da salg\u0131n riskini art\u0131r\u0131r. Toplumun vir\u00fcsten korunma yollar\u0131 konusunda d\u00fczenli e\u011fitimi salg\u0131n riski olu\u015fmadan \u00f6n\u00fcne ge\u00e7ebilmek a\u00e7\u0131s\u0131ndan olduk\u00e7a \u00f6nemlidir.<\/em><\/p>\n

Son y\u0131llarda giderek art\u0131\u015f g\u00f6steren zoonoz (hayvandan insana ge\u00e7i\u015fkenlik g\u00f6sterebilen) hastal\u0131klar insanlarda beklenmedik salg\u0131n ve pandemi endi\u015fesini art\u0131rd\u0131. S\u00fcrekli de\u011fi\u015fen \u00e7evre ko\u015fullar\u0131na kolayl\u0131kla adapte olan bu patojenler, uluslararas\u0131 yo\u011fun insan seyahatlerinin ve ticari hayvan transferlerinin de etkisiyle bir anda bir\u00e7ok bireye yay\u0131lma riski ta\u015f\u0131rlar. Yak\u0131n ge\u00e7mi\u015fte Bat\u0131 Afrika\u2019da Ebola, Orta Do\u011fu\u2019da MERS-CoV, Banglade\u015f\u2019te Nipah, G\u00fcney Amerika\u2019da Zika, \u00f6zellikle Asya ve Orta Do\u011fu\u2019da ku\u015f kaynakl\u0131 influenza (grip) salg\u0131nlar\u0131 ve son olarak \u00c7in\u2019in Vuhan kentinde ortaya \u00e7\u0131kan yeni bir koronavir\u00fcs tipi (COVID-19) sebebiyle \u00f6l\u00fcmle sonu\u00e7lanan vakalar g\u00f6r\u00fcld\u00fc.<\/p>\n

\u0130nfluenza vir\u00fcslerinin yol a\u00e7t\u0131\u011f\u0131 pandemiler
\n<\/em><\/strong>Zoonoz potansiyeli olan vir\u00fcslerin ba\u015f\u0131nda gelen influenza vir\u00fcsleri Orthomyxoviridae ailesine ait olup; A, B, C ve D olmak \u00fczere 4 antijenik gruba ayr\u0131l\u0131r. G\u00f6receli olarak daha yeni tan\u0131mlanm\u0131\u015f influenza D vir\u00fcsleri1<\/sup> hari\u00e7, her bir influenza tipinin insanlarda enfeksiyona neden oldu\u011fu bilinmektedir. Bu gruplar i\u00e7erisinden influenza A vir\u00fcsleri, zoonotik potansiyelinden dolay\u0131 insanlar ve bir\u00e7ok hayvan t\u00fcr\u00fc i\u00e7in b\u00fcy\u00fck tehdit olu\u015fturur. \u0130lk olarak 2011 y\u0131l\u0131nda domuzlardan izole edilen, fakat \u00e7o\u011funlukla s\u0131\u011f\u0131r pop\u00fclasyonlar\u0131nda g\u00f6r\u00fclen influenza D vir\u00fcslerinin de hayvan-insan aray\u00fcz\u00fcnde zoonotik ge\u00e7i\u015flere yol a\u00e7ma potansiyeli bulunur. Bug\u00fcne kadar yap\u0131lan \u00e7al\u0131\u015fmalarda, insanlarda influenza D kaynakl\u0131 enfeksiyon saptanmam\u0131\u015f, fakat s\u0131\u011f\u0131rlarla yak\u0131n temasta bulunan bireylerde vir\u00fcse kar\u015f\u0131 antikor tespit edilmi\u015ftir.<\/p>\n

\u0130nfluenza A vir\u00fcsleri ge\u00e7ti\u011fimiz 100 y\u0131l i\u00e7inde 4 b\u00fcy\u00fck pandemiye yol a\u00e7\u0131p milyonlarca insan\u0131n \u00f6l\u00fcm\u00fcne sebep oldu. \u0130nfluenza pandemileri H1N1 kaynakl\u0131 1918 \u0130spanyol gribi ve 2009 domuz gribi (pH1N1\/2009), H2N2 kaynakl\u0131 1957 Asya gribi ve H3N2 kaynakl\u0131 1968 Hong Kong gribi olarak bilinirler (\u015eekil 1). Dahas\u0131 bu pandemilerin \u00e7o\u011fu yaban\u0131l ku\u015flarda sirk\u00fcle eden d\u00fc\u015f\u00fck patojenli influenza A vir\u00fcslerinin baz\u0131 di\u011fer influenza A vir\u00fcsleri (di\u011fer ku\u015f t\u00fcrleri, insan ve\/veya domuz pop\u00fclasyonlar\u0131nda sirk\u00fcle eden vir\u00fcsler) ile gen takas\u0131 yapmas\u0131 sonucu ortaya \u00e7\u0131km\u0131\u015ft\u0131r. Bir sonraki pandeminin nerede ve ne zaman olabilece\u011fini tahmin edebilmek, d\u00fcnyan\u0131n her k\u00f6\u015fesinde, \u00f6zellikle ku\u015f g\u00f6\u00e7 yollar\u0131n\u0131n aktif olarak kullan\u0131ld\u0131\u011f\u0131 b\u00f6lgelerde yap\u0131lan aktif ve aral\u0131ks\u0131z s\u00fcrveyans \u00e7al\u0131\u015fmalar\u0131na ba\u011fl\u0131d\u0131r.<\/p>\n

\"\"
\u015eekil 1. 1918, 1957, 1968 ve 2009 influenza pandemik vir\u00fcslerinin genetik k\u00f6kenleri.20<\/figcaption><\/figure>\n

Pandemilerin yan\u0131 s\u0131ra, influenza A H1N1 ve H3N2 vir\u00fcsleri ile influenza B vir\u00fcsleri mevsimsel olarak insanlarda sirk\u00fcle etmektedir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc\u2019n\u00fcn (DS\u00d6) verilerine g\u00f6re, influenza vir\u00fcs\u00fc her sene yakla\u015f\u0131k 3-5 milyon ki\u015fiyi enfekte etmekte ve ne yaz\u0131k ki bu vakalardan 290.000 ila 650.000 kadar\u0131 \u00f6l\u00fcmle sonu\u00e7lanmaktad\u0131r2<\/sup>. Hastal\u0131k seyrinde ortaya \u00e7\u0131kan semptomlar, hafif ya da \u015fiddetli olabildi\u011fi gibi, baz\u0131 durumlarda enfeksiyonlar \u00f6l\u00fcmle de sonu\u00e7lanabilmektedir. 2020 y\u0131l\u0131 verilerine g\u00f6re, 2019-2020 sezonunda \u015fu ana kadar d\u00fcnya genelinde laboratuvar testleri ile do\u011frulanm\u0131\u015f 158.445 influenza vakas\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr3<\/sup>. \u00dclkemizde ise T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verilerine g\u00f6re Eyl\u00fcl 2019 – \u015eubat 2020 tarihleri aras\u0131nda solunum yolu rahats\u0131zl\u0131klar\u0131 nedeni ile hastaneye ba\u015fvuran hastalar\u0131n 2000 tanesinde influenza enfeksiyonu tespit edilmi\u015ftir4<\/sup>. Her y\u0131l, DS\u00d6 ve Hastal\u0131k Kontrol ve \u00d6nleme Merkezlerinin (CDC) yo\u011fun \u00e7abalar\u0131yla t\u00fcm d\u00fcnyadan ba\u015fl\u0131ca insan, ku\u015f ve domuz kaynakl\u0131 influenza vir\u00fcslerinin s\u00fcrveyans verileri toplan\u0131r, b\u00f6ylelikle vir\u00fcs\u00fcn d\u00fcnya genelindeki da\u011f\u0131l\u0131m\u0131 ve ge\u00e7irdi\u011fi genetik de\u011fi\u015fimler belirlenir. Bu verilere dayanarak her y\u0131l mevsimsel grip a\u015f\u0131lar\u0131 \u00fcretilmekte, en \u00f6nemlisi de insan-hayvan aray\u00fcz\u00fcnde hastal\u0131k riski de\u011ferlendirilerek \u00f6nlemler al\u0131nmaktad\u0131r.<\/p>\n

Hayvanlardan insanlara\u2026
\n<\/em><\/strong>\u0130nfluenza A vir\u00fcslerinin do\u011fal rezervuar\u0131 kaz-\u00f6rdek gibi yaban\u0131l su ku\u015flar\u0131 (Anseriformes) ile k\u0131y\u0131 ku\u015flar\u0131 olarak bilinen kumku\u015flar\u0131, d\u00fcd\u00fck\u00e7\u00fcn, bal\u0131k\u00e7\u0131l, ta\u015f\u00e7eviren, sumru, mart\u0131 gibi (Charadriiformes) t\u00fcrlerdir5,6<\/sup>. Do\u011fal rezervi yaban\u0131l su ku\u015flar\u0131 olmas\u0131na ra\u011fmen, ge\u00e7irdikleri baz\u0131 genetik de\u011fi\u015fikliklerle bu vir\u00fcsler insan, domuz, deniz memelileri, kedi, k\u00f6pek, at ve k\u00fcmes hayvanlar\u0131na da ge\u00e7ebilmektedir7<\/sup> (\u015eekil 2). Bunlar\u0131n yan\u0131 s\u0131ra, H17-H18 ve N10-N11 alt t\u00fcrleri sadece yarasalardan molek\u00fcler metotlar ile saptanm\u0131\u015f, fakat vir\u00fcs izolasyonu \u015fu ana kadar ba\u015far\u0131s\u0131z olmu\u015ftur8,9,10<\/sup>. Y\u00fczey glikoproteinleri olan hemagglutinin (HA) ve n\u00f6raminidaza (NA) g\u00f6re adland\u0131r\u0131lan vir\u00fcslerin, ku\u015flarda ta\u015f\u0131nan toplam 144 alt t\u00fcr\u00fc olup (H1-H16 ve N1-N9; H1N1, H7N2 vb gibi), bu alt t\u00fcrlerin sadece baz\u0131lar\u0131 di\u011fer konak organizmalara ge\u00e7i\u015fkenlik g\u00f6sterebilir5,11<\/sup>.<\/p>\n

\"\"
\u015eekil 2. \u0130nfluenza A vir\u00fcslerinin do\u011fal rezervuar\u0131 ve di\u011fer konak organizmalar\u0131.7<\/figcaption><\/figure>\n

\u0130nfluenza A vir\u00fcsleri ku\u015flar\u0131n gastroenterik sisteminde bulunan sialik asit \u03b1-2,3 resept\u00f6rlerine ba\u011flanarak yeni vir\u00fcs partik\u00fcllerinin \u00fcretilmesine yol a\u00e7arlar. A\u011f\u0131z yolu ile al\u0131nan vir\u00fcsler d\u0131\u015fk\u0131 yolu ile do\u011faya b\u0131rak\u0131l\u0131r ve ku\u015flarda \u00e7o\u011funlukla semptom g\u00f6stermeyen (asemptomatik) enfeksiyona sebep olurlar. \u00d6te yandan, bu vir\u00fcsler memelilerde genellikle sialik asit \u03b1-2,6 resept\u00f6rlerine ba\u011flanarak \u00fcst solunum yolu rahats\u0131zl\u0131klar\u0131na yol a\u00e7ar ve hastal\u0131\u011f\u0131n seyrinde tipik influenza semptomlar\u0131 olarak bilinen ate\u015f, \u00f6ks\u00fcr\u00fck, k\u0131rg\u0131nl\u0131k, burun ak\u0131nt\u0131s\u0131 gibi semptomlar\u0131n g\u00f6r\u00fclmesine neden olur. Pandemi riski olan vir\u00fcsler ciddi say\u0131da \u00f6l\u00fcml\u00fc vakaya neden olurken, mevsimsel influenza olarak bilinen vir\u00fcsler de hat\u0131r\u0131 say\u0131l\u0131r \u00f6l\u00e7\u00fcde hastanede tedavi gerektiren veya \u00f6l\u00fcmle sonu\u00e7lanan vakalara yol a\u00e7arlar. Solunum yolu enfeksiyonlar\u0131 s\u0131ras\u0131nda aeresoller arac\u0131l\u0131\u011f\u0131 ile ta\u015f\u0131nabilen bu vir\u00fcsler, memelilere ge\u00e7ti\u011fi takdirde \u00e7ok fazla bireyin hastalanmas\u0131na neden olmaktad\u0131r. Yap\u0131lan \u00e7al\u0131\u015fmalarda, ge\u00e7i\u015fkenlik riskini saptamak \u00fczere hesaplanan \u00e7o\u011falma say\u0131lar\u0131n\u0131n (R de\u011feri) pandemi ve epidemiye yol a\u00e7an influenza vir\u00fcsleri i\u00e7in farkl\u0131 oranlarda oldu\u011fu tespit edilmi\u015ftir12<\/sup>.<\/p>\n

Do\u011fada d\u00fc\u015f\u00fck patojenli olarak bulunan baz\u0131 influenza A vir\u00fcsleri ise k\u00fcmes hayvanlar\u0131na ge\u00e7tikten sonra, hemagglutinin proteinin proteolitik kesim noktas\u0131na eklenen d\u00f6rt veya alt\u0131 bazik amino asit sayesinde y\u00fcksek patojenli vir\u00fcslere d\u00f6n\u00fc\u015febilirler. Bu sayede, \u00f6nc\u00fc hemagglutinin proteinin (HA0) aktif hale ge\u00e7mesi i\u00e7in (HA1 ve HA2) gereken kesim, \u00e7e\u015fitli organlarda bulunan enzimler taraf\u0131ndan yap\u0131labilir ve hastal\u0131k sistemik bir enfeksiyona d\u00f6n\u00fc\u015febilir. Bu tarz genetik de\u011fi\u015fime u\u011frayan vir\u00fcslerin k\u00fcmes hayvanlar\u0131 ile temas eden insanlara bula\u015fmas\u0131 durumunda hastal\u0131\u011f\u0131n seyri \u015fiddetlenip tedavisi zorla\u015ft\u0131\u011f\u0131ndan \u00f6l\u00fcmc\u00fcl vakalar g\u00f6r\u00fcl\u00fcr. \u0130nsan ve hayvan \u00f6l\u00fcm\u00fcne sebep olan b\u00f6ylesine tehlikeli vir\u00fcsleri durdurabilmek amac\u0131yla bula\u015f g\u00f6r\u00fclen k\u00fcmes hayvan\u0131 \u00e7iftlikleri ve benzeri yerlerde bulunan t\u00fcm kanatl\u0131 hayvanlar itlaf edilerek salg\u0131n kontrol alt\u0131na al\u0131nmaya \u00e7al\u0131\u015f\u0131l\u0131r, fakat bu durum \u00fclke ekonomilerinde ciddi kay\u0131plara neden olur. D\u00fcnya Hayvan Sa\u011fl\u0131\u011f\u0131 \u00d6rg\u00fct\u00fc\u2019n\u00fcn (OIE) son verilerine g\u00f6re13<\/sup>, Polonya, Macaristan, Ukrayna, Almanya, Slovakya, \u00c7ek Cumhuriyeti, Suudi Arabistan, \u0130srail gibi bir\u00e7ok \u00fclkede Aral\u0131k 2019 – \u015eubat 2020 aylar\u0131 aras\u0131nda y\u00fcksek patojenli influenza vir\u00fcsleri (H5N8) saptanm\u0131\u015f, maalesef binlerce ku\u015f itlaf edilmi\u015ftir. Bu nedenle, yaban\u0131l su ku\u015flar\u0131nda g\u00f6r\u00fclen vir\u00fcslerin ve bu vir\u00fcslerde do\u011fal yollar ile ortaya \u00e7\u0131kan genetik de\u011fi\u015fimlerin takibi, insan-hayvan aray\u00fcz\u00fcnde risk de\u011ferlendirmesi a\u00e7\u0131s\u0131ndan olduk\u00e7a \u00f6nemlidir.<\/p>\n

Vir\u00fcs\u00fcn genetik de\u011fi\u015fimi
\n<\/em><\/strong>\u0130nfluenza A vir\u00fcslerinin genetik de\u011fi\u015fimlere u\u011framas\u0131 \u00e7e\u015fitli nedenlerden kaynaklan\u0131r. Tek sarmall\u0131 negatif polariteli RNA\u2019dan olu\u015fan vir\u00fcs genomu RNA-ba\u011f\u0131ml\u0131 RNA Polimeraz (RdRP) enzimi taraf\u0131ndan sentezlenir. Bu enzimin geriye d\u00f6n\u00fck hata d\u00fczeltme yetisi olmad\u0131\u011f\u0131ndan vir\u00fcs genlerinin sentezi s\u0131ras\u0131nda noktasal mutasyonlar\u0131n olu\u015fmas\u0131na yol a\u00e7maktad\u0131r. Bu tarz mutasyonlar\u0131n \u00e7o\u011fu sorun yaratmazken, baz\u0131lar\u0131 vir\u00fcse avantaj sa\u011flayarak vir\u00fcs\u00fcn konak organizma h\u00fccrelerine ba\u011flanma yetisini, hastal\u0131\u011f\u0131n \u015fiddetini, konak organizmalar aras\u0131 ge\u00e7i\u015fkenlik riskini, antiviral ila\u00e7lara dayan\u0131kl\u0131l\u0131klar\u0131n\u0131 ve RNA Polimeraz enzim kompleksinin sentez yetene\u011fini art\u0131rabilir. Bunun yan\u0131 s\u0131ra, vir\u00fcs genomunun par\u00e7al\u0131 olu\u015fu, yani 8 gen par\u00e7as\u0131n\u0131n ayr\u0131 ayr\u0131 sentezlenip paketlenmesi \u201creassortment\u201d (gen takas\u0131) ad\u0131 verilen olguya yol a\u00e7ar. Bir ba\u015fka deyi\u015fle, farkl\u0131 influenza alt t\u00fcrleri ile enfekte olmu\u015f bir konak organizmada farkl\u0131 vir\u00fcslere ait gen par\u00e7alar\u0131 paketlenerek yeni vir\u00fcs t\u00fcrleri ortaya \u00e7\u0131kar.<\/p>\n

\"\"
\u015eekil 3. 2013 y\u0131l\u0131nda Asya\u2019da bir\u00e7ok \u00f6l\u00fcmc\u00fcl vakaya sebep olan H7N9 vir\u00fcs\u00fcn\u00fcn \u00e7oklu gen de\u011fi\u015fimi (reassortment) ile ortaya \u00e7\u0131k\u0131\u015f\u0131.21<\/figcaption><\/figure>\n

\u00d6rne\u011fin, 2013 senesinde Asya\u2019da ortaya \u00e7\u0131kan ve \u00f6l\u00fcmc\u00fcl insan ve hayvan vakalar\u0131na da sebep olan H7N9 influenza vir\u00fcs\u00fc evcil \u00f6rdek, yaban\u0131l ku\u015flar ve k\u00fcmes hayvanlar\u0131nda g\u00f6r\u00fclen de\u011fi\u015fik vir\u00fcslerden derleme bir genoma sahiptir14<\/sup> (\u015eekil 3). Bu tarz gen takas\u0131 olaylar\u0131 yukar\u0131da s\u00f6z edildi\u011fi gibi pandemiye neden olan vir\u00fcslerin olu\u015fumunda da g\u00f6zlenmektedir (\u015eekil 1). Her ne kadar 1918 y\u0131l\u0131nda milyonlarca ki\u015finin \u00f6l\u00fcm\u00fcne sebep olan pandemi vir\u00fcs\u00fcn\u00fcn kayna\u011f\u0131 tam olarak bilinemese de, ku\u015f kaynakl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir15,16<\/sup>. 1957 ve 1968 y\u0131llar\u0131nda g\u00f6r\u00fclen pandemi vir\u00fcsleri de baz\u0131 genlerini ku\u015f kaynakl\u0131 influenza vir\u00fcslerinden edinmi\u015flerdir17<\/sup>. Son olarak 2009\u2019da ortaya \u00e7\u0131kan pandemi vir\u00fcs\u00fc ise ge\u00e7mi\u015f 30 sene i\u00e7erisinde ku\u015f, domuz ve insan kaynakl\u0131 influenza vir\u00fcsleri aras\u0131ndaki gen takaslar\u0131 sonucunda ortaya \u00e7\u0131km\u0131\u015ft\u0131r18<\/sup>.<\/p>\n

Ku\u015flar\u0131n g\u00f6\u00e7 yollar\u0131
\n<\/em><\/strong>D\u00fcnya genelinde g\u00f6\u00e7men ku\u015flar\u0131n kulland\u0131\u011f\u0131 9 ana g\u00f6\u00e7 yolu bulunur. Bu g\u00f6\u00e7 yollar\u0131ndan biri olan Akdeniz\/Karadeniz G\u00f6\u00e7 Yolu, Kuzey Kutbu\u2019ndan G\u00fcney Afrika\u2019ya kadar olan b\u00f6lgede 101 \u00fclkeyi kapsar19<\/sup>. Her y\u0131l bu g\u00f6\u00e7 yolunu kullanan milyonlarca ku\u015f vard\u0131r. Daha \u00f6nceki \u00e7al\u0131\u015fmalara ve uluslararas\u0131 veri tabanlar\u0131ndaki bilgilere dayanarak, influenza vir\u00fcslerini ta\u015f\u0131d\u0131\u011f\u0131 bilinen ku\u015f t\u00fcrlerinin \u00e7o\u011fu bu g\u00f6\u00e7 rotas\u0131 \u00fczerinde \u00e7e\u015fitli noktalarda konaklar. Akdeniz\/Karadeniz G\u00f6\u00e7 Yolu\u2019nun tam ortas\u0131nda bulunan \u00fclkemizdeki sulak alanlar ve milli parklar yaban\u0131l su ku\u015flar\u0131n\u0131n yan\u0131 s\u0131ra yaban domuzu, yaban kedisi, saz kedisi, gelincik, Akdeniz foku gibi influenza vir\u00fcslerinin enfekte edebilece\u011fi bir\u00e7ok memelinin de ya\u015fam alan\u0131d\u0131r. Sulak alanlar ve yak\u0131n \u00e7evrelerinde bulunan faunadaki bu birliktelik vir\u00fcs\u00fcn zoonoz riskini art\u0131rmakta ve toplum sa\u011fl\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan tehlike arz etmektedir. \u00d6yle ki, sulak alanlara yak\u0131n b\u00f6lgelerde ya\u015fam\u0131n\u0131 s\u00fcrd\u00fcren memeliler b\u00f6lgedeki enfekte ku\u015flar veya d\u0131\u015fk\u0131lar\u0131 ile temas ederek hastal\u0131\u011fa yakalanabilir ve hastal\u0131\u011f\u0131n di\u011fer memeli t\u00fcrlerine ge\u00e7mesine sebep olabilirler.<\/p>\n

\"\"
D\u00fcnya genelinde g\u00f6\u00e7men ku\u015flar\u0131n kulland\u0131\u011f\u0131 9 ana g\u00f6\u00e7 yolu bulunur. \u00dclkemiz bu g\u00f6\u00e7 yollar\u0131ndan biri olan Akdeniz\/Karadeniz G\u00f6\u00e7 Yolu\u2019nun tam ortas\u0131nda bulunur.<\/figcaption><\/figure>\n

Bu bilgiler do\u011frultusunda, genetik yap\u0131s\u0131 dolay\u0131s\u0131yla s\u0131kl\u0131kla de\u011fi\u015fime u\u011frayabilen ve do\u011fal rezervuar\u0131n\u0131n yan\u0131 s\u0131ra bir\u00e7ok konak organizmay\u0131 enfekte edebilen influenza A vir\u00fcsleri, her daim salg\u0131n riski ta\u015f\u0131rlar. T\u00fcm influenza vir\u00fcslerine kar\u015f\u0131 mevcutta etkin bir a\u015f\u0131n\u0131n olmamas\u0131 da salg\u0131n riskini art\u0131r\u0131r. Dolay\u0131s\u0131yla, insan ve hayvan kaynakl\u0131 influenza A vir\u00fcslerinin s\u00fcrveyans \u00e7al\u0131\u015fmalar\u0131 ile yak\u0131n takibi ve toplumun vir\u00fcsten korunma yollar\u0131 konusunda d\u00fczenli e\u011fitimi salg\u0131n riski olu\u015fmadan \u00f6n\u00fcne ge\u00e7ebilmek a\u00e7\u0131s\u0131ndan olduk\u00e7a \u00f6nemlidir.<\/p>\n

\u00a0<\/strong>KAYNAKLAR<\/strong><\/p>\n

1) Hause, B.M., Ducatez, M., Collin, E.A., Ran, Z., Liu, R., Sheng, Z., Armien, A., Kaplan, B., Chakravarty, S., Hoppe, A.D. ve Webby, R.J. 2013. \u201cIsolation of a novel swine influenza virus from Oklahoma in 2011 which is distantly related to human influenza C viruses\u201d, PLoS pathogens, 9(2).<\/p>\n

2) DS\u00d6 (D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc). 2018. \u201cInfluenza (Seasonal)\u201d. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/influenza-(seasonal), Son eri\u015fim tarihi: 19 \u015eubat 2020<\/p>\n

3) DS\u00d6 (D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc). 2020. \u201cWeekly seasonal influenza updates\u201d. https:\/\/www.who.int\/influenza\/surveillance_monitoring\/updates\/GIP_surveillance_2020_archives\/en\/. Son eri\u015fim tarihi: 19 \u015eubat 2020.<\/p>\n

4) T\u00fcrkiye Cumhuriyeti Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131, Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc. (2020). \u201cHaftal\u0131k \u0130nfluenza Raporu\u201d https:\/\/grip.gov.tr\/tr\/haftalik-influenza-raporu, Son ula\u015fma tarihi: 19 \u015eubat 2020.<\/p>\n

5) Webster, R.G., Bean, W.J., Gorman, O.T., Chambers, T.M., Kawaoka, Y. 1992. \u201cEvolution and Ecology of Influenza A Viruses\u201d, Microbiological Reviews, 56 (1): 152-179.<\/p>\n

6) Krauss, S., Obert, C.A., Franks, J., Walker, D., Jones, K., Seiler, P., Niles, L., Pryor, S.P., Obenaur, J.C., Naeve, C.W., Widjaja, L., Webby, R.J., Webster, R.G. 2007. \u201cInfluenza in Migratory Birds and Evidence of Limited Intercontinental Virus Exchange\u201d, PLoS Pathogens (Public Library of Science Pathogens), 3(11), e167. http:\/\/doi.org\/10.1371\/journal.ppat.0030167<\/p>\n

7) Ko\u00e7er, Z.A., Jones, J.C. ve Webster, R.G., 2014. \u201cEmergence of influenza viruses and crossing the species barrier\u201d One Health: People, Animals, and the Environment, pp.115-135.<\/p>\n

8) Tong, S., Li, Y., Rivailler, P., Conrardy, C., Castillo, D.A., Chen, L.M., Recuenco, S., Ellison, J.A., Davis, C.T., York, I.A., Turmelle, A.S., Moran, D., Rogers, S., Shi, M., Tao, Y., Weil, M.R., Tang, K., Rowe, L.A., Sammons, S., Xu, X., Frace, M., Lindblade, K.A., Cox, N.J., Anderson, L.J., Rupprecht, C.E., Donis, R.O. 2012. \u201cA distinct lineage of influenza A virus from bats\u201d, PNAS (Proceedings of National Academy of Science of the United States of America), 109 (11): 4269-4274.<\/p>\n

9) Zhu, X., Yang, H., Guo, Z., Yu, W., Carney, P.J., Li, Y., Chen, L.M., Paulson, J.C., Donis, R.O., Tong, S., Stevens, J., Wilson, I.A. 2012. \u201cCrystal structures of two subtype N10 neuraminidase-like proteins from bat influenza A viruses reveal a diverged putative active site\u201d, PNAS (Proceedings of National Academy of Science of the United States of America), 109 (46): 18903-18908.<\/p>\n

10) Tong, S., Zhu, X., Li, Y., Shi, M., Zhang, J., Bourgeois, M., Yang, H., Chen, X., Recuenco, S., Gomez, J., Chen, L.M., Johnson, A., Tao, Y., Dreyfus, C., Yu, W., McBride, R., Carney, P.J., Gilbert, A.T., Chang, J., Guo, Z., Davis, C.T., Paulson, J.C., Stevens, J., Rupprecht, C.E., Holmes, E.C., Wilson, I.A., Donis, R.O. 2013. \u201cNew world bats harbor diverse influenza A viruses\u201d, Public Library of Science Pathogens, 9(10): e1003657.<\/p>\n

11) Fouchier, R.A., Munster, V., Wallensten, A., Bestebroer, T.M., Herfst, S., Smith, D., Rimmelzwaan, G.F., Olsen, B., Osterhaus, AD. 2005. \u201cCharacterization of a novel influenza A virus hemagglutinin subtype (H16) obtained from black-headed gulls\u201d, Journal of Virology, 79: 2814-2822.<\/p>\n

12) Biggerstaff, M., Cauchemez, S., Reed, C., Gambhir, M., Finelli, L. 2014. \u201cEstimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature\u201d, BMC Infectious Diseases, 14:480. doi: 10.1186\/1471-2334-14-480.<\/p>\n

13) OIE (D\u00fcnya Hayvan Sa\u011fl\u0131\u011f\u0131 \u00d6rg\u00fct\u00fc),\u00a0 \u201cWeekly Disease Information\u201d https:\/\/www.oie.int\/wahis_2\/public\/wahid.php\/Diseaseinformation\/WI\/index\/newlang\/en. son eri\u015fim tarihi: 19 \u015eubat 2020<\/p>\n

14) Liu, D., Shi, W., Shi, Y., Wang, D., Xiao, H., Li, W., Bi, Y., Wu, Y., Li, X., Yan, J., Liu, W., Zhao, G., Yang, W., Wang, Y., Ma, J., Shu, Y., Lei, F., Gao, GF. 2013. \u201cOrigin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses\u201d, The Lancet, 381 (9881): 1926-1932.<\/p>\n

15) Reid, A.H., Fanning, T.G., Hultin, J.V., Taubenberger, J.K. 1999. \u2019\u2019Origin and evolution of the 1918 \u2018Spanish\u2019 influenza virus hemagglutinin gene\u201d, PNAS (Proceedings of National Academy of Science of the United States of America), 96:1651-1656.<\/p>\n

16) Taubenberger, JK., Reid, A.H., Lourens, R.M., Wang, R., Jin, G. ve Fanning, T.G. 2005. \u201cCharacterization of the 1918 influenza virus polymerase genes\u201d, Nature, 437: 889-893.<\/p>\n

17) Scholtissek, C., Rohde, W., Von Hoyningen, V., Rott, R. 1978. \u201dOn the origin of the human influenza virus subtypes H2N2 and H3N2\u201d, Virology, 87 (1): 13-20.<\/p>\n

18) Smith, G.J., Vijaykrishna, D., Bahl, J., Lycett, S.J., Worobey, M., Pybus, O.G., Ma, S.K., Cheung, C.L., Raghwani, J., Bhatt, S., Peiris, J.S.M., Guan, Y., Rambaut, A. 2009. \u201cOrigins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic\u201d, Nature, 459: 1122-1125.<\/p>\n

19) Bird Life International \u201cMediterranean\/BlackSeaFlyway\u201d http:\/\/datazone.birdlife.org\/userfiles\/file\/sowb\/flyways\/5_Mediterranean_Black_Sea_Factsheet.pdf7. Son eri\u015fim tarihi: 19 \u015eubat 2020<\/p>\n

20) Wang, T.T., Palese, P. 2013. \u201cEmergence and Evolution of the 1918, 1957, 1968 and 2009 Pandemic Virus Strain\u201d. Textbook of Influenza. Editor: Webster RG, Monto AS, Braciale TJ, Lamb RA. Hoboken, New Jersey, USA: John Wiley & Sons Ltd.<\/p>\n

21) CDC (Hastal\u0131k Kontrol ve \u00d6nleme Merkezleri). 2013 \u201cImages of Avian Influenza A H7N9\u201d.\u00a0 https:\/\/www.cdc.gov\/flu\/avianflu\/h7n9-images.htm, son eri\u015fim tarihi: 19 \u015eubat 2020.<\/p>\n","protected":false},"excerpt":{"rendered":"

Genetik yap\u0131s\u0131 dolay\u0131s\u0131yla s\u0131kl\u0131kla de\u011fi\u015fime u\u011frayabilen ve do\u011fal rezervuar\u0131n\u0131n yan\u0131 s\u0131ra bir\u00e7ok konak organizmay\u0131 enfekte edebilen influenza A vir\u00fcsleri, her daim salg\u0131n riski ta\u015f\u0131rlar. T\u00fcm influenza vir\u00fcslerine kar\u015f\u0131 mevcutta etkin bir a\u015f\u0131n\u0131n olmamas\u0131 da salg\u0131n riskini art\u0131r\u0131r. Toplumun vir\u00fcsten korunma yollar\u0131 konusunda d\u00fczenli e\u011fitimi salg\u0131n riski olu\u015fmadan \u00f6n\u00fcne ge\u00e7ebilmek a\u00e7\u0131s\u0131ndan olduk\u00e7a \u00f6nemlidir. Son y\u0131llarda giderek […]<\/p>\n","protected":false},"author":2324,"featured_media":40371,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5844,38],"tags":[5852,300,5851,2415],"class_list":["post-40370","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-193-sayi","category-dergi-sayilari","tag-grip-virusu","tag-hastaliklar","tag-influenza","tag-virusler"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t