Diphtheria, rubella, tuberculosis and syphilis pose the greatest challenges for Northwest Russia's attempts to reach the WHO goals for infectious disease control. The diphtheria incidence is still not back to pre-epidemic levels. Contrary to national policy, rubella vaccine is not used very much. Thus, congenital rubella remains a problem. Tuberculosis incidense has doubled during the last decade while syphilis incidense among children has increased 100 times from 1990 to 1997 - 1998. The increase in syphilis and tuberculosis has socio-economic causes. Improved surveillance and better control measures are needed.
Epidemiological surveillance is an important tool to determine actual problems as a basis for prophylactic measures and to estimate their effectiveness.
In 1991, on the 41 session of WHO Regional Office for Europe, regional tasks to improve health for everybody were revised. According to these tasks for year 2000 goals were set up to eliminate indigenous cases of poliomyelitis, diphtheria, congenital tetanus, measles, mumps and rubella in the European Region; and in addition to decrease the morbidity and disabling consequences of other infections.
Overall situation in Northwest Russia
Analysis of the epidemiological situation for morbidity of infections in the North-Western region of Russia shows optimistic results in the struggle against poliomyelitis, measles, neonatal tetanus and some other infections. Polio, caused by wild polio virus has not been registered in the Northwest of Russia for 8 - 30 years. Measles morbidity in Russia has decreased dramatically after the start of vaccination. In 1998 four territories of the North-Western region have an incidence morbidity less than 1,0 per 100.000 inhabitants, and in the three other territories no measles was registered.
But some infections do worry the scientists, specialists of the State Health Institutions, the State Epidemiological Service and governments. These are especially diphtheria, rubella, tuberculosis and syphilis.
The diphtheria epidemic is almost over in Russia. In 1998 diphtheria morbidity in Russia was 0,98 per 100.000, approaching the 1990 level. Only Arkhangelsk region has a diphtheria level lower than that of the whole of Russia (fig. 1).
In the other cities, regions and republics the morbidity also has decreased, but the level is still higher than in the pre-epidemic period. In non-epidemic years active surveillance is very important as a mean of controlling the vaccination quality and monitoring carriers, which can indicate circulation of the pathogen. Investigations in Pskov region show that the number of carriers of toxogenic C. diphtheriae per 100 examined dramatically increased during the two years before the epidemic level was registered (fig. 2).
One of the current problems is rubella which is an uncontrolled infection in Russia (fig. 3). Vaccination is included in our national policy from 1998, but due to the absence of a national rubella vaccine the vaccination coverage is very low. The control system of congenital rubella surveillance needs to be improved. So far, the newborns with neonatal pathology not tested for rubella in majority of Russian provinces. But according to data from the Municipal State Virological Centre of the Health Committee of Saint Petersburg, 4.2% of new-born children with clinical evidence of neonatal infection had IgM to the rubella`s virus.
Tuberculosis morbidity has increased in Russia and in the North-Western region (fig. 4) in adults as well as in children (fig. 5). Comparing 1991 with 1998 the tuberculosis morbidity doubled in the Barents and Baltic Sea regions.
In 1998 there were registered 300.000 syphilis cases in Russia. Syphilis morbidity among children increased 100 times from 1990 to 1997-1998. Also in the North-Western region of Russia the syphilis incidence is high (fig. 6,7). The syphilis surveillance system in Russia needs to be correct to detect the effects of the prophylactic measures implemented.
Tuberculosis and syphilis are chronic infections. High morbidity levels has as a consequence that more permanent infection foci are formed. The increase in tuberculosis and syphilis in Russia is connected to problems of social-economic character. It must be noted that it is also necessary to revise and improve surveillance systems and control measures for some of the infectious diseases.
First of all it concerns the using of modern information technology for morbidity monitoring, analysing, prognosing, laboratory supporting the epidemiological surveillance system and to estimate the efficacy of prophylactic measures with the purpose to take management actions in time.