TOPLUM BAĞIŞIKLIĞI VE HALKA BAĞIŞIKLAMA

Yıl 2023, , 97 - 104, 17.01.2023

Kübra Doğanay Bulduk , Gülsen Güneş

https://doi.org/10.35232/estudamhsd.1082185

Öz

Bağışıklama hizmetleri, insanların hastalıklardan korunmasında ve ölümlerin önüne geçmede son derece önemli halk
sağlığı müdahalelerinden biridir. Günümüzde 20’den fazla hastalığa karşı aşı geliştirilmiş olmakla birlikte pek çok
kişinin aşılara erişimi yetersizdir. Bununla birlikte sadece bazı kişilerin değil, toplumun tamamının aşılanması tercih
edilmektedir. Bu kapsamda toplum bağışıklığından bahsedilmektedir. Toplum bağışıklığı, aşı veya hastalığı geçirme
sonucu o hastalığa karşı bağışıklık kazananlar sayesinde diğer kişiler için hastalık bulaşmasına neden olacak
karşılaşma riskini azaltır. Bu sayede salgınların önlenmesi ve olası bir salgında da morbidite ve mortalitenin
sınırlanması sağlanır. Toplum bağışıklığından bahsedebilmek için her hastalık için değişen değerlerde, toplumun belli
bir oranda bağışık olması gerekmektedir. Bu; bazen ekonomik, lojistik vb. etkenler sebebiyle mümkün olamadığında
halka bağışıklama (ring vaccination) gibi başka bağışıklama stratejilerinin düşünülmesi söz konusu olabilmektedir.
Halka bağışıklığı, enfekte vaka etrafındaki bir "halka" içindeki herkesin aşılanması ile vaka etrafında bir bağışıklık
tamponu oluşturmayı amaçlamaktadır. Toplum bağışıklığını tamamlayıcı olarak kullanılabileceği gibi yetersiz kaynak
olan toplumlarda toplum bağışıklığı sağlanamıyorsa ve sporadik olarak görülen hastalıklarda tek bağışıklama stratejisi
olarak da tercih edilebilmektedir. Bu yaklaşım, COVID-19 salgınında belli durumlarda da uygulanabilirliği açısından
değerlendirme aşamasındadır.

Anahtar Kelimeler

Aşı, Toplum Bağışıklığı, Halka Bağışıklama, COVID-19

Teşekkür

Yazının Hazırlanmasında Emeği Geçen: Prof. Dr. Meltem ÇÖL Ankara Üniversitesi Halk Sağlığı Anabilim Dalı

HERD IMMUNITY AND RING VACCINATION

Öz

Immunization services are one of the most important public health interventions to protect people from diseases and
prevent deaths. Although vaccines have been developed against more than 20 diseases today, many people have
insufficient access to vaccines. However, it is preferable to vaccinate not only some people but also the entire society.
In this context, herd immunity is mentioned. Herd immunity reduces the risk of encounters that will cause disease
transmission to other people, thanks to those who have become immune to that disease as a result of vaccination or
exposure to the disease. In this way, it is ensured that epidemics are prevented and morbidity and mortality are limited
in a possible epidemic. In order to talk about herd immunity, society should be immune to a certain extent, with varying
values for each disease. This; is sometimes economic, logistics etc. when this is not possible due to various factors,
other immunization strategies such as ring vaccination may be considered. Ring vaccination aims to create an immune
buffer around the case by vaccinating everyone in a "ring" around the infected case. It can be used as a complement to
herd immunity or be preferred as the only immunization strategy in societies with insufficient resources if herd immunity
cannot be provided and in sporadic diseases. This approach is under evaluation in terms of its applicability in certain
situations in the COVID-19 outbreak.

Anahtar Kelimeler

Vaccine, Herd İmmunity, Ring Vaccination, COVID-19

Kaynakça

• 1. WHO, news room [Internet]. [cited 2020 Dec 17]. Available from: https://www.who.int/news-room/q-a-detail/vaccines-and-immunization-what-is-vaccination?adgroupsurvey=%7Badgroupsurvey%7D&gclid=EAIaIQobChMI3_Sa0JDV7QIVzeh3Ch2w9QEVEAAYASAAEgJEDPD_BwE
• 2. UNİCEF, Türkiye, Bağışıklama [Internet]. Available from: https://www.unicef.org/turkey/bağışıklama
• 3. Akdeniz M, Kavukcu E. Aşılama ve Aşıların Tarihçesi. Klin Tıp Aile Hekim [Internet]. 2016;8(2):11–28. Available from: https://dergipark.org.tr/tr/pub/ktah/issue/45376/487032
• 4. WHO, health topic [Internet]. [cited 2020 Dec 12]. Available from: https://www.who.int/health-topics/vaccines-and-immunization?adgroupsurvey=%7Badgroupsurvey%7D&gclid=EAIaIQobChMItICl0ojI7QIVl9wYCh1jrwjCEAAYASABEgI4CfD_BwE#tab=tab_1
• 5. Shukla V V., Shah RC. Vaccinations in Primary Care. Indian J Pediatr [Internet]. 2018;85(12):1118–27. Available from: http://dx.doi.org/10.1007/s12098-017-2555-2
• 6. Fine P, Eames K, Heymann DL. “Herd immunity”: A rough guide. Clin Infect Dis. 2011;52(7):911–6.
• 7. Heymann DL, Aylward RB. Mass vaccination: When and why. Curr Top Microbiol Immunol. 2006;304:1–16.
• 8. Lancet, herd immunity [Internet]. [cited 2021 Jan 14]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-67362031924-3/fulltext
• 9. Wikipedia, Herd immunity [Internet]. [cited 2021 Jan 14]. Available from: https://en.wikipedia.org/wiki/Herd_immunity
• 10. Kim TH, Johnstone J, Loeb M. Vaccine herd effect. Scand J Infect Dis. 2011;43(9):683–9.
• 11. ScienceDirect, mass immunization [Internet]. [cited 2021 Jan 14]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/mass-immunization
• 12. Flaherty DK, editor. Chapter 25 - Vaccine-Preventable Diseases. In: Immunology for Pharmacy [Internet]. Saint Louis: Mosby; 2012. p. 197–213. Available from: http://www.sciencedirect.com/science/article/pii/B9780323069472100252
• 13. Eskiocak M, Marangoz B. (2019) Türkiye’ de Bağışıklama Hizmetlerinin Durumu. Ankara: Türk Tabipleri Birliği.
• 14. Herd immunity [Internet]. [cited 2021 Jan 15]. Available from: https://en.wikipedia.org/wiki/Herd_immunity#/media/File:Herd_immunity.svg
• 15. World Health Organization. GVAP 2011-2020, Review and Lessons Learned;Strategic Advisory Group of Experts on Immunization. 2020;1–44. Available from: https://apps.who.int/iris/bitstream/handle/10665/329097/WHO-IVB-19.07-eng.pdf?ua=1
• 16. Chard AN, Gacic-Dobo M, Diallo MS, Sodha S V., Wallace AS. Routine Vaccination Coverage — Worldwide, 2019. MMWR Morb Mortal Wkly Rep. 2000;69(45):1706–10.
• 17. Shenton LM, Wagner AL, Ji M, Carlson BF, Boulton ML. Vaccination assessments using the Demographic and Health Survey, 2005-2018: A scoping review. BMJ Open. 2020;10(12):2005–18.
• 18. WHO, Aşılama Kapsamı [Internet]. [cited 2021 Jan 10]. Available from: https://www.who.int/data/gho/data/themes/immunization
• 19. Greenhalgh D. Optimal control of an epidemic by ring vaccination. Commun Stat Stoch Model [Internet]. 1986;2(3):339–63. Available from: https://doi.org/10.1080/15326348608807041
• 20. Deen J, von Seidlein L. The case for ring vaccinations with special consideration of oral cholera vaccines. Hum Vaccines Immunother [Internet]. 2018;14(8):2069–74. Available from: https://doi.org/10.1080/21645515.2018.1462068
• 21. Xu W, Su S, Jiang S. Ring vaccination of COVID‐19 vaccines in medium‐ and high‐risk areas of countries with low incidence of SARS‐CoV‐2 infection. Clin Transl Med. 2021;11(2):3–5.
• 22. Wells CR, Tchuenche JM, Meyers LA, Galvani AP, Bauch CT. Impact of Imitation Processes on the Effectiveness of Ring Vaccination. Bull Math Biol. 2011;73(11):2748–72.
• 23. Lau CY, Wahl B, Foo WKS. Ring vaccination versus mass vaccination in event of a smallpox attack. Hawaii Med J. 2005;64(2):34–7.
• 24. Kretzschmar M, Van Den Hof S, Wallinga J, Van Wijngaarden J. Ring Vaccination and Smallpox Control. Emerg Infect Dis. 2004;10(5):832–41.
• 25. Porco TC, Holbrook K, Fernyak SE, Portnoy D, Reiter R, Aragón TJ. Logistics of community smallpox control through contact tracing and ring vaccination: A stochastic network model. BMC Public Health. 2004;4:1–20.
• 26. Levine H, Rishpon S, Huerta-Hartal M, Davidovitch N. Preventing mumps outbreaks in confined settings: Comprehensive ring vaccination as a containment strategy. Hum Vaccin. 2011;7(12):1389–93.
• 27. Chowell G, Tariq A, Kiskowski M. Vaccination strategies to control Ebola epidemics in the context of variable household inaccessibility levels. arXiv. 2019;1–23.
• 28. Medaglini D, Siegrist CA. Immunomonitoring of human responses to the rVSV-ZEBOV Ebola vaccine. Curr Opin Virol [Internet]. 2017;23:88–94. Available from: http://dx.doi.org/10.1016/j.coviro.2017.03.008
• 29. Journal M. The ring vaccination trial: a novel cluster randomised controlled trial design to evaluate vaccine efficacy and effectiveness during outbreaks, with special reference to Ebola. BMJ. 2015;351:h3740.
• 30. Merler S, Kessler FB. RING VACCINATION FOR THE MITIGATION OF EBOLA IN DEMOCRATIC REPUBLIC OF CONGO. 2020;3099(14):14–5.
• 31. Ali M, Debes AK, Luquero FJ, Kim DR, Park Y, Digilio L, et al. Potential for Controlling Cholera Using a Ring Vaccination Strategy : Re-analysis of Data from a Cluster-Randomized Clinical Trial. 2016;1–16.
• 32. Backer JA, Hagenaars TJ, Nodelijk G, van Roermund HJW. Vaccination against foot-and-mouth disease I: Epidemiological consequences. Prev Vet Med [Internet]. 2012;107(1–2):27–40. Available from: http://dx.doi.org/10.1016/j.prevetmed.2012.05.012
• 33. Müller J, Schönfisch B, Kirkilionis M. Ring vaccination. J Math Biol. 2000;41(2):143–71.
• 34. Bausch DG. The need for a new strategy for Ebola vaccination. Nat Med [Internet]. 2021;27(4):580–1. Available from: https://www.nature.com/articles/s41591-021-01313-w
• 35. COVAX: the forecast for vaccine supply [Internet]. Available from: https://www.gavi.org/vaccineswork/covax-forecast-vaccine-supply
• 36. COVID-19: ‘Ring vaccination’ can teach us how to target limited supply [Internet]. Available from: https://globalnews.ca/news/7777204/COVID-19-ring-vaccination-canada/
• 37. Larry Brilliant, eradicator of smallpox, proposes ‘ring vaccination’ to combat coronavirus, says herd immunity is not achievable [Internet]. Available from: https://www.scmp.com/magazines/post-magazine/article/3144486/larry-brilliant-eradicator-smallpox-proposes-ring?module=perpetual_scroll&pgtype=article&campaign=3144486