Turkiye Klinikleri Infectious Diseases - Special Topics

İnfluenza Özel Sayısı
.: REVIEW
İnfluenza Epidemiyolojisi
Influenza Epidemiology
Dr. Behice KURTARANa
aEnfeksiyon Hastalıkları AD, Çukurova Üniversitesi Tıp Fakültesi, Adana
Turkiye Klinikleri J Inf Dis-Special Topics. 2010;3(2):5-14
Article Language: TR
ÖZET
İnfluenza A virüsü, 11 gen kodlayan sekiz RNA segmentinden oluşan bir RNA genomuna sahiptir. Hücresel reseptör siyalik asite bağlanan hemaglütinin (HA) ve tomurcuklanan virüslerden siyalik asit rezidülerini yıkan nöraminidaz (NA) adı verilen zarf proteinleri, influenza epidemiyolojisi açısından özel öneme sahiptir. Epidemi seyrinde bu genlerin sekansında meydana gelen insersiyonlar, delesyonlar ve değişiklikler NA ve HA yapılarında polimorfizm ile sonuçlanır, ancak bunlar antijenik isimlendirmelerini değiştirecek boyutta değildir; bu polimorfizmler antijenik sürüklenme (drift) olarak adlandırılır. Diğer bir deyişle bu mutasyonlara rağmen NA veya HA proteinin söz konusu birincil antijenik özellikleri halen korunmaktadır (örn., H1), ancak bu mutasyonlar herhangi bir popülasyon içinde konak bağışıklığının kısmi kaybı ile sonuçlanır (2, 8). Popülasyon içinde kısmi bağışıklık eksikliği nedeniyle pandemik yayılım ile sonuçlanabilecek antijenik kayma (şift), etkili şekilde antijenik olarak farklı bir HA (yeni NA varlığında veya yokluğunda) ortaya çıktığında meydana gelir. Antijenik kayma, ko-enfeksiyonu olan bir konak içinde, insana adapte olmuş influenza suşları ile hayvana adapte olmuş suşlar arasındaki yeniden sıralanma olayının bir sonucu olarak (insana bulaşma kapasitesi yavaş ve kalıcı bir virüs nesli ile sonuçlanan) veya kuş dahil bir hayvan influenza A virüsünün, hayvanlardan insanlara yeniden sıralanma olmadan bulaştığında yeni bir insana adapte olmuş HA'nın meydana gelmesi durumunda görülür. Yirminci yüzyılda üç pandemi meydana gelmiştir: 1918 H1N1 pandemisi, 1957 H2N2 pandemisi ve 1968 H3N2 pandemisi. Her bir pandemi kendine özgü epidemiyolojik patern ve orijine sahiptir. Mevsimsel ve pandemik influenzanın morbidite ve mortalitesini içerecek şekilde epidemiyolojisi, burada derlenmeye çalışılmıştır.

Anahtar Kelimeler: İnfluenza virus; epidemiology
ABSTRACT
Influenza A virus contains an RNA genome comprising eight RNA segments encoding 11 genes. Of these, the hemagglutinin (HA), which binds to the cellular receptor sialic acid, and neuraminidase (NA), which cleaves sialic acid residues from budding viruses, are of particular importance to the epidemiology of influenza. Over the course of epidemics, insertions, deletions, and changes in the sequence of these genes result in polymorphisms of NA and HA structures, although they are of insufficient magnitude to change their antigenic nomenclature; these polymorphisms are termed antigenic drift. Antigenic shift, which may result in pandemic spread because of lack of partial immunity within the population, occurs when a sufficiently antigenically dis-tinct HA (with or without a new NA) emerges. Antigenic shift may occur either as a result of a reassortment event between human-adapted influenza and animal-adapted strains within a coinfected host, resulting in a progeny virus capable of sustained human transmission, or if a new human-adapted HA arises when an animal or avian influenza A virus is transmitted without reassortment from an animal reservoir to humans outbreaks or pandemics without appropriate spontaneous genetic alterations that result in human host adaptations. Three major pandemics were recorded in the 20th century: the 1918 to 1919 pandemic (H1N1), the 1957 to 1958 pandemic (H2N2), and the 1968 pandemic (H3N2). Each had a unique epidemiologic pattern and origin. The epidemiologies of seasonal and pandemic influenza, including morbidity and mortality, will be reviewed here.

Keywords: Influenza virus; epidemiology

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30.03.2014

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