Contribution of Vaccination to the Reduction of Infectious Mortality in Ukraine in the Second Half of the 20^th and Early 21^st Century: A Comparative Population-Based Study of the Dynamics and Structure of Infectious Mortality and Incidence

Abstract

Our work presents an epidemiological analysis of the dynamics and structure of the annual indicators such as Cumulative Incidence, Mortality Rate (MR), and Case Fatality Rate for infections preventable by vaccines (vaccine-preventable infections–VPIs) in Ukraine between 1944 and 2015 compared to the same indicators for infections not preventable by vaccines (nonvaccine-preventable infections–non-VPIs). In 1965, the proportion of all infectious diseases in the context of mortality (7.47%), and especially of VPI (3.77%), including those registered among children aged 0–14 years (2.12%), testifies to the low profile of infectious diseases by the time of routine vaccination introduction. The analyses of these particular data are important with respect to the role of vaccination programs in reducing not only the total infectious mortality but also mortality related to VPIs in the twentieth century. Interestingly, in Ukraine between 1965 and 2015, similar rates of mortality reduction were observed in both the total population (1.6–2.6 times) and in children under 14 (15.2–20.4 times) for both VPIs and non-VPIs. During the 1944–2015 period in Ukraine, the reduction of MR of VPI (tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, measles, and hepatitis B) varied greatly, ranging from 40.5 times (tetanus) to 1,061.1 times (measles), but in general, the reduction incidence rate of VPI was significantly lower ranging from 42.4 times (measles) to 471.1 times (diphtheria). The ratio of incidence and mortality reduction in percent shows the contribution of vaccination to the mortality reduction for various infections during 1944–2015. This ratio ranged from 0% (tuberculosis) to 84.9% (tetanus), provided that the reduction of the VPI incidence 100% depends on vaccine effects. Thus, we can assume that the observed reduction in mortality for some VPIs was, in part, caused by factors not associated with vaccines.

Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees

“…After duplicates were removed, the titles and abstracts of 1,628 reports were reviewed by one of the authors (JFL), and 131 met the eligibility criteria (Figure 1). The current review was primarily based on 107 full papers, 2‐108 but, due to the scarcity of data, we also chose to cite five relevant abstracts 109‐113 for a more complete picture of child health in Ukraine. Our literature search was limited to papers published in English.…”

Evolving measles status and immunization policy development in six European countries

“…Two-dose monovalent measles childhood vaccination was long-established in the former USSR, with MCV1 (at 12–15 months of age) introduced in 1969 and MCV2 (at 6 years) in 1986 with this schedule continued following USSR dissolution and separation of Ukraine in 1991. 115 , 116 High reported vaccine uptake (>90%) was a feature before and after this transition, although the quality of these VC estimates has been questioned. 117 , 118 While measles incidence remained low after separation, periodic outbreaks occurred (in 1993, 1996 and 2001) and then a far substantial outbreak in late 2005 through most of 2006.…”

“… 4 , 118 A poorly coordinated political response led to the cancellation of this campaign, and continued public mistrust of vaccine quality and safety had an adverse effect on all childhood vaccine uptake in subsequent years. 115 , 118 Dramatic declines in national MCV1 and MCV2 uptake were seen in 2009, and remained low with a further marked decline to <50% in 2016. 18 , 119 , 120 Declining VC was accompanied by a substantial outbreak in 2012, although as elsewhere, regional variations in uptake and measles incidence are seen.…”

Bordetella pertussis in School-Age Children, Adolescents and Adults: A Systematic Review of Epidemiology and Mortality in Europe

“…There were 19 studies of pertussis deaths in Europe, including Germany [ 51 , 128 ], Greece [ 129 ], Ireland [ 130 ], Italy [ 107 , 131 ], The Netherlands [ 132 – 134 ], Poland [ 91 ], Portugal [ 135 ], Slovenia [ 97 ], Spain [ 136 ], UK [ 137 – 139 ], Ukraine [ 140 ] and pan-Europe [ 141 , 142 ].…”

“…A study in the Ukraine, using a combination of notification data and the literature (from pre-2000), showed that the overall case fatality rate was 0.163% between 1965 and 1991, rising to 0.183% between 1992 and 2005 and then declining to 0.106% between 2006 and 2015 [ 140 ]. In Italy, using national notification data between 1961 and 1994, the case fatality rate was 0–1% [ 107 ], and in Ireland between 1980 and 1984, the overall pertussis-related case fatality rate was 0.08%, of which 83% were aged < 1 year [ 130 ].…”