Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine

Abstract

Russia’s military incursion into Ukraine triggered the mass displacement of two-thirds of Ukrainian children and adolescents, creating a cascade of population health consequences and producing extraordinary challenges for monitoring and controlling preventable pediatric infectious diseases. From the onset of the war, infectious disease surveillance and healthcare systems were severely disrupted. Prior to the reestablishment of dependable infectious disease surveillance systems, and during the early months of the conflict, our international team of pediatricians, infectious disease specialists, and population health scientists assessed the health implications for child and adolescent populations. The invasion occurred just as the COVID-19 Omicron surge was peaking throughout Europe and Ukrainian children had not received COVID-19 vaccines. In addition, vaccine coverage for multiple vaccine-preventable diseases, most notably measles, was alarmingly low as Ukrainian children and adolescents were forced to migrate from their home communities, living precariously as internally displaced persons inside Ukraine or streaming into European border nations as refugees. The incursion created immediate impediments in accessing HIV treatment services, aimed at preventing serial transmission from HIV-positive persons to adolescent sexual or drug-injection partners and to prevent vertical transmission from HIV-positive pregnant women to their newborns. The war also led to new-onset, conflict-associated, preventable infectious diseases in children and adolescents. First, children and adolescents were at risk of wound infections from medical trauma sustained during bombardment and other acts of war. Second, young people were at risk of sexually transmitted infections resulting from sexual assault perpetrated by invading Russian military personnel on youth trapped in occupied territories or from sexual assault perpetrated on vulnerable youth attempting to migrate to safety. Given the cascading risks that Ukrainian children and adolescents faced in the early months of the war—and will likely continue to face—infectious disease specialists and pediatricians are using their international networks to assist refugee-receiving host nations to improve infectious disease screening and interventions.

Situation reports and impacts on public health during the war in Ukraine, 24 February to 21 June 2022: World Health Organization Emergency Reports

“…WHO is working in connection with the Ministry of Health of Ukraine to determine gaps and needs in the country's health system, medical evacuations, and support response activities. [6][7][8][9][10][11] WHO has developed a rehabilitation strategy focusing on decompressing the acute trauma system and improving rehabilitation care by supporting the strengthening of designated inpatient rehabilitation facilities, which is providing guidance on addressing the nutritional needs of older people who are IDPs in Ukraine and those in reception points in neighboring countries, and is ensuring the supply of antiretroviral drugs for people living with human immunodeficiency virus (Fig. 4).…”

“…Stories, video clips for news outlets, and photos regarding Ukraine Crisis are available by deployed communication specialists through social media, including tweets. [6][7][8][9][10][11]…”

“…In an effort to uphold its cause, WHO launched its second updated funding appeal, for US$ 80 million in Ukraine for March-August 2022 and US$ 67.5 million for March to December 2022 in refugee-receiving and hosting countries. [6][7][8][9][10][11]…”

“…the sense that its political rights and civil liberties scores are 34/40 and 47/60, respectively as of 2022[6] and that its gross domestic product (nominal) per capita is $ 19,056 USD as of 2022, which makes Poland one of the well-to-do countries in Eastern Europe [4]. …”

Nephrological care in the conditions of martial law in Ukraine

“…досягла рекордного рівня з часів Другої світової вій ни. Організація Об'єднаних Націй (ООН) постійно закликає всі конфліктуючі сторони до припинення вогню, але, незважаючи на це, понад один мільярд осіб (2022 рік) перебувають під загрозою для здоров'я і життя в умовах активних конфліктів (Африка, Сирія, Україна і інші) [3,4].…”