TUBERCULOSIS: Russia Bracing for Spread of Dangerous TB Strains

Sarah Schafer

 August 24, 2009
MOSCOW -- Russia's severe tuberculosis problem is about to get much worse, increasing the risk that the dangerous drug-resistant strains that are common here will spread, causing outbreaks elsewhere, local health officials and other experts warn.
Preliminary surveys have recorded an uptick in infections, which experts say could be the start of a surge fueled by declining living standards and deteriorating medical care resulting from the country's worst economic slowdown in a decade.
But Russian officials and health specialists also blame the government's failure to order supplies of key medicines last year, a blunder that could strengthen antibiotic-resistant forms of TB and threaten wealthier countries that have all but eradicated the disease.
Russia already has one of the highest rates of TB in the world. In parts of its Far East, the infection rate is three times what the World Health Organization considers epidemic levels. The government has made progress in recent years, with infection rates falling from a peak in 2000, but health officials are worried that those gains are now in jeopardy.
Preliminary state statistics show the rate of infection growing from 83.2 cases per 100,000 people in 2007 to 85.2 in 100,000 last year, and anecdotal evidence from hospitals and clinics around the country suggests that the numbers are still climbing.
By comparison, the infection rate in the United States is about 8 in 100,000, with about 0.2 percent of American TB cases ending in death. In Russia, about 18 percent of TB patients die of the disease, according to WHO figures.
"Because people are poorer and life is worse, the disease is progressing much faster now," said Veronika Agapova, a tuberculosis specialist with the Russian Red Cross. "The Ministry of Health didn't pay a lot of attention to this problem last year," she added.
Although the increase reported was small, officials are worried because the number of TB cases soared the last time Russia suffered a severe economic downturn, rising from 74 cases per 100,000 people before the 1998 financial crisis to 90.4 two years later.
"What was bad in 2008 will continue to be seen in 2009 and 2010," said Mikhail Perelman, Russia's most prominent TB specialist. "I am pessimistic. . . . The WHO set a goal to eradicate tuberculosis, but this task seems quite fantastic to us at this point."
A spike in infections in Russia could have consequences well beyond its borders because about a fifth of all TB patients here suffer from drug-resistant strains -- more than almost anywhere else in the world.
In 2006, a Russian-born man infected with a strain of drug-resistant TB was jailed after moving to Arizona and ignoring a judge's order to wear a mask outdoors. A year later, an American lawyer with drug-resistant TB set off an international panic and was quarantined after traveling across Europe and returning to the United States.
"Like air pollution, it doesn't see a border," said Murray Feshbach, an expert on Russian public health at the Woodrow Wilson International Center for Scholars who argues that Russia understates its TB rate by as much as 50 percent.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/23/AR2009082302208.html