Russia hit by infectious diseases

BMJ 1995; 310 doi: (Published 01 April 1995) Cite this as: BMJ 1995;310:821

Russia and the other countries of the former Soviet Union are seeing a sharp increase in the incidence of infectious diseases as poverty and the breakdown of the communist health care system take their toll. Diphtheria and tuberculosis are the main threats, although the incidence of cholera and sexually transmitted diseases is also rising. According to figures from the State Committee for Sanitary and Epidemiological Supervision, the overall incidence of infectious diseases rose by 180% in 1994. This was after a sharp 290% increase in the previous year.

Fighting in the region of Chechnya, which is feared to have claimed at least 25000 lives over the past three months, has added a new danger. Doctors in the capital, Grozny, where some 100000 people currently live without running water, gas, or electricity, are bracing themselves for an epidemic of cholera and other diseases as temperatures rise during spring.

Water in the city is supplied from trucks but has to be boiled over fires of wood. Makeshift graves, often dangerously shallow, dot the roadsides, while more bodies are trapped in the rubble. “The sanitary and epidemiological situation in Chechnya is close to an emergency,” said Yevgeny Bolyayev, head of Russia's Epidemics and Sanitary Control State Committee.

Yuri Fyodorov, the deputy chief of the Russian Health Ministry's infectious diseases department, has cited other potential dangers in Chechnya: diphtheria has claimed several victims in recent weeks, while hepatitis and dysentery are widespread. Health officials claim that the problem has been exacerbated by the collapse of state public health services during the three years of self proclaimed independence in Chechnya. Russian troops were sent in to end this state of independence.

Vaccination programmes virtually ground to a halt during the period, while epidemiologists from elsewhere in Russia were barred from visiting the region. But Chechnya is far from being the only black spot in the former Soviet Union: the danger of epidemics is also acute in several other regions.

South of the Caucasus in the Georgian capital, Tbilisi, officials have warned of the dangers of cholera because of a deterioration in the quality of the city's water supply system, which has not been properly renovated in more than half a century. Malaria is also emerging as a danger in the Krasnodar region and elsewhere across southern Russia.

On Russia's Pacific Coast, it is diphtheria that is the main problem. The incidence of the disease last year in the bleak Magadan district was 93 per 100000 population, more than four times the national average.

The situation seems to have worsened this year. Epidemiologists in the nearby Khabarovsk region registered 50 cases of diphtheria in two small towns, Sovetskaya Gavan and Vadino, in January, against 317 in the whole region last year.—PETER CONRADI, Moscow correspondent, European

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