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. Last Updated: 07/27/2016

Tuberculosis Infects Russia, CIS at Record Rate

Every second of the day, someone on the planet is infected with tuberculosis -- and the No. 1 killer of adults all over the world is on the prowl, stalking its victims in record numbers.


According to the World Health Organization, or WHO, the deadly lung disease claimed 3 million lives in 1995 -- surpassing all previous annual records.


"Not only has TB returned, it has upstaged its own horrible legacy," said Dr. Hiroshi Nakajima, the director general of WHO, which launched an international campaign to fight the spread of the highly infectious disease March 24 -- the same day the TB bacteria was discovered in 1882.


While 95 percent of the global TB cases originate in the developing nations of Asia and Africa, in recent years tuberculosis has been making a strong comeback in developed countries that had succeeded in nearly eradicating the disease -- with Russia and the CIS leading the pack in Europe.


Between 1991 -- when tuberculosis levels started rising in Russia for the first time in many decades -- and 1994, the TB infection rate rose more than 40 percent. And according to Valentina Aksyonova, the deputy director of Russia's central research center for tuberculosis, the airborne disease spread even more in 1995, rising to 57.4 cases per 100,000 people.


"That is even higher than we had predicted," Aksyonova said. "And we have been sounding the alarm for three years now."


Aksyonova and her colleagues are not the only ones concerned with the rapid spread of the deadly bacterial disease in Russia. WHO officials in Europe are also following the spread of a disease that knows no borders, and they have already launched cooperative programs with the Health Ministry in designated areas -- such as Ingushetia -- where TB levels are considerably higher than the national average.


"The levels of TB in Russia are among the highest in Europe," said Dr. Tunda Madaras, a WHO specialist, adding that the high rate of infection in the East is already spreading westward. In recent years, for example, Denmark, France Italy, Holland, Sweden, and Britain have witnessed an increase in TB infection.


Part of the reason for the resurgence of tuberculosis in industrialized countries is the spread of AIDS. Those patients whose immune systems are depleted by the virus are even more vulnerable to the ravages of the TB bacteria. People who are HIV positive are 30 times more likely to contract tuberculosis.


"Tuberculosis is a disease that thrives on weakness," said Aksyonova. Indeed, while as many as 1.9 billion people -- or one-third of the global population -- are infected with TB, only 5 percent to 10 percent of those infected will eventually fall ill. WHO -- which declared a global TB emergency in 1993 -- predicts that tuberculosis will send 30 million people to their graves within the next 10 years.


The outbreak of TB in Russia is particularly alarming, WHO experts say, because it is not associated with the spread of AIDS. Russia, which has only registered 1,102 HIV positive cases since 1987 when the first AIDS case appeared, still has insignificant numbers of AIDS patients compared to the West, even by unofficial statistics.


"In Russia tuberculosis is mostly an economic and social problem," said Aksyonova, citing the drop in living standards associated with unemployment and rampant inflation and environmental pollution as the main factors. While the national average of TB infection is 57.4 cases per 100,000, illness rates tend to be lower in the northwest and grow increasingly higher moving southeast.


Residents of the northern region of Murmansk, for example, are the least affected by tuberculosis, with only 0.1 case per 100,000 people. One of the hardest hit areas is Tuva, the coal and uranium mining region in eastern Siberia, where the rate of illness is more than twice the national average. Doctors blame the sharp decline in living standards for the resurgence of tuberculosis, but TB does not only attack the poor. Those who are at the greatest risk of contracting the disease are children, and as many as 50 percent of Russian children up to the age of 14 are infected with TB, Aksyonova says.


Other risk groups include the homeless, alcoholics, prisoners and medical personnel. Indeed, doctors like Aksyonova who come into contact with highly contagious disease every day are eight times more likely to get TB. With each cough, a person sick with TB produces a cloud of microscopic bacteria that can be suspended in the air for over an hour.


But Aksyonova is not worried about the risk. "The danger of TB is out there," she said, gesturing out of her office to the street. "In here I'm not afraid of it. I know how to take care of myself," she said.


"Half the battle is detection," said Aksyonova. If diagnosed on time, TB can be treated with a combination of medicines, resulting in a 95 percent recovery rate. But by the time patients come to her with symptoms -- chest pains, weight loss, fever, and a persistent, bloody cough -- it is often too late to help them. The other half of the battle, Aksyonova says, is persuading patients to go through the entire course of treatment, which normally lasts three to six months. Often a patient will start to feel better after a few weeks of daily medication and refuse further treatment or simply disappear.


This is particularly dangerous, health experts say, because until the full dosage is taken the TB virus is merely dormant -- not eradicated. Interrupting medication mid-course gives the bacteria the opportunity to develop an immunity to the medication. According to Aksyonova, up to 50 percent of the TB cases in Russia do not respond to the usual treatment.


This problem is not restricted to Russia. WHO estimates that as many as 50 million people throughout the world are infected with multidrug-resistant strains of TB. To combat the effects of poorly managed TB treatment programs, WHO has developed a treatment strategy known as DOTS -- Directly-Observed Treatment, Short-course -- which requires a health care worker to deliver daily doses of medication and watch the patient swallow it.


While WHO officials are trying to encourage Russia to adopt the DOTS program, Russian experts are resistant.


"It's fine for developing countries, but we have our own experts who have been studying TB for 70 years," said Aksyonova, adding that it would be a step backwards rather than forwards to send non-medical personnel to deal with patients.


"We prefer a more individual approach to treatment -- especially with the rise of drug resistant strains of TB."


She and her colleagues have developed a national TB prevention program that focuses on early detection, and they are awaiting presidential approval to put the 600 billion ruble ($125 million) project into effect.


Aside from channeling money into additional research, the focus of the program is to re-institute the old Soviet system of TB detection.


"We have a reliable system, it's just that it has fallen apart," said Aksyonova, referring to the mandatory screening that took place in schools, factories, and institutions requiring biennial fluorographies, or X-rays for all adults and microscopy smears for those in high risk groups.


"With TB there are two scenarios," Aksyonova added. "It's either hard to detect but easy to treat, or easy to detect but too late to treat. I have children who come to me and are already dying of TB, but they don't even realize they have it."


The Russian program also differs from WHO's in that it consists of full isolation of TB patients during treatment -- a point Aksyonova and her colleagues are trying to emphasize by law in a draft bill on tuberculosis they recently introduced to the Federation Council.


Among other things, the law calls for mandatory treatment and a system of fines that would essentially bar people contagious with TB from the workplace, public transportation, schools and residential buildings.


"Our people aren't used to thinking about their health and taking care of themselves. Especially now, their first thoughts are to go to work and there is no time to worry about their health," said Aksyonova. "A little freedom can be a bad thing."