TUBERCULOSIS IN SIBERIA .1. AN EPIDEMIOLOGIC AND MICROBIOLOGICAL ASSESSMENT

Setting: Siberia, Russian Federation. Objective: To assess the situati on regarding tuberculosis as a paradigm for the Russian Federation. De sign: Data was obtained from official sources and through visits to di spensaries and hospitals in 1994. Results: The downward trend in notif ications of tuberculosis throughout Russia reversed in 1990/91, the ra te 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 s urveillance 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 clini cal and radiological grounds, Bacille Calmette-Guerin 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 organisa tionally separate, and direct comparison of smear and culture data is not possible, Drug resistance to isoniazid and streptomycin is probabl y high and resistance to rifampicin low, but data on susceptibility of isolates from new cases are not available. Conclusion: Tuberculosis i s 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.