Cases of multi-drug resistant tuberculosis in the former Soviet Union are rising at an alarming rate and pose a global problem, the World Health Organization said Tuesday.
Estonia, Kazakhstan, Latvia, Lithuania, parts of the Russian Federation and Uzbekistan, where up to 14 percent of new patients have strains of the disease resistant to the most powerful drugs, are among the top 10 world TB hot spots.
“Tuberculosis remains a major public health problem globally,” Dr. Paul Nunn, of the WHO, told a news conference.
“The former Soviet Union is the multi-drug resistant tuberculosis capital of the world. The rate of drug resistance, and multi-drug resistance there is about 10 times that of the rest of the world.”
Nunn said the rising number of cases of tuberculosis resistant to multiple drugs, also called MDR, followed the collapse of public health infrastructure after the political and economic changes over the last several years.
“We worry about MDR because, untreated, it is a death sentence,” he added.
HIV increases transmission
A new WHO report on TB, an infectious airborne disease that affects nine million people each year and kills two million, focuses on the growing problem of MDR-TB.
Population growth, worldwide travel and this tougher form of tuberculosis have contributed to the increase in TB. Experts estimate that 300,000 new cases of MDR-TB are diagnosed each year.
The highest prevalence of MDR-TB also coincides with the world’s fastest growing HIV infection rates in Eastern Europe and Central Asia. Tuberculosis is one of the main opportunistic infections that kills people with AIDS.
“We know that HIV causes an increase in the transmission of tuberculosis. We are obviously concerned that in this context HIV will cause increased transmission of multi-drug resistant tuberculosis,” said Nunn.
Patients with TB are treated with a directly observed treatment, short-course program -- a multi-level approach adopted by WHO that involves government commitment, patient surveillance and treatment with the drugs isoniazid and rifampicin.
But people with MDR-TB do not respond to one or more of the main drugs and require different, more toxic and expensive treatments. Nearly 80 percent of MDR-TB cases are “super strains,” resistant to at least three or four of the main drugs used to cure TB.
“The response to this situation has to be global,” said Dr. Mario Raviglione, director of WHO’s Stop TB Department. “It is in the interest of every country to support rapid scale-up of TB control if we are to overcome MDR-TB. Passport control will not halt drug resistance; investment in global TB prevention will.”
