Polio risk increases as war continues in Ukraine
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WASHINGTON — War has increased the risk for polio in Ukraine and beyond, interrupting health resources in a country with low immunization rates that has experienced recent vaccine-derived polio outbreaks, experts said at ASM Microbe.
Dmytro Stepanskyi, MD, PhD, an American Society for Microbiology ambassador to Ukraine, noted that Europe was declared free of polio in 2002 but “remains at risk” for the reintroduction of wild poliovirus and the emergence of circulating vaccine-derived polioviruses (cVDPV) “until global polio eradication is achieved.”
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“Ukraine was considered to be at high risk of polio outbreak in recent years,” Dmytro, who is head of the department of microbiology, virology, immunology and epidemiology at Dnipro State Medical University and poliovirus containment coordinator in Ukraine, told Healio. “Years of low immunization coverage in Ukraine has created a large pool of unvaccinated or undervaccinated children who are vulnerable to polio.”
To assess the polio threat in Ukraine, Stepanskyi and colleagues reviewed epidemiologic, clinical and virologic data on cVDPV cases in 2021, surveillance and immunization coverage data, and reports of expert group meetings.
In 2015, Ukraine experienced a polio outbreak attributed to cVDPV1 type 1 (cVDPV1) that affected mostly children in southwestern Ukraine. Despite outbreak response efforts that included nationwide supplementary immunization, vaccination coverage with three doses of polio vaccine remained below 95%, they said.
In 2021, more cases were reported — first on Oct. 6 in a 17-month-old girl in Rivne Province who developed acute flaccid paralysis and then in December in a 2-year-old boy from Zakarpattya who also had acute flaccid paralysis. The girl had seven household contacts and eight community contacts in Rivne and four additional family contacts in Zakarpattya who tested positive but did not develop paralytic symptoms.
An analysis revealed that the newly detected poliovirus was genetically similar to an environmental sample from Dushanbe, Tajikistan. which was collected in 2020 and 2021.
The researchers assessed the risk for spread in Ukraine as high because of its low immunization coverage rates — 73.3% as of December 2021 — and immunization gaps at the regional level. By January, 19 isolates from two provinces in western Ukraine were confirmed and the outbreak was declared a public health emergency in Rivne and Zakarpattya provinces.
In response to these cases, the Ministry of Health approved a comprehensive polio outbreak response plan that included strengthening environmental surveillance, catch-up immunization with inactivated poliovirus vaccine among children aged 6 months to 6 years beginning Feb. 1, 2022, and the preparation of two nationwide campaign rounds with oral polio vaccine.
Shortly after, on Feb. 24, Russia began its attacks on Ukraine, leaving 15.7 million people affected by the war and 12.1 million in need of health care, according to Stepanskyi. The attacks led to disruptions in critical care, including tuberculosis testing and treatment, as well as to routine vaccinations and the response to the polio outbreak, according to the authors.
“The ongoing outbreak of cVDVP2 and low uptake [in the] mass immunization campaign have led to a high risk of circulation of polioviruses,” Stepanskyi said. “There is a risk of spreading polio into surrounding countries.”
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Stepanskyi D, et al. Vaccine-derived poliovirus type 2 outbreak in Ukraine. Presented at: ASM Microbe; June 9-13, 2022; Washington, D.C.
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