Paralysis went to the mountains – Newspaper Kommersant No. 36 (7481) dated 03/02/2023
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The outbreak of polio in Dagestan is widely discussed on social networks. The regional Rospotrebnadzor assured Kommersant that in 2022, 20 cases of acute flaccid paralysis were officially identified, but the diagnosis of poliomyelitis was not confirmed in any of them. Nevertheless, the department noted that now in the republic there is a “tense epidemiological situation” associated with a decrease in vaccination coverage against vaccine-controlled infections, including polio. 18,000 Dagestan children, according to doctors, did not receive the vaccine because their parents refused. In connection with this, the so-called round vaccination is taking place in the republic – all children are additionally vaccinated, regardless of whether they were previously vaccinated. Similar events are held in Ingushetia and the KChR. Infectionists also note a high incidence of other vaccine-preventable infections, such as measles and whooping cough.
An orthopedist from Khasavyurt, Ibragim Evtemirov, wrote on his Telegram channel in mid-February that he had consulted four children who had polio confirmed in the past two months. “Confirmation, as I understand it, is only preliminary, because the final answer is required from Moscow,” Mr. Evtemirov specified. Poliomyelitis is a life-threatening disease caused by the poliovirus. It affects mainly children under five years of age, damages the nervous system and can lead to various types of paralysis. In the middle of the last century, polio was the nightmare of parents all over the world. He was defeated by vaccination. The last official case of poliomyelitis in Russia was recorded in 2010, the patient came from Tajikistan.
Ibragim Evtemirov told Kommersant that in cases where he suspected poliomyelitis, pain in the lower extremities of patients was accompanied by febrile fever. “I made a preliminary diagnosis to the first one, sent him to a pediatrician, and she, in turn, did an additional examination and revealed poliomyelitis. In the wake of this incident and the subsequent one, there was a check from the sanitary and epidemiological station,” said Mr. Evtemirov. In the department of Rospotrebnadzor for Dagestan, Kommersant was told that the National Center for Laboratory Diagnosis of Poliomyelitis named after V.I. Chumakova (Moscow). “In 2022, 20 cases of AFP (acute flaccid paralysis) were officially identified, in none of them the diagnosis of poliomyelitis was confirmed, however, at present, there is a tense epidemiological situation in Dagestan, generally associated with a decrease in vaccination coverage against vaccine-controlled infections, including poliomyelitis. In 2022, coverage did not reach the recommended level,” the agency said. They clarified that officially the coverage of immunization against polio before the start of round vaccination (an additional vaccination campaign that takes place in two stages with an interval of four weeks) was 95%. The Telegram channel “Center of Dagestan” quoted Muminat Dzhabrailova, deputy chief physician of the republican infectious diseases hospital: more than 18 thousand children in Dagestan today have not been vaccinated against polio due to the refusal of their parents. This figure has been heard for more than a year. The RIA Derbent news agency reported that by December 31, 2021, 18,939 children under 15 years of age had not been vaccinated against polio in the republic.
The Dagestan Rospotrebnadzor added that a similar situation is noted for immunization against other infectious diseases: diphtheria, tetanus, whooping cough, measles, mumps, pneumococcal infection.
At the end of January of this year, the chief sanitary doctor of the republic ordered an additional immunization against poliomyelitis. The document clarifies that round vaccination is carried out regardless of the previous vaccination. Similar decrees appeared in Ingushetia and Karachay-Cherkessia. Irina Kovalchuk, deputy head of the Rospotrebnadzor department for the Stavropol Territory, told Kommersant that by the end of 2022, the coverage of childhood vaccination against polio and other diseases included in the national vaccination schedule in the region averages over 95%. She also confirmed that in some republics of the North Caucasus there are problems with children’s vaccination. According to Ibragim Evtemirov, the reasons for the refusal come down to mistrust and medical illiteracy.
“The situation is serious in all regions with low coverage of routine vaccination – below 90–95%,” comments Associate Professor of the Department of Infectious Diseases in Children of the Russian National Research Medical University. Pirogova Ivan Konovalov.- This applies to vaccinations against diphtheria, tetanus, whooping cough, measles, polio. An indicator that the problem persists for three to five years is precisely the need for emergency round vaccination, which, unfortunately, is not the first or second time in the North Caucasus region in recent decades.” According to Mr. Konovalov, due to low coverage, the non-immune layer is increasing and the risk of cases of paralytic poliomyelitis is increasing: “But we are also talking about the high incidence of measles and whooping cough, which cannot be controlled by anything other than routine immunization.”
Tatyana Kogut, an infectious disease specialist at the Doctis telemedicine service, says that outbreaks of poliomyelitis have been observed since the late 90s both in Russia and in neighboring countries. “It is a misconception that there is no polio now. The very fact of the occurrence of cases that are accompanied by paralysis suggests that the circulation of the virus has become more active, because for one paralytic case there are about 100–200 cases of asymptomatic forms, when a person does not have clinical symptoms, but he actively secretes the virus and can become a source of infection for others,” continues Ms. Kogut. According to her, several factors led to this. First of all, the behavior of parents who are convinced that vaccinations are not needed. In addition, the frequency of unreasonable medical recusals: “Absolute contraindications are rare, relative ones are often exaggerated, and this gives rise to unreasonable recusals.” And finally, the covid pandemic, which, according to Tatyana Kogut, not only changed the structure of infectious diseases, but also prevented routine vaccination, as people were in isolation and were afraid to take their children to the clinic: “After sitting behind the broad back of covid, infections begin to return. And outbreaks of measles, which are now being recorded, including on the territory of the Russian Federation, and an increase in the incidence of whooping cough, and poliomyelitis.” Ivan Konovalov agrees with her: “In many ways, of course, refusals to vaccinate were the result of fear of contacting medical institutions, a decrease in confidence in the medical community and the healthcare system, which requires further socially oriented educational activities.”
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