Rates of childhood vaccine refusal in Turkey during 2016-2017: Regional causes and solutions.

OBJECTIVE: Vaccine hesitancy is a growing problem globally. This study aimed to detect the rates of vaccine refusal (VR) during childhood in each province and region of Turkey from 2016 to 2017 and to evaluate the experiences of Expanded Programme on Immunization (EPI) managers regarding childhood VR and opinions to solve and reduce vaccine hesitancy in Turkey. METHODS: VR was defined as the refusal to vaccinate for at least one vaccine in children aged 0-23 months. In this descriptive study, information on notified VR cases and recommended solutions from every province in Turkey was accessed by the local EPI manager for the period 2016-2017. The VR rates were calculated. RESULTS: From 80 provinces, 8977 VR cases were detected in 2016 (VR rate 3.5‰) and 14,779 cases in 2017 (VR rate 5.9‰; p<0.001). One quarter of Family Health Units reported at least one case of VR. The highest VR rate in children aged under 2 years was in East Marmara (8.4‰) in 2016, and the West Anatolia Region (10.9‰) and East Marmara region (10.9‰) in 2017. Concerns about the vaccine content, harmfulness, and fears about adverse effects were the most common reasons underlying VR. Educating healthcare workers about vaccines and interpersonal communication skills, increasing patient information with informative brochures, and preventing anti-vaccination publications in the media were the most frequent recommendations to solve VR. CONCLUSIONS: In Turkey, VR cases continue to increase. Correct and adequate information, effective communication, and trust between healthcare workers and parents can help reduce VR.

Alteration in vaccination rates and an evaluation of physicians' perceptions of the possible impact of the SARS-CoV-2 pandemic on childhood vaccinations in Ankara, Turkey.

Vaccination is the most effective and cost-efficient approach to protect both individual and community health. Decreased vaccination rates have been reported in many countries during the COVID-19 pandemic. In this study, we compared the vaccination rates of the current year with those of the same period of 2019 in Ankara and presented the physicians' thoughts about effects of COVID-19 pandemic on vaccinations in Turkey. An online survey was sent to family practitioners, pediatricians, and pediatric infectious disease specialists to ascertain their thoughts on vaccination during the pandemic. A majority of family practitioners stated that, despite hesitations, families brought their children for vaccination. They noted that vaccination should be emphasized, physicians should be supported by health authorities, and all related media and social media channels should be used to promote maintaining vaccinations. In contrast, pediatricians and pediatric infectious disease specialists were of the opinion that families were expressing greater hesitation and would not bring their children for vaccination. Vaccination rates in Ankara have decreased 2-5% during the pandemic, and the greatest decrease was observed for vaccines administered after 18 months of age. Outbreaks of vaccine-preventable diseases can threaten community health worldwide. Thus, vaccinations must continue, and effective regulations and recommendations need to be implemented by healthcare authorities to promote it.

Unvaccinated children as community parasites in National Qualitative Study from Turkey.

BACKGROUND: This national qualitative study explores (1) the experiences, observations, and opinions of health care workers (HCWs) about beliefs, socioeconomic, cultural, and environmental characteristics of parents refusing vaccination and (2) regional differences in the identified risk factors; (3) recommended solutions to improve vaccine acceptance in each of 12 regions in Turkey. METHODS: In total, we carried out 14 individual semi-structured in-depth interviews and 10 focus group discussions with 163 HCWs from 36 provinces. A thematic analysis was performed to explore HCWs' observations about the parents' decisions to reject vaccination and possible solutions for vaccine advocacy. RESULTS: Within the analyzed data framework, vaccine refusal statements could be defined as vaccine safety, the necessity of vaccines, assumptions of freedom of choice, health workers' vaccine hesitancy, lack of information about national vaccination schedule and components, not trusting the health system, anti-vaccine publications in social media and newspapers, and refugees. Suggestions based on the HCWs suggestions can be summarized as interventions including (1) creating visual cards with scientific data on vaccine content and disease prevention and using them in counseling patients, (2) writing the vaccine components in a way understandable to ordinary people, (3) highlighting the national quality control and production in the vaccine box and labels, (4) conducting interviews with community opinion leaders, (5) training anti-vaccine HCWs with insufficient scientific knowledge and (6) reducing the tax of parents whose children are fully and punctually vaccinated. CONCLUSIONS: The solution to vaccine rejection begins with the right approaches to vaccination during pregnancy. Prepared written and visual information notes should present the information as "vaccination acceptance" rather than "vaccination refusal". Further studies on vaccine refusal rates should be carried out in various regions of the world so that region-specific actions are implemented to decrease the anti-vaxxer movement and to prevent an outbreak of infectious diseases.

Vaccination rates for Syrian population under temporary protection in Turkey.

OBJECTIVES: The aim of this study was to gather information on demographic and health indicators, primarily vaccination status, of Syrians under temporary protection in five provinces of Turkey and to develop infrastructure for vaccination planning. METHODS: The population under study consists of 89,986 Syrian children, 0-4 years of age, residing in Ankara, Mersin, Gaziantep, Izmir, and Bursa. Initially, we planned to evaluate 2,339 children, although a total of 2,827 children were evaluated by the end of the study. RESULTS: Of these children, 74% were born in Turkey, while 20% were born in Syria. In addition, 22.4% (n = 634) of the children were never vaccinated, and of these, 67.0% (n = 425) were born in Turkey. In other words, one in five Syrian children born in Turkey (20.3%) had never been vaccinated. Of the Syrian children under temporary protection, the missing vaccinations were as follows: hepatitis B (54.7%); Bacillus Calmette-Guérin (62.5%); five-component combined vaccine (64.6%); conjugated pneumococcal vaccine (58.0%); oral polio vaccine (70.8%); measles, mumps, and rubella (76.6%); varicella (66.8%); and hepatitis A vaccine (76.0%). CONCLUSION: It is important to increase the immunization rates of Syrian children under temporary protection and establish regular vaccination procedures.