Rotavirus wata ƙwayar cuta ce mai ɗauke da RNA daga dangin Reoviridae wadda ke haddasa gudawa mai tsanani da amai, musamman ga yara ƙanana. Wannan ƙwayar cuta tana daga cikin mafi yawan dalilan da ke haddasa cututtukan hanji (gastroenteritis) a duniya, musamman a ƙasashe masu tasowa inda tsaftar muhalli da samun ruwa mai tsafta ke da ƙaranci. Ana kiran cutar da Rotavirus ne saboda siffarta da ke kama da (wheel) a ƙarƙashin na’urar hangen ƙananan ƙwayoyin halitta (microscope).
An fara gano Rotavirus a shekarar 1973, a birnin Melbourne na ƙasar Ostiraliya. An gano ta daga hanjin jariran da suka kamu da gudawa mai tsanani. Daga nan ne binciken kimiyya ya tabbatar cewa Rotavirus ita ce babbar ƙwayar cutar da ke haddasa gudawa ga yara ƙanana a duk faɗin duniya.
Ƙwayar cutar rotavirus mai haddasa amai da gudawa.
Kafin a fara amfani da allurar rigakafin rotavirus, ana ƙiyasin cewa sama da yara miliyan ɗaya ke mutuwa a kowace shekara sakamakon gudawa da wannan ƙwayar cuta ke haifarwa, musamman a nahiyar Afirka da Asiya. Duk da cigaban da aka samu a fannin lafiya, har yanzu rotavirus na daga cikin manyan ƙalubale a tsakanin jarirai da yara ƙanana saboda rashin ruwa a jiki da cutar ke haifarwa.
Rotavirus tana da muhimmanci sosai a fannin kiwon lafiya na duniya, saboda ita ce ke haddasa kusan kashi 40 cikin 100 na cututtukan gudawa masu buƙatar kai yara zuwa asibiti. Hukumar Lafiya ta Duniya (WHO) da UNICEF sun haɗa kai wajen tabbatar da cewa dukkan ƙasashe sun saka rigakafin rotavirus cikin tsarin rigakafi na yara tun daga ƙarshen shekarar 2009.
Bincike ya nuna cewa ƙasashen da suka fara aiwatar da wannan rigakafi sun samu raguwa da kaso mai yawa na mutuwar yara da kamuwa da gudawa mai tsanani. Wannan ya nuna cewa rotavirus tana daga cikin ƙwayoyin cuta mafi tasiri, amma kuma za a iya daƙile ta cikin sauƙi idan aka yi amfani da rigakafi da tsaftace muhalli.
Siffofin ƙwayar cutar rotavirus
Rotavirus tana da siffofi na musamman da suka bambanta ta da sauran ƙwayoyin cuta masu haddasa gudawa. Ƙwayar tana da siffar zobe (circular) wadda ke kama da tayar mota, abin da ya sa aka ba ta suna “Rota”, ke nan. Daga kalmar Latin rota wadda ke nufin “wheel”. Wannan siffa tana bayyana ne a ƙarƙashin na’urar hangen ƙananan ƙwayoyin halitta (microscope).
Rotavirus tana daga cikin dangin Reoviridae, kuma tana ɗauke da layuka biyu na RNA (double-stranded RNA); abin da ya sa take da ƙarfi fiye da wasu ƙwayoyin cuta masu RNA ɗaya. Wannan tsarin RNA biyu yana taimaka mata wajen rayuwa a cikin hanji na ɗan lokaci ba tare da ta lalace ba, duk da matsanancin sinadaran da ke wajen narkar da abinci.
Ƙwayar tana da sassa uku na fatar kariya (triple-layered protein capsid) waɗanda ke kare ƙwayar RNA a ciki daga zafi, sinadarai, da kuma enzymes masu lalata ƙwayoyin cuta a jikin mutum. Wannan kariya ce ke sa Rotavirus ta zama mai ɗorewa sosai a muhalli, tana iya rayuwa a wajen jiki har tsawon makonni da dama, musamman a ruwa ko a saman abubuwa kamar tebura da kayan wasa.
A tsarin kimiyya, Rotavirus tana da nau’o’in serotype da genotype masu yawa. An fi sanin nau’o’in G da P, waɗanda ke bayyana irin bambancin kwayar halitta da tsarin antigen ɗinta. Mafi yawan nau’o’in da ke haddasa cuta ga yara sun haɗa da G1P[8], G2P[4], G3P[8], G4P[8], da G9P[8]. Waɗannan nau’o’i suna bambanta daga yanki zuwa yanki, kuma suna iya canjawa lokaci zuwa lokaci saboda mutation da haɗuwar ƙwayoyin RNA.
Rotavirus tana iya kama dabbobi kamar shanu, awaki, kaji, da aladu, amma nau’in da ke kama mutane ya bambanta da na dabbobi. Sai dai a wasu lokuta ana samun canjin ƙwayar halitta tsakanin nau’in dabbobi da na mutane, wannan kan iya haifar da sabbin nau’o’in cuta.
Ƙwayar tana yaɗuwa ne a cikin hanji bayan mutum ya sha ruwa ko abinci mai ɗauke da ita. Bayan ta shiga jiki, tana shiga cikin ƙwayoyin hanji (enterocytes) ta kuma lalata su. Wannan lalacewa tana sa jiki ya kasa karɓar ruwa da abincin yadda ya kamata, don haka ruwa yana fita da yawa ta hanyar gudawa.
Saboda irin wannan tsarin rayuwa da ƙarfin kariya, Rotavirus tana daga cikin ƙwayoyin cuta mafi ƙarfi da juriya, wacce ke iya tsira daga yanayi mai zafi ko sanyi, da kuma sinadaran da ake amfani da su wajen tsaftace muhalli. Wannan ne yasa tsafta kaɗai ba ta wadatarwa wajen hana yaɗuwar cutar, sai an haɗa da rigakafi da tsauraran matakan tsaftar.
Yadda ƙwayar cutar ke yaɗuwa
Rotavirus tana yaɗuwa ne ta hanyar najasa zuwa baki (fecal–oral route), wato mutum yana kamuwa idan ya ci abinci ko ya sha ruwa, ko kuma ya taɓa wani abu da ya gurɓata da najasar da ke ɗauke da ƙwayar cutar. Wannan hanya ce da ta fi yawan haddasa cutar musamman a wuraren da tsaftar muhalli ke da rauni, kamar inda ba a samun ruwa mai tsafta ko inda ba a killace sharar gida.
Babban tushen yaɗuwar Rotavirus shi ne najasa ta yara ƙanana. Bayan yaro ya kamu da cutar, jikinsa yana fitar da ƙwayoyin cutar cikin najasa a adadi mai yawa har na tsawon makonni biyu zuwa uku. Idan wannan najasa ta gurɓata ruwa, abinci, ko kayan wasan yara, sai ƙwayar cutar ta shiga jikin wasu yara ko manya ta hanyar baki. Wannan na iya faruwa ta hanya mai sauƙi, kamar:
- Rashin wanke hannu da kyau bayan wanke wa jariri bahaya.
- Yin amfani da ruwa ko abinci da aka gurɓata.
- Yin amfani da abu ɗaya kamar cokali, kofi kayan wasa tsakanin yara.
- Rashin tsaftace muhalli, musamman a wuraren kiwon yara, makarantu, da asibitoci.
Rotavirus tana iya rayuwa a muhalli na tsawon lokaci. A cikin ruwa mai ɗan sanyi, tana iya rayuwa har makonni uku zuwa hudu, yayin da a saman kayan da mutane ke taɓawa (kamar tebura, ƙofa, ko kayan wasan yara) tana iya rayuwa na tsawon awanni 48 zuwa 72. Saboda wannan juriyar, kwayar cutar na da sauƙin yaɗuwa daga mutum zuwa mutum.
Yara ƙanana su ne suka fi kamuwa saboda ba su da cikakken rigakafi, kuma sukan kasance suna wasa da abubuwan da ke ƙasa, suna ɗauka suna sakawa a baki. Haka kuma, jarirai masu shan nono kaɗan ko waɗanda suka daina shan nono da wuri kan fi kamuwa da cutar.
A cikin gidaje ko cibiyoyin renon yara, idan yaro ɗaya ya kamu da Rotavirus, yana iya yaɗa ta cikin sauƙi ga sauran yara da ma’aikata saboda yawan cuɗanyar hannayen juna. Wannan dalilin ne ya sa cutar ke yaɗuwa cikin gaggawa musamman a cikin lokutan damina ko sanyi, lokacin da ake samun ruwa da yawa ko rashin cikakkiyar tsafta.
Cutar tana iya yaɗuwa daga mutumin da ke ɗauke da ita koda bai nuna alamomin cutar ba (asymptomatic infection), domin jikinsa na iya fitar da ƙwayoyin cutar cikin najasa ba tare da an lura ba. Wannan yana ƙara wahalar daƙile yaɗuwar Rotavirus a cikin al’umma.
Alamomi ƙwayar cutar Rotavirus
Alamomin cutar rotavirus sukan bayyana bayan kwana 1 zuwa 3 idan mutum ya kamu da ƙwayar cutar. Yawanci cutar tana bayyana ne da ciwon gudawa mai tsanani wanda zai iya wuce sau goma zuwa ashirin a rana ɗaya, tare da amai da sauran alamomin rashin lafiya. Cutar tana da matakai uku: matakin farko (onset), mataki mai tsanani (acute stage), matakin farfaɗowa (recovery period).
Matakin farko (Onset)
A matakin farko, yaro zai fara nuna rauni, rashin kuzari, da rashin son cin abinci. Bayan wasu sa’o’i ko kwana ɗaya, sai zazzabi ya fara hawa, sannan amai ya biyo baya.
Mataki mai tsanani (Acute Stage)
Wannan shi ne matakin da cutar ke nuna ƙarfinta sosai. Alamomi sukan haɗa da:
- Gudawa mai ruwa sosai (wani lokaci kamar ruwa.
- Amai mai yawa, wanda ke sa jiki ya rasa ruwa cikin gaggawa.
- Zazzabi, wanda zai iya sa jiki ya yi zafi mai tsanani.
- Ciwon ciki mai tsanani
- Rashin kuzari da gajiya sosai.
- Rashin ruwa a jiki (dehydration); wannan shi ne mafi hatsari daga cikin illolin Rotavirus.
Alamomin bushewar jiki sukan haɗa da:
- Bushewar baki da harshe.
- Rashin hawaye lokacin kuka.
- Fitsari kaɗan ko babu.
- Fatar jiki ta yi sanyi.
- Idanu su zurma.
- Rashin kuzari ko suma a lokuta masu tsanani.
- A yara ƙanana, musamman jarirxai, bushewar jiki tana iya kai su ga mutuwa idan ba a ba su ruwa da sauri ba.
Matakin farfadowa (Recovery Period)
Idan an kula da lafiya da ƙarin ruwa yadda ya kamata, cutar kan lafa a cikin kwanaki 3 zuwa 8. Amma har bayan yaro ya warke, zai iya ci gaba da fitar da ƙwayar cutar a cikin najasa har tsawon makonni biyu, wanda ke nufin yana iya yaɗa cutar ga wasu.
Cutar rotavirus tana iya kama manya, amma yawanci alamomin ba su da tsanani a gare su saboda sun riga sun samu wani ɓangare na rigakafi. Sai dai a wasu lokuta, musamman ga tsofaffi ko masu raunin garkuwar jiki, cutar na iya zama mai tsanani.
Illolin rotavirus ga lafiyar jama’a
Rotavirus na daga cikin manyan dalilan mutuwar yara ‘yan ƙasa da shekara biyar a duniya, musamman a ƙasashen Afirka da Asiya. Duk da cewa cutar ba ta da matuƙar hatsari ga manya, tana da tsanani sosai ga jarirai da yara ƙanana.
A cewar Hukumar Lafiya ta Duniya (WHO), kafin a fara amfani da rigakafin Rotavirus, ana kiyasin cewa fiye da yara miliyan ɗaya ke kamuwa da cutar a duk shekara, kuma dubban yara na mutuwa sakamakon rashin ruwa a jiki.
Lokacin ɓarkewar cutar Rotavirus
Cutar Rotavirus tana iya ɓarkewa a kowane lokaci a shekara, amma tana da lokutan da ta fi yawan yaɗuwa bisa ga yanayi da yanayin ƙasa.
A ƙasashen da ke da sanyi (temperate regions), cutar tana yawan bayyana ne a lokacin sanyi (winter season), musamman daga watan Disamba zuwa Maris. A wannan lokaci, yara da yawa kan kamu da gudawa da amai sakamakon yaɗuwar ƙwayar cutar a cikin al’umma.
A ƙasashe masu zafi (tropical regions) kamar Najeriya da sauran ƙasashen Afirka, cutar Rotavirus tana iya ɓarkewa a ko’ina cikin shekara, amma ta fi yawan faruwa a lokacin damina, wato daga watan Mayu zuwa Satumba. A wannan lokaci ne ruwa ke yawan gurɓatawa da najasa, tsafta kuma kan ragu, wanda hakan ke ba ƙwayar cutar damar yaɗuwa cikin sauƙi.
Binciken masana ya nuna cewa cutar ta fi shafar yara ‘yan ƙasa da shekara biyu, musamman tsakanin watanni 6 zuwa 24 na haihuwa. Wannan saboda tsarin garkuwar jikinsu bai gama yin ƙarfi ba, don haka ƙwayar cutar na samun sauƙin kai hari.
Rigakafi da maganin rotavirus
Rigakafi (prevention)
Rigakafi ita ce hanya mafi inganci wajen kare yara daga kamuwa da Rotavirus. Hukumar Lafiya ta Duniya (WHO) ta amince da amfani da rigakafin Rotavirus ga dukkan jarirai a dukkan ƙasashe. Ana bavda rigakafin ne ta baki (oral vaccine), wato a ɗiga shi a cikin baki maimakon allura.
Rotarix da RotaTeq
A halin yanzu, akwai manyan nau’o’in rigakafi guda biyu da Hukumar Lafiya ta Duniya (WHO) ta amince da su, wato Rotarix da RotaTeq.
Rotarix rigakafi ce da kamfanin GlaxoSmithKline (GSK) ya samar. Ana bayar da ita ta baki, ba ta hanyar allura ba. Wannan rigakafi tana ƙunshe da nau’in ƙwayar Rotavirus guda ɗaya da aka raunana, wanda ake kira G1P[8]. Wannan nau’in shi ne mafi yawan wanda ke haddasa cutar a duniya. Ana ba da Rotarix kashi biyu, kashi na farko a lokacin da jariri yake da watanni shida, sai kashi na biyu a lokacin da jaririn yake da watanni goma. Ana ajiye rigakafin a wurin da yanayinsa yake tsakanin digiri biyu zuwa takwas (2°C zuwa 8°C).
Rotarix
Rotarix tana motsa garkuwar jikin jariri ta hanyar sa antibodies su fuskanci ƙwayar cutar da aka raunana, domin su koyi yadda za su ƙirƙiri kariya idan ƙwayar cutar ta gaske ta shiga jiki daga baya. Bincike ya nuna cewa Rotarix tana rage yawan kamuwa da cutar Rotavirus da kashi tamanin zuwa tamanin da biyar cikin ɗari (80–85%), kuma tana rage yawan mutuwar yara ƙanana dalilin gudawa. Bayan rigakafin, idan jariri ya kamu da cutar, tana zama mai sauƙi fiye da yadda take ba tare da rigakafi ba. Illolin da kan bayyana bayan amfani da Rotarix yawanci ba su da tsanani, kamar ɗan zazzabi, amai, ko gudawa na ɗan lokaci.
RotaTeq
RotaTeq kuwa, ita ma rigakafi ce ta baki da kamfanin Merck & Co. ya samar. Ita ce rigakafin Rotavirus mai nau’o’i biyar, domin tana ɗauke da ƙwayoyin Rotavirus guda biyar da aka raunana. Waɗannan nau’o’in sun haɗa da G1, G2, G3, G4, da P[8], waɗanda su ne manyan nau’o’in da ke haddasa cutar Rotavirus a duniya. Saboda haka, RotaTeq tana da kariya mai faɗi fiye da Rotarix, domin tana iya kare yara daga nau’o’in cutar da dama a lokaci guda. Ana ba da RotaTeq kashi uku, na farko a watanni shida, na biyu a watanni goma, na uku a watanni goma sha huɗu. Ana adana ta a yanayin sanyi kamar yadda ake ajiye Rotarix.
Yadda RotaTeq ke aiki shi ne, bayan an shigar da ita cikin jikin jariri, ƙwayoyin cutar da aka raunana suna motsa garkuwar jiki ta samar da rigakafi da ke iya kare yaro daga kamuwa da Rotavirus na zahiri. An tabbatar da cewa RotaTeq tana rage yawan kamuwa da cutar da kusan kashi casa’in cikin ɗari (90%) kuma tana bayar da kariya mai ɗorewa na shekaru da dama.
Illolin da ake iya gani bayan shan RotaTeq sukan zama masu sauƙi, kamar zazzaɓi, gudawa ko amai, amma a lokuta masu wuya ana iya samun matsalar intussusception, wato cunkushewar hanji, duk da cewa hakan yana faruwa ne a kaso ƙanƙani.
A taƙaice, bambancin da ke tsakanin Rotarix da RotaTeq shi ne Rotarix tana ɗauke da nau’in ƙwayar Rotavirus guda ɗaya (monovalent), ana bayar da ita kashi biyu, yayin da RotaTeq tana ɗauke da nau’o’i biyar (pentavalent), ana bayar da ita a kashi uku. Dukansu ana bayar da su ta baki, suna da inganci sosai wajen rage kamuwa da gudawa da mutuwar yara ƙanana, kuma suna taka muhimmiyar rawa a cikin shirin rigakafin yara na ƙasa (EPI) a ƙasashe da dama, ciki har da Najeriya.
Tasirin Rotarix da RotaTeq a Najeriya
A Najeriya, cutar Rotavirus ta kasance ɗaya daga cikin manyan dalilan mutuwar yara ƙanana ‘yan ƙasa da shekara biyar, musamman sakamakon gudawa da amai da ke jawo rashin ruwa a jiki. A tsawon lokaci, an gano cewa fiye da rabin cututtukan gudawa a tsakanin jarirai da yara ƙanana a ƙasar na da alaƙa da ƙwayar cutar Rotavirus. Wannan ne ya sa gwamnatin Najeriya tare da haɗin gwiwar Hukumar Lafiya ta Duniya (WHO), UNICEF, da Gavi (the Vaccine Alliance) suka aiwatar da shirin ƙara rigakafin Rotavirus a cikin shirin rigakafin yara na ƙasa (National Programme on Immunization – NPI).
An fara amfani da rigakafin Rotavirus a Najeriya a hukumance a cikin shekarar 2022, inda aka zabi Rotarix a matsayin rigakafin farko da za a yi amfani da ita saboda sauƙin adanata da tsarin kashi biyu da take da shi. Wannan ya sauƙaƙa aiwatarwa a cibiyoyin lafiya, musamman a yankunan karkara. Ana bayar da Rotarix tare da sauran rigakafin yara kamar Pentavalent, OPV, da PCV, domin tabbatar da cewa jarirai suna samun kariya daga cututtuka da dama a lokaci guda.
Bayan shekara ɗaya da fara amfani da rigakafin Rotavirus a Najeriya, rahotannin asibitoci da hukumomin lafiya sun nuna raguwa mai yawa a yawan yaran da ke kamuwa da gudawa mai tsanani. An kiyasta cewa yawan mutuwar yara da ke da alaƙa da gudawa ya ragu da fiye da kashi 40% a wasu jihohi, musamman a yankin Arewa wanda yawan yara ke da yawa kuma tsaftar muhalli ke da rauni.
Bugu da ƙari, rigakafin Rotavirus ta taimaka wajen rage cunkoso a asibitoci da asibitocin ƙananan yara, inda adadin kwantar da marasa lafiya saboda gudawa ya ragu sosai. Wannan ya ba ma’aikatan lafiya damar mai da hankali kan sauran cututtukan yara kamar mura, ciwon huhu, da zazzaɓin cizon sauro.
Masana lafiya a Najeriya sun tabbatar da cewa haɗin rigakafin Rotavirus da wayar da kan jama’a game da tsaftar muhalli da tsaftar hannu zai taimaka wajen rage kamuwa da cututtukan gudawa da ke addabar yara ƙanana. Haka kuma, wannan shiri ya dace da manufar Universal Health Coverage (UHC) da gwamnati ke aiwatarwa, wacce ke nufin samar da kariyar lafiya ga kowa ba tare da bambanci ba.
Haka kuma, akwai wasu matakan kariya da ya kamata a kiyaye domin rage yaduwar cutar:
- Tsaftace hannu da sabulu bayan zuwa bayan gida da kuma kafin ciyar da yara.
- Tsabtace abinci da ruwa sosai kafin ci ko sha.
- Guje wa ciyar da jarirai da ruwan da bai da kyau.
- Tsaftace muhalli da kayayyaki (kayan wasan yara, kujera, da sauran abubuwan da suke taɓawa).
Maganin ƙwayar Rotavirus (Treatment)
Babu magani na musamman da ke kashe ƙwayar Rotavirus kai tsaye. Abin da ake yi shi ne magance alamomi da kuma mayar da ruwan da jiki ya rasa.
- Ƙarin ruwa (Oral Rehydration Therapy): Ana amfani da ruwan gishiri da sukari (ORS) domin mayar da ruwan da jiki ya rasa ta hanyar gudawa da amai. Wannan ita ce hanya mafi muhimmanci da ta fi ceton rayuka.
- Allurar ruwa ta jijiya (Intravenous Fluids): Idan gudawa ta tsananta kuma yaro ya kasa shan ruwa, likita na iya saka ruwa ta jijiya domin ceto ransa.
- Abinci mai sauƙin narkewa: Ana ba yaro abinci mai sauƙin narkewa kamar shinkafa, gero, koko, ko plantain. Bai kamata a hana yaro abinci ba, saboda hakan na iya jawo rashin ƙarfi da bushewar jiki.
- Guje wa magungunan da ba su da inganci: Ba a amfani da maganin rigakafi (antibiotics) ko magungunan da ke dakatar da gudawa (antidiarrheals), domin ba su da tasiri kan ƙwayar Rotavirus.
Illolin rotavirus ga lafiyar jama’a
Cutar Rotavirus tana daga cikin manyan matsalolin lafiya da ke shafar yara ƙanana a duniya. Illolinta ba kawai a jiki ba ne, har ma ga iyalai, al’umma, da tattalin arzikin ƙasa bakiɗaya.
Asarar ruwan jiki (dehydration)
Wannan shi ne mafi haɗari daga cikin illolin cutar. Yaro kan rasa ruwa da sinadarai masu mahimmanci a jiki, wanda zai iya haifar da bugun zuciya, suma, ko ma mutuwa idan ba a kula da shi da gaggawa ba.
Raunin jiki
Gudawa mai tsanani kan hana jiki samun abinci da sinadarai masu ƙarfi. Hakan na iya jawo matsalar rashin abinci mai gina jiki (malnutrition), wanda ke ƙara raunana garkuwar jiki.
Asarar lokaci da kuɗi
Iyaye da ke kula da yara masu fama da Rotavirus kan ɓata lokaci wajen zuwa asibiti akai-akai, tare da kashe kuɗaɗe da yawa a kan ƙarin ruwa, magunguna, da biyan sufuri. Wannan na rage yawan lokutan aiki da kuma samar da matsin tattalin arziki.
Cunkoso a asibitoci
A lokacin da cutar ta yawaita, musamman a lokacin damina, asibitoci kan cika da yara masu fama da gudawa da amai. Wannan na iya kawo cunkoso da ƙarancin kayan aiki ko ma’aikatan lafiya.
Muhimmancin rigakafi a al’umma
- Rigakafin Rotavirus ya tabbatar da cewa yana da gagarumin tasiri wajen rage yawan kamuwa da cutar da kuma mutuwar yara ƙanana.
- Kasashen da suka fara amfani da rigakafin Rotavirus kamar Amurka, Brazil, da Afrika ta Kudu, sun samu raguwa da fiye da kashi 80% na yawan kamuwa da cutar da mutuwar da take haifarwa.
- Rigakafi yana taimaka wa al’umma ta hanyar rage cunkoso a asibitoci, saboda yara da dama ba sa sake kamuwa da cutar ko kuma idan sun kamu, tana zama mai sauƙi.
- Haka kuma, rigakafi yana taimaka wa gwamnati da iyaye wajen rage kuɗaɗen da ake kashewa kan kula da cututtukan gudawa.
- Ta hanyar rigakafi da tsaftar muhalli, ana iya kawar da Rotavirus gabaɗaya cikin shekaru masu zuwa.
Manazarta
Murunga, N., Tate, J. E., Mandomando, I., Omore, R., Mwenda, J. M., Parashar, U. D., & Otieno, G. P. (2020). Effectiveness of Rotarix® vaccine in Africa in the first decade of progressive introduction, 2009–2019: Systematic review and meta-analysis. Vaccine, 38(32), 5091–5101.
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Tarihin Wallafa Maƙalar
An wallafa maƙalar 9 October, 2025
An kuma sabunta ta 20 October, 2025
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