Çocukluk Çağı Aşıları ve Aşı Tereddütü: Türkiye ve Dünya’nın Karşılaştırması

Abstract

Aşılama, çocuk sağlığını korumak ve bulaşıcı hastalıkları önlemek için en ucuz, en güvenli ve en başarılı halk sağlığı yaklaşımıdır. Yüksek aşılama oranları sayesinde toplum bağışıklığı sağlanır ve salgınlar önlenir. Bağışıklama oranlarında %95'in altına düşmesi, özellikle kızamık olmak üzere aşı ile önlenebilir hastalıkların salgınlarına ve artan morbidite ve mortaliteye yol açabilir. Son zamanlarda özellikle gelişmiş ülkelerde aşı tereddüdü ve aşı reddi kavramlarının ortaya çıkmasıyla birlikte, hem ülkemizde hem de dünya çapında aşılanmamış çocuk sayısı artmaktadır. Aşı tereddüdü, birçok kişisel ve çevresel nedenin yanı sıra sosyokültürel, toplumsal, ekonomik ve politik nedenlerden kaynaklanmaktadır. Aşılar hakkında bilgi eksikliği, yan etki korkusu, aşı etkinliği ve güvenliğiyle ilgili endişeler, aşıların zararlı olduğu düşüncesi, internette ve sosyal medyadaki aşı karşıtı yayınlar, doğal bağışıklığa inanç ve dini nedenler, farklı çalışmalarda aşı tereddütü ve aşı reddinin en yaygın nedenleri olarak görülmektedir. Toplumda aşılamanın önemi ve gerekliliği konusunda farkındalık yaratmak, aşı tereddütüne yol açan faktörleri belirlemek ve çözümler üretmek alınacak öncelikli önlemler arasındadır. Sağlık personeli aşı tereddüdüyle mücadelede çok önemli bir rol oynamaktadır. Aşı tereddüdü olan ebeveynlerle iyi, etkili ve güvenilir bir iletişim kurmak önemlidir. Son dönemde aşı redlerine ek olarak K vitamini uygulamasını, topuk kanı alımasını reddeden ailelerin sayısı da giderek artmaktadır. Aşı reddi ve sağlık hizmetlerinin reddi, yenidoğan ve çocukluk çağı morbidite ve mortalitesini artıracaktır. Çocuğun yüksek yararını gözetecek şekilde yasal önlemler alınması elzemdir. Ebeveynlerin aşı kabulünü ve tereddüdünü değerlendiren geçerli ve güvenilir ölçekler aşı tereddüdüyle mücadelede bilgi kaynağı olacaktır.

Keywords

• Aşı tereddütü
• aşı reddi
• aşılama
• aşı
• K vitamini reddi

Childhood Vaccination and Vaccine Hesitancy: A Comparison Between Türkiye and the World

Abstract

Vaccination is the cheapest, safest, and most successful public health approach to protect children's health and prevent infectious diseases. High vaccination rates ensure community immunity and prevent epidemics. A drop in immunization rates below 95% can lead to outbreaks of vaccine-preventable diseases, particularly measles, as well as increased morbidity and mortality. With the recent emergence of vaccine hesitancy (VH) and vaccine refusal (VR) concepts, especially in developed countries, the number of unvaccinated children is increasing both in our country and around the world. Vaccine hesitancy stems from many personal and environmental reasons, as well as sociocultural, environmental, economic, and political reasons. Lack of information about vaccines, fear of side effects, concerns about vaccine efficacy and safety, the idea that vaccines are harmful, anti-vaccine publications on the internet and social media, belief in natural immunity, and religious reasons are seen as the most common reasons for VH and VR in different studies. Raising awareness in society about the importance and necessity of vaccination, identifying the factors that lead to VH, and producing solutions are among the primary measures to be taken. Healthcare personnel play a very important role in the fight against vaccine hesitancy. It is important to establish good, effective, and trusting communication with vaccine-hesitant parents. Recently, in addition to vaccine refusal cases, the number of families refusing vitamin K and heel blood sampling has been increasing. Vaccine refusal, and refusal of health care services will increase neonatal and childhood morbidity and mortality. Legal measures should be taken to protect the best interests of the child. Valid and reliable scales that evaluate parents' vaccine acceptance and hesitancy will be a source of information in the fight against vaccine hesitancy.

Keywords

• Vaccine hesitancy
• vaccine refusal
• vaccination
• vaccine
• vitamin K refusal

References

1. Dubé E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines 2015;14:99-117.
2. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Hum Vaccin Immunother 2013;9:1763-73.
3. Gür E. Aşı kararsızlığı. Turkiye Klinikleri Social Pediatrics-Special Topics 2021;2:28-33.
4. UNICEF. Immunization Roadmap to 2030. 2023. Accessed:10.07.2024. [Available from: https://www.unicef.org/media/138976/file/UNICEF%20Immunization%20Roadmap%20To%202030.pdf.
5. World Halth Organization. Meeting of the Strategic Advisory Group of Experts on Immunization, March 2023: conclusions and recommendations. Weekly Epidemiological Record 2023;98:239-55.
6. Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RC, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. The Lancet 2024;403:2307-16.
7. Türkiye Cumhuriyeti Sağlık Bakanlığı. Genişletilmiş bağışıklama programı genelgesi. 2009. Accessed: 15.07.2024. [Available from: https://www.saglik.gov.tr/TR-11137/genisletilmis-bagisiklama-programigenelgesi-2009.html].
8. Türkiye Cumhuriyeti Sağlık Bakanlığı. Sağlık İstatistikleri Yıllığı 2022 Haber Bülteni. 2022. Accessed: 15.07.2024. [Available from: https://sbsgm.saglik.gov.tr/Eklenti/46511/0/haber-bulteni-2022-v7pdf.pdf?_tag1=3F123016BE50268AF4A10917870BF5962AC79ECF.

9. Kömürlüoğlu A, Yalçın SS. Çocukluk çağı aşılarında ebeveyn kararsızlığı nedenleri, yönetimi ve önlenmesi. Turkiye Klinikleri Social Pediatrics-Special Topics 2021;2:9-17.
10. World Health Organization. Understanding the behavioural and social drivers of vaccine uptake WHO position paper–May 2022.Weekly Epidemiological Record 2022;97:209-24.
11. World Health Organization. The global vaccine action plan 2011-2020: review and lessons learned: strategic advisory group of experts on immunization. 2019. Accessed: 20.07.2024. [Available from: https://iris.who.int/bitstream/handle/10665/329097/WHO-IVB-19.07-chi.pdf ].
12. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015;33:4161-4.
13. Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: a regression in modern medicine. Cureus 2018;10: e2919.
14. World Health Organization. Strategic Advisory Group of Experts (SAGE) on Immunization Vaccine Hesitancy. Accessed: 24.07.2024. [Available from: https://iris.who.int/bitstream/handle/10665/242069/WER8820_201-216.PDF?sequence=1.
15. World Health Organization. Report of the SAGE working group on vaccine hesitancy. Geneva: 2014. Accessed: 26.07.2024. [Available from: https://www.asset-scienceinsociety.eu/sites/default/files/sage_working_group_revised_report_vaccine_hesitancy.pdf].
16. World Health Organization. SAGE- Vaccine Hesitancy. Accessed: 24.07.2024. [Available from: [https://www.who.int/immunization/sage/meetings/2013/april/1_Model_analyze_driversofvaccineConfidence_22_March.pdf?ua=1].
17. 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.
18. Yalçin SS, Bakacak AG, Topaç O. Unvaccinated children as community parasites in National Qualitative Study from Turkey. BMC Public Health 2020;20:1-17.
19. Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines 2018;17:989-1004.
20. Dubé E, Gagnon D, Ouakki M, Bettinger JA, Guay M, Halperin S, et al. Understanding vaccine hesitancy in Canada: results of a consultation study by the Canadian Immunization Research Network. PloS one 2016;11:e0156118.
21. Topçu S, Almış H, Başkan S, Turgut M, Orhon FŞ, Ulukol B. Evaluation of childhood vaccine refusal and hesitancy intentions in Turkey. Indian J Pediatr 2019;86:38-43.
22. Napolitano F, D’Alessandro A, Angelillo IF. Investigating Italian parents’ vaccine hesitancy: A cross-sectional survey. Hum Vaccin Immunother. 2018;14:1558-65.
23. Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine 2014;32:3623-9.
24. Madsen KM, Lauritsen MB, Pedersen CB, Thorsen P, Plesner A-M, Andersen PH, Mortensen PB. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics 2003;112:604-6.
25. Flarend RE, Hem SL, White JL, Elmore D, Suckow MA, Rudy AC, Dandashli EA. In vivo absorption of aluminium-containing vaccine adjuvants using 26Al. Vaccine 1997;15:1314-8.
26. Offit PA, Hackett CJ. Addressing parents’ concerns: do vaccines cause allergic or autoimmune diseases? Pediatrics 2003;111:653-9.
27. World Health Organization. Measles and rubella elimination country profile Turkey 2019 Accessed: 28.07.2024. [Available from: [https://www. euro.who.int/__data/assets/pdf_file/0015/4012 26/TUR.pdf ].
28. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. Türkiye Nüfus ve Sağlık Araştırması (TNSA) 2018. Accessed: 28.07.2024. [Available from: [http://www.hips. hacettepe.edu.tr/tnsa2018/rapor/TNSA2018_ana_Rapor.pdf].
29. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Türkiye Nüfus ve Sağlık Araştırması (TNSA) 2013. Accessed: 28.07.2024. [Available from: [http://www.hips. hacettepe.edu.tr/tnsa2013/rapor/TNSA_2013_ana_rapor.pdf].
30. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Türkiye Nüfus ve Sağlık Araştırması (TNSA) 2008, 2008. Accessed: 28.07.2024. [Available from: [http://www.hips. hacettepe.edu.tr/TNSA2008-AnaRapor.pdf].
31. Yalçin SS, Kömürlüoğlu A, Topaç O. Rates of childhood vaccine refusal in Turkey during 2016–2017: Regional causes and solutions. Archives de Pédiatrie 2022;29:594-8.
32. Eryurt MA, Yalçin SS. Zero-dose children in Turkey: regional comparison of pooled data for the period 1990 to 2018. BMC Infec Dis 2022;22:421.
33. Word Health Organization. Measles. Accessed: 01.08.2024. [Available from: https://www.who.int/news-room/factsheets/detail/measles.
34. Dabbagh A. Progress toward regional measles elimination—worldwide, 2000–2016. MMWR 2017;66: 1148–53.
35. Word Health Organization. Surveillance for Vaccine Preventable Diseases (VPDs) Accessed: 01.08.2024. [Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/surveillance/surveillance-for-vpds.
36. Türkiye Cumhuriyeti Sağlık Bakanlığı. Sağlık İstatistikleri Yıllığı 2022. Accessed: 01.08.2024 [Available from: https://dosyasb.saglik.gov.tr/Eklenti/48054/0/siy202205042024pdf.pdf].
37. World Health Organization. Measles and rubella monthly update—WHO European Region 2024 Accessed: 01.08.2024 [Available from: https://cdn.who.int/media/docs/librariesprovider2/euro-health-topics/vaccines-and-immunization/eur_mr_monthly-_update_en_april-2024.pdf?sfvrsn=cf07c69e_2&download=true.
38. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. 2018 Türkiye Nüfus ve Sağlık Araştırması İleri Analiz Çalışması. 2021. Accessed: 02.08.2024 [Available from: https://openaccess.hacettepe.edu.tr/xmlui/handle/11655/25746]
39. Karafillakis E, Larson HJ. The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations. Vaccine 2017;35:4840-50.
40. Argüt N, Yetim A, Gökçay G. Aşı kabulünü etkileyen faktörler. Journal of Child 2016;16:16-24.
41. Witteman HO, Zikmund-Fisher BJ. The defining characteristics of Web 2.0 and their potential influence in the online vaccination debate. Vaccine 2012;30:3734-40.
42. Çelik K, Turan S, Üner S. I’m a mother, therefore I question”: Parents’ legitimation sources of and hesitancy towards early childhood vaccination. Soc Sci Med 2021;282:114132.
43. Vanderslott S, Marks T. Charting mandatory childhood vaccination policies worldwide. Vaccine 2021;39:4054-62.
44. MacDonald NE, Harmon S, Dube E, Steenbeek A, Crowcroft N, Opel DJ, et al. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine 2018;36:5811-8.
45. Trent MJ, Zhang EJ, Chughtai AA, MacIntyre CR. Parental opinions towards the “no jab, no pay” policy in Australia. Vaccine 2019;37:5250-6.
46. Haverkate M, D’Ancona F, Giambi C, Johansen K, Lopalco PL, Cozza V, et al. Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes. Euro Surveill 2012;17:20183.
47. Düzgün MV, Dalgıç Aİ. Toplum sağliği için giderek artan tehlike aşi reddi önlenebilir mi? Güncel Pediatri 2019;17:424-34.
48. Shapiro GK, Kaufman J, Brewer NT, Wiley K, Menning L, Leask J, et al. A critical review of measures of childhood vaccine confidence. Curr Opin Immunol 2021;71:34-45.
49. Opel DJ, Taylor JA, Mangione-Smith R, Solomon C, Zhao C, Catz S, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine 2011;29:6598-605.
50. Gilkey MB, Magnus BE, Reiter PL, McRee A-L, Dempsey AF, Brewer NT. The Vaccination Confidence Scale: a brief measure of parents’ vaccination beliefs. Vaccine 2014;32:6259-65.
51. Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine 2015;33:4165-75.
52. Wallace AS, Wannemuehler K, Bonsu G, Wardle M, Nyaku M, Amponsah-Achiano K, et al. Development of a valid and reliable scale to assess parents’ beliefs and attitudes about childhood vaccines and their association with vaccination uptake and delay in Ghana. Vaccine 2019;37:848-56.
53. Sarathchandra D, Navin MC, Largent MA, McCright AM. A survey instrument for measuring vaccine acceptance. Prev med 2018;109:1-7.
54. Bulun MA, Acuner D. Turkish adaptation and reliability and validity study of parent attitudes about childhood vaccines survey. J Pediatr Res 2020;7:323-30.
55. Kömürlüoğlu A, Akaydın Gültürk E, Yalçın SS. Turkish Adaptation, Reliability, and Validity Study of the Vaccine Acceptance Instrument. Vaccines 2024;12:480.
56. Dilcen HY, Dolu İ, Turhan Z. Validity and reliability study of the vaccine hesitancy scale in Turkish sample. Eur Res J 2022;8:50-8.
57. Silahlı NY, Gürpınar K, Aslıyüksek H, Celkan TT. Malpraktis İddiaları ile Değerlendirilen Yenidoğan Hemorajik Hastalık Olguları.J Curr Pediatr 2022;20:197-201.
58. El Hasbaoui B, Karboubi L, Benjelloun BS. Newborn haemorrhagic disorders: about 30 cases. Pan Afr Med J 2017;28:150.
59. Türkiye Cumhuriyeti Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Tarama Programları. Accessed: 20.08.2024. [Available from: https://hsgm.saglik.gov.tr/tr/programlar/tarama-programlari.html