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

Yıl 2019, Cilt: 17 Sayı: 3, 424 - 434, 02.12.2019

Mustafa Volkan Düzgün , Ayşegül İşler Dalgıç

Öz

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.

Anahtar Kelimeler

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

TOPLUM SAĞLIĞI İÇİN GİDEREK ARTAN TEHLİKE AŞI REDDİ ÖNLENEBİLİR Mİ?

Öz

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

Kaynakça

• 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.