Drug-resistant TB on rise in Russia
Experts fear world health crisis as new strains flourish in poor conditions

MICHAEL MAINVILLE - SPECIAL TO THE STAR
The Toronto Star – Saturday, March 3, 2007

MOSCOW – Once a hospital for Napoleon’s troops, Moscow’s Phthisio-Pulmonary Institute is now home to hundreds of Russian patients suffering from dangerous new strains of tuberculosis.  Quarantined for months on end, they rest on shabby beds or shuffle through the corridors in cotton face masks.  On the ground floor, a young man in pyjamas sits by a window looking out onto a snowy courtyard, chatting on his cellphone with a pretty girl shivering in the cold outside.

The patients have been sent here from across Russia after they failed to respond to traditional drug treatment for TB, a highly contagious bacterial infection that can be deadly.

TB remains on of the most common infections in the world’s poorer countries.  As in most Western countries, TB was all but eliminated in Russia under the Soviet system.  But it has flourished here in recent years, feeding on the poverty and lack of proper health care that followed the Soviet collapse.  According to the World Health Organization, Russia registered nearly 120,000 new TB cases in 2005, compared with only 1,615 in Canada.

Worryingly, Russia has also become a breeding ground for drug-resistant strains of TB.  According to the WHO, nearly 20 percent of patients in Russia are suffering from multi-drug-resistant TB, or MDR-TB, which develops if patients are treated improperly and then becomes contagious as a new strain.

Of those, some are developing a virulent and incurable strain knows as extensive-drug-resistant tuberculosis, or XDR-TB, which experts warn could cause a global health crisis.

“This is a very serious health problem, with very serious risks,” says Sergei Borisov, the Phthisio-Pulmonary Institute’s deputy director.  “XDR-TB is the next step in the evolution of TB.  We already have 30,000 people with drug-resistant strains who are a danger to the people around them and to the whole world.”

The majority of Russia’s TB cases can be traced to the country’s overcrowded and under-funded prison system.  Alcoholics, the homeless and migrant workers are also especially susceptible to the disease.  But health experts say TB is increasingly spreading into the general population.

Dmitri Kozlov, a 24-year-old patient at the institute, was an active student when he was diagnosed with TB two years ago.  The says he has no idea how he contracted the disease.  He didn’t respond to a first round of treatments and was diagnosed with MDR-TB eight months ago.  After being sent to the institute, he had a second round of drug treatments and seems to be recovering.

“It’s been a very difficult time, but I’ve made a lot of progress and I hope I will be going home soon,” he says, his voice muffled by a cotton mask he must wear over his mouth and nose.

Borisov says he’s happy for his young patient, but still worries.

“If he has a relapse, there’s a strong chance it will develop as XDR-TB,” Borisov says.

Few Rissian doctors, even TB specialists, seem to be aware of the new strain.  Murray Feshbach, an expert on Russian health policy at the Washinton-based Woodrow Wilson International Centre for Scholars, says that on a recent fact-finding trip to Russia almost none of the doctors he interviewed in Moscow and St. Petersburg knew about XDR-TB.

“At first, HIV/AIDS was ignored and the same thing appears to be happening here,” says Feshbach, who is researching a report on XDR-TB in Russia.  In the early 1990’s, Russian health officials refused to accept the dangers of HIV/AIDS and today the country is suffering from a severe epidemic of the disease, with an estimated 1 million Russians infected with HIV.

“We need to head this off before it gets worse.  Russia is potentially a source for very dangerous forms of drug-resistant TB,” Feshbach says.

Attempts are being made to tackle Russia’s TB epidemic and with state offers swelling thanks to booming energy prices, the Russian government is spending more.  Health Minister Mikhail Zurabov last month announced a five-year, $3 billion (U.S>) program to fight diseases such as TB, diabetes, HIV/AIDS and cancer saying the government hopes to stem Russia’s rapid population decline.

More money is also coming from the international community.  The Global Fund to Fight AIDS, Tuberculosis and Malaria, which has received about $430 million in funding from the Canadian government, is providing about $100 million for TB projects in Russia over the next five years, mostly focusing on increasing doctor training and buying new equipment to fight drug-resistant strains.

Sitting in his cramped office at the Phthisio-Pulmonary Institute, Borisov says he believes more money for training and equipment will help.  But he says Russia also needs to tackle social ills like rampant alcoholism, poverty and inadequate housing if it wants to come to grips with TB and stop it from spreading.

“The fight against TB in Russia is not only a medical problem.  It’s a social problem.”

------

Micheal Mainville is a Canadian freelance writer based in Russia.

Back to List of Articles