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A team of technical experts assessed Ukraine’s response to a polio outbreak and concluded that transmission of poliovirus has been interrupted. Nevertheless, the team remains concerned about significant gaps in immunization and surveillance that put Ukraine at high risk for new outbreaks.

“Thanks to the efforts of the Ministry of Health, health workers and parents, many more children are vaccinated against polio, and I commend them for their commitment,” said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “But these efforts do not stop now. The immunization gap persists and, if Ukraine does not continue vaccinating its children, this gap will expand for polio and other vaccine-preventable diseases to strike.”

High routine immunization coverage

Owing to low coverage, immunization gaps accumulated in Ukraine; it interrupted polio transmission with a campaign of three rounds of catch-up vaccination. High routine immunization coverage is a top priority for WHO, to ensure that another outbreak of polio or any other vaccine-preventable disease does not hit the country.

“We need to seize the momentum gained during the polio outbreak to strengthen Ukraine’s immunization programme, so that parents may exercise their right and responsibility to vaccinate their children,” said Dr Luigi Migliorini, WHO Representative in Ukraine.

With the United Nations Children’s Fund (UNICEF), WHO is supporting the Ministry of Health in making vaccines available to close the country’s immunization gap and protect against all vaccine-preventable diseases.

Recommendations of the expert team

An expert team from different United Nations agencies and partners assessed the polio-outbreak response over two weeks in five Ukrainian regions, at both oblast and rayon levels. Experts analysed the disease surveillance systems, supplementary immunization activities, and communications “, said Dr Patrick O’Connor, leader of the WHO assessment team.

As well as concluding that poliovirus transmission in Ukraine had been interrupted, the team recommended key actions to mitigate the risk of future outbreaks:

• increase political commitment for childhood immunization;

• re-establish high, uniform immunization coverage with polio vaccines;

• improve the communication skills of frontline health workers; and

• enhance surveillance for early detection of polioviruses.

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Girl proudly displaying her marked finger, indicating that she has been vaccinated against polio. © Unicef
Girl proudly displaying her marked finger, indicating that she has been vaccinated against polio.
© Unicef

In Ukraine, 2 cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) have been confirmed, with dates of onset of paralysis of 30 June and 7 July 2015. The genetic similarity between the cases indicates active transmission of cVDPV1. Both are from the Zakarpatskaya oblast, in south-western Ukraine, bordering Romania, Hungary, Slovakia and Poland. One child was 4 years old and the other 10 months old at the time of onset of paralysis.

Ukraine had been at particular risk of emergence of a cVDPV, due to inadequate vaccination coverage. In 2014, only 50% of children were fully immunized against polio and other vaccine-preventable diseases.

Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response. An outbreak response of internationally-agreed standard, as adopted by the World Health Assembly in May 2015, requires a minimum of three large-scale supplementary immunization activities with an appropriate oral polio vaccine, to begin within two weeks of confirmation of the outbreak and covering a target population of 2 million children aged less than five years, and the public declaration of the outbreak as a national public health emergency.

Circulating VDPVs are rare but well-documented strains of poliovirus that can emerge in some populations which are inadequately immunized. A robust outbreak response can rapidly stop such events. The emergence of cVDPV strains underscores the importance of maintaining high levels of routine vaccination coverage.

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation or emergence and to facilitate a rapid response. Countries should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s International Travel and Health recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

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