> NY Times, December 5, 2000 > > FREEDOM'S TOLL > =============== > Infectious Diseases Rising Again in Russia > ------------------------------------------ > By ABIGAIL ZUGER > > VORONEZH, Russia - Natalia Kostina lay flat on her back on a metal > examining table in this city's tuberculosis hospital, staring impassively > at the ceiling. In an instant, a doctor jabbed into her abdomen a thick > needle attached to a syringe and pushed in a few cubic inches of air. > > A moment later the needle was withdrawn and Ms. Kostina, silent and stoic, > got off the table and returned to her room. Her treatment was over for > another week. > > Injecting air into the abdomen is a painful, archaic, last-ditch way to > battle tuberculosis when medications are scarce or can no longer help. It > has not been used in the West for decades. > > But this is Russia, where TB, once nearly under control, has become > epidemic since the collapse of the Soviet Union. Doctors often use air > injections to fight TB strains that resist the most commonly used drugs. > The technique compresses infected lungs, giving them time to rest and heal. > > Ms. Kostina, 24, was healthy until two years ago, working as a nurse at the > local prison, just a mile down the road from this hospital. There, as in > most of Russia's overcrowded prisons, tuberculosis has been spiraling out > of control. When she fell ill with fever and a cough, doctors quickly > ascertained that she had caught tuberculosis from one of her inmate patients. > > Despite months of treatment, her disease got worse. All four of the > antituberculosis drugs she tried were powerless against it. Moreover, > during the year she spent traveling from work to home, then into the > hospital, then to a convalescent home, then back to the hospital, she had > undoubtedly exposed dozens of others to her drug-resistant germs. > > Russia's political turmoil, its economic crisis and its new freedoms have > been accompanied by a wave of old diseases. Tuberculosis is flooding the > country, producing what some authorities are calling the world's largest > outbreak of the drug-resistant variety, one of medicine's most ominous > problems. > > Rates of other infections, including hepatitis, syphilis and AIDS, are > skyrocketing. An epidemic of diphtheria swept through in the mid-1990's. > Reports of smaller, regional outbreaks of encephalitis, typhoid fever, > malaria, polio, pneumonia and influenza pepper the nightly news. > > Health experts describe Russia's prison system as an "epidemiologic pump," > continuously seeding the country with pockets of tuberculosis that can > spread on their own. Increasingly, TB cases of Russian origin are turning > up in the Baltic countries and even farther afield - for instance, Germany > and Israel. > > Specialists worry that if the rising rates of infectious diseases in Russia > continue unabated, the country itself may turn into an epidemiologic pump, > sending infectious diseases into the rest of the world. > > "It's not surprising to see a case here," said Barry N. Kreiswirth, a > tuberculosis expert at the Public Health Research Institute in New York > City, "but it's a good reminder that it doesn't take much for one person to > be a vector and start an epidemic." > > An Old Scourge Made New > > Tuberculosis is hardly new in Russia. It ravaged the country in the 19th > century and the first half of the 20th. But before the Soviet Union fell it > was finally being brought under control, through major government effort > and expense. Infection rates, though roughly three times higher than in the > United States, were falling in parallel with those in Europe and developed > countries elsewhere. > > This victory bred "a tremendous pride on the Russian side," said Dr. Mario > Raviglione, coordinator for TB activities at the World Health Organization > in Geneva. > > That has changed. > > With thin budgets, government health programs are no match for infections > given new momentum by increasing poverty, stress, alcoholism, overcrowding > and intravenous drug use. > > Mortality from infectious diseases has not reached third world rates here. > Last year, infections were estimated to account for 2 percent of all deaths. > > But that is still four times higher than in most developed nations. "The > total cost of infectious diseases in Russia is not that great," said Martin > McKee, an expert in Russian public health at the London School of Hygiene > and Tropical Medicine, "but the important thing is that it is going up and > up and up." As AIDS becomes more firmly entrenched, that cost is expected > to rise even faster. Deaths due to tuberculosis alone rose 30 percent in > 1999. > > In the days of the Soviet Union, the powerful Sanitation and Epidemiology > Service, or "SanEp," sought out infectious diseases and stamped them out > with compulsory vaccinations and annual disease screenings: chest X-rays > for tuberculosis, blood tests for syphilis. People suspected of harboring > infection were removed from society for as long as it took to guarantee > that they were no longer contagious. The SanEp tactics were brutal - people > were often taken from their families and hometowns for months to years - > but they were effective. > > "Now, instead, we have human rights," said Alla Loseva, the Voronezh > tuberculosis hospital's deputy chief doctor, rolling her eyes. SanEp is but > a poorly funded shell of its former self. Its job has fallen instead to > doctors like Ms. Loseva, struggling to contain the epidemic with minuscule > budgets and skeletal staffs. > > A colleague, Dr. Galina Chervanova, said that when she arrived at the > hospital in 1987, "there was even talk of eliminating TB completely." > > "Now we are not even close to that anymore," added Dr. Chervanova, the > hospital's deputy chief superintendent. "The number of sick people has > risen, and we are seeing many, many difficult, chronic cases." > > Full article at: http://www.nytimes.com/2000/12/05/science/05INFE.html >
