“I’d settle for a year being sick, as long as it’s not her, not for a single day”
Little Varya was 3 years old when Alexei and Nastya Naumov adopted her from an orphanage. They had long dreamed of children, when they found this girl who looked so much like Alexei Naumov. Nothing could stop them: neither difficulties, nor Varyusha's diagnosis – HIV, which the orphanage told them about right away. Varya Varya at the New Year celebration Nastya and Alexei decided that they wouldn’t conceal their now 9 year old daughter’s diagnosis. It is better to put all the cards on the table, than constantly have to look over their shoulder, they say. The parents always emphasize: they have never regretted their decision. In November 2018, when Varya was in the first grade, she fell ill with scarlet fever. The family had just moved to Almaty from Atyrau. Nastya Naumova brought her daughter to two pediatricians, but they did not suspect anything. And then their infectious disease specialist at the AIDS center confirmed the diagnosis. ‘Guys, you have scarlet fever,’ she said. “It seemed to me that this was a forgotten disease, that it is simply impossible. Varya has recovered, but I was still afraid. And as it turned out, not in vain,” says Nastya. The Naumovs were warned that live vaccines are contraindicated for a child with HIV. “I was afraid that Varya would get infected,” Anastasia says. “I didn’t know how the virus would work with her diagnosis, how it would affect the body. And, thank God, for a long time she was able to avoid infection. But, as it turned out, not measles.” In Kazakhstan all children diagnosed with HIV usually receive a medical contraindication for vaccination, which applies to the so-called live vaccines against measles, mumps and rubella. Although in accordance with the WHO clinical protocol, a vaccine against measles, mumps, and rubella (MMR) and other measles-containing vaccines (MCV) should be considered for HIV-infected patients who are asymptomatic or mildly immunosuppressed, as per the routine national schedule. For infants with high risk of exposure to the measles virus, an additional dose of single-antigen measles vaccine administered at 6–11 months of age is recommended, followed by a first dose of routine MMR or another MCV at age 12 months or older (with a minimum interval of 1 month between doses).1 Parents can learn more about each vaccine, included into the National Vaccination Calendar, at a special website dedicated to children routine vaccination: EGU.kz In February 2019, when Varya was preparing to go to school, she noticed red dots on her legs: hemorrhagic vasculitis. Nastya and Varya were immediately taken to the hospital; they thought it was an allergy. For 3 weeks the child was not diagnosed, doctors had not realised that it was measles. Anastasia Naumova shares her story Anastasia Naumova shares her story Later, it turned out that hemorrhagic vasculitis was Varya’s body's reaction to measles. The incubation period was already in progress. But the doctors the Naumovs visited did not understand this. Their infectious disease specialist arrived at the hospital only after Varya's temperature rose to 40 degrees, and diagnosed her with measles. Varya and her mother were taken to the infectious diseases hospital. Varya at the hospital with measles Varya at the hospital with measles “I will never forget the following 10 days…,” Nastya says. Varya fell seriously ill. She was burning with a fever, crying from pain at night. There was nothing Nastya could do to help her child. “I have hardly slept these ten days. I would lean on the table, doze off, the timer would go off - I set Varya's temperature to be measured every hour. And you can't do anything - the treatment is symptomatic,” Nastya says. The complications were the worst. Varya had right-sided pneumonia, so severe that she could not swallow saliva. How would Nastya give her pills? Water? Food? “I was almost shoving this pill into her mouth, and Varya cried and shouted: ‘Mom, it hurts! Mom, don't!’ Almost two years have passed since that moment, and I am still shaking. I’d settle for a year being sick, as long as it’s not her, not for a single day. When you see that your child suffers so much simply because someone did not give her the vaccine, how would you feel about it? I have no words,” Nastya says. In total, they spent about 6.5 weeks in the hospital. During their stay the hospital was full. Children and many adults - all with measles. Fortunately, Varya pulled through. Emaciated, she weighed 17 or 18 kilograms, weak, but alive. Varya does not mention her illness. Nastya noticed that after the illness Varya started having problems studying. Apparently, this ten day long fever affected her cognitive abilities. “I believe if opponents of vaccination ever saw how people bear measles, they would think about it. It's a shame that children who have medical contraindication are at risk,” Nastya says. The Naumovs then vaccinated their daughter (with those vaccines that are not contraindicated for her) in an ordinary district hospital. “The child has HIV infection, an incurable disease, but even she did not have a reaction to the vaccine,” Nastya says. In 2019, there was an outbreak of measles in Kazakhstan with 16,871 cases, of which 13,326 (78.9%) were laboratory confirmed.2 19 children and two adults dies from the disease. Among the victims of measles, 8 children were not vaccinated due to medical contraindications. In 2020, 3,270 cases of measles were registered, of which 2,265 were children under 14 years of age. False contraindications and medical exemptions have been identified as one of the main causes of missed opportunities to vaccinate against measles during the root cause analysis conducted by UNICEF Kazakhstan. The analysis was the part of the UNICEF Kazakhstan Measles Outbreak Prevention Program funded by the US Agency for International Development (USAID). “We sincerely thank USAID for partnering in such an important program for children's lives to prevent a measles outbreak in the future and strengthen the immunization programme in Kazakhstan. We believe that this project will help save and preserve the lives and health of Kazakhstani children and families," said the UNICEF Representative in Kazakhstan Arthur van Diesen. The Program provided technical support to analyze the causes of the measles outbreak, study parents' views on vaccination and awareness campaigns, as well as recommendations for improving the supply of vaccines and building the capacity of healthcare workers for immunization. For example, UNICEF is providing a series of trainings to address false contraindications in cooperation with the Association of Family Doctors of Kazakhstan in Aktobe, Atyrau, Eastern-Kazakhstan, Kyzylorda, Turkestan, Karaganda oblasts, Almaty and Shymkent.
Safeguarding the health of refugee and migrant children during COVID-19
, the initiative has supported UNICEF’s efforts to improve the immunization process for refugee children and migrants by strengthening the assessment and monitoring process. As a result of such efforts, refugees and migrants have been included in the national COVID-19 Immunization Plan.
Support for frontline workers: Implementation of health policies for refugee and migrant children
“I find the tool for identification of unaccompanied and separated girls [UASGs] very useful since the indicators included are clear and help us recognise UASGs more quickly.” A frontline worker in Serbia welcomes a new tool to identify refugee and migrant girls Two girls are talking to each other. The ‘RM Child-Health’ initiative has supported work across five European countries over the past year to equip those who work directly with refugee and migrant children and adolescents with all the skills and resources they need to turn health policies into concrete action. In its first full year, this 27-month, co-funded €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, has enhanced the knowledge and skills of frontline workers to maximize the impact of their work with young refugees and migrants. The initiative promotes and supports multi-disciplinary approaches and teams to address the complex causes of health problems among refugee and migrant children, from trauma, anxiety and over-crowded conditions, to lack of hygiene facilities and immunization. As a result, support from the ‘RM Child-Health’ initiative builds trust between refugee and migrant families and a wide range of frontline workers, including health service providers.
Making the European Child Guarantee a Reality. Insights from testing the European Child Guarantee
State Secretary, Ministry of Labour, the Pension System, the Family and Social Policy European Union Margareta Mađerić was born on 2 July 1977 in Zagreb. After finishing high school, she enrolled in Zagreb School of Business where she obtained her bachelor’s degree in Marketing and Communication and worked as a marketing and communications manager before entering into politics. In 2005, as a member of Croatian Democratic Union (HDZ), Mađerić was elected to the Zagreb City Assembly, where she served three consecutive terms and served as president of the Deputy Club of the Croatian Democratic Union. In the 2013 local elections in Zagreb, she ran as the HDZ candidate for mayor, and in the 2015 Croatian parliamentary elections, Mađerić ran as a candidate for the Patriotic Coalition, led by the HDZ. She was a member of the Croatian Parliament and was named president of the Parliamentary committee for mandates and immunity, before she assumed the position of State Secretary in the Ministry for Demography, Family, Youth and Social policy. Following the 2020 parliamentary elections she continued to serve as State Secretary in the new Ministry of Labour, Pension system, Family and Social Policy. SAILA RUUTH Personal archive