Öz
Vektör kaynaklı hastalıklar, tarihsel olarak bitkiler, insanlar, evcil hayvanlar ve yaban hayatı için önemli tehditler oluşturmuş ve etkileri özellikle tropikal ve subtropikal bölgelerde belirginleşmiştir. Bunlar arasında kene kaynaklı hastalıklar (KKH’lar), giderek daha kritik bir küresel endişe kaynağı haline gelmiştir. Bu büyüyen tehdit, büyük ölçüde kenelerin genişleyen coğrafi yayılımı ve virüsler, bakteriler, protozoalar, nematodlar, mantarlar ve enfeksiyöz prion proteinleri dahil olmak üzere bulaştırdıkları çok çeşitli patojenlerden kaynaklanmaktadır. Keneler ve KKH’ların neden olduğu zorlukların küresel kümülatif ekonomik etkisi, özellikle kaynakları kısıtlı ve düşük gelirli bölgelerde yoksulluk ve gıda güvensizliğinin devam etmesine katkıda bulunmakta ve durumu daha da kötüleştirmektedir. Bu çok faktörlü yük, iklim değişikliği, habitat bozulması ve ekolojik bozulma, hızlı kentleşme, tarımsal ekosistem yönetimindeki değişiklikler, yaban hayatı rezervuarlarının yeniden canlanması ve artan antropozoonotik hareketlilik gibi karmaşık bir antropojenik faktör ağı tarafından daha da ağırlaştırılmaktadır. Ek olarak, uzun mesafeli ve kıtalararası hareket eden göçmen kuşlar, önemli ekolojik taşıyıcı konaklar olarak hizmet vererek, doğal olarak ixodid kene popülasyonlarının ve ilişkili patojen komplekslerinin yaygın dağılımını ve coğrafi yayılımını kolaylaştırmaktadırlar. Bu zorlukları daha da kötüleştiren bölgesel çatışmalar, zayıf çevresel ve sosyal yönetişim ve artan antimikrobiyal direnç, KKH’ların önlenmesi ve kontrol çabalarını zorlaştırmaktadır. Başta küresel ısınma olmak üzere çok sayıda antropojenik faktörün etkileri nedeniyle, ortaya çıkan ve yeniden ortaya çıkan KKH’ların risk potansiyeli, kenelerin zoocoğrafik dağılımı ve oluşturdukları küresel zorluklarla birlikte her geçen gün artmaktadır. Küresel epidemiyolojik bir bakış açısından, KKH’ların artan insidansı ve yaygınlığı hem medikal hem de veteriner hekimliği disiplinleri için önemli sonuçlar doğurmaktadır. Bu kritik durum, özellikle vektör kapasiteleri ve patojen bulaşma dinamikleri gibi temel hususlar açısından keneler hakkında gelişmiş ve kapsamlı bir anlayışı gerektirmektedir. İksodolojik kayıtlara göre, bugüne kadar dünya çapında fosil türler de dahil olmak üzere toplam 1,025 kene türü bildirilmiştir. Bu türlerden bazıları Türkiye’den de bildirilmiştir. Türkiye’nin yedi coğrafi bölgesinden bildirilen mevcut kene faunası toplam 58 türden oluşmaktadır: Argasidae familyasından 6 cinse ait 8 tür (Argas - 2 tür, Carios - 1 tür, Ornithodoros - 2 tür, Alectorobius - 1 tür, Alveonasus - 1 tür ve Otobius - 1 tür) ve Ixodidae familyasından 7 cinse ait 50 tür (Ixodes - 17 tür, Rhipicephalus - 8 tür, Dermacentor - 4 tür, Hyalomma - 9 tür, Haemaphysalis - 8 tür, Alloceraea - 1 tür ve Amblyomma - 3 tür). Özellikle Hyalomma ve Ixodes cinslerinin Türkiye’de insan enfestasyonlarıyla en sık ilişkilendirilen cinsler olarak bildirilmesi, epidemiyolojik önemlerini ve kene kaynaklı patojenlerin (KKP’ler) bulaşmasındaki potansiyel rollerini vurgulamaktadır. Dünya genelinde zoonotik özelliklere sahip birçok KKH bildirilmiştir. Bunlar arasında yaklaşık 100 viral hastalık (bunların yaklaşık yarısı zoonotiktir) ve çoğunluğu zoonotik potansiyel gösteren çok sayıda bakteriyel, protozoan, filarial nematod, fungal ve prionla ilişkili patojen bulunmaktadır. Son yıllarda moleküler epidemiyolojik çalışmalar, ortaya çıkan KKH’ların artan önemini vurgulamaktadır. Özellikle yaban hayatındaki KKP’lerin (geyiklerdeki bulaşıcı prion proteinleri ve dağ keçileri ile dağ koyunlarında tanımlanan riketsiyal patojenler gibi) yakından izlenmesi ve zoonotik potansiyellerinin açıklığa kavuşturulması kritik öneme sahiptir. Ayrıca, yarasalarla ilişkili kene türlerinin (özellikle mağaralarda yaşayan yarasaları enfeste eden Ixodes vespertilionis, Ixodes simplex, Ixodes ariadnae, Ixodes kaiseri ve Haemaphysalis erinacei gibi) ekolojik önemi ve ortaya çıkan ve yeniden ortaya çıkan KKP’ler için potansiyel vektörler olarak rolleri göz ardı edilmemelidir. Lyme borreliosis, anaplazmosis, ehrlichiosis, babesiosis ve theileriosis gibi küresel ekonomik kayıplara yol açan başlıca KKH’lar, Türkiye’de de önemli epidemiyolojik ve ekonomik zorluklara sebep olmaktadırlar. Özellikle Türkiye bağlamında, babesiosis, theileriosis, anaplazmosis ve ehrlichiosis gibi KKH’lar tüm coğrafi bölgelerden rapor edilmiş olup, büyük ekonomik kayıplara yol açmışlardır. İnsanlarda Kırım-Kongo hemorajik ateşi ağırlıklı olarak Orta Anadolu ve Karadeniz’in sahilden uzak iç kesimlerinde görülmüş olup, ülkenin diğer bölgelerinde de nadir olgular meydana gelmiştir. Lyme borreliosis en sık Marmara Bölgesi’nde bildirilmiş olup, bunu Orta Anadolu ve Akdeniz Bölgeleri takip etmiştir. KKH’ların küresel tehdidi, sürdürülebilir kalkınma hedeflerini doğrudan baltalamakta ve Dünya Sağlık Örgütü’nün “küçük ısırık, büyük tehdit” kampanyası ve sektörler arası iş birliği yoluyla zoonotik hastalık risklerini azaltmayı amaçlayan Tek Sağlık yaklaşımları ve eylemleri gibi uluslararası girişimleri teşvik etmektedir. Amaç, insan, hayvan ve çevre sağlığını kapsayan entegre stratejiler aracılığıyla ortaya çıkan ve yeniden ortaya çıkan KKH’larla mücadele etmektir. Kene kaynaklı mikroRNA’lar, CRISPR/Cas9 gen düzenleme, transfeksiyon sistemleri, hücre dışı vezikül araştırmaları ve DNA ve miRNA tabanlı aşılar gibi yenilikçi stratejiler, kene biyolojisini ve patojen bulaşmasını engellemede umut vadetmektedir. Entegre kene kontrol (EKK) programları, erken uyarı sistemleri, küresel izleme ve açık veri paylaşımı ile birleştirilen bu gelişmeler, etkili kene ve KKH yönetimi için hayati önem taşımaktadır. Bu karmaşık zorluğun üstesinden gelmek, uluslararası iş birliği, disiplinlerarası araştırma ve çevre yönetimini ve bilimsel okuryazarlığı destekleyen “ekosentrik eğitim” yaklaşımını gerektirir. Nihayetinde, kenelerin yayılmasını durdurmak ve KKH’ların küresel yükünü azaltmak; Tek Sağlık ilkelerini uygulamağa, güçlü yönetişim sergilemeğe ve araştırma, eğitim ve kapasite geliştirmeye ayrılan yatırıma bağlıdır. Bu derleme, keneler ve onların dağılımları, vektör yeterlilikleri, tıbbi ve veteriner önemleri, kene-patojen-konak etkileşimleri, ortaya çıkan KKH tehditleri, EKK stratejileri ve keneler ile KKH’ların kümülatif ekonomik etkileri hakkında genel bir bakış sunmaktadır.
Anahtar Kelimeler: Epidemiyoloji, keneler, kene kaynaklı hastalıklar, kene kontrolü, ekonomik yük, Türkiye
Kaynakça
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