Kiev may be facing an unprecedented tuberculosis crisis. This is according to Larissa Kanarovskaya, the Head of the Kiev City Union of health workers. On December 1, 2014, at a press conference (a video in Russian can be seen here), she announced that on the average, 100 people die every day in Ukraine’s capital, of which one case is from active tuberculosis. The situation, Mrs Kanarovskaya continued, is complicated by an acute shortage of doctors and nurses of TB profile, as well as a critical situation in Ukraine’s health care in general. The growing workload on health workers is accompanied by more and more TB cases being detected among physicians.
“Every day in Kiev 100 people die, one of which if from active tuberculosis. And five people in Kiev get infected with TB daily,” – said L. Kanarovskaya.
She could not be reached for further comment.
While these statistics are not official (nationally in 2013, Ukraine reported a total number of 6,390 TB death cases, of which 207 TB deaths were reported in Kiev – according to the State Statistical Services of Ukraine), the numbers reported by L. Kanarovskaya, even if representing a fraction of the real mortality, warrant close attention as there is possibly a major TB crisis brewing. Ukraine’s TB situation needs to be closely monitored.
Background
As a result of a humanitarian catastrophe in south-eastern oblasts of Ukraine and in Crimea Autonomous Republic, caused by an armed conflict, significant numbers of Ukrainian citizens were forced to flee the area of conflict and leave their homes. While the ability of the government to fund the health care programmes is severely impaired because of the conflict, the rapid growth of TB rates is an anticipated outcome of such a situation. As a result, a new risk group to TB is rapidly emerging – refugees and displaced persons – left out without access to health and social care, and in disparate living conditions. They are often left without documents, financial means, and lose access to health care services. As of September 2014, UNHCR had information about 275,489 forced migrants from south-eastern Ukraine (17,794 from Crimean peninsula and 257,695 from eastern Ukraine).
Forced migrants usually do not have money to purchase quality medical care services, buy medication, etc. The numbers of people who would require medical help in connection to TB are growing in all parts of Ukraine. Likely, health and social assistance will be required by the people with Multi-Drug-Resistant TB (MDR-TB), HIV/AIDS, Hepatitis, co-infection, PWID[1] on substitution therapy (ST), whose life has been endangered because of interrupted treatment. The situation is aggravated by a political crisis, and colossal currency devaluation. This problem requires urgent response.
Another problem is BCG vaccination. According to RT, in September 2014 Kiev maternity units have run out of the BCG vaccine that is administered to all newborns before leaving the hospital. The BCG vaccination is used in Ukraine, and in many other FSU states to prevent TB in children. The first vaccination is usually made at birth, to form the immune response to TB in a newborn baby.
According to RT, the reason for the vaccine absence was a refusal of Ukraine’s government to procure Russian-made BCG vaccine. Ukrainian internet site Korrespondent on Sept 18, 2014 has informed that BCG was absent not only in maternity wards in Kiev, but across all Ukraine, and situation was like this in the previous six months. Instead, the Ministry of Health has promised to supply Ukraine’s maternity wards with a vaccine made in Denmark. There is no information of what the situation with BCG vaccines is now in Ukraine.
[1] PWID – People Who Inject Drugs
Source: TB Europe Coalition