Türkiye’de çocukluk çağı ulusal aşı takviminde yeni hedefler

Amaç: Türkiye’de Çocukluk Çağı Ulusal Bağışıklama Programının kapsayıcılığı yüksektir; bu programda yer almayan rotavirüs, human papilloma virüs, meningokok, influenza ve erişkin tip boğmaca aşılarının uygulaması bağışıklama ile ilgili uzmanlar tarafından önerilmesine rağmen yaygın değildir. Bu çalışmada bu aşıların uygulanma oranının ve nedenlerinin belirlenmesi hedeflendi.Yöntemler: Ankete dayalı kesitsel bir çalışma olarak planlanan bu çalışma Orta Kuzey Anadolu’da küçük bir il merkezinde aile hekimleri ile yürütüldü. Katılımcılar tarafından elektronik posta veya telefon görüşmeleri ile sosyodemografik ve mesleki özelliklerini, Çocukluk Çağı Ulusal Aşı Programı dışındaki aşılar konusunda tutumlarının sorulduğu anket formları dolduruldu. Bulgular: Çalışmaya 108 aile hekiminin 78’i (%72) katıldı. Rotavirus aşısı hem günlük çalışma hayatında, hem de Ulusal Aşı Takvimi’ne dahil edilme önerisi konusunda en yaygın aşı idi. Tdab her iki durumda da en az önerilen aşı idi. Takvimde olmayan aşıların uygulanmaması konusunda en sık neden olarak hekimlerin konuyla ilgili bilgi ve deneyimlerinin yetersiz olması saptandı.Sonuç: Aşılar enfeksiyon hastalıklarından korunmanın en güvenilir ve ucuz yoludur, bu hizmetlerin sahada yürütülmesini sağlayan kaptanlar aile hekimleridir. Onların bağışıklama ile ilgili güncel bilgi ve gelişmelere ulaşmasını sağlamak için eğitim programları düzenlenmelidir. Çocuk sağlığı izlemelerinde Sosyal Pediatri hekimleri bağışıklama konusunda danışmanlık verebilir. Ek olarak, bu aşılar sosyal güvenlik sisteminin geri ödeme kapsamına alınmalıdır.

Anahtar Kelimeler:

Bağışıklama, Aile hekimi, Tutum

New targets for Turkish childhood national immunization schedule

Aim: The National Immunization Schedule (NIS) of Childhood has high coverage, but the administration of non-NIS vaccines (rotavirus, human papilloma virus, meningococcal, influenza, adult type pertussis vaccines [Tdap]) is not widespread in Turkey, despite recommendations by immunization experts. This report intended to explore the administration rates of these vaccines and their reasons in this province. Methods: This questionnaire based cross-sectional study was conducted in a small city in middle northern Turkey. The target population was the family physicians of this city. The participants filled a survey containing questions about their sociodemographic and professional features and attitudes about non-NIS vaccines via email or telephone interviews.Results: Seventy-eight (72%) of 108 physicians were enrolled in the study. The most and least recommended vaccines in daily practice and for addition to NIS were rotavirus and Tdap vaccines, respectively. The main reason of not administrating non-NIS vaccines was lack of knowledge and experience.Conclusion: Vaccination is the safest and cheapest way of protecting from infectious diseases. Family physicians are the leaders of these procedures in the field. Education should be provided to help them reach current knowledge regarding immunizations. Community pediatricians can provide expert consultation. These vaccines should be covered by social security.

Keywords:

Immunization, Family physician, Attitude,

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1. Barrett ADT. Vaccinology in the twenty-first century. NPJ Vaccines. 2016;1:16009.
2. Arısoy S, Ceyhan M, Çiftçi E, Hacımustafaoğlu M, Kara A, Kuyucu N, et al. The National Vaccination Schedule in Previously Healthy Children: The Practical Recommendations about Additional Vaccines. J Pediatr Inf. 2014;8:1-6.
3. Dorell C, Yankey D, Strasser S, Parent-reported reasons for nonreceipt of recommended adolescent vaccinations, national immunization survey: Teen, 2009 Clin Pediatr. 2011;50:1116–24.
4. Opel DJ, Heritage J, Taylor JA, Mangione-Smith R, Salas HS, De Vere V, et al. The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics 2013;132:1037–46.
5. Çataklı T, Duyan-Çamurdan A, Aksakal-Baran FN, Güven AE, Beyazova U. Attitudes of physicians concerning vaccines not included in the national immunization schedule. The Turkish Journal of Pediatrics. 2018;60:290-7. doi: 10.24953/turkjped.2018.03.009
6. Tapısız A, Demirdağ TB, Cura Yayla BC, Güneş C, Uğraş Dikmen A, Tezer H, et al. Rotavirus infections in children in Turkey: A systematic review. Rev Med Virol. 2019 Jan;29(1):e2020. doi: 10.1002/rmv.2020
7. Centers for Disease Control and Prevention (CDC). Epidemiology and prevention of vaccine-preventable diseases. In: Hamborsky J, Kroger A, Wolfe S (Eds.) 13th ed. Washington D.C. Public Health Foundation; 2015
8. Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI: Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 2003;9:565-72.
9. Sancar M, Dalgıç N, Haşim O, Pullu M. Bir eğitim ve araştırma hastanesindeki rotavirüslü çocuklarda yatış maliyeti. Çocuk Enfeksiyon Dergisi. 2011;5:7-11.
10. Patel MM, Janssen AP, Tardif RR, Herring M, Parashar UD. A qualitative assessment of factors influencing acceptance of a new rotavirus vaccine among health care providers and consumers. BMC Pediatr. 2007;7:32. doi:10.1186/1471-2431-7-32
11. Ceyhan M, Gürler N, Ozsurekci Y, Keser , Aycan AE, Gürbüz V, et al. Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005-2012 in Turkey. A multicenter prospective surveillance study. Hum Vaccin Immunother. 2014;10:2706-12.
12. Tekin RT, Dinleyici EC, Ceyhan M, Karbuz A, Salman N, Sütçü M, et al. The prevalence, serogroup distribution and risk factors of meningococcal carriage in adolescents and young adults in Turkey. Hum Vaccin Immunother. 2017;13:1182-9.
13. Dursun P, Ayhan A, Mutlu L, Haberal A, Güngör T, Özat M, et al. HPV types in Turkey: multicenter hospital based evaluation of 6388 patients in Turkish gynecologic oncology group centers. Turk Patoloji Derg. 2013;29:210-6. doi: 10.5146/tjpath.2013.01188.
14. World Health Organization (WHO). Pertussis vaccines: WHO position paper-August 2015. Weekly epidemiological record. Vol 90. Switzerland: World Health Organization; 2015. p.433-60.
15. Forsyth K, Plotkin S, Tan T, Wirsing von König CH. Strategies to decrease pertussis transmission to infants. Pediatrics. 2015;135(6):e1475‐e1482. doi:10.1542/peds.2014-3925
16. Giannattasio A, Mariano M, Romano R, Chiatto F, Liguoro I, Borgia G, et al. Sustained low influenza vaccination in health care workers after H1N1 pandemic: a cross sectional study in an Italian health care setting for at-risk patients. BMC Infect Dis. 2015;15:329.
17. Grizas AP, Camenga D, Vazquez M. Cocooning: a concept to protect young children from infectious diseases. Current Opinion in Pediatrics. 2012;24:92-7.
18. Seale H, Sitaresmi MN, Atthobari J, Heywood AE, Kaur R, MacIntyre RC, et al. Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia. BMC Health Serv Res. 2015;15:528. doi:10.1186/s12913-015-1187-3
19. Hanley SJB, Yoshioka E, Ito Y, Kishi R. HPV vaccination crisis in Japan. Lancet. 2015;385:2571.
20. Katsuta T, Moser CA, Offit PA, Feemster KA. Japanese physicians’ attitudes and intentions regarding human papillomavirus vaccine compared with other adolescent vaccines Papillomavirus Res. 2019;7:193–200.
21. Celep G, Duyan Çamurdan A, Baran Aksakal FN, Kara OF. Different perspectives of immunizations during pregnancy. Turk J Med Sci. 2020;50:316‐23. doi:10.3906/sag-1910-23.
22. Centers for Disease Control and Prevention (CDC). Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020 available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (accessed in May 2020)
23. Uğraş Dikmen A, Baran Aksakal F, Aycan Z, Aycan S. Prevalence of influenza vaccination among health care workers and adverse effects after vaccination: A cross-sectional study. J Surg Med. 2019;3(7):520-4.
24. Esposito S, Bosis S, Pelucchi C, Begliatti E, Rognoni A, Bellasio M, et al. Pediatrician knowledge and attitudes regarding human papillomavirus disease and its prevention. Vaccine. 2007;25:6437-46.
25. Killian M, Detoc M, Berthelot P, Charles R, Gagneux-Brunon A, Lucht F, et al. Vaccine hesitancy among general practitioners: evaluation and comparison of their immunisation practice for themselves, their patients and their children. Eur J Clin Microbiol Infect Dis. 2016;35:1837-43.