Ukraine war pushing dangerous diseases to ‘alarming levels’ in Kharkiv

Russia’s war against Ukraine has pushed highly contagious disease cases in the Kharkiv region to “alarming levels”, public health experts have determined. The increase in infections like rubella and shigellosis has also been accompanied by falling levels of case detection and childhood vaccination rates in Kharkiv. This eastern region of Ukraine has been under attack since the opening of the war and saw some of the most intense combat in the country over the last year — severely disrupting regular medical activities.

The study was undertaken by epidemiologists Dr Maryna Railian and Dr Tetyana Chumachenko of the Kharkiv National Medical University.

The duo analysed official data from the Ukrainian Ministry of Health on the incidence of infectious diseases and vaccination coverage in the Kharkiv region from January–September last year.

In this period, a total of 124,170 cases of infectious disease were reported in the Kharkiv region — some 40 percent less than during the same period in 2021, before the war.

The data also indicate that the total percentage of the population exposed to infectious diseases decreased 1.7-fold in comparison with the same period the year before.

The proportion of children recorded as being affected by infectious diseases also fell from 29 percent in 2021 to 23 percent in 2022.

Despite these apparent reductions in overall disease incidence, reported cases of the highly contagious diarrheal disease shigellosis were three times higher in the Kharkiv region than the Ukraine average.

Similarly, reported cases of rubella — also known as German measles — were 11 times higher than the national average, whooping cough five times higher than viral meningitis two times higher.

In addition, new cases of viral hepatitis B in Kharkiv during the study period exceeded the Ukraine average by 87 percent, viral hepatitis A by 2.4 percent and chronic viral hepatitis B and C combined by 72 percent.

Dr Railian said: “During this period, only severe forms of infections and diseases with a pronounced clinical picture were recorded.

“These data underscore the unfavourable epidemic situation that arose during the hostilities and partial occupation of the Kharkiv region.

“Mild cases were not registered or isolated and continued to be sources of infection, exacerbating the spread of diseases.”

Similar patterns were seen among children, the researchers noted, with incidences of both shigellosis and viral meningitis being six times in Kharkiv than the national average, rubella incidence 23 times higher and whooping cough five times higher.

Dr Railan added: “The shockingly high incidence of highly contagious infectious diseases in the Kharkiv region compared to Ukraine as a whole reflects the appalling living conditions across the region.

“Water supply interruptions were common and residents were unable to buy even basic healthy foods.

“The widespread damage and destruction to infrastructure and atrocious living conditions meant much of the population had to be relocated for their safety.”

The team also concluded that the ongoing war has had dramatic effects on routine vaccination coverage for children in the Kharkiv region — putting the most vulnerable at increased risk of severe illness and death.

Between January and September 2022, they noted, the rate of vaccinations against hepatitis B fell to 37 percent; polio to 40 percent; tuberculosis to 43 percent; diphtheria, tetanus and whooping cough to 46 percent; and measles, mumps and rubella to 50 percent.

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The findings, the researchers cautioned, may only be the tip of the iceberg.

Dr Railan said: “The upsurge in measles and other vaccine-preventable infectious diseases could soon become uncontrollable.

“The stark reality is that, in the absence of surveillance, diagnostic, and preventative measures, these figures most likely represent an underestimate of the true situation.”

In fact, a follow-up analysis focussed on the infectious disease surveillance capacity of Kharkiv Hospital found that the case detection rate is only half that of prior to the war.

Between January and October 2021, 2,306 cases of infectious disease were registered in the medical facility, compared to just 1,056 reports in the same period in 2022. In fact, only 31 cases in total were recorded between March and April that year.

On top of this, the team noted, the hospital was unable to fully record infectious illnesses during the study period — with two-thirds of patients receiving no laboratory results and three-quarters of cases not being given a final diagnosis.

Dr Railan said: “Because of the hostilities, medical staff could not get to work, and large numbers of workers responsible for registration of cases left the country.

“Our findings underscore the urgent need to strengthen medical support in the regions of Ukraine where active hostilities are taking place.”

She concluded: “We must prioritise field vaccination teams in populated areas and health education campaigns to highlight the growing threats of infectious diseases.”

The full findings of the study are to be held at the European Congress of Clinical Microbiology & Infectious Diseases, which is being held from April 15–18 in Copenhagen, Denmark.

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