Joint mission to western Ukraine assesses critical polio outbreak response
To assess ongoing efforts in response to a poliomyelitis (polio) outbreak first detected in Ukraine in October 2021, the WHO Country Office in Ukraine; Deputy Minister of Health of Ukraine, Dr Ihor Kuzin; and Global Polio Eradication Initiative (GPEI) partners (United Nations Children’s Fund (UNICEF), United States Centers for Disease Control and Prevention (US CDC), Bill and Melinda Gates Foundation and Rotary International) conducted a joint field mission to western Ukraine (Lviv, Rivne and Zakarpattia regions) on 13–15 July 2022. The joint mission focused on assessing the response to the outbreak and providing technical guidance on disease surveillance and polio vaccination in the three regions of the country. The mission also provided an opportunity to ensure that the polio outbreak response, including achievement of high coverage with routine and catch-up polio vaccination, remains a priority activity of the Ukrainian regional Centres for Disease Control and Prevention. The team met with heads of regional health departments, representatives of regional state administrations and health-care workers.
Since the detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Rivne region last year, the GPEI partners have been assisting the Ministry of Health and the Public Health Center of Ukraine in responding to the polio outbreak. A polio vaccination campaign for children aged 6 months to 6 years who missed routine polio doses in the past began on 1 February 2022, aiming to reach nearly 140 000 children throughout the country. Despite the ongoing war in the country, which began later the same month, the catch-up vaccination campaign is continuing in primary health care centres, albeit very slowly. So far 70% of the targeted number of children nationwide have been vaccinated with inactivated polio vaccine.
“We are working hard to ensure that everything necessary for vaccination is made available, including trained health workers to administer vaccinations in the health facilities and all the logistics needed,” said Roman Safonov, chief sanitary doctor of the Rivne region.
Challenges to achieving high vaccination coverage
Routine polio vaccination coverage in Ukraine, which had been increasing from a low in 2017, has been negatively affected by the COVID-19 pandemic and further disrupted in many locations by the war this year. Millions of people have been displaced within and outside the country, making it more difficult to locate and vaccinate children. There is also low awareness of the importance of vaccines among some hard-to-reach communities.
“Vaccination rates across the country have dropped significantly because of the war,” said Dr Kuzin.“Our task is to do everything possible to ensure that the coverage of routine immunization is high; one of the priorities is vaccination against poliomyelitis. We will not rest until all children are fully vaccinated against polio and other vaccine preventable infections.” To increase coverage in western Ukraine, health authorities have conducted awareness-raising sessions and supported mobile vaccination sessions 2–3 times per week. Following the joint mission, additional organizational, training and information initiatives have been planned to strengthen the response to the polio outbreak.
Poliovirus outbreak in Ukraine and risk of international spread
The circulation of poliovirus has been confirmed in 2 regions: Rivne and Zakarpattia. To date, 2 children with acute flaccid paralysis (AFP) have tested positive for cVDPV2 (both with onset of illness in 2021), and the virus has also been detected in 19 asymptomatic contacts. Intensified AFP surveillance is ongoing across the country, along with environmental poliovirus surveillance. Since January 2022, 61 AFP cases have been reported, all of whom have tested negative for polio.
In the current crisis setting, this outbreak poses a substantial risk of international spread due to subnational gaps in immunization coverage and suboptimal AFP surveillance in countries surrounding Ukraine, and mass population movement linked to the war.
“GPEI partners will continue to support and coordinate with regional and health authorities to provide all necessary skills and technical expertise to improve the country’s vaccination and surveillance indicators. Polio vaccine procurement is also ongoing to avoid stockouts,” said Raymond Dankoli, WHO Polio Outbreak Response Coordinator in Ukraine.