Mustafa Volkan DÜZGÜN, Ayşegül İşler DALGIÇ

TOPLUM SAĞLIĞI İÇİN GİDEREK ARTAN TEHLİKE AŞI REDDİ ÖNLENEBİLİR Mİ?

Aşılama çeşitli hastalıkların mortalite ve morbiditesini azaltmada etkili, uygun maliyetli ve kabul edilmiş bir yöntem olarak toplum sağlığının en önemli başarıları arasında gösterilmektedir. Dünya Sağlık Örgütü’nün Mart 2018 raporunda küresel bağışıklamanın yılda 2–3 milyon ölümü engellediği açıklaması aşılamanın toplum sağlığı için ne kadar önemli olduğunun bir göstergesidir. Son yıllarda aşılamanın kanıtlanmış faydaları iyi bilinmesine rağmen çocukluk çağındaki aşılanma oranlarında global bir düşüş yaşanmaktadır. Avrupa’da 2017 verilerine göre kızamık vaka sayısı bir önceki yıla göre yaklaşık üç kat arttığı ve tanı alan vakaların %87’sinin aşılanmayı reddettiği tespit edilmiştir. Yine Avrupa’da boğmaca, tetanoz ve difteri aşısı ile bağışıklama oranı %92’ye, Amerika’da %91’e kadar düşmüştür. Türkiye’de ise genel aşılanma oranlarında düşüş yaşandığı belirlenmiştir. Kızamık, kızamıkçık, kabakulak, difteri, aselüler boğmaca, tetanoz, konjuge pnömokok ve hepatit B aşıları ile bağışıklama oranları 2016 yılında %98 iken sonraki yılda %96’ya gerilemiştir. Bu nedenle DSÖ 2019 yılı için belirlediği 10 küresel sorun içerisinde aşı reddine de yer vermiştir. Bu bağlamda aşı karşıtlığını önlemek toplumsal bir sorumluluk olup sağlık personelinden, medya çalışanlarına hatta politikacılara önemli görevler düşmektedir. Literatürde aşı reddinin nedenlerine yönelik çalışmalar olmakla birlikte önlemeye yönelik herhangi bir çalışmaya rastlanılmamıştır. Bu derlemenin amacı aşı ret ve tereddüt nedenleri doğrultusunda aşı karşıtlığını önlemeye yönelik girişimlerin sunulmasıdır. Derlemede verilen öneriler doğrultusunda yapılacak girişimsel çalışmalarla aşı ret ve tereddütlerinin önlenebileceği düşünülmektedir.

Anahtar Kelimeler:

Aşı reddi, aşı tereddüdü, çocuk, aşı karşıtlığı

Can Vaccine Rejection, an Increasing Danger to Public Health, be Prevented?

Vaccination is an effective, cost-effective, and accepted method for reducing mortality and morbidity of various diseases. It is also considered one of the most important achievements of public health. The World Health Organization's March 2018 report states that global immunization prevents 2-3 million deaths annually, proving how important vaccination is important to public health. Although the proven benefits of vaccination are well known, there has been a global decline in immunization rates in childhood in recent years. According to 2017 data in Europe, the number of measles cases increased approximately threefold compared to the previous year and 87% of the diagnosed cases refused to be vaccinated. The immunization rate with pertussis, tetanus and diphtheria vaccines has decreased to 92% in Europe and 91% in the US. In Turkey, it was determined that the overall vaccination rates declined. Immunization rates of measles, rubella, mumps, diphtheria, acellular pertussis, tetanus, conjugated pneumococcal and hepatitis B vaccines decreased from 98% in 2016 to 96% in the following year. The World Health Organization has included vaccine rejection among the 10 global problems identified for 2019. A multidisciplinary effort is needed to reduce vaccine hesitation and increase vaccination rates in the community. In this context, preventing anti-vaccination is a social responsibility and it imposes important duties for health personnel, media workers and even politicians. Although there are studies on the causes of vaccine rejection in the literature, no studies have been found to prevent it.The purpose of this review is to suggest interventions to prevent anti-vaccine in line with the reasons for vaccine rejection and hesitation.Vaccine rejection and hesitations are thought to be prevented by interventional studies in line with the recommendations given in the review.

Keywords:

Vaccine rejection vaccination hesitation, child, anti-vaccination, immunization,

PDF

___

1. Kutlu R. Çocukluk Çağı Aşıları. Turkiye Klinikleri Journal of Family Medicine Special Topics 2017;8:311-8.
2. Fine P, Eames K, Heymann DL. “Herd immunity”: a rough guide. Clinical infectious diseases 2011;52:911-6.
3. Aggarwal A. Childhood Vaccine Refusal and Hesitancy–Reasons. The Indian Journal of Pediatrics 2019;86:5-6.
4. Dubé E, Gagnon D, Ouakki M, et al. Understanding vaccine hesitancy in Canada: Results of a consultation study by the Canadian Immunization Research Network. PloS one 2016;11:e0156118.
5. Gür E. Aşı kararsızlığı-aşı reddi. Türk Pediatri Arşivi 2019;54:1-2.
6. Larson HJ, Jarrett C, Schulz WS, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine 2015;33:4165-75.
7. Gowda C, Dempsey AF. The rise (and fall?) of parental vaccine hesitancy. Human vaccines immunotherapeutics 2013;9:1755-62.
8. WHO. Ten threats to global health in 2019. 2019.
9. Bozkurt HB. Aşı Reddine Genel Bir Bakış ve Literatürün Gözden Geçirilmesi. Kafkas Tıp Bilimleri Dergisi 2018:71.
10. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015;33:4161-4.
11. Repalust A, Šević S, Rihtar S, Štulhofer A. Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study. Psychology, health medicine 2017;22:1045-55.
12. Brown KF, Kroll JS, Hudson MJ, et al. Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review. Vaccine 2010;28:4235-48.
13. Topçu S, Almış H, Başkan S, Turgut M, Orhon FŞ, Ulukol B. Evaluation of childhood vaccine refusal and hesitancy intentions in Turkey. The Indian Journal of Pediatrics 2019;86:38-43.
14. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine 2014;32:2150-9.
15. Callender D. Vaccine hesitancy: more than a movement. Human vaccines immunotherapeutics 2016;12:2464-8.
16. Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: a critical review. Social science medicine 2014;112:1-11.
17. Siddiqui M, Salmon DA, Omer SB. Epidemiology of vaccine hesitancy in the United States. Human vaccines immunotherapeutics 2013;9:2643-8.
18. WHO. Global and regional immunization profile Region of the Americas. 2017.
19. Sağlık Bakanlığı TC. Sağlık İstatistikleri Yıllığı. Vol 20192017.
20. WHO. SAGE working group dealing with vaccine hesitancy. 2014.
21. Argüt N, Yetim A, Gökçay EG. The factors affecting vaccination acceptance. The Journal of the Child 2016;16:16-24.
22. Hausman BL, Ghebremichael M, Hayek P, Mack E. ‘Poisonous, filthy, loathsome, damnable stuff’: The rhetorical ecology of vaccination concern. The Yale journal of biology medicine 2014;87:403.
23. Egan W, Baylor N. Preservatives in vaccines, I: FDA perspective. Workshop on Thirmerosal in Vaccines1999.
24. Mahaffey KR. Methylmercury exposure and neurotoxicity. JAMA 1998;280:737-8.
25. Ball LK, Ball R, Pratt RD. An assessment of thimerosal use in childhood vaccines. Pediatrics 2001;107:1147-54.
26. Offit PA. Thimerosal and vaccines—a cautionary tale. New England Journal of Medicine 2007;357:1278-9.
27. Miller NZ. Aluminum in childhood vaccines is Unsafe. Journal of American Physicians Surgeons 2016;21:109-17.
28. Baylor NW, Egan W, Richman P. Aluminum salts in vaccines—US perspective. Vaccine 2002;20:S18-S23.
29. Lyons-Weiler J, Ricketson R. Reconsideration of the immunotherapeutic pediatric safe dose levels of aluminum. Journal of Trace Elements in Medicine Biology 2018;48:67-73.
30. CDC. Measles cases in the United States reach 20-year high. 2014.
31. Burghouts J, Del Nogal B, Uriepero A, Hermans PW, de Waard JH, Verhagen LM. Childhood vaccine acceptance and refusal among Warao Amerindian Caregivers in Venezuela; A qualitative approach. PloS one 2017;12:e0170227.
32. Attwell K, Smith DT, Ward PR. ‘The Unhealthy Other’: How vaccine rejecting parents construct the vaccinating mainstream. Vaccine 2018;36:1621-6.
33. Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine hesitancy: causes, consequences, and a call to action. Vaccine 2015;33:D66-D71.
34. WHO. Report of the SAGE Working Group on Vaccine Hesitancy. 2014.
35. Peterson RM, Cook C, Yerxa ME, Marshall JH, Pulos E, Rollosson MP. Improving immunization coverage in a rural school district in Pierce County, Washington. The Journal of School Nursing 2012;28:352-7.
36. Hoekstra S, Margolis L. The importance of the nursing role in parental vaccine decision making. Clinical pediatrics 2016;55:401-3.
37. Kata A. A postmodern Pandora's box: anti-vaccination misinformation on the Internet. Vaccine 2010;28:1709-16.
38. Scott SD, Gilmour J, Fielden J. Nursing students and internet health information. Nurse Education Today 2008;28:993-1001.
39. Kondro W. Mandatory vaccinations: The international ladscape. CanadianMedAssoc J 2012;184:1456-7.