Tuberculosis in Siberia: 1. An epidemiological and microbiological assessment.
METHODS
Siberia, Russian Federation.


OBJECTIVE
To assess the situation regarding tuberculosis as a paradigm for the Russian Federation.


METHODS
Data was obtained from official sources and through visits to dispensaries and hospitals in 1994.


RESULTS
The downward trend in notifications of tuberculosis throughout Russia reversed in 1990/91, the rate increasing from 34/100,000 to 42.9/100,000 in 1993. Incidence rates are higher in Siberia, varying from approximately 43 to 108/100,000; prevalence is 250-300/100,000. The tuberculosis service is centralized and based on specialized polyclinics and dispensaries. An extensive surveillance system employs regular fluorography and tuberculin testing: half of the cases diagnosed are detected by fluorography, against 1% through contact tracing. Patients are classified principally on clinical and radiological grounds. Bacille Calmette-Guérin immunisation is performed at birth and at age 7, and again at 13, 21, and 28 years if Mantoux test is negative. Microscopy and culture services are organisationally separate, and direct comparison of smear and culture data is not possible. Drug resistance to isoniazid and streptomycin is probably high and resistance to rifampicin low, but data on susceptibility of isolates from new cases are not available.


CONCLUSIONS
Tuberculosis is increasing in Siberia. Homelessness, unemployment and alcoholism are important factors, but concurrent human immunodeficiency virus (HIV) infection appears to be uncommon. Prisons probably form a significant reservoir of infectious cases.
Drobniewski
F
F
Regional Tuberculosis Centre, Dulwich Public Health Laboratory, London.
Tayler
E
E
Ignatenko
N
N
Paul
J
J
Connolly
M
M
Nye
P
P
Lyagoshina
T
T
Besse
C
C
D000328:Adult; D001500:BCG Vaccine; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D015995:Prevalence; D012800:Siberia / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control
D001500:BCG Vaccine