interesting information
Date: Monday, September 14, 1998 8:56 AM
From: ProMED-mail
Source: The Baltimore Sun, 14 Sep 1998 [excerpts] & The Public Health
Research Institute
***********
Tuberculosis cases in Russia:
Afflicted in overall population: 3 million
New cases in 1997: 150,000
TB afflicted in prisons: 100,000 TB; multidrug resistant in prisons:
20,000
TB national mortality rate: 17 per 100,000 people
TB prison population mortality rate: 484 per 100,000
SOURCE: Public Health Research Institute (Estimates)
**********
Strains of tuberculosis that resist ordinary treatment, nurtured in
Russia's crowded prison system, are reaching epidemic proportions, and
Russian and Western efforts to combat the disease here are making the
problem worse, a panel of doctors said last week.
Millions of people are at risk, and the disease won't stop at Russia's
borders. It is already spreading quickly into the general population as
infected prisoners are released.
"And those people get on planes, they go to Moscow, they go to
Baltimore,
and it spreads even farther," said Dr. Lee B. Reichman, director of the
U.S. National Tuberculosis Center. Already, tuberculosis has been moving
westward from Russia into Europe. Now the new resistant -- and therefore
deadlier -- strains pose a threat that could, the doctors say, get out
of
hand in two years or less.
"A time bomb waiting to go off? It already went off," said Dr. Paul
Farmer,
a Harvard Medical School expert in what is called multidrug-resistant
tuberculosis.
Reichman and Farmer were among a group of specialists who spent last
week
visiting prisons and tuberculosis treatment centers in Siberia. They
came
away impressed by the dedication of local health care workers but shaken
by
the extent to which resistant strains have taken hold. "It's
extraordinarily scary," said Reichman.
Resistant forms of tuberculosis are difficult and expensive to cure. But
as
Russia falls deeper into economic collapse, resistant strains have
mushroomed because of the fitful and erratic care that patients receive.
Even in pilot programs run by Western organizations, which provide more
thorough treatment, an indiscriminate use of "first-line" drugs against
tuberculosis has helped give rise to resistant bacteria.
At least 20,000 Russian inmates have contracted multidrug-resistant
strains; there were 15,000 new cases in the civilian population last
year.
Each person with the disease can be expected to infect 10 to 12 others
within a year, Farmer said. That's a minimum of 3.5 million people
infected
within the next two years.
"This is probably the worst situation for multidrug-resistant
tuberculosis
ever documented in the world," said Dr. Richard O'Brien of the Centers
for
Disease Control and Prevention.
The three Western medical organizations that have been providing
tuberculosis treatments at Russian prisons -- the Public Health Research
Institute, Doctors Without Borders, and Medical Emergencies Relief
International -- issued a joint appeal Friday for $100 million in
foreign
donations to provide the drugs and lab equipment needed to fight
resistant
tuberculosis properly.
"If we wait a year or two more, not even the richest country in the
world
would be able to cope with this situation," said Dr. Malgosia Grzemska,
of
the U.N. World Health Organization.
Since the fall of the Soviet Union in 1991, Russia has seen an alarming
rise in tuberculosis, with the health care system in disarray and poor
nutrition a growing problem. The health ministry reports 3 million cases
nationwide.
In the United States, by contrast, the CDC reported 19,855 cases in
1997.
Multidrug-resistant strains accounted for 1.3 percent of those.
For several years, the argument was whether to follow traditional
Russian
treatments, which can involve lengthy hospitalization, or to use a
Western
regimen called "direct observed therapy short-course," or DOTS, which
involves giving infected persons modern antibiotics daily while a
medical
worker watches to make sure there is no backsliding.
At five prisons and surrounding communities, the Western agencies
established DOTS programs, along with nutritional support. Death rates
went
down, but people weren't being cured. And cases of tuberculosis that
resisted the drugs are going up.
In essence, the antibiotics killed off the easily susceptible bacteria,
leaving a clear field for resistant strains to prosper. "The patients
with
multidrug-resistant tuberculosis are getting the standard DOTS regime,
which will not cure them," O'Brien said.
[Written by: Will Englund]
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ProMED-mail
e-mail: [email protected]
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