The resurgence of tuberculosis in Russia

This paper documents and attempts to explain the epidemic spread of tubercu losis (TB) in Russia during the 1990s. After several decades of decline, th e notification rate of all new TB cases among permanent residents increased by 7.5% per year from 1991-1999 and the death rate by 11% per year. Growth was quickest from 1993-1995 but increased again after the economic crisis of August 1998. Approximately 120 000 new cases and 30 000 deaths were repo rted in 1999. Case detection and cure rates have fallen in Russia since the mid-1980s; the fall has been accompanied by a higher frequency of severe d isease among cases, and higher death and case fatality rates. With a mathem atical model describing the deterioration in case finding and cure rates we could replicate the average rate of increase in incidence 1991-1999 but no t the precise timing of the observed changes. Other factors that probably h elped to shape the observed rise in caseload include enhanced transmission due to the mixing of prison and civilian populations, an increase in suscep tibility to disease, and changes in the proportion of cases detected by sur veillance. Although our explanation for the resurgence of TB is incomplete, we have identified a set of measures that can be implemented now to cut tr ansmission, incidence and deaths.