Tuberculosis in Russia is one of the country's top health emergencies.  The country has the highest TB mortality rate in Europe, 20 times higher than in the West.  About half of all cases reported in the former Soviet Union are in Russia. Of particular concern in the region is the prevelance of a drug-resistant form of TB.  VOA's Lisa McAdams in Moscow looks at Russian and Eurasian efforts to contain the disease, which doubled in the 1990s, but has leveled off since 2000.

An x-ray of a patient affected by tuberculosis

Last month, the Russian parliament approved a nearly $3 billion program aimed at raising the country's overall life expectancy by tackling infectious diseases, such as tuberculosis. 

Russian Health and Social Development Minister Mikhail Zurabov says the new program will bring the treatment regimen for infectious diseases up to Western standards. 

However, others say the program apparently fails to address the long-standing problem of continued under reporting of illness.

According to Russian statistics, 83 of every 100,000 people in Russia are infected with TB. The Red Cross says 30,000 people die of the disease every year. However, the number of people infected is not fully known, as health officials say under-reporting of cases is a problem.

Stigma surrounding TB plays a part.  But, according to the WHO's regional coordinator for TB control in Central Asia, Dr. Gombrogaram Tsogt, lack of access to information also factors into the trend.

"I would say TB education activities among the population in these countries is almost prohibited, or not well supported," said Dr. Gombrogaram Tsogt.  "So, the population is very unaware about what TB is, what the symptoms of TB are, and what should be done to complete treatment."

The U.N. says the highest rates of reported infection are among men aged 35-64. Dr. Wieslaw Jakubowiak, the head of WHO's TB Prevention Control Program in Russia, describes what he says is a typical TB patient.

"The typical patient is male, his age is a little bit above 40 years old, he's unemployed, usually very often abusing alcohol, and coming from socially vulnerable groups," said Dr. Jakubowiak.  "To some extent, there are a number of patients who are ex-prisoners, who are also homeless.  So, treatment and to get good adherence of such a patient is not an easy job."

International health experts say the prison system has been a breeding ground for TB and that the notification rate of infection in the system is about 20 times higher than in the population at large.

Of particular concern is a drug-resistant form of TB, which results from incomplete or incorrect medication.

Dr. Jakubowiak says fighting TB is not just a medical problem, but also one of economics and organization.

He says that, as late as the 1990's, there were no supervisory visits to state treatment facilities to track the care and progress of the disease.  But now, he says government funds are allocated to support such visits.

Dr. Jakubowiak also points to clear strides in staff training and the equipping of laboratories as further signs of hope in the fight against TB.

"We expect that the major indicators can improve within the next two years," he added.  "But what we have as of today - the notification rates, or number of cases identified, is about 83 per 100,000.  So, its relatively stable.  We can expect mortality can decrease a little bit in the next two years.  What we see now is that all drugs - first line drugs - are in place and stock is relatively stable. Even in the prison systems, they have a stock for more than two years."

Dr. Jakubowiak says the most important lesson learned is that TB control requires patience.  As he put it, it is not possible to expect dramatic change.  But bit by bit, he says, the scourge of TB can be alleviated.