Day: August 21, 2022

Echoing down the corridors of eastern Ukraine’s Pokrovsk Perinatal Hospital are the loud cries of tiny Veronika.

Born nearly two months prematurely weighing 1.5 kilograms (3 pounds, 4 ounces), the infant receives oxygen through a nasal tube to help her breathe while ultraviolet lamps inside an incubator treat her jaundice.

Dr. Tetiana Myroshnychenko carefully connects the tubes that allow Veronika to feed on her mother’s stored breast milk and ease her hunger.

Before Russia’s invasion of Ukraine in late February, three hospitals in government-controlled areas of the country’s war-torn Donetsk region had facilities to care for premature babies. One was hit by a Russian airstrike and the other had to close as a result of the fighting — leaving only the maternity hospital in the coal mining town of Pokrovsk still operating.

Myroshnychenko, the site’s only remaining neonatologist, now lives at the hospital. Her 3-year-old son divides the week between staying at the facility and with his father, a coal miner, at home.

The doctor explains why it’s now impossible to leave: Even when the air-raid sirens sound, the babies in the hospital’s above-ground incubation ward cannot be disconnected from their lifesaving machines.

“If I carry Veronika to the shelter, that would take five minutes. But for her, those five minutes could be critical,” Myroshnychenko says.

Hospital officials say the proportion of births occurring prematurely or with complications has roughly doubled this year compared to previous times, blaming stress and rapidly worsening living standards for taking a toll on the pregnant women still left in the area.

Russia and Moscow-backed separatists now occupy just over half the Donetsk region, which is similar in size to Sicily or Massachusetts. Pokrovsk is still in a Ukrainian government-controlled area 60 kilometers (40 miles) west of the front lines.

Inside the hospital’s maternity wards, talk of the war is discouraged.

“Everything that happens outside this building of course concerns us, but we don’t talk about it,” Myroshnychenko said. “Their main concern right now is the baby.”

Although fighting in the Dontesk region started back in 2014, when Russia-backed separatists began battling the government and taking over parts of the region, new mothers are only now being kept in the hospital for longer periods because there’s little opportunity for them to receive care once they have been discharged.

Among them is 23-year-old Inna Kyslychenko, from Pokrovsk. Rocking her 2-day-old daughter Yesenia, she was considering joining the region’s massive evacuation westward to safer areas in Ukraine when she leaves the hospital. Many essential services in government-held areas of Donetsk — heat, electricity, water supplies — have been damaged by Russian bombardment, leaving living conditions that are only expected to worsen as the winter grows near.

“I fear for the little lives, not only for ours, but for all the children, for all of Ukraine,” Kyslychenko said.

More than 12 million people in Ukraine have fled their homes due to the war, according to U.N. relief agencies. About half have been displaced within Ukraine and the rest have moved to other European countries.

Moving the maternity hospital out of Pokrovsk, however, is not an option.

“If the hospital was relocated, the patients would still have to remain here,” said chief physician Dr. Ivan Tsyganok, who kept working even when the town was being hit by Russian rocket fire.

“Delivering babies is not something that can be stopped or rescheduled,” he noted.

The nearest existing maternity facility is in Ukraine’s neighboring Dnipropetrovsk region, a 3 1/2 hour drive along secondary roads, a journey considered too risky for women in late-term pregnancy.

Last week, 24-year-old Andrii Dobrelia and his wife Maryna, 27, reached the hospital from a nearby village. Looking anxious, they talked little as doctors carried out a series of tests and then led Maryna to the operating room for a C-section. Tsyganok and his colleagues hurriedly changed their clothes and prepared for the procedure.

Twenty minutes later, the cries of a newborn baby boy, Timur, could be heard. After an examination, Timur was taken to meet his father in an adjoining room.

Almost afraid to breathe, Andrii Dobrelia tenderly kissed Timur’s head and whispered to him. As the newborn calmed down on his father’s chest, tears came to Andrii’s eyes.

As the war reaches the six-month mark, Tsyganok and his colleagues says they have a more hopeful reason to stay.

“These children we are bringing into the world will be the future of Ukraine,” says Tsyganok. “I think their lives will be different to ours. They will live outside war.”

Source: Voice of America

For years, global health officials have used billions of drops of an oral vaccine in a remarkably effective campaign aimed at wiping out polio in its last remaining strongholds — typically, poor, politically unstable corners of the world.

Now, in a surprising twist in the decades-long effort to eradicate the virus, authorities in London, New York and elsewhere have discovered evidence that polio is spreading there.

The original source of the virus? The oral vaccine itself.

Scientists have long known about this extremely rare phenomenon. That is why some countries have switched to other polio vaccines. But these incidental infections from the oral formula are becoming more glaring as the world inches closer to eradication of the disease and the number of polio cases caused by the wild, or naturally circulating, virus plummets.

Since 2017, there have been 396 cases of polio caused by the wild virus, versus more than 2,600 linked to the oral vaccine, according to figures from the World Health Organization and its partners.

“We are basically replacing the wild virus with the virus in the vaccine, which is now leading to new outbreaks,” said Scott Barrett, a Columbia University professor who has studied polio eradication. “I would assume that countries like the U.K. and the U.S. will be able to stop transmission quite quickly, but we also thought that about monkeypox.”

The latest incidents represent the first time in several years that vaccine-connected polio virus has turned up in rich countries.

Earlier this year, officials in Israel detected polio in an unvaccinated 3-year-old, who suffered paralysis. Several other children, nearly all of them unvaccinated, were found to have the virus but no symptoms.

In June, British authorities reported finding evidence in sewage that the virus was spreading, though no infections in people were identified. Last week, the government said all children in London ages 1 to 9 would be offered a booster shot.

In the U.S., an unvaccinated young adult suffered paralysis in his legs after being infected with polio, New York officials revealed last month. The virus has also shown up in New York sewers, suggesting it is spreading. Officials, however, said they are not planning a booster campaign because they believe the state’s high vaccination rate should offer enough protection.

Genetic analyses showed that the viruses in the three countries were all “vaccine-derived,” meaning that they were mutated versions of a virus that originated in the oral vaccine.

The oral vaccine at issue has been used since 1988 because it is cheap, easy to administer — two drops are put directly into children’s mouths — and better at protecting entire populations where polio is spreading. It contains a weakened form of the live virus.

But it can also cause polio in about two to four children per 2 million doses. (Four doses are required to be fully immunized.) In extremely rare cases, the weakened virus can also sometimes mutate into a more dangerous form and spark outbreaks, especially in places with poor sanitation and low vaccination levels.

These outbreaks typically begin when people who are vaccinated shed live virus from the vaccine in their feces. From there, the virus can spread within the community and, over time, turn into a form that can paralyze people and start new epidemics.

Many countries that eliminated polio switched to injectable vaccines containing a killed virus decades ago to avoid such risks; the Nordic countries and the Netherlands never used the oral vaccine. The ultimate goal is to move the entire world to the shots once wild polio is eradicated, but some scientists argue that the switch should happen sooner.

“We probably could never have gotten on top of polio in the developing world without the (oral polio vaccine), but this is the price we’re now paying,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “The only way we are going to eliminate polio is to eliminate the use of the oral vaccine.”

Aidan O’Leary, director of WHO’s polio department, described the discovery of polio spreading in London and New York as “a major surprise,” saying that officials have been focused on eradicating the disease in Afghanistan and Pakistan, where health workers have been killed for immunizing children and where conflict has made access to some areas impossible.

Still, O’Leary said he is confident Israel, Britain and the U.S. will shut down their newly identified outbreaks quickly.

The oral vaccine is credited with dramatically reducing the number of children paralyzed by polio. When the global eradication effort began in 1988, there were about 350,000 cases of wild polio a year. So far this year, there have been 19 cases of wild polio, all in Afghanistan, Mozambique and Pakistan.

In 2020, the number of polio cases linked to the vaccine hit a peak of more than 1,100 spread out across dozens of countries. It has since declined to around 200 this year so far.

Last year, WHO and partners also began using a newer oral polio vaccine, which contains a live but weakened virus that scientists believe is less likely to mutate into a dangerous form, but supplies are limited.

To stop polio in Britain, Israel and the U.S., what is needed is more vaccination, experts say. That is something Columbia University’s Barrett worries could be challenging in the COVID-19 era.

“What’s different now is a reduction in trust of authorities and the political polarization in countries like the U.S. and the U.K.,” Barrett said. “The presumption that we can quickly get vaccination numbers up quickly may be more challenging now.”

Oyewale Tomori, a virologist who helped direct Nigeria’s effort to eliminate polio, said that in the past, he and colleagues balked at describing outbreaks as “vaccine-derived,” wary it would make people fearful of the vaccine.

“All we can do is explain how the vaccine works and hope that people understand that immunization is the best protection, but it’s complicated,” Tomori said. “In hindsight, maybe it would have been better not to use this vaccine, but at that time, nobody knew it would turn out like this.”

Source: Voice of America