WHO: TB poses greatest threat to Europe

ERICA BULMAN,
Associated Press Writer

Tuberculosis has come back in a new, more deadly form to pose the disease's greatest threat to Europe since World War II, world health officials said Tuesday.

Drug-resistant strains of the disease are lurking just beyond the European Union's borders, in countries where AIDS blossomed following the collapse of the Soviet Union, according to U.N. and Red Cross health officials.

"The drug resistance that we are seeing now is without doubt the most alarming TB situation on the continent since World War II, and our message to EU leaders is: Wake up. Do not delay. Do not let this problem get further out of hand," said Markuu Niskala, secretary-general of the International Federation of Red Cross and Red Crescent Societies.

The high levels of multi-drug resistant tuberculosis in Baltic countries, Eastern Europe and Central Asia, and the emergence of a new, extremely drug-resistant strain of TB have led international health officials to create the "Stop TB Partnership in Europe" to fight the epidemic.

Tuberculosis, a respiratory illness spread by coughing and sneezing, is the world's deadliest infectious disease that is curable. The World Health Organization estimates that 1.7 million people died from TB in 2004.

Of the 20 countries in the world with the highest rates of multi-drug resistant tuberculosis, 14 are in "the European region," according to a recent global survey by the WHO and the U.S. Centers for Disease Control and Prevention.

European countries also have the highest rate of extreme drug-resistant tuberculosis known as XDR-TB.

"TB has always been low on the European Union agenda. It's a mystery there has been so little concern in addressing the TB epidemic in Europe," said Michael Luhan, an official at the Geneva-based Red Cross federation. "The purpose of this partnership is to stimulate a much greater sense of concern, engagement and commitment on the part of the European Union to address this problem in its own region."

Luhan said the bulk of technical support in the European region and central Asia is currently provided by the United States, which is also a major financial contributor.

"In the last few years, there's been more contribution from EU countries, but they still are a fraction of those provided by countries outside the region," he said.

In Europe, 50 people get sick with TB and eight people die of the disease every hour, said Pierpaolo de Colombani, a WHO tuberculosis expert. About 15 percent of all TB cases in Europe are multi-drug resistant.

But the incidence of TB varies widely from West to East. For instance, Sweden has four new cases per 100,000 people a year, compared with 177 for Tajikistan.

The rate of incidence of TB in the Western European countries that belonged to the EU before it enlarged in 2004 is 13 cases per 100,000 people every year. That number doubles in the 10 new EU members.

It doubles again to 53 in Romania and Bulgaria and yet again to 98 in the former-Soviet republics farther East.

But migration and EU expansion could change things.

"Not a large number of cases are being imported into the EU from Eastern Europe but it's not necessarily going to stay that way with continued enlargement," Luhan said.

He said TB cases in London have been increasing every year for almost 10 years. In some London areas with many immigrants, rates are as high as 100 per 100,000.

Luhan said that TB had ceased for decades to be a problem in the region, but that it doubled over the past 10 years in the former Soviet Bloc as public health systems collapsed.

If diagnosed at all, patients were treated late, with little follow up to make sure they completed their courses of medication, increasing the drug-resistance of some TB strains.

Luhan said Europe ranks with Africa as areas where TB is a big problem.

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