Eastern Europe faces swelling TB epidemic

Scandinavia prepares to lend aid to its neighbors

On World TB Day, inhabitants of Scandinavia woke up to find some unsettling news in their morning papers: namely, that next door lies the region experiencing the sharpest increases in reported cases of TB anywhere on earth.

No other region, except for Africa, has seen so rapid an increase, experts say; even Africa has not experienced the rise in multidrug-resistant cases currently threatening Eastern Europe and Russia.

According to figures released for World TB Day by the World Health Organization (WHO), reported cases in the region rose 25% between 1994 and 1996. The region as a whole reported more than 249,000 cases of TB in 1996, representing an increase of nearly 50,000 cases since 1994. Russia saw the largest increase in actual numbers, and 18 of 26 Eastern European countries also saw substantial increases.

"A population the size of Copenhagen has become sick with TB over the past four years in Eastern Europe," says Nils Strangberg Pederson, director of research and technology for the Stat ens Serum Institute in Copenhagen. "Because they have not received proper treatment, these people have likely infected a population the size of Denmark and Norway combined."

Scandinavian countries have an obligation to share their own experience in controlling TB, Pederson adds. "The sensible thing to do is to help our neighbors become more effective in curing TB, and thus break the cycle of transmission."

Although TB is under control in Denmark at the moment, with good programs already in place, there is growing reason for concern, say experts. As in the United States, immigration has been a powerful factor in pushing case totals up in the past 10 years. Of the 1,194 reported cases in Denmark, Norway, and Swe den in 1996, 683 occurred among non-nationals. Increased travel, migration, and commerce between Scandinavia, Russia, and the Baltic states are expected to add to the problem.

Arata Kochi, chief of WHO's global TB program, has praise for the willingness expressed by Scandinavian TB control experts to meet the gathering threat head-on. "We are in a race against time to use the DOTS strategy more widely in Eastern Europe before multidrug-resistant strains become more common," says Kochi. "When you become sick with multidrug-resistant TB, you have an illness which is often impossible to cure, and which is a hundred times more expensive to treat than ordinary TB."