Russia's raging tuberculosis epidemic has spread to Scandinavia through emigration and threatens other Western countries, including the United States, officials of the World Health Organization warned Tuesday.
The alarming rate of new TB cases reported in Russia and other Eastern European countries last year underscored earlier cautions that collapsing health care systems in the former Communist world have fostered a flourishing of the disease that already kills 3-million in the world each year.
But the rising numbers of TB infections in previously low-incidence countries to which Russians have been emigrating has made a reality of health officials' worst fears: that the epidemic will transcend borders and social classes.
"The focus here has been on Scandinavian countries, but elevated risk has to apply to all Western European states and to other low-incidence countries like the United States," WHO scientific officer Chris Dye said of the report he wrote and released in Copenhagen, Denmark.
Tuberculosis is primarily spread through coughing; an infected person can spread the disease to dozens of healthy people a year, experts say. The disease is treatable, but poor care has allowed drug-resistant strains to flourish.
While most countries of the former Soviet Union and Eastern Europe have seen a sharp rise in reported TB cases since post-Communist economic restructuring diverted money from state-run medical services, Russia has the dubious distinctions of harboring the most TB cases in the developed world and openly resisting WHO recommendations for diagnosis and treatment.
In a separate report issued last week, the Geneva-based global health agency named Russia as one of the countries most responsible for the disease getting out of control.
Russian health officials, for example, insist on requiring costly chest X-rays to diagnose TB, rather than sputum samples relied on under WHO's Directly Observed Treatment Short-Course. The global health agency program also allows most of the months-long drug treatment for TB to be self-administered, allowing the infected to return to their homes and jobs within two to three months instead of the two years of hospitalization usually dictated by the Soviet-era method.
WHO officials agree the Soviet program showed good results in its time, but Russia cannot now afford networks of TB clinics. Infections and drug resistance have soared as a result.
Russia posted a 28 percent increase in reported new TB cases over the past two years and a doubling of the annual growth rate since the Soviet Union disintegrated in 1991, WHO officials said.
"Only Africa has witnessed such a rapid increase in TB cases in recent years," Jo E. Asvall, the agency's European regional director, said at a conference in Copenhagen. "Yet even Africa has not experienced the alarming number of multidrug-resistant TB cases which we are seeing in Eastern Europe."
Russia has an estimated 2-million TB sufferers, and the number of new cases grew from 50,641 in 1990 to 111,075 in 1996, the last year for which figures are available. This means that this country of 148-million has 75 cases per 100,000 population; the rate in the United States is eight per 100,000.
Like most of Western Europe, Scandinavian countries record low incidence of TB, but the figures released Tuesday show what WHO officials say is a disturbing rise traceable to those coming from more highly infected countries, primarily Russia.
Denmark, Norway and Sweden last year had low rates of new cases of TB: nine per 100,000 in Denmark, six per 100,000 in Sweden and five per 100,000 in Norway. But of the 1,194 new cases reported last year, 683, or 57 percent, were among immigrants, the vast majority from Russia.