The use of thiopurine (azathioprine and mercaptopurine) reduces the immune response to viruses, which is associated with an increased risk of opportunistic infections. There is limited evidence that they increase the risk of respiratory infections. The risks and benefits should be considered, but most patients can continue on a stable dose. In patients in stable remission, elderly patients and in the presence of concomitant pathology, it is recommended to stop taking thiopurine. During a pandemic, it is recommended to avoid starting thiopurine or increasing the dose, which will allow patients to avoid potential side effects. If the patient is in contact with a COVID-19 person, temporary withdrawal of thiopurine for 2 weeks should be considered. If a patient tests positive for SARS-CoV-2 and/or develops COVID-19, temporary discontinuation of thiopurine may be recommended until the patient clears the infection.
At present, the risk of increased circulation of vaccine-related polioviruses and associated outbreaks with a low level of vaccination coverage against the background of the use of an oral vaccine is also complicated by military operations in the country, leading to the destruction of the infrastructure of cities and towns, intensive migration and evacuation of the population. Ukraine, and to regions where there are no active hostilities (Chernivtsi, Transcarpathian, Lvov, Volyn regions). These areas were the ones with the lowest polio vaccination rates in 2021.
The first and mandatory step in the treatment of hypertension is lifestyle modification (LS), which is aimed at correcting the above risk factors, primarily modifiable ones. A big problem is the choice of the most optimal treatment for hypertension, which can slow down the progression of lesions of the heart, blood vessels, kidneys, brain and eyes. The vast majority of hypertensive patients who seek medical help require combination antihypertensive therapy. At the same time, the most appropriate at the present level is the use of fixed combinations of such drugs.
In 2021, in Ukraine, vaccination coverage rates for children under 1 year of age against such infections as tuberculosis, measles, whooping cough, diphtheria, poliomyelitis, hepatitis B, etc. ranged from 78% to 80.1% (with the required level >90 %), which is undoubtedly not enough to recognize the epidemic situation under control. In particular, this figure for 3 vaccinations against polio at the age of up to 1 year was 80.1%, 5 vaccinations at the age of 6 years received only 78.4% of children. At the same time, vaccination coverage rates varied widely across regions. In 12 regions, among children under 1 year old, they were <80% and ranged from 68.5% to 73.9%, and among children under 18 months. (4 vaccinations) - 66% to 73%. That is, almost 20-30% of children did not receive routine vaccination against poliomyelitis due to age in the above target groups, subject to vaccination according to the Immunization Schedule.