Tuberculosis (TB) is spreading at an alarming rate in Russia, according to an international health team that has analyzed the epidemic at one TB clinic. Their findings--published today in the Morbidity and Mortality Weekly Report of the U.S. Centers for Disease Control and Prevention (CDC)--indicates that TB strains isolated at widely distant sites in Russia are developing resistance to the mainline drugs now used to hold the disease in check.
Based on an investigation of 514 cases of TB logged from 1996 to 1998 at a clinic in Ivanovo Oblast, 280 kilometers northeast of Moscow, the public health team found that nearly a third of the patients experienced "treatment failure" or died. Most had not received a full course of TB drugs. Yet, when the researchers examined the types of TB isolated from the patients, they found that 5% were already known to be "multidrug resistant." This suggests that the patients had acquired primary infections of resistant TB. And because earlier studies had established a similar pattern of infection in Siberia, it also suggests that resistant strains are becoming common in Russia. Moreover, the researchers report that drug-resistant cases in the Ivanovo clinic increased from 1996 to 1998.
The study--carried out by TB experts from the CDC, the Central TB Research Institute in Moscow, the World Health Organization, the Public Health Research Institute (PHRI) of New York City, and others--indicates that traditional TB-fighting techniques are failing in Russia, and that new, more expensive methods will be needed to halt the epidemic. PHRI's Barry Krieswirth, an expert on TB strains, warns that "unless you treat these cases appropriately," with expensive second-line drugs and intensive patient monitoring, "all you do is make the TB more resistant." Russia can't afford these new approaches, but they're essential, he says: "The more you think about it, the scarier it is."