Published: 06.10.05 Updated: 06.10.2005 11:02:03
Hans Blystad, Lars Blad, Johan Giesecke, Swedish Institute for Infectious Disease Control, Sweden, the Steering Group of the Project "Building a Network for Infectious Disease Surveillance in the Batlic Sea Region
Tuberculosis is a notifiable disease in all countries of the region. For Russia, cases diagnosed in prisons or in military institutions are not included in the supplied data.
Incidence rates for tuberculosis have for many years remained low and relatively stable in the Nordic countries. Germany and Poland have experienced falling rates during the 1990s.
For Northwest Russia as for the whole Russia and the Baltic countries, the incidences have risen sharply in the 1990s and early 2000s. In the last year a slight downward trend has been noted in the Baltic countries. Several factors have contributed to the increase in TB in Russia and the Baltic countries: economic recession, malnutrition, poor living conditions and overcrowding in prisons. Disruption of the health sector, severe shortages of drugs and laboratory supplies also contribute to inadequate tuberculosis control.
Multi-drug resistant tuberculosis is an increasing problem in the Baltic countries and Russia and poses a major challenge of treatment at the individual level and of tuberculosis control at the population level. In the Nordic countries and Germany, the relatively few cases of multi-drug resistant tuberculosis reported so far have mostly been seen among immigrants from developing countries.
In the Nordic countries and Germany, the decrease in incidence among residents is counterbalanced by an increase in the cases among immigrants arriving from developing countries. The two main groups are thus resident elderly persons and young immigrants from high endemic areas. The overwhelming majority of tuberculosis cases in the Baltic countries, Poland and in Russia occur among people with a low socio-economic standard. Overcrowded prisons greatly enhance the spread of multi-resistant tuberculosis.
A number of measures are taken to prevent the further spread of tuberculosis in the eastern part of the region. Control programmes have actively been reoriented according to recent WHO recommendations. The most important measures are increased cooperation between reference laboratories for better diagnostics, implementation of directly observed treatment to ensure higher cure rate, and improved social conditions in prisons. Directly observed treatment have not yet been fully implemented in Poland and most of the countries in the western part of the region.
On the individual level, contact tracing is important to prevent further spread. The importance of BCG vaccination is more disputed. BCG vaccination is a part of the national immunisation programmes in all the countries in the region, except in Denmark, Germany, Iceland and Sweden.