Adult Vaccination

Let’s Get Vaccinated: Vaccination Practices for Adults in Turkey:

In recent years, immunization of adults has become as important as that of children all over the world. Many diseases that may result in mortality and morbidity in adults can be prevented by vaccination.

With the increase in the elderly population in our country, there is a corresponding increase in chronic diseases and cancers, which has led to adult vaccination becoming more and more prominent.

Our Ministry is aware of the increasing importance of adult immunization and carries out and supports vaccination activities in line with the objectives of protecting pregnant women, the elderly, people with chronic diseases, people with immunodeficiency and other risk groups from infectious diseases, both those whose childhood immunization schedule is incomplete and those who need additional vaccinations to reinforce immunity.

Adult vaccination should be seen as an opportunity to vaccinate people who were not vaccinated during infancy in accordance with the vaccination schedule.

In developed countries, pneumococcal bacteria are the most common cause of pneumonia requiring hospitalization. Deaths from pneumococcal diseases occur mainly among older adults, with mortality rates among this group reaching 10-20% for pneumonia and 60% for pneumococcal bacteremia.

In 2002, maternal tetanus cases accounted for 14% of tetanus-related deaths worldwide. In 2014, adults accounted for 65% of tetanus cases reported in the European Union.

Although pertussis is generally recognized as a childhood disease, it is often not recognized in adolescents and adults because of its atypical course. As a matter of fact, pertussis cases in the adult age group, which have been increasing in recent years, are an important source of infection for susceptible children.

The importance of high vaccination coverage against diphtheria among adults has been demonstrated in recent outbreaks around the world – particularly in the countries of the former Soviet Union in the 1990s. However, in most developed countries, diphtheria cases are shifting towards the adult age group, driven by high vaccination coverage in the pediatric age group.

It is estimated that around 900,000 people die each year from the acute or chronic consequences of hepatitis B. Approximately 25% of infected adults die of cirrhosis or liver cancer. The World Health Organization recommends that in countries with medium/low hepatitis B endemicity, such as Turkey, vaccination strategies targeting the older age group or hepatitis B risk groups should be considered in support of routine childhood vaccination. It is also known that hepatitis A has a more severe course in adults.

Most deaths over the age of 65 in developed countries are associated with influenza infection. The administration of influenza vaccine, especially to older adults with chronic diseases and pregnant women, reduces hospitalizations and deaths.

Although measles vaccination has been practiced in Turkey since the 1970s, widespread and high-dose vaccination success has been achieved in all provinces only since the 1990s. Therefore, since the rate of non-vaccination is high among all adults born between 1970 and 1991, especially among adults born between 1980 and 1991, adults in this age group are very susceptible to measles.

Vaccination against rubella is important because when the disease is contracted during pregnancy, it can result in congenital rubella syndrome. 100,000 babies are born with congenital rubella syndrome every year in the world. It causes babies to be born with severe sequelae such as heart disease, cataracts and blindness, and severe mental retardation. The only way to prevent the disease is for all women of childbearing age to be vaccinated against rubella.

The vaccines administered to the adult age group by family physicians within the scope of the Expanded Immunization Program (EIP), which has been implemented in Turkey since 1985, are summarized below.

Adult Tetanus Vaccine:

All adults who have not been previously vaccinated should be vaccinated with 3 doses of adult diphtheria-tetanus (Td) vaccine and their primary vaccination should be completed. All adults who have completed the primary vaccination series should be vaccinated with Td vaccine every 10 years.

Fertile Age Female/Pregnant Immunizations

Vaccination with tetanus vaccine during pregnancy is important to protect against newborn tetanus, which is fatal in infants. For this reason, Td vaccine is recommended for all pregnant women who were not vaccinated in childhood, whose vaccination status is unknown, incompletely vaccinated or fully vaccinated but who have not received a booster dose in the last 10 years. Pregnant women who have never been vaccinated should receive at least two doses of Td vaccine 4 weeks apart. The second dose should be completed at least two weeks before delivery. Click here for detailed information about vaccination during pregnancy.

It is also necessary for all pregnant women to receive the pregnancy vaccine to prevent maternal deaths from pneumonia caused by viruses. Flu vaccines for pregnant women are provided free of charge upon prescription. The flu vaccine can be administered at any stage of pregnancy. The flu vaccine should be administered to pregnant women as a single dose and repeated every pregnancy.

Measles, Rubella, Mumps and Measles (MMR) Vaccine:

A person does not need to be vaccinated if they have received two doses of measles-containing vaccine (for people born after the 1980s) or MMR vaccine (for people born after 2006), or if they have a record of having had measles, or if laboratory tests show that they are immune. Otherwise, all adults outside the gestation period should receive one dose of MMR vaccine at four-week intervals.

In Turkey, rubella vaccine was added to the national childhood vaccination schedule in 2006. Therefore, since the measles vaccines administered by the Ministry before 2006 were not combined with rubella vaccine, the person is not protected against rubella virus even if the person is vaccinated. For this reason, it is especially important to administer MMR vaccine to all women of childbearing age, except during pregnancy, and to all other adults who do not have a record of having received two doses of MMR vaccine.

The MMR vaccine is administered free of charge to all adults who do not have MMR vaccine, upon request, by family physicians in two doses at four-week intervals.

Pneumococcal Vaccine:

Vaccination is especially important for older people. As we age, the immune system weakens and it can be more difficult to fight infections. For people aged 65 and over, two pneumococcal vaccines are recommended to protect against serious diseases caused by pneumococcal bacteria, such as pneumonia, blood infections and meningitis. Conjugated pneumococcal vaccine is administered free of charge in health institutions. Polysaccharide pneumococcal vaccine is covered for risk groups defined in the Health Implementation Communiqué, if prescribed. Vaccination schemes differ depending on whether you are healthy or have a concurrent disease that increases the risk. Please contact your family physician for information about these vaccines.

Flu Vaccine:

The cost of the flu vaccine is covered once a year for people aged 65 and over and for people staying in nursing homes and retirement homes, without a health report, if they document this situation.

 

Vaccination Practices for Adults at Additional Risk Due to Underlying Disease or Occupation:

  1. Hepatitis A Risk Group Vaccinations:

Within the scope of the Hepatitis A Control Program carried out by the Ministry of Health, all identified risk groups (see Hepatitis A Vaccine Risk Groups) are vaccinated free of charge upon application to health institutions.

  1. Hepatitis B Risk Group Vaccinations:

Within the scope of the Hepatitis B Control Program carried out by the Ministry of Health, all identified risk groups (see Hepatitis B Vaccine Risk Groups) are vaccinated free of charge upon application to health institutions.

Hepatitis B vaccine can be administered free of cost in health institutions to people outside of these risk groups who the physician deems appropriate to be vaccinated due to high risk.

  1. Pneumococcal Vaccines

The Ministry of Health’s pneumococcal disease control program includes childhood vaccinations as well as adult and risk group vaccinations. Diseases caused by pneumococcal bacteria are more likely to be prolonged, require hospitalization and have a fatal course, especially in adults aged 65 years and older, people with chronic diseases and people with weakened immune systems due to illness or drug use.

In the presence of diseases that increase the risk of pneumococcal disease, the conjugated pneumococcal vaccine and polysaccharide pneumococcal vaccine provide protection against these serious and potentially fatal diseases. Conjugated pneumococcal vaccine is administered free of charge at health facilities. Polysaccharide pneumococcal vaccine is covered for the risk groups defined in the Health Implementation Communiqué, if prescribed. (For detailed information, see Pneumococcal Vaccine Risk Groups)

  1. Health Worker Vaccination

Students of medical faculties, dental faculties, nurse/midwifery training schools, health vocational schools, etc. have an increased risk of exposure to infectious diseases, as do health personnel working in health institutions during their internship and health services during their education. Therefore, it is necessary to administer certain vaccines in order to reduce occupational risk and due to the presence of high-risk patients in the patient group they serve and the risk of being a source of these patients.

Other workers, including cleaning workers working in health institutions, 112 emergency health services personnel, National Medical Rescue Team (UMKE) personnel working in emergencies, disasters and extraordinary situations, and personnel working in emergency health vehicles, are also required to be vaccinated with certain vaccines to protect themselves from the risk of occupational exposure and to prevent them from being a source for patients.

Click for detailed information (Occupational Risk Group Vaccination: Health Worker Vaccination)

  1. Flu Vaccines

The cost of the flu vaccine is covered by the state once a year for adults with chronic lung, heart and other chronic diseases, including asthma, when prescribed by all physicians based on a medical report stating their disease.

In addition, since the 2005-2006 influenza season, the Ministry has been purchasing and distributing influenza vaccine to provinces so that all health workers (public and university) can be vaccinated with influenza vaccine.

  1. Soldier Vaccinations:

Soldiers serving in the Turkish Armed Forces are more at risk than the rest of the population in terms of exposure to infections and epidemics for various reasons.

Adult-type tetanus-diphtheria (Td) and meningitis vaccines are administered to all conscripts in the military service in our country, and measles-mumps-rubella-mumps (MMR) vaccines are administered to conscripts born between 1980-1991.Click for detailed information (Vaccination of Occupational Risk Groups: Military Vaccinations)

  1. Travel Vaccinations:

Vaccination of travelers in accordance with the infectious disease risk in the country of travel is carried out in the travel health units of the General Directorate of Health of Borders and Coasts in line with the recommendations of the World Health Organization’s “International Travel and Health” Program (http://www.who.int/ith/en/). Click here for detailed information (http://www.seyahatsagligi.gov.tr/).

  1. Hajj-Umrah Vaccinations:

In our country, individuals who will routinely visit Hajj and Umrah are provided with meningococcal vaccination before leaving the country. Click for detailed information (Hajj and Umrah Vaccinations)