Key Concept

Key Evidence: The ongoing conflict in Syria has caused the breakdown of immunization services, leading to outbreaks of vaccine preventable diseases in the region and the re-emergence of polio in Syria for the first time in 15 years. The potential for polio to re-emerge in neighboring areas with low coverage of inactivated polio vaccine (IPV) threatens the success of global efforts to eradicate polio.

Lam E., Diaz M., Maina A.G., et al. 2016. Displaced populations due to humanitarian emergencies and its impact on global eradication and elimination of vaccine-preventable diseases. Conflict and Health. 10(27).
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Key Evidence: Researchers investigating the causes of a measles outbreak in Burkina Faso that occurred despite a recent mass vaccination campaign found that migration to and from Cote d’Ivoire was a major risk factor for children. Unvaccinated children who developed measles were 8.5x more likely to have recently traveled to Cote d’Ivoire than unvaccinated children who had not traveled across the border. Children returning to Burkina Faso after a period of time in Cote d’Ivoire were less likely to have been vaccinated due to low routine coverage of measles vaccines in Cote d’Ivoire. Conversely, unvaccinated children from Burkina Faso who traveled to Cote d’Ivoire and returned were more likely to be exposed to measles and thus had a higher rate of disease than children who never visited Cote d’Ivoire.

Yameogo, K.R., Perry, R.T., Yameogo, A., et al. 2005. Migration as a risk factor for measles after a mass vaccination campaign, Burkina Faso, 2002. International Journal of Epidemiology. 34(3).
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Key Evidence: In a study of the overlap between complex humanitarian emergencies and disease outbreaks, researchers found that more than 40% of complex emergencies that occurred between 2005-2014 were associated with an outbreak of infectious disease, with a high likelihood that the outbreak was vaccine-preventable.

Culver A, Rochat R, Cookson S 2017. Public health implications of complex emergencies and natural disasters. Conflict and health. 11(1).
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Key Evidence: The influx of Syrian refugees into Turkey as a result of the Syrian civil war has led to a re-emergence of several infectious diseases in Turkey, including vaccine-preventable diseases, such as measles (930 cases reported among refugees over 4 years), tuberculosis and hepatitis A.

Doyanay M, Demiraslan H 2016. Refugees of the Syrian civil war: impact on reemerging infections, health services, and biosecurity in Turkey. Health Security. 14(4).
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Key Evidence: An outbreak of wild polio virus began two years after the onset of the civil war in Syria and subsequently spread to Iraq, causing a total of 38 cases (36 in Syria). Factors leading to the outbreak included a decline in polio surveillance and in polio vaccination coverage (from 83% for 3 doses of oral polio vaccine pre-war in Syria to 47-52%).

Mbaeyi C, Ryan MJ, Smith P et al. 2017. Response to a large polio outbreak in a setting of conflict- Middle East, 2013-2015. MMWR. 66(8).
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Key Evidence: The humanitarian emergency in Venezuela, and resulting collapse of its primary health care infrastructure, has caused measles and diphtheria to reemerge — disproportionately affecting indigenous populations — and to spread to neighboring countries. This sets the stage for the potential reemergence of polio. The re-establishment of measles as an endemic disease in Venezuela (with >5,500 confirmed cases) and its spread to neighboring countries threaten the measles-free status.

Paniz-Mondolfi AE, Tami A, Grillet ME et al. 2019. Resurgence of vaccine-preventable diseases in Venezuela as a regional public health threat in the Americas. Emerging Infectious Diseases. 25(4).
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Key Evidence: Insecurity resulting from armed conflict, political instability, or social disruption increases the risk of communicable disease outbreaks during complex humanitarian emergencies by inhibiting populations’ access to health services, disrupting activities such as immunization and surveillance that prevent the spread of diseases, and making adequate humanitarian responses more difficult.

Hammer CC, Brainard J, Hunter PR 2018. Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: a qualitative systematic review. BMJ Global Health. 3.
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Key Evidence: Large measles outbreaks occurred in Lebanon and Jordan, following an influx of Syrian refuges migrating to escape conflict. In Lebanon, the measles incidence increased 200-fold in one year following high migration. There were 2.1 measles cases per million population in Lebanon in 2012; this increased to 411 cases per million in 2013.

Teleb N. and Hajjej R. 2017. Vaccine preventable diseases and immunization during humanitarian emergencies: challenges and lessons learned from the Eastern Mediterranean Region. East Mediterr Health J.. 22(11).
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