Resurgence of communicable diseases in Europe

24 WoddHeolth r 50thYeor, No. 1, Jonuory-Februoryl99/ Resurgen(e of (ommunicoble diseoses in Europe Sieghort Dittmonn Bosnion refugees on the move. Civil unrest ond sociol upheovol tncreose lhe potent'iol for lhe ropid spreod of communicoble diseoses. Photo: Keysfone,/Comero Press/P. Horris @. (holero Cholera had disappeared from Europe by the end of the last cen- tury. A few isolated imported cases were reported occasionally from some countries of the region, usually the result of increased travel and tourism to cholera-endemic coun- tries. Since 1990, howeveq larger outbreaks of this waterborne disease have occurred, affecting hundreds of people in Albania, Kazakstan, Moldova, Romania, the Russian Federation and Taj ikistan. Molorio The number of indigenous malaria cases has exploded in recent years, from 20 000 in 1992 to more than 100 000 in 1995, with most cases found in Azerbaijan, Tajikistan and Turkey. In addition, some 3000 to 4000 imported malaria cases are reported each year in other countries of the European Region, some of them misdiagnosed or diagnosed too late and therefore resulting in death. AIDS ond HIV infection HIV is continuing to spread, and now affects particularly groups of drug users in several eastern European countries. HIV infection has risen dramatically among intra- venous drug users in Ukraine, and the start of a similar pattern has been reported from Belarus. Sexuolly tronsmilted diseoses Almost all countries of the former USSR have in recenl years experi- enced a sharp increase in the inci- Since the beginning of the l?90s,0 serious r. re-emergence 0r communr coble diseoses hos been threofening Europe. ollowing a general improvement in living conditions, the success of immunization programmes and the treatment of life-threatening infections in Europe in recent decades, communicable diseases seemed to be losing their importance as a major public health issue. Since the beginning ofthe 1990s, however, a serious re-emergence of communi- cable diseases has been threatening the European Region of WHO. This mainly affects the countries of cen- tral and eastern Europe and particu- larly the newly independent states (NIS) of the former Soviet Union. Economic hardship, rapid social change, greater opportunities for travel, increased numbers of refugees and displaced persons caused by civil unrest in many areas, and the shorl- age of essential vaccines and drugs have all increased the potential for a more rapid rise in the transmission of communicable diseases. The resur- gence ofdiseases such as cholera, diphtheria, malaria and syphilis in many eastern European countries has become a very serious problem, and not only for the people of the coun- tries involved. Frontiers may act as checkpoints for people and goods crossing from country to country but, as new and re-emerging diseases threaten, no country can seal off its borders from risks to public health. Diphtherio Epidemic diphtheria has re-emerged on a massive scale in the NIS, begin- ning in the Russian Federation in 1990 and affecting all 15 countries by the end of 1994. More than 907o of all diphtheria cases reported worldwide during 1990-95 were reported from the NIS. Since the epidemic began, more than 125 000 cases and 4000 deaths have been reported in the NIS, and imported cases have occurred in other coun- tries of Europe and Asia. WoddHeolth r 50lhYeor. No. l. Jonuory-tebruory1997 dence of syphilis, gonorrhoea and certain other sexually transmitted diseases. Together with the increase in intravenous drug use, this indi- cates an increased risk of HIV trans- mission. Tuberrulosis Morbidity and mortality due to tuberculosis are increasing in many countries of the eastern part of the European Region. The downward trend in tuberculosis in western Europe has levelled off, with 3V5OVo of new tuberculosis cases occurring among migrant popula- tions. Tuberculosis strains resistant to drugs are spreading. Globolthreots The problem of emerging and re- emerging diseases is of growing concem to all countries of the world. The situation described above, as well as recent outbreaks of plague in India and of Ebola fever inZure, should underline the importance of improved surveillance, prompt epidemiological investigation, the need for adequate laboratory capac- ity and the global implications of the problem. One of the most alarming aspects of the threats presented by new and emerging infections is antibiotic drug resistance. Coolition of ollies In view of these changes in the panorama of communicable dis- eases, WHO's Regional Office for Europe has stepped up efforts against communicable diseases in Europe by reallocating resources. A broad coalition with other interna- tional, governmental and nongovernmental organizations has been developed to assist the eastern European countries in their fight against these diseases. Considerable support for disease control, through immunization and the completion of primary immunization in children in the NIS, has also been provided by the international donor community, including the Interagency Immunization Coordinating Committee for the NIS, created in 1994in Kyoto, Japan. The secre- tariat of this coordinating committee is located in WHO's Regional Office for Europe. In September 1995, the annual meeting of the European Regional Committee, which was attended by official delegates from the 50 Member States of the Region, called for a much stronger effort to support Member States in re-establishing effective progftrmmes to control communicable diseases. Priority actions and targets, with emphasis on support to countries in central and eastern Europe, are as follows. I Surveillance for early detection of emerging and re-emerging dis- eases, including resistance to antibiotics, must be improved in Europe by setting up a network of national collaborating centres. The epidemic of diphtheria in the NIS must be controlled by carry- ing out sEategies, recommended by WHO andUNICEF, focusing on mass immunization of the affected populations, appropriate case management and greater surveillance. Surveillance, prevention and control of AIDS, HIV infection, syphilis and other sexually trans- mitted diseases must be improved, in close cooperation with UNAIDS. The transmission of wild polio- viruses in the European Region should be intemrpted by the end of 1997, using coordinated mass immunization campaigns across national and regional borders, and the surveillance of poliomyelitis should be strengthened in order to certify Europe as a polio-free region. National immunization prograrnmes with specific targets should be strengthened in all countries ofEurope, and new and improved vaccines should be introduced. Tuberculosis control in all European countries should be strengthened and supported by putting into effect WHO- recommended policies. The countries of central and eastern Europe should be assisted in applying WHO-recommended strategies for the control of diar- rhoeal and acute respiratory diseases. I I I I I I I Dr Sieghon Diftmonn is Coordinotor, Connunicoble Diseoses ond lmmunizotion, WHO Regionol Office for Europe, 8 Scherfigsvej, DK-2 I 0O Copenhogen, Denmork. A mossive epidemic of diphtherio reemerged in the Newly lndependenl Sfoles of eostern Europe in the 1990s. Thonks to moss immunizolion, oppropriote cose monogement ond greoter surueillonce, the situotion improved greotly in 1996. Groph byWHO.