BibTex RIS Kaynak Göster

Meningokok Aşıları

Yıl 2017, Cilt: 17 Sayı: 3, 93 - 98, 01.07.2017
https://doi.org/10.5222/j.child.2017.093

Öz

Meningokok hastalıkları tüm dünyada yaygın görülen ve yaşamı tehdit eden tablolara neden olmaktadır. Polisakkarit meningokok aşıları uzun yıllardır kullanımdadır ve hasta- lık sıklığında azalma sağlamıştır. Ancak, polisakkarit aşıla- rın sütçocukları ve ufak çocuklarda zayıf immünojenite göstermesi, kısa süreli koruma sağlaması, immünolojik bellek geliştirmemesi, nazofarengeal taşıyıcılığa etki etme- mesi ve yineleyen dozlarda azalmış yanıt sağlaması gibi önemli sorunları vardır. Polisakkarit aşıların kimyasal olarak konjügasyonu bu sorunların aşılmasını sağlamıştır. Günümüzde konjüge meningokok aşıları olarak kuadriva- lan aşılar MenACWY-DT, MenACWY-CRM ve MenACWY- TT ve monovalan A ve B aşıları bulunmaktadır. Kuadri- valan konjüge meningokok aşılarından MenACWY-TT Nimenrix™ , tetanoz toksoit proteine konjüge edilmiş serogrup A, C, W ve Y içermektedir ve Avrupa’da 12. ayda tek doz olarak onay almış ilk meningokok aşısıdır. Yapılan çalışma sonuçları, MenACWY-TT aşısının sütçocuğu, çocuk, adolesan ve erişkinlerde tek doz uygulama sonrası yeterli immünojenisite ve etkinlik profiline sahip olduğunu göstermektedir. Ayrıca güvenilirlik ve istenmeyen etki pro- fili plasebo ile eşdeğerdir ve diğer aşılarla eşzamanlı ola- rak uygulanabilir

Kaynakça

  • Rouphael NG, Stephens DS. Neisseria meningitidis: biology, microbiology, and epidemiology. Meth Mol Biol 2012;799:1-20. https://doi.org/10.1007/978-1-61779-346-2_1
  • T.C Başbakanlık Türkiye İstatistik Kurumu Ölüm İstatistikleri. Ölüm nedenlerinin cinsiyete göre dağılı- mı, 27/04/2017 tarihi itibariyle, 2009-2016. http:// www.tuik.gov.tr/PreTablo.do?alt_id=1083
  • Centers for Disease Control and Prevention (CDC). Licensure of a meningococcal conjugate vaccine (Menveo) and guidance for use - Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep 2010;59:273.
  • Assaf-Casals A, Dbaibo G. Meningococcal quadriva- lent tetanus toxoid conjugate vaccine (MenACW-TT, NimenrixTM): A review of its immunogenicity, safety, co-administration, and antibody persistence. Hum Vaccin Immunother 2016;12:1825-37.
  • Punar M, Çağatay AA, Özsüt H, Eraksoy H, Çalangu S, Dilmener M. İstanbul’da bir ilkokulda asemptomatik Neisseria meningitidis taşıyıcılığı. Klimik Derg 2001;14:17-8.
  • Bakir M, Yagci A, Ulger N, Akbenlioglu C, Ilki A, Soyletir G. Asymptomatic carriage of Neisseria menin- gitidis and Neisseria lactamica in relation to Streptococcus pneumoniae and Haemophilus influen- zae colonization in healthy children: apropos of 1400 children sampled. Eur J Epidemiol 2001;11:1015-8. https://doi.org/10.1023/A:1020021109462
  • Tekin RT, Dinleyici EC, Ceyhan M, Karbuz A, Salman N, Sutçu M. The prevalence, serogroup distri- bution and risk factors of meningococcal carriage in adolescents and young adults in Turkey. Hum Vaccin Immunother 2017;13:1182-9. https://doi.org/10.1080/21645515.2016.1268304
  • Ceyhan M, Gürler N, Ozsurekci Y, Keser M, Aycan AE, Gurbuz V. Meningitis caused by Neisseria Meningitidis, Haemophilus influenzae Type b and Streptococcus pneumoniae during 2005-2012 in Turkey. A multicenter prospective surveillance study. Hum Vaccin Immunother 2014;10:2706-12. https://doi.org/10.4161/hv.29678
  • Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2013;62 (RR02):1-22.
  • Croxtall JD, Dhillon S. Meningococcal quadrivalent (serogroups A, C, W-135 and Y) tetanus toxoid conju- gate vaccine (Nimenrix). Drugs 2012;72:2407-30. https://doi.org/10.2165/11209580-000000000-00000
  • Miller JM, Mesaros N, Van Der Wielen M, Baine Y. Conjugate meningococcal vaccines development: GSK Biologicals Experience. Adv Preventive Med 2011; 2011:846756. https://doi.org/10.4061/2011/846756
  • Zlotnick GW, Jones TR, Liberator P. The discovery and development of a novel vaccine to protect against Neisseria meningitidis serogroup B disease. Hum Vaccines Immunotherapeutics 2015;11:5-13. https://doi.org/10.4161/hv.34293
  • Kim DK, Riley LE, Harriman KH. Recommended immunization schedule for adults aged 19 years or Older, United States, 2017. Ann Intern Med 2017;166:209. https://doi.org/10.7326/M16-2936
  • Department of Health & Human Servıces fda/cber/ovrr/ dvrpa 135nloads/BiologicsBloodVaccines/Vaccines/ ApprovedProducts/UCM246961.pdf.
  • Centers for Disease Control and Prevention (CDC). Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June- July 2005. MMWR Morb Mortal Wkly Rep 2005;54: 1023-25.
  • Centers for Disease Control and Prevention (CDC). Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June 2005-September 2006. MMWR Morb Mortal Wkly Rep 2006;55:1120-24.
  • Centers for Disease Control and Prevention (CDC). Licensure of a meningococcal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adolescents and other persons at increased risk for meningococcal disease-Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep 2011;60:1018-9.
  • Novartis media release. FDA expands age indication for Menveo®, first and only quadrivalent meningococ- cal vaccine for infants as young as 2 months of age. http://www.novartisvaccines.com/newsroom/media- releases/2013/US_Menveo_Infant_FDA_Approval_ Press_Release_US.pdf.
  • GlaxoSmithKline Inc. Nimenrix_Meningococcal poly- saccharide groups A, C, W-135 and Y conjugate vacci- ne. Product Monograph GlaxoSmithKline Inc 2015.
  • Pellegrinoa P, Perronea V, Radicea S, Capuanod A, Clementin E. Immunogenicity of meningococcal quadrivalent (serogroup A, C, W-135 and Y) tetanus toxoid conjugate vaccine: Systematic review and meta- analysis. Pharmacol Res 2015;92:31-9. https://doi.org/10.1016/j.phrs.2014.10.006
  • Quiambao BP, Bavdekar A, Dubey AP, et al. Antibody persistence up to 5 y after vaccination with a quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine in adolescents. Hum Vaccin Immunother 2017;13:636-44. https://doi.org/10.1080/21645515.2016.1248009
  • Borja-Tabora CFC, Montalban C, Memish ZA, et al. Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W and Y tetanus toxoid conjugate vaccine in adoles- cents and adults: 5-year follow-up of an open, randomi- zed trial. BMC Infect Dis 2015;15:409. https://doi.org/10.1186/s12879-015-1138-y
  • Vesikari T, Forsten A, Boutriau D, Bianco V, Van der Wielen M, Miller JM. Randomized trial to assess the immunogenicity, safety and antibody persistence up to three years after a single dose of a tetravalent meningo- coccal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine in toddlers. Hum Vacc Immunotherapeutics 2012;8:1892-903. https://doi.org/10.4161/hv.22166
  • Klein NP, Baine Y, Bianco V, et al. One or two doses of quadrivalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine is immunoge- nic in 9- to 12-month-old children. Pediatr Infect Dis J 2013;760-67. https://doi.org/10.1097/INF.0b013e31828693c5
  • Dbaibo G, Macalalad N, Reyes MRA-DL, et al. The immunogenicity and safety of an investigational menin- gococcal serogroups A, C, W-135, Y tetanus toxoid conjugate vaccine (ACWY-TT) compared with a licen- sed meningococcal tetravalent polysaccharide vaccine: a randomized, controlled non-inferiority study. Hum Vaccin Immunother 2012;8:873-80. https://doi.org/10.4161/hv.20211
  • Reyes MRA-DL, Dimaano E, Macalalad N, et al. The investigational meningococcal serogroups A, C, W-135, Y tetanus toxoid conjugate vaccine (ACWY- TT) and the seasonal influenza virus vaccine are immu- nogenic and well-tolerated when co-administered in adults. Hum Vaccin Immunother 2012;8:881-7. https://doi.org/10.4161/hv.20212
  • Ostergaard L, Lebacq E, Poolman J, et al. Immunogenicity, reactogenicity and persistence of meningococcal A, C, W-135 and Y-tetanus toxoid can- didate conjugate (MenACWY-TT) vaccine formulati- ons in adolescents aged 15–25 years. Vaccine 2009; 27: 161-8. https://doi.org/10.1016/j.vaccine.2008.08.075
  • Knuf M, Kieninger-Baum D, Habermehl P, et al. A dose-range study assessing immunogenicity and safety of one dose of a new candidate meningococcal serog- roups A, C, W-135, Y tetanus toxoid conjugate (MenACWY-TT) vaccine administered in the second year of life and in young children. Vaccine 2010;28:744- 53. https://doi.org/10.1016/j.vaccine.2009.10.064
  • Baxter R, Baine Y, Ensor K, et al. Immunogenicity and safety of an investigational quadrivalent meningo- coccal ACWY tetanus toxoid conjugate vaccine in healthy adolescents and young adults 10 to 25 years of age. Pediatr Infect Dis J 2011;30:e41-8. https://doi.org/10.1097/INF.0b013e3182054ab9
  • Vesikari T, Karvonen A, Bianco V, et al. Tetravalent meningococcal serogroups A, C, W-135 and Y conju- gate vaccine is well tolerated and immunogenic when co-administered with measles mumps-rubella-varicella vaccine during the second year of life: an open, rando- mized controlled trial. Vaccine 2011;29:4274-84. https://doi.org/10.1016/j.vaccine.2011.03.043
  • Memish ZA, Dbaibo G, Montellano M, et al. Immunogenicity of a single dose of tetravalent menin- gococcal serogroups A, C, W-135, and Y conjugate vaccine administered to 2- to 10-year-olds is noninferi- or to a licensed-ACWY polysaccharide vaccine with an acceptable safety profile. Pediatr Infect Dis J 2011;30:e56-62. https://doi.org/10.1097/INF.0b013e31820e6e02
  • Knuf M, Pantazi-Chatzikonstantinou A, Pfletschinger U, et al. An investigational tetravalent meningococcal serogroups A, C, W-135 and Y-tetanus toxoid conjuga- te vaccine co-administered with InfanrixTM hexa is immunogenic, with an acceptable safety profile in 12–23-month-old children. Vaccine 2011;29:4264-73. https://doi.org/10.1016/j.vaccine.2011.03.009
  • Bermal N, Huang L-M, Dubey A, et al. Safety and immunogenicity of a tetravalent meningococcal serog- roups A, C, W-135 and Y conjugate vaccine in adoles- cents and adults. Hum Vaccine 2011;7:239-47. https://doi.org/10.4161/hv.7.2.14068
  • Dbaibo G, El-Ayoubi N, Ghanem S, et al. Immunogenicity and safety of a quadrivalent meningo- coccal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine (MenACWY-TT) administered to adults aged 56 years and older: results of an open-label, randomized, controlled trial. Drugs Aging 2013;30:309- 19. https://doi.org/10.1007/s40266-013-0065-0
  • General recommendations on immunization-recommen- dations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations Reports 2011;60:1-64.

Meningococcal Vaccines

Yıl 2017, Cilt: 17 Sayı: 3, 93 - 98, 01.07.2017
https://doi.org/10.5222/j.child.2017.093

Öz

Meningococcal disease is a serious and global life- threatening disease. Meningococcal polysaccharide vacci- nes have been used for years and have led to the decline in the burden of the disease. However, polysaccharide vaccines have several limitations, including poor immunogenicity in infants and toddlers, short-lived protection, inability to deve- lop immunologic memory, negligible impact on nasophary- ngeal carriage, and induction of hyporesponsiveness after repeated doses. The chemical conjugation of plain polysacc- haride vaccines has overcome these drawbacks. Meningococcal conjugate vaccines include the quadrivalent vaccines MenACWY-DT, MenACWY-CRM, and MenACWY- TT as well as the monovalent A and C vaccines. The quad- rivalent meningococcal conjugate vaccine MenACWY-TT , comprising the serogroups A, C, W and Y conjugated to tetanus toxoid carrier protein marketed under the trade name Nimenrix™ , is the first quadrivalent vaccine appro- ved in Europe as a single dose for ages 12 months. Study results have demonstrated that MenACWY-TT has an adequ- ate immunogenicity, and efficacy profile across a broad age range including toddlers, children, adolescents, and adults following its application. It has also a reliability, and side effect profiles equivalent to placebo, and it can be adminis- tered concurrently with other vaccines

Kaynakça

  • Rouphael NG, Stephens DS. Neisseria meningitidis: biology, microbiology, and epidemiology. Meth Mol Biol 2012;799:1-20. https://doi.org/10.1007/978-1-61779-346-2_1
  • T.C Başbakanlık Türkiye İstatistik Kurumu Ölüm İstatistikleri. Ölüm nedenlerinin cinsiyete göre dağılı- mı, 27/04/2017 tarihi itibariyle, 2009-2016. http:// www.tuik.gov.tr/PreTablo.do?alt_id=1083
  • Centers for Disease Control and Prevention (CDC). Licensure of a meningococcal conjugate vaccine (Menveo) and guidance for use - Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep 2010;59:273.
  • Assaf-Casals A, Dbaibo G. Meningococcal quadriva- lent tetanus toxoid conjugate vaccine (MenACW-TT, NimenrixTM): A review of its immunogenicity, safety, co-administration, and antibody persistence. Hum Vaccin Immunother 2016;12:1825-37.
  • Punar M, Çağatay AA, Özsüt H, Eraksoy H, Çalangu S, Dilmener M. İstanbul’da bir ilkokulda asemptomatik Neisseria meningitidis taşıyıcılığı. Klimik Derg 2001;14:17-8.
  • Bakir M, Yagci A, Ulger N, Akbenlioglu C, Ilki A, Soyletir G. Asymptomatic carriage of Neisseria menin- gitidis and Neisseria lactamica in relation to Streptococcus pneumoniae and Haemophilus influen- zae colonization in healthy children: apropos of 1400 children sampled. Eur J Epidemiol 2001;11:1015-8. https://doi.org/10.1023/A:1020021109462
  • Tekin RT, Dinleyici EC, Ceyhan M, Karbuz A, Salman N, Sutçu M. The prevalence, serogroup distri- bution and risk factors of meningococcal carriage in adolescents and young adults in Turkey. Hum Vaccin Immunother 2017;13:1182-9. https://doi.org/10.1080/21645515.2016.1268304
  • Ceyhan M, Gürler N, Ozsurekci Y, Keser M, Aycan AE, Gurbuz V. Meningitis caused by Neisseria Meningitidis, Haemophilus influenzae Type b and Streptococcus pneumoniae during 2005-2012 in Turkey. A multicenter prospective surveillance study. Hum Vaccin Immunother 2014;10:2706-12. https://doi.org/10.4161/hv.29678
  • Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2013;62 (RR02):1-22.
  • Croxtall JD, Dhillon S. Meningococcal quadrivalent (serogroups A, C, W-135 and Y) tetanus toxoid conju- gate vaccine (Nimenrix). Drugs 2012;72:2407-30. https://doi.org/10.2165/11209580-000000000-00000
  • Miller JM, Mesaros N, Van Der Wielen M, Baine Y. Conjugate meningococcal vaccines development: GSK Biologicals Experience. Adv Preventive Med 2011; 2011:846756. https://doi.org/10.4061/2011/846756
  • Zlotnick GW, Jones TR, Liberator P. The discovery and development of a novel vaccine to protect against Neisseria meningitidis serogroup B disease. Hum Vaccines Immunotherapeutics 2015;11:5-13. https://doi.org/10.4161/hv.34293
  • Kim DK, Riley LE, Harriman KH. Recommended immunization schedule for adults aged 19 years or Older, United States, 2017. Ann Intern Med 2017;166:209. https://doi.org/10.7326/M16-2936
  • Department of Health & Human Servıces fda/cber/ovrr/ dvrpa 135nloads/BiologicsBloodVaccines/Vaccines/ ApprovedProducts/UCM246961.pdf.
  • Centers for Disease Control and Prevention (CDC). Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June- July 2005. MMWR Morb Mortal Wkly Rep 2005;54: 1023-25.
  • Centers for Disease Control and Prevention (CDC). Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June 2005-September 2006. MMWR Morb Mortal Wkly Rep 2006;55:1120-24.
  • Centers for Disease Control and Prevention (CDC). Licensure of a meningococcal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adolescents and other persons at increased risk for meningococcal disease-Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep 2011;60:1018-9.
  • Novartis media release. FDA expands age indication for Menveo®, first and only quadrivalent meningococ- cal vaccine for infants as young as 2 months of age. http://www.novartisvaccines.com/newsroom/media- releases/2013/US_Menveo_Infant_FDA_Approval_ Press_Release_US.pdf.
  • GlaxoSmithKline Inc. Nimenrix_Meningococcal poly- saccharide groups A, C, W-135 and Y conjugate vacci- ne. Product Monograph GlaxoSmithKline Inc 2015.
  • Pellegrinoa P, Perronea V, Radicea S, Capuanod A, Clementin E. Immunogenicity of meningococcal quadrivalent (serogroup A, C, W-135 and Y) tetanus toxoid conjugate vaccine: Systematic review and meta- analysis. Pharmacol Res 2015;92:31-9. https://doi.org/10.1016/j.phrs.2014.10.006
  • Quiambao BP, Bavdekar A, Dubey AP, et al. Antibody persistence up to 5 y after vaccination with a quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine in adolescents. Hum Vaccin Immunother 2017;13:636-44. https://doi.org/10.1080/21645515.2016.1248009
  • Borja-Tabora CFC, Montalban C, Memish ZA, et al. Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W and Y tetanus toxoid conjugate vaccine in adoles- cents and adults: 5-year follow-up of an open, randomi- zed trial. BMC Infect Dis 2015;15:409. https://doi.org/10.1186/s12879-015-1138-y
  • Vesikari T, Forsten A, Boutriau D, Bianco V, Van der Wielen M, Miller JM. Randomized trial to assess the immunogenicity, safety and antibody persistence up to three years after a single dose of a tetravalent meningo- coccal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine in toddlers. Hum Vacc Immunotherapeutics 2012;8:1892-903. https://doi.org/10.4161/hv.22166
  • Klein NP, Baine Y, Bianco V, et al. One or two doses of quadrivalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine is immunoge- nic in 9- to 12-month-old children. Pediatr Infect Dis J 2013;760-67. https://doi.org/10.1097/INF.0b013e31828693c5
  • Dbaibo G, Macalalad N, Reyes MRA-DL, et al. The immunogenicity and safety of an investigational menin- gococcal serogroups A, C, W-135, Y tetanus toxoid conjugate vaccine (ACWY-TT) compared with a licen- sed meningococcal tetravalent polysaccharide vaccine: a randomized, controlled non-inferiority study. Hum Vaccin Immunother 2012;8:873-80. https://doi.org/10.4161/hv.20211
  • Reyes MRA-DL, Dimaano E, Macalalad N, et al. The investigational meningococcal serogroups A, C, W-135, Y tetanus toxoid conjugate vaccine (ACWY- TT) and the seasonal influenza virus vaccine are immu- nogenic and well-tolerated when co-administered in adults. Hum Vaccin Immunother 2012;8:881-7. https://doi.org/10.4161/hv.20212
  • Ostergaard L, Lebacq E, Poolman J, et al. Immunogenicity, reactogenicity and persistence of meningococcal A, C, W-135 and Y-tetanus toxoid can- didate conjugate (MenACWY-TT) vaccine formulati- ons in adolescents aged 15–25 years. Vaccine 2009; 27: 161-8. https://doi.org/10.1016/j.vaccine.2008.08.075
  • Knuf M, Kieninger-Baum D, Habermehl P, et al. A dose-range study assessing immunogenicity and safety of one dose of a new candidate meningococcal serog- roups A, C, W-135, Y tetanus toxoid conjugate (MenACWY-TT) vaccine administered in the second year of life and in young children. Vaccine 2010;28:744- 53. https://doi.org/10.1016/j.vaccine.2009.10.064
  • Baxter R, Baine Y, Ensor K, et al. Immunogenicity and safety of an investigational quadrivalent meningo- coccal ACWY tetanus toxoid conjugate vaccine in healthy adolescents and young adults 10 to 25 years of age. Pediatr Infect Dis J 2011;30:e41-8. https://doi.org/10.1097/INF.0b013e3182054ab9
  • Vesikari T, Karvonen A, Bianco V, et al. Tetravalent meningococcal serogroups A, C, W-135 and Y conju- gate vaccine is well tolerated and immunogenic when co-administered with measles mumps-rubella-varicella vaccine during the second year of life: an open, rando- mized controlled trial. Vaccine 2011;29:4274-84. https://doi.org/10.1016/j.vaccine.2011.03.043
  • Memish ZA, Dbaibo G, Montellano M, et al. Immunogenicity of a single dose of tetravalent menin- gococcal serogroups A, C, W-135, and Y conjugate vaccine administered to 2- to 10-year-olds is noninferi- or to a licensed-ACWY polysaccharide vaccine with an acceptable safety profile. Pediatr Infect Dis J 2011;30:e56-62. https://doi.org/10.1097/INF.0b013e31820e6e02
  • Knuf M, Pantazi-Chatzikonstantinou A, Pfletschinger U, et al. An investigational tetravalent meningococcal serogroups A, C, W-135 and Y-tetanus toxoid conjuga- te vaccine co-administered with InfanrixTM hexa is immunogenic, with an acceptable safety profile in 12–23-month-old children. Vaccine 2011;29:4264-73. https://doi.org/10.1016/j.vaccine.2011.03.009
  • Bermal N, Huang L-M, Dubey A, et al. Safety and immunogenicity of a tetravalent meningococcal serog- roups A, C, W-135 and Y conjugate vaccine in adoles- cents and adults. Hum Vaccine 2011;7:239-47. https://doi.org/10.4161/hv.7.2.14068
  • Dbaibo G, El-Ayoubi N, Ghanem S, et al. Immunogenicity and safety of a quadrivalent meningo- coccal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine (MenACWY-TT) administered to adults aged 56 years and older: results of an open-label, randomized, controlled trial. Drugs Aging 2013;30:309- 19. https://doi.org/10.1007/s40266-013-0065-0
  • General recommendations on immunization-recommen- dations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations Reports 2011;60:1-64.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Collection
Yazarlar

Ayper Somer Bu kişi benim

Manolya Acar Bu kişi benim

Yayımlanma Tarihi 1 Temmuz 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 17 Sayı: 3

Kaynak Göster

APA Somer, A., & Acar, M. (2017). Meningokok Aşıları. Çocuk Dergisi, 17(3), 93-98. https://doi.org/10.5222/j.child.2017.093
AMA Somer A, Acar M. Meningokok Aşıları. Çocuk Dergisi. Temmuz 2017;17(3):93-98. doi:10.5222/j.child.2017.093
Chicago Somer, Ayper, ve Manolya Acar. “Meningokok Aşıları”. Çocuk Dergisi 17, sy. 3 (Temmuz 2017): 93-98. https://doi.org/10.5222/j.child.2017.093.
EndNote Somer A, Acar M (01 Temmuz 2017) Meningokok Aşıları. Çocuk Dergisi 17 3 93–98.
IEEE A. Somer ve M. Acar, “Meningokok Aşıları”, Çocuk Dergisi, c. 17, sy. 3, ss. 93–98, 2017, doi: 10.5222/j.child.2017.093.
ISNAD Somer, Ayper - Acar, Manolya. “Meningokok Aşıları”. Çocuk Dergisi 17/3 (Temmuz 2017), 93-98. https://doi.org/10.5222/j.child.2017.093.
JAMA Somer A, Acar M. Meningokok Aşıları. Çocuk Dergisi. 2017;17:93–98.
MLA Somer, Ayper ve Manolya Acar. “Meningokok Aşıları”. Çocuk Dergisi, c. 17, sy. 3, 2017, ss. 93-98, doi:10.5222/j.child.2017.093.
Vancouver Somer A, Acar M. Meningokok Aşıları. Çocuk Dergisi. 2017;17(3):93-8.