Doctors Fear Untreatable Russia Tuberculosis Boom
January 27, 2004
Post-Soviet medical mismanagement of tuberculosis in Russia has allowed an explosive TB epidemic to break out, and international health experts are particularly concerned about increasing multi-drug resistant (MDR) TB among prisoners and the homeless. "The reservoirs of super-resistance will be huge, it will be impossible to treat," said Andrei Slavutsky of Medecins Sans Frontieres, which ended its TB program in Siberian prisons after Russian officials refused to adopt treatment techniques backed by the World Health Organization.
MDR-TB often results from failure to ensure that patients finish a course of standard treatment, and it can only be treated with expensive second-line drugs. MDR-TB drugs must be used for longer, are less effective, and have more harmful side effects than traditional treatment.
WHO figures show MDR-TB running as high as one in 10 new TB cases among the general population in some regions of Russia, and almost as high as one in five in prisons. "Insufficient supervision, poor management and low treatment effectiveness led to the growth of MDR-TB. This situation needs to be immediately addressed," said Wieslaw Jakubowiak, WHO's TB control program coordinator in Russia.
But many doctors say Russia is now incorrectly using new TB drugs -- the last line of defense against MDR-TB. Zulfira Kornilova, deputy director of an institute outside Moscow that treats Russia's most serious TB cases, said her experts are picking up terrifying rates of super-resistant strains. "There is now a group of patients who do not respond to any medicine. It is maybe 15-20 percent of those who have MDR-TB," said Kornilova, adding that there are no exact figures because laboratories are ill equipped to assess the true scope of the problem.
Hoping to improve these diagnosis rates, the World Bank has loaned Russia $150 million. And WHO says Russia is closely approaching internationally acknowledged standards for treatment and has put TB at the top of its agenda. But Slavutsky remains unconvinced. "There is already massive supply of second-line drugs going on, but without clear guidelines explaining how to use them efficiently this is absolutely criminal," he said.
01.25.04; Oliver Bullough
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.