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Cumartesi, 13 Ekim 2007
Alm. Impstoff, Impfung, Fr. Vaccin, İng. Vaccine. Vücuda önceden belli maddelerImage (canlı mikrop, ölü mikrop, mikrop antijenleri gibi) vererek kişide belli hastalıklara karşı özel dayanıklılık durumu geliştirme işlemi.
Mikropların vücuda girip çoğalmalarına “enfeksiyon”, vücuda yabancı olup da vücutta karşı reaksiyon uyandıran maddelere de “antijen” denir. Vücutta yabancı maddeye karşı çıkan savunma maddelerine “antikor” denmektedir. Başta çeperleri olmak üzere mikropların maddeleri vücut için iyi birer antijendirler. Birçok enfeksiyon hastalığında, hastalığı geçirdikten sonra, kişide, o hastalıklara karşı bir dayanıklılık durumu (bağışıklık) ortaya çıkar. O halde, bu hastalıklara karşı sun’i tedbirlerle kişilere bağışıklık kazandırmak imkanı vardır. Bu bağışıklık kazandırma; ya insan vücuduna zararsızlaştırılmış, etkisizleştirilmiş antijenleri münasip yollarla vererek veya başka bir bünyenin (insan, at, sığır) o mikroba karşı yaptığı antikorları alıp vermekle (serumları ile) olur. Bu işlerden birincisine aktif bağışıklama, ikincisine de pasif bağışıklama denir.
ImageAktif bağışıklık: Antijen verilir. Vücut kendi gayretiyle antijene karşı savunma maddelerini, yani antikorlarını hazırlar.
Pasif bağışıklık: Başka organizmada, o mikroba karşı meydana gelmiş antikorlar (gamma globulinli serum) verilir. Tesiri çok çabuk başlar, ama bir kaç hafta gibi çok kısa bir zaman devam eder. Aktif bağışıklamada ise (aşılama ile) bağışıklık süresi yıllarla ölçülür.
Bakterilerce ifraz edilen (salınan) zararlı maddelere, diğer bir deyişle bakteri zehirlerine toksin (ekzotoksin) denir. Toksinlerin zararsızlaştırılmasıyla, bakterilerin toksinlerine karşı da aşılar yapılmıştır. Bunlardan en başta gelenleri difteri ve tetanos aşılarıdır (toksoit).
Mikropları genel olarak dört ana grupta toplamak mümkündür.
Bunlar: Bakteriler, mantarlar, virüsler ve parazitlerdir. Bu mikroorganizmalardan virüsler hariç, diğerleri canlılık özellikleri gösterirler. Bunların kendi başlarına hayatlarını devam ettirebilme ve üreme özellikleri vardır. Virüsler ise kendi başlarına yaşama özellikleri olmayan, hücreler içine girerek ancak onlarda üreyebilen varlıklardır. Virüs, kendisi için gerekli maddeleri, içinde parazit olarak yaşadığı hücreye yaptırır. Başarılı bir şekilde bağışıklık kazandırmak, virüs hastalıklarına ve bakteri toksinleri ile olan hastalıklara karşı mümkündür. Bakterilerin üremesi ile olan enfeksiyon hastalıklarında başarı o kadar fazla değildir. Buna göre antiviral, antibakterial ve antitoksin bağışıklıklarından söz etmek mümkündür. Difteri, tetanos, şarbon, botulizm (konserve gıda zehirlenmesi) gibi hastalıkların belirtileri; bakteriler değil, bakterinin salgıladığı ekzotoksinlerImage sebebiyle ortaya çıkar. Ekzotoksinin sebep olduğu hastalıklarda vücut savunma maddelerini, yani antikorlarını bakteriye karşı değil de, toksinlere karşı yapar. Böylece antitoksik bir bağışıklık ortaya çıkar. Bakteri toksinleri ile meydana gelen hastalıklarda hasıl olan bağışıklık uzun sürelidir. Toksinlere karşı olan bağışıklık, zehirliliği giderilmiş toksinlerin (toksoitlerin) zerk edilmesi ile olur. Böyle imal edilen toksoitler vücuda zerk edilince kişide bağışıklık yapar, ama hastalık belirtileri meydana getirmez. Toksoit kullanımı en çok tetanos ve difteri hastalıklarına karşı kazanılan bağışıklıkta mühimdir. Virüs hastalıkları da uzun süreli bağışıklık bıraktığı için bunlarda da aktif bağışıklık kazanmak mümkündür.
Virüs aşıları ikiye ayrılır:
1. Canlı aşılar: Hastalandırıcılığı azaltılmış, ancak çoğalma kabiliyetini koruyan virüslerle olur. Bu tip aşıların en önemlileri; çiçek, çocuk felci, kuduz, kızamık, kabakulak aşılarıdır.
2. Ölü aşılar: Çoğalma özelliği yok edilmiş virüslerle yapılır. Canlı ve ölü aşıların avantajlı ve dezavantajlı tarafları vardır. Canlı aşılar, ölü aşılardan daha uzun süreli bağışıklık bırakırlar; ancak, canlı virüs aşılarının en önemli dezavantajı, virüsün hastalandırıcılık özelliğini yeniden kazanmasıdır. Bakterilere karşı meydana gelen bağışıklık, çeşitli bakteriler arasında çok değişiklik gösterir. Ruam, yumuşak yara gibi hastalıklara hiç bağışıklık gelişmemesine karşılık, boğmaca da ömür boyu bağışıklık gelişebilir. Bakterilere karşı geniş etkili aşılar, şimdilik kolera ve tifüs hastalıkları için yapılmaktadır. Mantar ve parazitlere karşı aşı geliştirmek çok zor olup henüz pratiğe yansımamıştır. Köpek kisti hastalığına karşı aşı çalışmaları yapılmaktadır. Son yıllarda pratiğe sokulan en mühim aşı, Hepatitis-B virüsüne karşı geliştirilen aşıdır. Bu virüs; nükseden karaciğer iltihabına, siroza ve karaciğer kanserine sebeb olan bir hastalığa yol açtığından, aşısı da çok mühimdir. Pasif bağışıklık: Bir hastalık amiline (etkenine) karşı, kendi vücudu yerine başka bir bünyede yapılmış antikorların verilmesi ile kişide ani başlayan geçici bir bağışıklığın hasıl olmasıdır. Pasif bağışıklık ancak bir kaç hafta devam eder. Koruyucu mekanizma, antikor verilir verilmez başladığı için, aktif aşıdaki gibi bir ön gecikme dönemi yoktur (yaralanmalarda tetanos serumu yapılması gibi). Toksinlerle olan hastalıklarda, antitoksini havi serum zerki çok etkili olur. Burada vücuttaki toksinleri nötralize edecek büyük bir antitoksin kitlesinden hemen faydalanmak mümkün olur. Kızamık ve bulaşıcı karaciğer iltihabı gibi belirli bazı virüs hastalıklarında serum verilmesi; korunmayı ve hastalık belirtilerinin hafiflemesini temin edebilir. Gebeliğin erken devresinde annede teşekkül eden antikorların cenine geçmesi ile meydana gelen pasif bağışıklık; bebeği, hayatın ilk aylarında bir çok enfeksiyon hastalıklarından korur. Anne kanıyla geçen antikorlar sayesinde olan bağışıklık, annenin sütü, özellikle ilk süt (kolostrum)’ten geçen antikorlarla da kuvvetlendirilir. Bu bağışıklık çocuk 4-6 aylık olunca kaybolur.
ImageYaygın Olarak Kullanılan Aşılar
Difteri aşısı: Difteri mikrobunun toksininin zararsız hale getirilmesiyle yapılır. Koruma değeri % 95’tir.
Boğmaca aşısı: Ölü boğmaca bakterisinden elde edilen bakteri aşısıdır. Koruma değeri % 85’tir.
Tetanos aşısı: Tetanos mikrobunun toksininin zararsız hale getirilmesiyle yapılır. Difteri aşısı gibi bu da toksoit aşıdır. Koruma değeri % 100’dür. Difteri, boğmaca ve tetanos aşıları karma aşı olarak (DBT) bir arada yapılabildikleri gibi ayrı ayrı da yapılabilir. Aşı küçük yaştaki çocuklara kas içine 0,5-1 ml yapılabilir. Ateş yükselmesi, lenf bezi şişmesi, huzursuzluk gibi yan etkiler görülebilir.
Çocuk felci (Polio) aşısı: Çocuk felci virüsünün etkisiz hale getirilmesiyle elde edilen bir canlı virüs aşısıdır. Ağızdan damla şeklinde verilen ve cilt altına enjekte edilen çeşitleri vardır. Ülkemizde ağızdan verilen şekli uygulanmaktadır. Koruma değeri % 85-90’dır. Yaz aylarında bu aşıyı yapmamak gerekir.
Kızamık aşısı: Canlı virüs aşısıdır. Koruma değeri % 95’tir. Üst kola kas içine 0,5 ml uygulanır. Aşıdan
7-10 gün sonra ateş, göz nezlesi, döküntü olabilir.
Kızamıkçık aşısı: Canlı virüs aşısıdır. Bir yaşından ergenliğe kadar yapılabilir.
Kabakulak aşısı: Canlı virüs aşısıdır. Bir yaşından sonra yapılır. Kızamık, kızamıkçık ve kabakulak aşısının bir arada yapılan karma şekli vardır. Ülkemizde yaygın olarak kullanılmamaktadır. Koruma değeri % 95 civarındadır.
BCG aşısı: Verem hastalığına karşı kullanılan bir canlı bakteri aşısıdır. Sol omuza deri içine 0,1 ml yapılır. Yeni doğan çocuklara ilk ay içinde yapılır. İleri yaşlarda PPD (Tüberkülin) testi menfi ise yapılır. Aşıya bağlı deri altı apsesi, lenf bezi şişmesi görülebilir.
Özel Gayeyle Yapılan Aşılar
Kuduz aşısı: Canlı virüs aşısıdır. Kuduz olma ihtimali olan bir hayvan tarafındanImage ısırılan insanlara yapılır. Kuduz virüsünün ördek embriyosunda üretilmesinden elde edilen aşı, 12-14 gün üst üste karından zerk edilir. Nadiren yan etkileri olabilir. 1980 yılından beri insan hücre kültürlerinde üretilen bir kuduz aşısı geliştirilmiştir. Yan etkisi yoktur ve fasılalarla 5 defa uygulanır, çok pahalıdır.
Hepatit-B aşısı: B tipi bulaşıcı karaciğer iltihabı (viral hepatit, sarılık) hastalığına karşı kullanılır. Pahalı olması sebebiyle yaygın olarak kullanılmamaktadır. Hastalıkla karşılaşma ihtimali yüksek olan kişilere (sağlık personeli) yapılmalıdır. Yan etkisi yoktur, bağışıklama için üç aşı gerekmektedir.
Canlı çiçek aşısı: Aşılama, vaccinia virüsünden (çiçek aşısı virüsü) hazırlanan canlı aşı ile yapılır. Bu virüse karşı vücutta ortaya çıkan bağışıklık çiçek hastalığına karşı da korunma sağlamaktadır. Aşı ile lokal (bölgesel) vaccinia hastalığı meydana getirilir. Aşı olarak hastalandırıcılık kabiliyeti azaltılmış, canlı vaccinia aşıları tercih edilir. Bu aşıları, ışıktan korumalı ve soğukta muhafaza etmelidir. Bu aşı 1978’de ülkemizde kaldırılmıştır. Birçok ülkede mecburi olmaktan çıkarılmıştır. Artık dünyada çiçek hastalığı görülmemektedir.
Berlin Prusya kraliyet eczacısı ve hekim olan Casper Neuman’ın Almanca eserinde, Türk tababet ve kültür tarihi bakımından önemli kısımlar vardır. Çiçek aşısını “Türkiye’de kullanılan çiçek aşısı metodu” deyimi ile anlatmaktadır. Çok uzun zaman Türkler tarafından kullanılan çiçek aşısı, ancak 1700 yıllarından sonra İngiltere’de mahkumlarda denemek suretiyle kullanılmaya başlanmıştır. Türk usulü çiçek aşısı 1745’ten sonra İngiltere’den Rusya’ya İsveç’ten İtalya’ya ve Fransa’ya kadar yayıldı. Bu yayılmanın yanında 1796 yılında Edward Jenner tarafından Vaccination şeklinde inekten alınarak insana aşılama usulünün bulunmasına yol açmıştır. Jenner, yeni usulü tatbike başlayıncaya kadar Türk usulü çiçek aşısı yapıyordu.Ve çiçek aşısını bulan Jenner değil, Türklerdir.
Aşılamada Uyulması Gereken Genel Kurallar
1. En erken aşılama yaşı: Her aşının kendisi için en uygun zamanda yapılması gerekir. Bir aşının belirtilen zamandan önce yapılmasının hemen hiç bir yararı olmayabilir. Mesela kızamık aşısı için durum böyledir. 15 aylıktan önce kızamık aşısının yapılmaması tavsiye edilmektedir. Bir salgın durumunda altıncı ayını doldurmuş kızamık geçirmemiş veya kızamık aşısı olmamış bütün çocukların aşılanması faydalı olur. Ancak bu bebeklere yapılan aşının da 15 aylıktan sonra tekrarlanması gereklidir.
2. En son aşılama yaşı: Difteri boğmaca aşılarının yan etkileri yaşla birlikte artma göstermektedir. Bu sebeple altı yaşından büyüklere boğmaca aşısı yapılmamaktadır. Difteri her yaşta öldürücü olabilen bir hastalıktır. Bu sebeple altı yaşından büyüklere de yapılması gerekir, (dozu azaltılır).
3. Rapeller arası süre: Bazı aşılarda yeterli bağışıklık sağlamak veya sağlanan bağışıklığın aynı düzeyde devam etmesini sağlamak için aşının belirli aralıklarla pekiştirme “rapel” dozları şeklinde verilmesi gerekir. Rapellerin yapılmasında herhangi bir sebeple gecikme olursa, aşı programına yeniden başlanmasına veya fazladan bir doz aşı yapılmasına gerek yoktur; programa bırakılan yerden devam edilir. Bunun aksine, teklif edilenden daha kısa bir süre geçtikten sonra ayapılan rapel aşıları sayılmamalı, teklif edilen zaman geldiğinde tekrar edilmelidir.
Image4. Aynı anda birkaç aşı yapma: Ölü aşılar aynı zamanda değişik yerlerden yapılabilir. Bir ölü aşı ile bir canlı aşı aynı anda değişik yerlerden uygulanabilir. Canlı virüs aşıları aynı gün uygulanabilirler, ancak aynı gün uygulanmadıklarında en az bir ay ara ile verilmeleri gerekir. DBT, kızamık ve polio (çocuk felci) aşıları ikisi veya üçü bir arada aynı günde yapılabilir.
5. Ateşli hastalıklarda: Ateşli hastalığı olanlara iyileşene kadar aşı yapılmamalıdır. Hafif üst solunum yolu hastalığı gibi durumlarda ateşin kontrol altına alınmasından sonra aşının geciktirilmesine gerek yoktur.
6. Gebelikte: Genel olarak, gebelik süresince canlı virüs aşıları yapılmaz. Salgında gebeliğin ilk üç ayından sonra yapılabilir. Gebe kadınların çocuklarına bütün aşılar yapılabilir.
7. Daha önce aynı aşıya karşı aşırı duyarlılık göstermiş olanlar aşılanmaz.
8. Erişkinlerde aşılama: Difteri ve tetanos bağışıklığının devamı için her on yılda bir tetanos, difteri rapelinin yapılması gerekmektedir. Çocukluklarında kızamıkçık geçirmemiş kadınlara da gebe kalmadan önce kızamıkçık aşısı bulunabilirse yapılmalıdır.
9. Yaz aylarında aşılama: Bu aylarda ağızdan çocuk felci aşısı yapılmaması teklif edilmektedir. Aşıların taze olarak bulunabildiği, ishallerin olmadığı yerlerde yaz aylarında aşı yapılmasında hiçbir mahzur yoktur.
10. Aşıların saklanması: Aşının üretildiği yerden bozulmadan uygun sıcaklıkta aşı yapılacak kişiye ulaştırılması gereklidir.
 
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