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A nurse gives a child a measles shot at City Children’s Hospital in Odessa, Ukraine, in October 2018.

Julia Phil/Odessa city children’s hospital

Measles cases have tripled in Europe, fueled by Ukrainian outbreak

Measles cases more than tripled across Europe in 2018, and one country drove much of the surge: Ukraine. Nearly 83,000 cases of measles were reported in the World Health Organization’s (WHO’s) European Region in 2018, compared with some 25,500 in 2017, WHO, headquartered in Geneva, Switzerland, announced last week. Ukraine had more than 54,000 cases in 2018, its government says. Last year, 16 Ukrainians died of the extremely contagious viral disease, which is easily prevented with a vaccine.

“The current epidemic is the most massive in the entire postvaccine period,” says Nataliya Vynnyk, a pediatric infectious disease specialist at Children’s Clinical Hospital in Kyiv. With more than 15,000 cases and seven deaths between 28 December 2018 and 1 February, according to the country’s Ministry of Health (MOH), the epidemic continues to worsen.

Ukraine’s government is taking action. “It’s egregious to have people have measles in the 21st century in a European country,” says Ulana Suprun, a physician who has been Ukraine’s acting minister of health since August 2016. She blames a decade of corruption, war, a lack of political commitment to vaccination, and antivaccine sentiment.

Measles is spread by respiratory droplets. Most people recover, but the disease can cause sometimes-fatal complications including pneumonia and inflammation of the brain. Typically, children are vaccinated around their first birthday and again before starting school. According to WHO, 95% of children need to be fully vaccinated to stop the disease from spreading.

Elsewhere in Europe, vaccine skepticism has given the virus an opening. Cases in Greece doubled from 2017 to 2018; cases in France grew nearly sixfold. Meanwhile, the United States logged 372 cases last year. An outbreak in Washington this year has resulted in 53 confirmed cases as of 11 February, nearly all in unvaccinated children, pushing the U.S. year-to-date tally above 100.

In the past decade, vaccine refusal has also played a big role in Ukraine. In 2008, a day after receiving the measles vaccine, a 17-year-old died—from an unrelated cause, according to WHO and the United Nations International Children’s Emergency Fund (UNICEF). His death led to a huge loss of confidence among parents: Vaccination rates plunged from 97% of 1-year-olds in 2007 to 56% in 2010. Coverage then slowly improved, reaching 79% in 2012 and 2013.

But in 2014, then-President Viktor Yanukovych was ousted after violent protests, Russia annexed Crimea, and armed conflict broke out in eastern Ukraine. Paralyzed, the government failed to order measles vaccine until late 2015. Because of shortages, in 2016, Ukraine vaccinated only 42% of its infants. And that year, just 31% of 6-year-olds received the recommended second measles shot—one of the lowest rates in the world.

“If you have a high rate of unvaccinated children, you will face this kind of outbreak,” says Vusala Allahverdiyeva, a physician who is a technical officer in WHO’s Kyiv office.

There are other problems, too. Authorities have grappled with basic challenges. Investigating an outbreak of 90 cases in children in a mountainous region in western Ukraine in 2018, MOH found the children had been vaccinated at a clinic that experienced frequent power outages and had no generator. (The vaccine must be stored at less than 8°C to be effective.)

A faulty vaccine may also have played a role. According to MOH, more than 20,000 of those infected in 2018 were adults who would have been vaccinated decades ago with a Russian vaccine that was dropped in 2001. The ministry is trying to identify whether that vaccine was less effective in some years, with an eye to revaccinating those who received it.

MOH has been striving to catch up. It is now procuring vaccine more cheaply through UNICEF, sending mobile vaccination brigades from school to school in Lviv, a hard-hit area, and preparing to provide cash incentives to Ukraine’s underpaid physicians to vaccinate all children in their practices. In 2017, the country’s coverage rebounded to 93% of infants and 91% of 6-year-olds.

But because of Ukraine’s large pool of unvaccinated or undervaccinated people, the epidemic roars on. “We need to start thinking outside the box,” Suprun says. For instance, UNICEF is working with the government on a campaign urging grandparents, who often care for young children in Ukraine, to get their charges vaccinated.

The Ukrainian outbreak caps a year in which measles cases surged around the globe. As of mid-January, WHO had received reports of more than 229,000 measles cases in 2018. The global number is expected to rise by the time it is finalized in June, but it’s already a 32% increase from 2017.

“The root cause of the measles outbreaks … is a failure to adequately vaccinate,” says Katrina Kretsinger, the lead measles expert at WHO headquarters. “Many people in many countries remain susceptible, and large pockets of susceptible persons can lead to large outbreaks.”