ВОЗ и ЮНИСЕФ: Продолжение оказания услуг по плановой иммунизации имеет жизненно важное значение во время пандемии COVID-19
избежать дальнейшего воздействия COVID-19 на наши системы здравоохранения, обеспечив продолжение вакцинации людей всех возрастов в соответствии с национальными графиками. Я призываю страны даже в это трудное время продолжать оказание услуг по иммунизации и стимулировать спрос на вакцинацию на протяжении всей жизни человека. Обеспечение приоритетности иммунизации является одной из моих четырех основных областей моей работы и занимает центральное место в концепции ВОЗ в отношении здоровья в новой Европейской программе работы», – заявил д-р Ханс Генри П. Клюге, директор Европейского регионального бюро ВОЗ. ВОЗ и ЮНИСЕФ будут и впредь поддерживать усилия правительств по укреплению их программ иммунизации, в том числе посредством стратегического планирования для оказания услуг по иммунизации на справедливой основе, усиления эпиднадзора за болезнями, предупреждаемыми с помощью вакцин, а также обеспечения участия и просвещения местных сообществ. В новом будущем, в которое мы сейчас вступаем, вакцины будут по-прежнему служить основой для обеспечения здоровья и благополучия для всех. Именно благодаря солидарности, совместным действиям и неустанной приверженности принципу «не оставить никого без внимания» мы сможем вместе создать более здоровое будущее. #ВакциныРаботают Georgia immunization UNICEF/UN0326765/Georgia
Защита детей от кори в Румынии
Родители из общины рома, проживающей в городе Стрехае на юго-западе Румынии, кивают и с облегчением улыбаются после просмотра короткого видеоролика о пользе иммунизации для их детей, показанного местным врачом. Врач отвечает на вопросы родителей, прежде чем они вместе со своими детьми перейдут в следующий кабинет, где всем детям будет проведена вакцинация. Здесь дети разного возраста: те, кто только начинает ходить, и те, кому уже исполнилось 18 лет. Самые маленькие крепко держат своих мам за руку, а те, кто постарше, улыбаются и просят посмотреть фильм еще раз. Производство и показ данного фильма осуществляется в рамках программы ЮНИСЕФ в Румынии по поддержке усилий министерства здравоохранения страны, направленных на повышение показателей охвата иммунизацией и предотвращение распространения кори. С 2000 года показатели охвата иммунизацией в Румынии значительно снизились. В 2017 году только 75 процентов детей получили две дозы вакцины MMR - комбинированной вакцины против кори, эпидемического паротита и краснухи. Этот показатель намного ниже рекомендованных 95 процентов, необходимых для защиты всех детей. В результате низких показателей охвата иммунизацией в Румынии произошла вспышка кори. В 2016 году ею заболели более 15 000 человек, из которых 59 человек умерли. Большинство из них составили дети. В рамках непрекращающихся усилий по повышению охвата детей иммунизацией, в июле 2018 года стартовала организованная министерством здравоохранения Румынии кампания по вакцинации детей, которые не были привиты. Для информирования населения о важном значении иммунизации участники кампании ходили по домам. В целях поддержки данной кампании ЮНИСЕФ разработал серию информационных материалов, предоставляющих предоставить родителям фактическую информацию о преимуществах и самом процессе иммунизации детей в доступной для понимания взрослых форме. В состав этих информационных материалов входит короткометражный фильм, который посмотрели семьи в Стрехае. Фильм демонстрируется семьям из наиболее уязвимых общин Румынии - родителям, живущим в труднодоступных районах, семьям, пострадавшим от нищеты, и общинам рома. Показатели иммунизации среди детей в этих общинах чаще всего самые низкие по стране. В этом фильме рассказывается о необходимости и преимуществах вакцинации, и одновременно даются ответы на часто задаваемые и волнующие родителей вопросы относительно вакцинации: Безопасно ли делать прививку моему ребёнку? Что делать, если она/он заболеют другой болезнью? Что, если мой ребёнок заболеет после прививки? Эта прививка бесплатна? A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. Девочка получает прививку в общинном центре в Бухуши, в восточной Румынии, в рамках кампании по проведению вакцинации детям, которые её не прошли. Эта кампания проводится при поддержке ЮНИСЕФ и ВОЗ. «Вначале родители не хотели прививать своих детей, но потом они доверились нам. Мы рассказали родителям о пользе прививок и попросили их задавать врачу все вопросы, которые могут возникнуть у них в ходе проведения кампании. Таким образом, родители смогли получить чёткое представление о пользе вакцинации», - сказала Габриэла Стан, медицинский работник в городе Бухуши, в Восточной Румынии. Габриэла была членом группы, ходившей по домам, для того чтобы информировать родителей из уязвимых сообществ о преимуществах вакцинации. И хотя за последние несколько месяцев в Румынии произошли положительные сдвиги в деле вакцинации уязвимых детей спасающей жизни прививкой MMR, дети будут по-прежнему находиться в опасности до тех пор, пока охват иммунизацией не достигнет 95 процентов. ЮНИСЕФ в Румынии будет и впредь помогать в проведении информационно-разъяснительных кампаний о важном значении и необходимости вакцинации и поощрять всех родителей и лиц, обеспечивающих уход за детьми, к своевременному проведению этой профилактической процедуры. Таким путём они смогут защитить своих детей от болезней, предотвратимых с помощью вакцинации.
Interpersonal Communication for Immunization
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immunization-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. It consist of a Facilitator Guide, Participant Manual and a set of Presentations. Options Available options Facilitator guide Participant manual Presentation Download file (PDF, 5,62 MB) (PDF, 5,57 MB) (PDF, 11,88 MB) November 2019
Interpersonal Communication for Immunization. Presentation
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Download file (PDF, 11,88 MB) November 2018
Interpersonal Communication for Immunization. Participant manual
Good interpersonal communication can mean the difference between a child being fully immunized or not at all. This Interpersonal Communication for Immunization Participant manual seeks to help health workers value, acquire, and consistently use the knowledge, skills, and attitudes needed to communicate effectively with caregivers and communities about childhood immunization. Interpersonal communication for immunization capacity development is critical. Almost every study of health worker practices in the region finds that interpersonal communication for immunization overall is weak. Yet, at the same time, the vast majority of caregivers of young children cite health workers as their primary source of information about immunization. Health workers and health services must close this gap if nations and the world are to achieve universal immunization. Download file (PDF, 5,57 MB) November 2019
Interpersonal Communication for Immunization. Facilitator Guide
Health providers have always been an important and trusted source of information for parents and caregivers in the Europe and Central Asia (ECA) region and beyond. The way they interact with families and the quality of their communication and engagement may have a positive or negative influence on caregivers’ decision to immunize their children. Research in ECA has shown that health workers do not always engage with caregivers in an open and supportive way, often using a patronizing and top-down approach in communication. As a result of time constraints and limited communication capacities, they often fail to understand the immuni-zation-related concerns, fears and expectations of caregivers and fail to identify and address vaccine hesitancy. To help strengthen the communication and community engagement skills of front-line workers, the UNICEF Regional Office for Europe and Central Asia (ECARO) has developed this interactive and evidence-based training package to identify and address their own biases and misconceptions and to equip them with the essential knowledge, skills, and attitudes they need for positive and meaningful interpersonal communication. Download file (PDF, 5,62 MB) November 2019
Maintaining routine immunization services vital during the COVID-19 pandemic – WHO and UNICEF
The COVID-19 pandemic is a stark reminder that infectious diseases know no borders. All countries are vulnerable, regardless of income levels or the strength of their health care systems. Across the European Region, where tens of millions of people have been living in lockdown for weeks, and over 100,000 people have died, the speed and devastation of the novel coronavirus has completely upended lives. The urgent need for a COVID-19 vaccine underscores the pivotal role immunizations play in protecting lives and economies. As scientists around the world work to develop a vaccine against the novel coronavirus and health care capacities are stretched in responding to COVID-19, national routine immunization programmes are more critical than ever before. Governments across the Region must use every opportunity possible to protect people from the many diseases for which vaccines are already available. When routine vaccinations are missed, the risk of disease outbreaks increases. In 2018, approximately 527 000 children missed their first-dose of measles-containing vaccine in the WHO European Region. One year later in 2019, the measles virus exposed immunity gaps in Europe, infecting over 100 000 people, across all age-groups. Protecting children, adolescents and adults from vaccine-preventable diseases through vaccination is a must for the sustainability of health care systems. “We know that vulnerability to infectious diseases anywhere is a threat to public health everywhere,” said Ms. Afshan Khan, UNICEF Regional Director for Europe and Central Asia. “It is critical that routine immunization programmes continue during this crisis, while adequately protecting health workers and individuals receiving vaccinations. Reaching the most vulnerable children who have missed routine immunizations in the past should be prioritized.” If, during these unprecedented times, local COVID-19 response measures cause temporary interruptions of routine immunization services, countries should plan to resume immunization services as quickly as possible after the situation stabilizes. Countries should be prepared to vaccinate those at higher risk and ensure everyone, including the most marginalized, will have equal access to a COVID-19 vaccine when it becomes available. “ We can prevent further impact of COVID-19 on our healthcare systems by assuring that individuals of all ages remain vaccinated according to national schedules. I urge countries to maintain immunization service delivery and drive demand for vaccination, through the life-course even at this difficult time. Prioritizing immunization is one of my four flagship areas and central to WHO’s vision for health in the new European Programme of Work” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. WHO and UNICEF will continue to support governments’ efforts to strengthen their immunization programmes, including through strategic planning for equitable provision of immunization, strengthening vaccine-preventable disease surveillance and community engagement and education. As we step into a new future, vaccines will continue to serve as a foundation for health and wellbeing for all. It is through solidarity, joint action and tireless commitment to leaving no one behind that we can create a healthier future together. #Vaccineswork Georgia immunization UNICEF/UN0326765/Georgia
Protecting children against measles in Romania
Parents living in Strehaia, a Roma community in South-West Romania, nod and smile in relief after watching a short video shown by their local physician on the benefits of immunizing their children. The physician answers questions from the parents before they gather their children and move to the next room where all of the children are vaccinated. The children range in age from young toddlers to 18 years old. The young ones hold their mothers’ hands tightly, but the older ones laugh and ask to watch the film again. The film is part of UNICEF Romania’s ongoing support to the Ministry of Health’s efforts to increase immunization coverage and prevent the spread of measles. Vaccination coverage in Romania has declined since 2000. In 2017, only 75 per cent of children had received two doses of Measles, Mumps and Rubella (MMR) vaccine – a coverage rate far below the recommended 95 per cent needed to protect all children. As a result of low immunization coverage, Romania has experienced a measles outbreak, with over 15,000 people affected since 2016. This includes 59 deaths, the majority being children. As part of ongoing efforts to increase immunization coverage, in July 2018 Romania’s Ministry of Health launched a door-to-door catch up campaign to vaccinate children who missed their vaccinations. In support, UNICEF developed a series of materials to provide parents with easy to understand, factual information about the benefits and process of children being immunized. These materials include the short film watched by families in Strehaia. The film is shown to parents and families in the most vulnerable communities in Romania - people living in hard to reach areas, those affected by poverty, and Roma communities. These communities often have children with the lowest rates of immunization. The film talks about the necessity and benefits of vaccination and, at the same time, addresses the most common vaccine-related questions from parents: Is it safe to vaccinate my child? What if she/he catches another disease? What if my child gets sick after the vaccination? Is the vaccine free of charge? A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. A girl is vaccinated at a community center in Buhuși, in Eastern Romania as part of the UNICEF and WHO supported immunization catch-up campaign. “In the beginning parents did not want to vaccinate their children, but then they put their trust in us. We told them vaccines are good and we encouraged them to ask the doctor all the questions they have during the campaign. So they were able to have a clear picture on the benefit of vaccination,” said Gabriela Stan, a health mediator in the town of Buhuși, in Eastern Romania. Gabriela was part of the team that went door-to-door to inform parents from vulnerable communities about the benefits of vaccination. Although there have been positive developments in reaching vulnerable children with lifesaving MMR immunizations over the past few months in Romania, until the coverage rate reaches 95 per cent, children will remain at risk.
Protecting young children from vaccine-preventable diseases
Vaccination is one of the world’s safest and most cost-effective public health interventions. Yet growing distrust in science, coupled with misinformation, means that vaccination coverage rates are declining in some countries and communities, resulting in an upsurge of vaccine-preventable diseases. Research shows that those caring for children…
Turning every “no” into a “yes” to protect children from the current measles outbreak in Romania
Over 19,000 people in Romania have been diagnosed with measles since 2016. To date, 64 people have died – 58 of them children. The outbreak is the result of a drop-in immunization coverage over the past two decades, with many parents fearful of vaccination, due to the spread of misinformation. For example, the proportion of children who have received a second dose of the measles vaccine – which is needed to adequately protect a child form the deadly disease - dropped from 97 per cent in 2000 to 76 per cent in 2016. It was only after UNICEF started re-engaging in the national measles programme that this drop was stopped, and the coverage is currently up 5 percent from 2016 for the second dose. UNICEF focused on improving immunization awareness of the general public via TV, radio and social media, as well as on redesigning the national electronic vaccination registry, on conducting catchup immunization campaigns in areas with extremely low coverage, and on improving behavior and communication skills of local health workers on immunization. Besides these actions, UNICEF supported teams of health and social workers in 45 communities in Bacău county, in eastern Romania. Their interventions focus on providing a minimum package of community-based health services, including access to vaccination, to save and improve children’s lives. Adina and Didina are two mothers who have been reached by these community-based teams, and whose children are now fully immunized against the disease. The initiative relies on the work of health professionals such as Gabi Stan and social workers like Magda Grigoriu to build trust with families. Delia and Mario are the first children to come home from school, followed by Alberto at 2 pm and Petrina at 3 pm. All four children do their homework at this small table with their mother Adina. Delia and Mario are the first children to come home from school, followed by Alberto at 2 pm and Petrina at 3 pm. All four children do their homework at this small table with their mother Adina.
“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.