As Russian Quality of Life Slips, Preventable Diseases Soar : Health: A diphtheria epidemic is proving difficult to combat because people refuse to be inoculated. They fear the vaccines will be of poor quality or the needles contaminated.

As standards of living, nutrition and sanitation decline, Russia is struggling with epidemics of such preventable diseases as diphtheria, anthrax and cholera, the country’s chief epidemiologist said Monday.

The former Soviet Union had prided itself on having practically eliminated many infectious diseases, including diphtheria. But about 3,700 cases of diphtheria have been reported in Russia so far this year--compared with 593 cases in all of 1989--and 104 people have died, said Yuri M. Fyodorov, chief specialist of the Russian Committee for Epidemic Control.

The diphtheria epidemic is proving difficult to combat because in recent years many Russians have begun refusing to be vaccinated, fearing that the vaccines will be of poor quality or the needles contaminated, Fyodorov said.

After widespread publicity about a 1989 incident in the city of Elista, where one health clinic apparently infected at least 41 infants with AIDS by giving them injections with infected syringes, some parents reportedly bribed doctors to fake vaccination certificates for their children.

Currently only 72% of Russian children have been inoculated against diphtheria, and only about 10% to 15% of adults are immune, Fyodorov said. Adults need diphtheria booster shots at least every 10 years to retain their immunity.

Russia now manufactures disposable syringes, but widespread underfunding means hospitals and clinics are not always able to buy them.

“We are not too happy about the mentality and habits of our medical personnel,” Fyodorov said. “Some of them try to reuse even disposable syringes.”

To thwart such potentially deadly carelessness, Russia is now seeking to import new disposable syringes designed in such a way that it is impossible to reuse them. Financial assistance for this has been offered by U.S. aid organizations, Fyodorov said.

Infectious diseases were easier to control when travel was restricted in the former Soviet empire, but this summer many Russians are enjoying their new freedom to venture abroad--and some are bringing diseases home with them.

This year has seen a record 22 cases of cholera--up from six last year. All but five of the patients contracted the illness abroad, and two have died.

Cholera has been a problem in Tajikistan, and refugees fleeing the civil war there have spread the malady. But there have also been outbreaks in Georgia and in Dagestan in southern Russia. Three days ago, a homeless person in Moscow was diagnosed as having cholera--as was a nurse who had cared for him, Fyodorov said.

Progress has been made in combatting some illnesses, including salmonella, which was down 90% in the first six months of this year compared with the same period of 1992, and anthrax, down 40% over the same period.

But last week 71 people in the Altai city of Barnaul contracted anthrax after eating contaminated meat, the Reuters news agency reported.

Diseases of all kinds are on the rise in the former Soviet Union as food prices outstrip wage boosts, and nutritional levels drop.

Cases of tuberculosis--an index of public health--leaped 26% in the first half of 1993.

Life expectancy has declined over the past four years and infant mortality is up, according to a March report by the Red Cross.

In Moscow, city authorities have failed to crack down on squalid conditions at unregulated markets that have sprung up on sidewalks near train stations and other central locations.

The markets are not served by drainage or sewage systems, and the streets are rarely cleaned. The grass that lined the sidewalks is long gone. Spoiled meat, produce and garbage are trampled into fetid mud.

Fyodorov calls the spectacle both unsightly and menacing. “The unsanitary conditions are becoming dangerous in Russia,” he said.