Red Cross Fighting Rise of TB in Central Asia

Written by Becky Orfinger, Staff Writer, RedCross.org

March 23, 2001 —  Although no longer the public health threat that it once was in the United States, tuberculosis (TB) remains the world's leading infectious disease killer. Because people with weakened immune systems are more susceptible to the disease, developing countries in Central Asia, Africa and Eastern Europe — those with the highest prevalence of HIV/AIDS — bear the majority of the TB burden.

In an effort to raise awareness about the return of this ruthless disease, the UN's World Health Organization (WHO) has been promoting "World TB Day" every March since 1992. In the Aral Sea Region of Central Asia, American Red Cross workers are marking World TB Day on March 24 with a celebration of life.

According to Tim Cummings, American Red Cross Head of Programs for Central Asia, the Red Cross is working to educate people in Kazakhstan and Uzbekistan about the best way to recognize the symptoms of TB and to seek medical attention. TB is a highly infectious disease, but one that is curable with the appropriate course of treatment. "Unfortunately, the common symptoms of TB — a long-lasting cough, phlegm, aches and pains — mimic those of a cold or flu, so it's important to teach people what to look for," said Cummings.

Cummings said that, along with representatives from Medecins Sans Frontieres, an international humanitarian aid organization, Red Cross youth workers will stage several events to raise TB awareness in Kazakhstan on World TB Day Saturday (March 24). In addition to participating in a table tennis tournament and a T-shirt design contest, attendees will learn about TB and its treatment from doctors and Red Cross visiting nurses. Cummings said that youth workers will also put on plays about successful treatment of TB and ways to prevent the disease from spreading.

Cummings said that a great deal if misinformation exists in Kazakhstan about how TB is spread. Over the years, Cummings has heard stories about people who refuse to marry anyone who may have suffered from TB at one time. "There is a lot of paranoia about catching the disease, although people don't really understand how to avoid it," he said. "People who have infectious TB are basically shunned from society."

Patients who do not continue to take medication after symptoms cease frequently fall victim to an even more virulent strain of TB.

Halting a Quickly Spreading Disease

TB is extremely contagious because it can spread through the air, like the common cold. According to WHO, when a TB-infected person sneezes, coughs or spits, people nearby are at risk of contracting the disease. When a person's immune system is weakened, he or she is even more susceptible to infectious TB (meaning that it is likely the disease will not remain dormant, if he or she inhales the bacteria). Cummings said that in Kazakhstan, general poor health and malnutrition make much of the population vulnerable to becoming sick from TB. The shrinking of the Aral Sea, which once was a source of revenue and food products for Kazakhstan, is an ecological disaster that contributed to rampant malnutrition and poverty. "The key to slowing down the spread of TB in Central Asia is teaching people to maintain good nutrition and do all they can to stay healthy. These are the prevention strategies that will be stressed at the World TB Day activities," he said.

Also particularly susceptible to infectious TB are people with HIV/AIDS, because it weakens the body's ability to fight disease. The Centers for Disease Control and Prevention (CDC) reports that people infected with both HIV and TB are up to 800 times more likely to develop active TB disease during their lifetimes than people without HIV infection.

According to Cummings, in Kazakhstan, the number of people with the infectious form of both diseases is rising because of recent mass prison amnesties. As part of the governmental upheaval in the former Soviet Union, Kazakhstan and several other countries have begun to pass amnesty laws that authorize the release of large groups of prisoners. "Because so many of these people are infected with TB, their release introduces even more TB bacteria into the general population," Cummings said. "The hope is that the former prisoners will receive TB treatment once released into the civilian system, but many slip through the cracks."

DOTS: TB Cure for All

WHO has developed and piloted a comprehensive TB-treatment in developing countries called Directly Observed Therapy, Short-course (DOTS). Already successfully implemented in China, Peru, Vietnam and several other countries, DOTS combines the latest anti-TB medication and close monitoring of patients by health officials. During the intensive-treatment phase, which lasts two months, patients are observed around the clock to make sure that they take the proper combination of drugs at the correct times. When patients are no longer contagious, health workers become responsible for monitoring their ongoing treatment and frequent follow-up examinations.

According to WHO, TB can only be successfully eliminated in developing countries like Kazakhstan if patients are not only treated with the proper drugs, but also followed throughout their entire course of treatment to make sure that they do not stop taking the medications once their symptoms disappear. Because the number of MDR-TB cases is on the rise in many countries, WHO has made strict patient follow-up an important component of their anti-TB efforts.

The Human Face of TB

Just a few years ago, Orolhon Khodjaisova served as a provincial chair of a Red Crescent branch in Uzbekistan near the Aral Sea. For years, she had helped people in her community who were unable to help themselves. Now, roles have been reversed, and it is Khodjaisova who relies upon the assistance and kindness of others, of the Red Crescent.  more...

TB bacteria die very slowly, so TB-infected patients must remain on a medication regimen for at least six months (although symptoms will disappear within a few weeks of starting the medication.) According to CDC, remembering to take medication for many months might seem tedious, it is the only way to fully rid a person's body of the TB bacteria. When patients do not complete the full course of medication, the TB bacteria can return in a new form that is resistant to one or more of the prescribed drugs. Called multi-drug resistant TB (MDR-TB), this condition is much more complicated and costly to treat than the more common form of TB.

Cummings said that DOTS has just begun to be implemented in Kazakhstan, and only the largest cities have been targeted so far. He and several other Red Cross workers have implemented an alternate strategy to try to get TB-infected individuals to continue their drug therapy. "We have used something that we know everyone is interested in: food aid. People who have TB are automatically beneficiaries of food aid. By combining a hot meal with a dose of medication, we hope to encourage these people to follow the full course of treatment," he said.

Cummings anticipates that DOTS will be more widely implemented in the next few years. "It's a slow process, but the Red Cross and other humanitarian organizations want to make sure that the TB situation in Central Asia does not reach epidemic proportions," he said. "Hopefully, the hard work that has gone in to planning the World TB day activities will have a lasting effect on the young people of the Aral Sea region."