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Kazakhstan: Tuberculosis Constitutes A Deadly Threat

By Esther Pan

Prague, 2 February 1998 (RFE/RL) -- It's a health official's nightmare: a global disease that has the potential to wipe out entire populations, requires expensive drugs to treat and is so contagious it can be caught by inhaling someone's sneeze.

Tuberculosis is back, and it is hitting the Central Asian republic of Kazakhstan especially hard.

The Associated Press reported Tuesday that Kazakhstan has the highest rate of tuberculosis, or TB, among the former Soviet republics. And the numbers are increasing rapidly: over the last three years, TB has grown from 67.1 to 90.9 cases per every 100,000 people. The number of deaths shot up over 50 percent.

In Kazakhstan, which has a population of 15.8 million people, medical authorities say that 52,560 have tuberculosis. In 1997, 6,000 people died of the disease.

Health Department chief Vasily Devyatko told a press conference in Almaty last Tuesday that the government desperately needs more money to fight the disease.

Devyatko said that the Kazak government spends the equivalent of $26.3 million per year to test and treat people for tuberculosis, but it needs 1.5 times that to contain the spread of the epidemic.

Tuberculosis is a disease caused by bacteria which can attack any part of the body, but usually affects the lungs. It is highly contagious. When a person with TB of the lungs or throat coughs or sneezes, he puts bacteria into the air. People nearby who breathe in the bacteria may become infected. The TB bacteria that a person breathes can settle in the lungs and begin to grow. From there, the bacteria can move through the blood to other parts of the body, such as the kidney, spine and brain.

Many people infected with the TB bacteria never contract the disease. They don't feel sick, don't show any symptoms, and can't spread the virus. Their risk of developing TB disease is 10 percent over a lifetime. Medical authorities say that people born in Third World countries are particularly at risk.

The World Health Organization estimates that 95 percent of the eight million people who contract TB every year live in developing countries. An estimated 3 million people die from the disease every year.

New cases of TB worldwide correspond roughly to economic conditions: the highest incidences of the disease are seen in those countries of Africa, Asia, and Latin America with the lowest GNPs, or gross national products.

In industrialized countries, TB dropped steadily from the 1950's through the mid-1980s. Then it began to increase. Much of this rise, says the WHO, is due in part to immigration from countries with high TB rates.

The organization reports that while wealthy industrialized countries with good public health care systems can be expected to keep TB under control, in much of the developing world a catastrophe awaits.

The most effective way to control the spread of the disease is to detect it early and promptly isolate and treat infected people.

In mostly rural countries like Kazakhstan, these steps may prove difficult to provide. Common methods for detecting and treating the disease, including the tuberculin skin test, the recommended four-drug regimen, and x-rays to monitor a patient's progress, may be unavailable or too expensive for small villages. The best treatment for the disease, a combination of drugs, good nutrition, rest and supervised medical care, may be out of reach for high-risk groups like prisoners and the poor, among whom the disease is spreading the fastest.

TB bacteria mutate quickly to resist the drugs being used against them; so it is necessary to use four different drugs to fight the disease.

In 1994, the WHO's Global Tuberculosis Program started an international project to record the levels of anti-tuberculosis drug resistance worldwide and study the correlation between the level of drug resistance and treatment policies in those countries.

The project concluded that resistance to TB drugs is evident around the world, and unless TB control is improved more drug-resistant strains will develop.

The WHO also identified several hot spots around the world where TB is prevalent and threatening to rage out of control. They include Latvia, Estonia and Russia, the Dominican Republic, Argentina, and the Ivory Coast, and much of Asia. The project urged immediate intervention in these areas.

The project concluded with several recommendations to fight the global spread of TB, including a global network to monitor outbreaks, early detection, isolation and treatment of infected patients, and the four-drug regimen to prevent infection from becoming full-fledged TB.