Polio mission to Western Ukraine to assess critical outbreak response activities being implemented to protect children from further infection especially during this war period.

The aim of the visit was to assess the polio outbreak response activities like vaccination and surveillance being implemented during this war period and to reawaken the commitment of the regional authorities and Regional Center for Disease Control and Prevention (RCDC) towards the ongoing polio outbreak. During the 3 days mission, the team had discussions with Heads of Health Departments of Regional State Administrations, Representatives of Regional State Administrations and health care workers.

Since the confirmation of circulating vaccine-derived poliovirus type 2 (cVDPV2) in Ukraine last year in Rivne oblast, the GPEI Partners – WHO, UNICEF, US Centers for Disease Control and Prevention, Bill and Melinda Gates Foundation and Rotary International – are assisting the Ministry of Health of Ukraine and the Public Health Center of Ukraine in responding to the polio outbreak in Ukraine.

The polio outbreak is still ongoing and is being complicated by the war, when high population movement started due to the invasion by the Russian Federation, hence increasing the risk of exporting poliovirus to other regions and countries. Despite the war, the catch-up vaccination campaign is ongoing though very slowly. So far 70% of the targeted children have been vaccinated with Inactivated Polio Vaccine (IPV).

About Poliovirus in Ukraine

Ukraine has been experiencing an outbreak of type-2 circulating vaccine-derived poliovirus (cVDPV2) since October 2021. The circulation of virus has been confirmed in two oblasts: Rivne and Zakarpattya.

To date two children with acute flaccid paralysis (AFP) have tested positive for cVDPV2, and the virus has also been detected in 19 asymptomatic contacts.

Since the war began, a lot of population were displaced, including the 2 positive cases whose whereabout cannot be traced. An intensified AFP (acute flaccid paralysis) surveillance is ongoing across the country, along with environmental surveillance. To date 61 AFP cases have been reported from January 2022, results have been negative so far.

About international spread

In the current crisis setting, this outbreak poses a substantial risk of international spread due to subnational gaps in immunization coverage in countries surrounding Ukraine since 2020 caused by local-level disruptions in immunization programmes due to COVID-19 pandemic, declining performance of acute flaccid paralysis (AFP) surveillance in multiple countries and mass population movement linked to the war.

About Poliovirus and how to protect children

Poliovirus is transmitted via a fecal-oral route, this can also contaminate the environment hence posing a great risk for vulnerable children. The only reliable way to prevent the development of poliomyelitis is vaccination. The vaccines are free, safe and effective. In Ukraine, children are vaccinated for the prevention of poliomyelitis at the age of 2 and 4 months with an inactivated polio vaccine (IPV) and at 6, 18 months and 6, 14 years with an oral poliovaccine (OPV). To protect against polio all children MUST be vaccinated against polio with at least 3 doses of the vaccine with an interval of 1 month between each dose.

A catch-up polio vaccination campaign was launched on February 1st targeting children 6 months to 6 years. This activity is being affected by the war but is ongoing in primary health care facilities.

Mission participants about Poliovirus in Ukraine

Dr Ihor Kuzin, the Deputy Minister of Health of Ukraine: “Vaccination rates across the country have dropped significantly because of the war. And 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 organized this joint mission with WHO in three regions: Lviv, Zakarpattya and Rivne, where additional organizational, training and information initiatives are planned to strengthen response to the polio outbreak. Poliomyelitis is a debilitating infectious disease which causes irreversible paralysis and there is no medicine to cure it. Vaccination is the only reliable method of protection. We will not be calm until all children are fully vaccinated against polio and other vaccine preventable infections”.

Orest Chemerys, Director of Healthcare department of Lviv Regional State Administration: “We recognize the fact that we are yet to achieve the desired polio vaccination coverage. Before the war, we were negatively affected by COVID-19. With the war, there are many displaced persons in the territory of the region. We have been working to support the IDPs. We have conducted some awareness sensitization sessions and supported 2 to 3 mobile vaccinations per week. Vaccines are available, there is no problem with availability and logistics now. Some of our challenges in Lviv region is that some communities are hard to reach because they are in mountainous areas, others are along the international border which is also very far and hard to reach. There is also low perception about vaccines amongst these hard-to-reach communities hence low coverage of vaccination in these districts. We request that WHO should organize seminars, webinars to build our capacity about polio”.

Anatolii Pshenychnyi Director of Healthcare department of Zakarpattya Regional State Administration: “We are happy to welcome this delegation who is on an international mission to Zakarpattya and we are expecting technical recommendations on how to deal with the challenges that the region had been facing before the war, and which have become even greater due to the large number of internally displaced persons.

Zakarpattya being a border region with several countries, we had many challenges associated with migration even before the war. Other issues are personal prejudices about vaccination in general, including polio vaccination. We hope to work more actively with territorial communities, looking for our own approach to each community, how to effectively involve them in immunization routines, including polio”.

Raymond Dankoli, WHO Polio Outbreak Response Coordinator: “Polio is one of the diseases that threatens the life and development of a child. Vaccination is one of the safe way to protect children from the threat of infectious diseases. GPEI partners will continue to support and coordinate with regional and health authorities to provide all necessary skills and technical expertise to improve on the country’s vaccination and surveillance indicators. Process of polio vaccine procurement is ongoing to avoid stockout. All eligible children should be presented for vaccination. There are common challenges to all regions however, there are some region-specific challenges. The efforts of the regions to solve their challenges are appreciated. The polio team will continue to work together with the regions to stop further transmission of the poliovirus. I call on everyone to use their circle of control and circle of influence to ensure that all children are vaccinated according to the national vaccination schedule”.

Roman Safonov, Chief sanitary doctor of the Rivne region: “As the representative of the regional authority we can confidently say that we are working hard to ensure everything necessary for vaccination is made available. We ensure that there are trained health workers to administer vaccinations in the health facilities and all the logistics needed to make vaccines available in the health facilities are also provided. However, one of our biggest challenges is wrong perception about vaccination among some parents or caregivers, religious and community leaders. We need a lot of support in this direction so that we get their buy-in as we contribute to eradicating crippling disease as polio and other vaccine preventable infections. We call on international partners to support us in educating these group of influential persons in our communities”.

Contacts: Tatiana Dolhova, WHO Ukraine communication officer, dolhovat@who.int, tel:+ 380 63 800 77 35