Ukraine restores immunization coverage in momentous effort to stop measles outbreak that has affected more than 12 000 this year

Over 12 000 people have been infected with measles in Ukraine so far this year. Of those affected, 9158 have required hospitalization and 9 have died, according to information provided by national health authorities as of 27 April 2018. Large-scale outbreak response measures have been undertaken since the start of the outbreak in 2017 to curb further spread of the disease and restore high routine immunization coverage.

“Ukrainian health authorities, with WHO and UNICEF support, have recovered huge ground in the fight against measles. But there are still many vulnerable children and adults in the country; and this highly infectious disease continues to find them,” says Marthe Everard, WHO Representative in Ukraine. “More needs to be done to ensure that everyone is protected.”

Dramatic drop in immunization coverage

In 2008, 95% of eligible children in Ukraine received their second (and final) recommended dose of measles-mumps-rubella vaccine (MMR) on time according to the national routine schedule. By 2016, this rate had fallen to 31%, the lowest coverage in the WHO European Region and among the lowest in the world. In addition, in 2016 only 19% of children received the third recommended vaccine dose of diphtheria-tetanus-pertussis (DTP) and 56% of children received the third recommended dose of oral polio vaccine (OPV).

This tragic nationwide drop in immunization coverage left an increasing number of children in Ukraine susceptible to dangerous, preventable diseases. Among these dangers, it created the ideal setting for the extensive spread of measles, one of the most infectious diseases affecting humans. Measles can affect people of all ages, but infants, young children and older adults are the most at risk of serious measles-related complications and death.

Large-scale outbreak response

Since July 2017, a national Measles Task Force, including the Ministry of Health, key stakeholders and partners such as WHO and the United Nations Children’s Fund (UNICEF), has been working to:

  • vaccinate every eligible child as they reach the appropriate age for MMR vaccination according to the national routine immunization schedule;
  • vaccinate every child who missed routine immunization in the past;
  • train laboratory staff to ensure early detection of all measles (and rubella) cases;
  • inform health-care professionals and parents about the disease and the importance of ensuring that children and their families are fully protected;
  • ensure the availability of vaccines at all vaccination points.

During European Immunization Week (23–29 April 2018) stakeholders were sensitized to the importance of immunization. Kicking off with a press conference on 23 April, events involving the Ministry of Health, WHO, UNICEF, Rotary International and national Rotary clubs, a parents group (Parents for Immunization), bloggers and even participants dressed as super heroes, included a national conferences with opinion leaders, a flash mob at schools in Kyiv, a webinar on vaccination and a roundtable discussion with paediatricians.

Routine immunization coverage back on track and pool of vulnerable people shrinking

By the end of 2017, routine vaccination coverage had drastically improved compared to previous years: 93% of 1-year-olds received the first dose of MMR on time in 2017 and 91% of 6-year-olds received their second dose as recommended. Figures for January and February 2018 indicate that the country is on track to reach at least 95% routine coverage with both doses of MMR vaccine by the end of the year.

If Ukraine can reach and sustain this target, it will prevent the renewed accumulation of susceptible individuals and ultimately protect the population from future outbreaks of measles.

To stop further spread of the disease, those who missed vaccinations in the past also need to be protected. Since September 2017, over 621 000 un- or undervaccinated children have been identified, and over 80% of them have received their first and/or second MMR dose.

Alarming increase in measles in the WHO European Region

For the Region as a whole, more measles cases have been reported for the first 2 months of 2018 than for the same period in the previous 5 years. Ukraine is facing the largest outbreak in the Region, but high case numbers (100 or more per month) are also being reported by France, Georgia, Greece, Italy, Romania, the Russian Federation and Serbia.