This paper documents and attempts to explain the epidemic spread of tuberculosis (TB) in Russia during the 1990s. After several decades of decline, the 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 reported 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 disease among cases, and higher death and case fatality rates. With a mathematical model describing the deterioration in case finding and cure rates we could replicate the average rate of increase in incidence 1991-1999 but not the precise timing of the observed changes. Other factors that probably helped to shape the observed rise in caseload include enhanced transmission due to the mixing of prison and civilian populations, an increase in susceptibility to disease, and changes in the proportion of cases detected by surveillance. Although our explanation for the resurgence of TB is incomplete, we have identified a set of measures that can be implemented now to cut transmission, incidence and deaths.

Much of the Russian Federation's large tuberculosis hospital infrastructure is unnecessary when clinical and public health criteria are used, but the large hospital infrastructure within the tuberculosis-control system has an important social support function. Improving the efficiency of the system will require the reform of health-system norms and regulations as they relate to resource allocation and clinical care and implementation of lower-cost approaches to case management for patients with social problems. Additionally, closer attention will need to be paid to the management of staff numbers in the tuberculosis system.

The epidemic situation with tuberculosis in the Russian Federation is improving, but remains tense. From 2008 to 2018, the tuberculosis incidence rate of the population of the Russian Federation decreased by 1.9 times. The factors affecting the course of the epidemic process of tuberculosis infection are considered: the reliability of indicators, the standard of living of the population, the timely identification of patients with tuberculosis, HIV infection in patients with tuberculosis and the resistance of mycobacterium tuberculosis (MBT) to medicinal anti-TB drugs. The incidence of tuberculosis in some cases underestimated due to deliberate misregistration and registration of newly diagnosed patients with tuberculosis. The use of Diaskintest during mass examinations of children and adolescents does not allow for the timely diagnosis of active tuberculosis in 60 % of children and in 12 % of adolescents identified from the Mantoux test. Primary infection of MBT in children 0–17 years of age with the use of Diaskintest, compared with the use of the Mantoux test (virage), is detected on average only in 6.9 % (from 3.1 to 26.3 %) of children with primary infection (virage) diagnosed by Mantoux test.

This study shows the dynamics of the epidemiological process over the last decade and presents the causes of the deterioration in TB control. Explanations are given for the TB mortality rate increase, the trustworthiness of the data, and the factors influencing its formation. The present-day TB epidemiological situation in Russia is characterized by an increase in exogenous infection. Peaks of epidemiological deterioration were registered in 1993 and 1999. Marked deterioration of the epidemiological situation in 1999 resulted from an economic crisis in August 1998 and a consequent dramatic decrease in the living standards of the population. In the 1990s this trend has changed. TB infection spreads according to trends that are quite similar to those at the beginning of 20th century. The official TB morbidity rate does not reflect the true level of incidence because of undetected TB cases (approx. 10%).

No abstract