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Geçtiğimiz hafta Amerikan Hastalık Kontrol ve Önleme Merkezi CDC , resmi sayfasında yayınladığı yeni bir rehberde, Ortadoğu ve Asya ülkeleri başta olmak üzere aralarında Türkiye 'nin de bulunduğu çok sayıda ülkeden, kuduz riski nedeniyle köpek girişinin geçici olarak askıya alındığı açıklandı. Açıklamada, bu geçici önlemin ABD 'ye ithal edilen köpeklerin sağlık ve güvenliğini sağlamak ve halk sağlığını, köpek kuduz virüsü varyantının (köpek kuduzları) ABD'ye yeniden girmesine karşı korumak için gerekli olduğu belirtildi. İngiltere 'nin de ülkemizi bir süredir hayvanlardaki kuduz açısından yüksek riskli ülkeler kategorisinde tuttuğuna değinen Mikrobiyoloji ve Enfeksiyon Hastalıkları Bölümü 'nden Tropikal Hastalıklar uzmanı Doç. Dr. Şiran Keske, Türkiye'de 'hayvan kuduz vakaları' açısından rakamların halen yüksek olduğunu, ancak başarılı aşılama ve takip merkezleri sayesinde 'insan kuduz vakalarının' ülkemizde uzun zamandır görülmediğini söyledi. Konuyla ilgili Demirören Haber Ajansı na bilgi veren Doç. Dr. Keske, bu ülkelere yolculuk yapacak evcil hayvan sahiplerinin sıkıntı yaşamaması için başvuru işlemlerine 6 hafta önceden başlaması gerektiğini söyledi.
"GÜNCELLEME ÜLKELERDEKİ KUDUZ HAYVAN SAYISINA GÖRE YAPILIYOR" Doç. Dr. Keske, "CDC, yakın zamanda yayınladığı bir rehberde kuduz riski taşıyan yüksek riskli ülkeler listesini güncelledi. Bu güncelleme, kuduz görülen hayvan sayısı üzerinden yapılıyor ve Türkiye dahil çok sayıda ülke, yüksek riskli gruba dahil edildi. İngiltere'de bu uygulama zaten vardı bir süredir. Yüksek riskli ülkelerden evcil hayvanlar ile birlikte ülkeye girmek isteyenler için böyle bir önlem alıyorlar. Kuduzla enfekte olabilen hayvanlar ABD'ye girişte özel bir uygulamaya tabi olacaklar. Hayvan sahiplerinin 6 hafta öncesinden işlemlerini başlatması gerekiyor. Hayvanın aşılı olup olmadığı, doğum tarihi, geçirdiği hastalıkları da içeren detaylı dökümanlar istiyorlar. Bu durumdan haberdar olmayanlar giderse ne olacak, bir kere hayvanın kesinlikle ülkeye girişine izin vermeyecekler. Hayvanın Amerika'ya gelmeden bir önceki durağına geri gönderileceği belirtilmiş açıklamada" dedi.
"İNSAN VAKASI YOK AMA HAYVANLARDA KUDUZ SAYISI HALA YÜKSEK" Doç. Dr. Keske, Türkiye 'nin neden kuduz açısından yüksek riskli bir bölge olarak listeye alındığına ise şu bilgilerle yanıt verdi: "Türkiye'de vahşi doğada ve evcil hayvanlarda kuduz görülebiliyor. Zaten Amerika bu listeyi hayvan kuduzları üzerinden yapıyor. İnsan kuduz vakası görülmüyor Türkiye'de çok uzun zamandır. Bunun en temel nedeni, kuduz konusunda çok sayıda merkezimiz var, temas sonrası aşılama ve immunglobulin gibi uygulamaları hızla uygulayabilen bir sistemimiz var. Bu yüzden insan kuduzu görmüyoruz. Ama bu, hayvanlarda olmadığı anlamına gelmiyor. Bu konuda özellikle Sağlık Bakanlığı'nın verilerine bakarsak, kuduz ile enfekte hayvan sayısı Türkiye'de halen az diyemeyiz. Bu Türkiye'yi yüksek riskli ülke konumuna sokuyor."
KOVİD-19 AŞILAMA VE DOZLARLA İLGİLİ KAFA KARIŞIKLIĞI BÜYÜK Delta varyantının hızla yayıldığı bugünlerde aşılala ilgili yaşanan kafa karışıklığına da değinen Doç. Dr. Keske, "Türkiye'de Kovid-19 aşılaması ile ilgili çok sayıda soru var. Bunlardan bir tanesi hastalığı geçirenlerin 'Ne yapalım?' kaygısı. Kovid-19 geçiren kişilerin en az 3 ay boyunca yeniden hasta olmayacağı farzediliyor. 3 ila 6 arasında da bu risk son derece düşük. 6 aydan sonra ise reinfeksiyon dediğimiz yeniden Kovid olma ihtimali var. O halde Kovid-19 geçirenlerde, 3 ila 6 ay aşı olmadan beklemek mümkün. Bu kişiler aşılanmak isterlerse bir doz mu iki doz mu aşı olacak? Bu konuda da kafalar karışık. Bununla ilgili bazı çalışmalar var. Bu çalışmalar Kovid-19 geçiren kişilerin bir doz mRNA aşısı olsalar bile belirgin bir bağışıklama yanıtı gösterdiğini, yani koruyuculuğun oldukça yüksek olduğunu, ikinci dozu olmaya mutlaka gerek olmadığını gösteriyor. Ama aşı pasaportu meselesi nedeniyle sanırım, iki doz BioNTech olmak isteyen grupların sayısının da artması nedeniyle, Sağlık Bakanlığı ikinci dozu da isteyenlerin yaptırabileceğini belirtti. Ama bilimsel olarak tek doz şu anda yeterli görünüyor" diye konuştu.
"HASTALIĞI GEÇİRENLER SİNOVAC YAPTIRACAKSA İKİ DOZ OLMALI" Kovid geçirip hastalık sonrası Sinovac aşısı olmak isteyenlerin iki doz olmasında fayda olacağını söyleyen Doç. Dr. Keske, bunu da şu şekilde açıkladı: "Kovid-19 geçirenler Sinovac aşısı olmak isterlerse tek doz mu çift doz mu olacak? Şunu görüyoruz, bir şekilde Sinovac aşısını olmuş ama ikinci dozu olamadan arada Kovid enfeksiyonu geçiren kişilerin de aslında antikor düzeyi çok yüksek. Ama burada biraz daha güvenli alanda kalmak adına, çünkü Delta varyantı tehlikesi var, iki doz Sinovac aşısı olmanın daha iyi olabileceğini düşünüyorum. Ama bu tamamen kişisel görüşüm."
"ÜÇÜNCÜ DOZ KONUSU DÜNYADA DA HALEN NET DEĞİL" Peki Sinovac sonrası üçüncü doz aşı gerekli mi? Yaptırılacaksa hangi aşı olmalı? Doç. Dr. Şiran Keske, aslında bu soruların da henüz bilimsel olarak yanıtının net bir şekilde bilinmediğini belirterek "Ülkeler kendilerine göre pozisyon alıyorlar. Örneğin ABD üçüncü dozun henüz gerekli olmadığını söyledi. Ama biliyoruz ki onlar BioNTech (mRNA) ile iki doz yaptıktan sonra üçüncü dozun yapılmasına gerek olmadığını belirtiyor. İsrail ise özellikle bağışıklık sistemi baskılanmış olan kişilerde iki doz BioNTech'e rağmen üçüncü bir BioNtech dozunu öneriyor. Endonezya, Birleşik Arap Emirlikleri gibi Sinovac aşısını yoğun uygulayan ülkelerin ise durumu biraz daha farklı. Burada birkaç şeye bakmamız gerekiyor. Birincisi bu ülkeler ne kadar bağışıklama yaptılar? Örneğin Endonezya'nın bağışıklama (aşılama) oranı son derece düşük. Endonezya'da Delta varyantına bağlı ciddi olgu artışı var. Ancak bu artışın nedeni aşılama oranının düşük olması mı yoksa Sinovac yapmış olmaları mıdır? Bunu çok net olarak bilmiyoruz" dedi.
"VERİLER GELENE KADAR ÖNLEMLERE SIKI BİR ŞEKİLDE DEVAM ETMELİYİZ" Türkiye 'nin kısıtlamalarla birlikte vaka sayısını oldukça düşürdüğünü ancak hem serbestleşme hem de Delta varyant nedeniyle durumun biraz daha zor hale dönüştüğünü belirten Doç. Dr. Keske, sözlerini şöyle noktaladı: "Delta varyantın ülkemizde ne sıklıkta olduğunu henüz tam bilmiyoruz ama giderek arttığını görüyoruz. Bağışıklık sistemi daha baskılanmış olan kişiler özellikle risk grubuna giriyorlar. Bunların üçünü doz olması gerekebilir. Sinovac aşısı olanlar arasında hastalık görülmeye başlıyor ama bu acaba bağışıklık yanıtının giderek zayıflaması ile mi ilgili, bunları biraz daha araştırıp ondan sonra net bir veri sunabiliriz. Aslında Sinovac aşısı olan ülkelerden gelen veriler tabii ki büyük önem kazanıyor ama Türkiye bu aşıyı en çok yapan ülkelerden biri olarak bu alanda veriler sunarak bu durumu aydınlatacaktır. Bizler de Sinovac aşısı sonrası Delta varyanta etkinliği, Kovid-19 geçirenlerde kaç doz yapılmalı gibi sorulara daha net yanıt verebiliriz böylece. Tabii veriler gelene kadar bunu bir yana bırakarak aşılanmanın yanı sıra özellikle sosyal mesafeyi korumak, hijyene dikkat etmek ve izolasyon önlemlerine uyumu arttırmamız gerekiyor."