Published: 09.02.05 Updated: 09.02.2005 18:22:14

Based on data complied through the EpiNorth project and presented in this article, the epidemiological situation for most communicable diseases in the Baltic Sea region has improved considerable during the last three years. The decrease in incidence rates has been most striking in the eastern part of the region, especially with regards to blood borne and sexually transmitted diseases like HIV infection and viral hepatitis. A combination of effective preventive measures and decrease in numbers of susceptible drug users may have contributed to this improvement in the epidemiological situation. An increasing proportion of newly diagnosed cases of HIV in the eastern part of the region occur among women and children. Available data is not sufficient to determine if this increase reflects the start of a general heterosexual epidemic. In the Nordic countries, no such heterosexual epidemic was observed following the large outbreaks among drug users in the 1980s. The situation may however be different in the eastern part of the region where the incidence of other sexual transmitted diseases like syphilis and gonorrhoea is still very high, especially among young people, the unemployed, substance abusers and sex workers. It may be that the situation in the eastern part of the region is more comparable to other countries, f.inst. Ukraine, where a clearer pattern of a two-phase epidemic has been noted first an incidence peak predominantly among drug users, and thereafter a peak reflecting an increased heterosexual spread. It is also well documented that the presence of other sexual transmitted diseases greatly increases the risk of sexual transmission of HIV. This has been seen in the Nordic countries, where increasing incidence rates of syphilis and gonorrhoea in men who have sex with men have been followed by a dramatic increase in the number of newly infected cases of HIV. This is a trend that has been observed in many western European countries and reflects a resurgence in unsafe sex practices in the group.

In contrast to other communicable diseases, the incidence of tuberculosis has remained high and even increased in some regions in the eastern Baltic Sea area. It is still not clear if this increase in reported cases of tuberculosis is caused by more case detections due to more effective services or other factors. The proportion of multi drug resistant tuberculosis is still some of the highest in the world. The spread of tuberculosis and HIV infection still represent one of the most important public health issue in the region. Considering the size of the problem and the fact that epidemics of these diseases are not quenched quickly, it will continue to do so for some time. This mandates continued and further coordinated action in this field where attention is paid both to the medical side of the problem as well as to the social aspects.

The favourable epidemiological situation for most of the communicable diseases in the region can be attributed to many factors. One important factor is the extensive collaboration and exchange of experiences between health authorities, infectious disease control professionals and non-governmental organisations that has developed within the region. This is of special importance in the development of infection control programs and other preventive measures.

Its hoped that this cooperation across the borders can continue and develop further.