2022, like in the rest of the world, has been a year that contained many significant events affecting public health in our country as well. The COVID-19 pandemic, which started in 2019, is still ongoing worldwide and in our country. The measures taken during the pandemic, efforts in testing and vaccination, have yielded results, and the impacts of the COVID-19 outbreak has decreased compared to previous years. Another consequence of the measures taken due to the pandemic (such as wearing masks, social distancing, school closures, etc.), is the increase in respiratory tract infections, especially ‘RSV, Influenza A and B, COVID-19,’ which were not commonly seen in previous years, as these measures have been relaxed this year.
According to the World Health Organization (WHO) data, more than 83,000 Moneypox cases have been reported in 110 countries in 2022, while the virus has been detected in 12 people in Türkiye. In addition, some regional public health incidents have occurred in our country in 2022. In July, cases of gastroenteritis were observed in some individuals affected by drinking water in a village in Bolu, with 14 of them being admitted to intensive care and one person losing their life. Some patients were diagnosed with Hemolytic Uremic Syndrome (HUS) during their examinations. In November 2022, one of two children bitten by a dog were diagnosed with rabies.
In 2022, within the scope of the ‘SIHHAT’ project developed by the Ministry of Health, access to healthcare services for vulnerable groups such as immigrants has been increased and services for vulnerable groups such as immigrants has been increased and services have been continued. Towards the end of the year, there have been some new developments in terms of health. It has been decided that the HPV vaccine will be provided free of charge by the Ministry of Health, and screening for SMA disease will be included in the newborn metabolic and endocrine disease screening program (NTP).
COVID-19
The number of COVID-19 cases has been increasing since it was first reported to the WHO in December 2019. According to the latest data updated by the WHO on December 19, 2022, there have been 649,038,437 cases and 6,645,812 deaths worldwide.1 In Türkiye, up until that date, there have been a total of 17,042,722 cases and 101,492 deaths.2 In 2022, the weekly number of COVID-19 cases reached its peak on February 8 with 103,375 cases and has been decreasing since then.3 Due to the decreasing number of COVID-19 cases, the Minister of Health, Dr. Fahrettin Koca, announced in March 2022 that the mask requirement in outdoor and indoor spaces was lifted, and the HES code application was completely discontinued.4 On April 4, 2022, it was decided that the Coronavirus Science Committee would not convene except for extraordinary circumstances.5 Subsequently according to a circular from the Ministry of Interior, the obligation to wear masks would only continue in healthcare facilities.6
According to the latest data in Türkiye, as of December 19, 2022, 93.6% of the population received the first dose of the COVID-19 vaccine, while 85.68% received the second dose. A total of 152,598,271 doses of the vaccine, including the first, second, and third doses, have been administered.2 Additionally, the Phase 3 interim results of the domestic COVID-19 vaccine ‘TurkoVac,’ were published in an internationally peer-reviewed journal in November 2022, entering the scientific literature.7
One Kit Four Tests
Due to the decrease in the number of cases and the increase in vaccinations in 2022, the relaxation of mask and social distancing rules, and the transition to fully face-to-face education in schools as of the 2022-2023 academic year, people have increased contact with each other due to reasons such as a decrease in flexible working hours and remote work.4 5 6As a result of approximately 3 years of social isolation and the impact of non-pharmacological measures, various respiratory diseases, which had been decreased in frequency, have started to reoccur together. The frequency of lower respiratory tract infections has increased in the entire community, especially in younger children, and there have been increases in hospitalizations.8 Based on assessments, it has been determined that COVID-19, Influenza A, Influenza B, and RSV are common infectious agents in the community during the winter period.9 In order to detect these four disease-causing agents, the Türkiye Health Institute has been assigned the task of developing a single kit, as announced by Health Minister Dr. Fahrettin Koca on November 29, 2022.10
HUS-Monkeypox-Rabies
With the detection of numerous cases of monkeypox in several non-endemic countries in May 2022, a new concern emerged worldwide due to the increasing number of cases reported by the WHO on July 23, 2022, regarding the monkeypox virus. As a result, a global state of emergency was declared.11 12 The first case in Türkiye was announced on June 30, with Health Minister Dr. Fahrettin Koca stating that a 37-year-old patient was in isolation and placed under treatment.13 A total of 12 cases of this virus have been detected in Türkiye.14
In July 2022, some individuals in a village in Bolu were diagnosed with gastroenteritis due to drinking water contamination. Among them, 112 cases were reported, including children, and 14 of them were admitted to intensive care. Unfortunately, one person lost their life.15 During the examination of these patients, some were diagnosed with ‘Hemolytic Uremic Syndrome (HUS),’ which presented with bloody diarrhea, anemia, and acute kidney failure. Cleanliness and disinfection measures were taken in the sources that provide drinking water to the village, and the pipeline system of the water reservoir was replaced. The water needs of the village residents were provided by the governorship and the Turkish Red Crescent teams.15
In November 2022, one of the two children attacked by street dogs in Bitlis was diagnosed with rabies and placed under intensive care treatment. Following this incident, the District Health Board conducted a screening and directed suspected contacts bitten by stray animals to healthcare institutions, but no other cases of rabies were found.16 The 10-year-old patient who was admitted for rabies treatment passed away on November 9, 2022.17 Subsequently, certain neighborhoods and villages in Adıyaman, Kars, and Bandırma were quarantined due to suspicion of rabies, and rabies virus was detected in several animals, leading to a rollout of the vaccination of stray animals in the region.18
SMA Screening-HPV Vaccine
In Türkiye, importance has been given to pre-marital health checks and screening programs to protect individuals, families, and the community. As part of the pre-marital screening program in our country, those who apply to family physicians to obtain a mandatory marriage report are subjected to ‘Anamnesis’ and physical examination, as well as laboratory tests such as blood collection; ‘Hemoglobinopathy’ screening, blood type determination, and screening for infectious diseases (HIV, HBV, HCV, VDRL, Syphilis) are conducted.19 According to 2019 TURKSTAT marriage statistics, while 5.9% of official marriages in 2010 were consanguineous marriages, this rate decreased in subsequent years and was 3.8% in 2020.20
Spinal Muscular Atrophy (SMA) is a genetic disease characterized by muscle atrophy and weakness. Considering that there were 1.2 million live births in Türkiye annually, it is estimated that the annual number of new cases for SMA is between 130-180, and a total of 3,000 SMA patients are being monitored. As of December 2021, the premarital ‘SMA Carrier Screening Program’ has been implemented in all provinces.21 Following this development, as of May 9, 2022, the screening for SMA disease has been added to the newborn metabolic and endocrine disease screening program. While Phenylketonuria (PKU), Cystic Fibrosis (CF), Congenital Hypothyroidism, and Biotinidase Deficiency are screened with the heel blood sample taken from newborns, Congential Adrenal Hyperplasia (CAH) was added to the screening panel in 2017, and SMA was added in 2022. Currently, a total of 6 diseases are screened, and studies are being conducted regarding diseases that can be added to the panel.22
Human Papillomavirus (HPV) is a virus that is primarily transmitted through sexual contact and is known to cause cervical cancer in women, as well as vulgar, vaginal, anal, penile, and oral cavity centers.23 WHO called for global action in 2018 aimed at eliminating cervical cancer and stated that if action is not taken, the mortality rate from cervical cancer will increase by 50% by 2040.24 Therefore, since 2014, the Ministry of Health Cancer Department has been implementing the ‘National Cervical Cancer Screening Program.’ As part of this program, cervical samples are taken every five years from women aged between 30 and 65 for HPV testing or Pap smear. National community-based cervical cancer screenings are carried out by Cancer Early Diagnosis, Screening, and Training Centers (KETEM) within Family Health Centers (ASM) and Community Health Centers (TSM). Currently, vaccines have been developed against the types of HPV that are most likely to cause cancer.23 There are three types of HPV vaccines available: ‘Cervavix 2,’ ‘Gardasil 4,’ and ‘Gardasil 9.’ The bivalent and quadrivalent vaccines are approved for females and males aged 9-26, while the nonvalent vaccine is approved for females and males aged 9-45. Many countries, including developed countries worldwide, are attempting to include HPV vaccines in their national immunization programs.24 As of November 2022, Minister of Health Dr. Fahrettin Koca announced that the HPV vaccination would be initiated in specific groups and gradually expand, and subsequently, it was announced that the vaccination would be included in the national vaccination schedule and provided free of charge.26
Project on Migrant Health and Wellbeing
As a result of the internal turmoil that broke out in Syria in 2011, a large number of people had to migrate to Türkiye. Currently, according to official data, there are 3,561,183 Syrians living under temporary protection in our country.27 Türkiye ranks first among refugee-receiving countries, according to the IOM 2022 Report.28 The nationalities of irregular migrants apprehended most frequently are Afghanistan, Syria, and Pakistan.
Health services for Syrians under temporary protection in Türkiye are provided in accordance with the ‘Principles Directive on Health Services to be Provided to Persons Under Temporary Protection,’ dated November 4, 2015, no. 9,648. Syrians registered and issued temporary identification numbers in Türkiye can benefit from emergency health, preventive and basic healthcare services, as well as curative health services free of charge. For those who do not have a temporary identification number, services related to combating infectious diseases, immunization, and emergency health care are provided in line with the ‘Temporary Protection Regulation.’29
Since 2016, healthcare services for Syrian refugees have been provided under the Ministry of Health. These services are carried out within the scope of the ‘SIHHAT Project’ financed by the European Union. The aim of the SIHHAT Project is defined as supporting and improving the primary and secondary healthcare services provided by the Ministry of Health for Syrian refugees in Türkiye.30 The health services provided consist of Migrant Health Centers, Enhanced Migrant Health Centers, Health Services, and Community Mental Health Centers.
In line with this aim, so far:
- 181 Migrant Health Centers and Enhanced Migrant Health Centers have been opened in 29 provinces.31
- Approximately 4,000 personnel have been employed (general practitioners, dentists, specialist doctors, psychologists, social workers, midwives/nurses, laboratory and radiology technicians, interpreters, patient guidance and support staff).
- According to 2021 data, there have been approximately 5,517,000 patient visits to migrant health checks, over 17 million examinations, and 6,371,669 vaccine doses administered.31
1. World Health Organization. (2022 19 December). Coronavirus (COVID-19) Dashboard With Vaccination Data. World Health Organization. https://covid19.who.int/
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2. Republic of Türkiye Ministry of Health, General Coronavirus Data. (2022 19 December). https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html
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3. JHU CSSE. (2022 19 Aralık). COVID-19 Novel Coronavirus (COVID-19) Cases, JHU CSSE. https://github.com/CSSEGISandData/
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4. NTV News (2022 2 March). Bakan Koca salgın için alınan yeni kararları açıkladı: Açık havada maske zorunluluğu kaldırıldı. https://www.ntv.com.tr/saglik/ bakan-koca-salgin-icin-alinan-yeni-kararlari-acikladi-acik-havada-maske-zorunlulugu-kaldirildi,1YliDZYS0USmboJe1f5sIQ.
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5. TRT News (2022 26 April). Cumhurbaşkanı Erdoğan: Kapalı alanlarda maske zorunluluğu kaldırıldı. https://www.trthaber.com/haber/gundem/cumhurbaskani-erdogan-kapali-alanlarda-maske-zorunlulugu-kaldirildi-675912.html.
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6. Republic of Türkiye Ministry of Interior (2022 27 Nisan). 81 İl Valiliğine Kapalı Alanlarda Maske Kullanımı Genelgesi. https://www.icisleri.gov.tr/81-il-valiligine-kapali-alanlarda-maske-kullanimi-genelgesi-gonderildi.
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7. Tanriover, M.D.; Aydin, O.A.; Guner, R.; Yildiz, O.; Celik, I.; Doganay, H.L.; Kose, S.; Akhan, S.; Akalin, E.H.; Sezer, Z.; Ozdarendeli, A.; Unal, S.(2022). On behalf of the TURKOVAC Study Group. Efficacy, Immunogenicity, and Safety of the Two-Dose Schedules of TURKOVAC versus CoronaVac in Healthy Subjects: A Randomized, Observer-Blinded, Non-Inferiority Phase III Trial. Vaccines, 10(11). https://doi.org/10.3390/vaccines10111865
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8. Cumhuriyet News (2022 2 Kasım). Kış dönemi için ‘üçlü salgın’ uyarısı: Covid-19, grip ve RSV. https://www.cumhuriyet.com.tr/saglik/kis-donemi-icin-uclu-salgin-uyarisi-covid-19-grip-ve-rsv-1998881.
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9. WHO. (2022 14 December). Director-General’s Opening Remarks At The Media Briefing, https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing—14-december-2022.
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10. TRT News (2022 29 November). Bakan Koca: Yerli Tanı Kiti 1 Ay İçinde Hastanelerde Kullanılmaya Başlayacak. https://www.trthaber.com/haber/gundem/bakan-koca-yerli-tani-kiti-1-ay-icinde-hastanelerde-kullanilmaya-baslayacak-726834.html.
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11. World Health Organization. (2022 19 December) Monkeypox, https://www.who.int/ news-room/fact-sheets/detail/monkeypox.
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12. World Health Organization. (2023 23 July). WHO Director-General’s statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox. https://www.who.int/director-general/ speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi–country-outbreak-of-monkeypox–23-july-2022.
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13. NTV News. (2022 27 July). Maymun çiçeği vaka sayısı 18 bin oldu https:// www.ntv.com.tr/saglik/maymun-cicegi-vaka-sayisi-18-bin-oldu,wZK9HobQ2EGyldY-C0xKqg.
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14. CDC. (2022 19 December). Monkeypox Outbreak Global Map https://www.cdc. gov/poxvirus/monkeypox/response/2022/world-map.html.
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15. NTV News. (2022 22 July). Bolu’da içme suyundan etkilenen bazı hastalarda ‘HÜS’ çıktı (HÜS nedir?) https://www.ntv.com.tr/turkiye/boluda-icme-suyundan-etkilenen-bazi-hastalarda-hus-cikti-hus-nedir,RV4FLeeqO0mj18jXIBiCpA.
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16. A News. (2022 2 November). Bitlis’te kuduz paniği! İl Sağlık Müdürlüğünden flaş açıklama https://www.ahaber.com.tr/yasam/2022/11/02/bitliste-kuduz-panigi-il-saglik-mudurlugunden-flas-aciklama?paging=3.
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17. Klimik. (2022 9 November). Kuduz tanısıyla tedavi gören çocuk yaşamını yitirdi. https://www.klimik.org.tr/2022/11/10/kuduz-tanisiyla-tedavi-goren-cocuk-yasamini-yitirdi/.
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18. Klimik. (2022 15 November). Kuduz. https://www.klimik.org.tr/?s=kuduz.
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19. TÜSEB. (2018). Evlilik Öncesi Tarama Programı Tarihçesi, Mevzuatı, Mevcut Durumu ve Genişletme Modelleri https://www.tuseb.gov.tr/tacese/uploads/genel/ files/yayinlar/raporlar/evlilik_oncesi_tarama_programi_tarihcesi_mevzuati_ mevcut_durumu_ve_genisletme_modelleri.pdf.
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20. TÜİK. (2021 6 May). İstatistiklerle Aile 2020 https://data.tuik.gov.tr/Bulten/ Index?p=Istatistiklerle-Aile-2020-37251.
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21. General Directorate of Public Health (2022 19 December) . Evlilik Öncesi Spinal Musküler Atrofi (SMA) Taşıyıcı Tarama Programı. https://hsgm.saglik.gov.tr/tr/cocukergen-tp-liste/evlilik-oncesi-spinal-muskuler-atrofi-sma-tasiyici-tarama-programi. html
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22. General Directorate of Public Health. (2022 19 December). Yenidoğan Metabolik ve Endokrin Hastalık Tarama Programı (NTP). https://hsgm.saglik.gov.tr/tr/cocukergen-tp-liste/yenidogan_tarama_programi.html.
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23. General Directorate of Public Health. (2022 19 December). Hepatit B ve HPV Aşılarını Yaptırmakhttps://hsgm.saglik.gov.tr/tr/kanserden-korunma/kanserden-korunmalist/hepatit-b-ve-hpv-a%C5%9F%C4%B1lar%C4%B1n%C4%B1-yapt%C4%B1rmak.html (Erişim Tarihi: 19 Aralık 2022)
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24. Akalın, A. (2022). Human Papillomavirus (HPV) Enfeksiyonu ve HPV aşısında güncel yaklaşımlar. Androloji Bülteni, 24(2), s.133-139.
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25. General Directorate of Public Health. (2022 19 December). Serviks Kanseri Tarama Programı Ulusal Standartları. Halk Sağlığı Genel Müdürlüğü. https://hsgm.saglik.gov. tr/tr/kanser-tarama-standartlari/listesi/serviks-kanseri-tarama-program%C4%B1-ulusal-standartlar%C4%B1.html
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26. Hürriyet News. (2022 13 December). Bakan Koca’dan açıklama: HPV aşısı ne zaman ücretsiz olacak? https://www.hurriyet.com.tr/bilgi/bakan-kocadan-aciklama-hpv-asisi-ne-zaman-ucretsiz-olacak-42186918.
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27. Ministry of Interior Presidency of Migration Management (2022 19 December). İstatistikler/ Geçici Koruma. https:// www.goc.gov.tr/gecici-koruma5638.
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28. International Organization for Migration. (2022). World Migration Report 2022. . https://publications.iom.int/books/world-migration-report-2022.
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29. Ministry of Interior Presidency of Migration Management. (2022 19 December). İstatistikler/ Düzensiz Göç. https://www. goc.gov.tr/duzensiz-goc-istatistikler.
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30. Republic of Türkiye Ministry of Health. (2019). Göç ve Sağlık. Göç ve Sağlık. http://www.sihhatproject.org/Belgeler/Göç ve Sağlık Kitabı_Final.pdf.
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31. Republic of Türkiye Ministry of Health (2022). Sıhhat Projesi http://www.sihhatproject.org/index-html.
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