Russia’s TB Epidemic Spreading, WHO Reports

Russia’s raging tuberculosis epidemic has spread to Scandinavia through emigration and threatens other Western countries, including the United States, officials of the World Health Organization warned Tuesday.

The alarming rate of new TB cases reported in Russia and other Eastern European countries last year underscores earlier cautions that collapsing health care systems in the former Communist world have caused the disease, which already kills 3 million in the world each year, to flourish.

But the rising number of TB infections in previously low-incidence countries to which Russians have emigrated has made a reality of health officials’ worst fear: that the epidemic can and will transcend borders.

“The focus here has been on Scandinavian countries, but elevated risk has to apply to all Western European states and to other low-incidence countries like the United States,” WHO scientific officer Chris Dye said of the report he wrote and released in Copenhagen.

Tuberculosis is primarily spread through coughing, and an infected person can spread the disease to dozens of healthy people in a single year, experts say. The disease is treatable, but poor care has allowed drug-resistant strains to flourish.

While most countries of the former Soviet Union and Eastern Europe have seen a sharp rise in reported TB cases since post-Communist economic restructuring diverted money from state-run medical services, Russia has the dubious distinction of harboring the most TB cases in the developed world and openly resisting WHO recommendations for diagnosis and treatment.

In a separate report issued last week, the Geneva-based global health agency named Russia as one of the countries most responsible for the airborne disease getting out of control.

Russian health officials, for example, insist on requiring costly chest X-rays to diagnose TB, rather than the sputum samples relied on under WHO’s approach, which is called directly observed treatment, short-course, or DOTS. The global health agency program also permits most of the months-long drug treatment for TB to be self-administered, allowing the infected to return to their homes and jobs within two to three months instead of undergoing the two years of hospitalization usually dictated by the Soviet-era method.

WHO officials agree that the Soviet program showed good results in its time, but current economic realities do not allow proper funding of TB clinics. Infections and drug-resistance have soared as a result: There has been a doubling of the annual growth rate for new TB cases in Russia since the Soviet Union disintegrated in 1991, WHO officials said.

“Only Africa has witnessed such a rapid increase in TB cases in recent years,” Jo E. Asvall, the agency’s European regional director, told the conference in Copenhagen. “Yet even Africa has not experienced the alarming number of multi-drug-resistant TB cases which we are seeing in Eastern Europe.”

Russia has an estimated 2 million TB sufferers, and the annual number of new cases grew from 50,641 in 1990 to 111,075 in 1996, the last year for which figures are available. This means that the country of 148 million had a ratio of 75 new cases per 100,000 population; the rate in the United States was 8 per 100,000.

Like most of Western Europe, Scandinavian countries record low incidence of TB, but the figures released Tuesday show what WHO officials say is a disturbing rise directly traceable to those coming from more highly infected countries, primarily Russia.

Denmark, Norway and Sweden last year had admirably low rates of new cases of TB--with 9 new cases per 100,000 people in Denmark, 6 per 100,000 in Sweden and 5 per 100,000 in Norway. But of the 1,194 new cases reported last year in the three countries, 683, or 57%, were among immigrants, the vast majority from Russia.

“As the TB situation worsens in Eastern Europe, increased travel, international commerce and migration between Scandinavian, Russian and Baltic countries are likely to add to these numbers,” said Arata Kochi, director of WHO’s global tuberculosis program.

Nils Strandberg Pedersen, director of research and technology for the Statens Serum Institut in Copenhagen, observed: “A population the size of Copenhagen has become sick with TB over the past four years in Eastern Europe. Because they have not received proper treatment, these people have spread the bacteria and likely infected a population approximately the size of Denmark and Norway combined [about 9.7 million people]. The most sensible thing for us to do is to help our neighbors become more effective in curing infectious TB patients and break this cycle of transmission.”

In a telephone interview from Copenhagen, Dye said global health officials applauded recent U.S. congressional funding for programs to contain the global spread of infectious diseases. But he described the efforts currently underway as “embryonic” and likely to require years, if not decades, to mature into an effective TB-combating program.