Alarming levels of drug-resistant tuberculosis in Belarus: results of a survey in Minsk

Abstract

Resistance to anti-tuberculosis (TB) medicines is a major public health threat in most countries of the former Soviet Union. As no representative and quality-assured information on the magnitude of this problem existed in Belarus, a survey was conducted in the capital city of Minsk.Between November 2009 and December 2010, 156 consecutively diagnosed new and 68 previously treated culture-positive TB patients residing in Minsk were enrolled in the survey. Mycobacterium tuberculosis isolates were obtained from each patient and tested for susceptibility to first- and second-line anti-TB drugs.Multidrug-resistant (MDR)-TB was found in 35.3% (95% CI 27.7–42.8) of new patients and 76.5% (95% CI 66.1–86.8) of those previously treated. Overall, nearly one in two patients enrolled had MDR-TB. Extensively drug-resistant TB was reported in 15 of the 107 MDR-TB patients (14.0%, 95% CI 7.3–20.7). Patients <35 yrs of age have shown a two times higher odds ratio of multidrug-resistant TB than those aged >35 yrs.The findings of this survey in Minsk city are alarming and represent the highest proportions of MDR-TB ever recorded in the world. This study greatly contributes to the understanding of the burden of drug-resistant TB in urban areas of Belarus.

Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors

“…The results show that the alarming levels of drug-resistant TB recently detected in Minsk 5 are not confined to the capital city but are widespread throughout the country. The prevalence of MDR-TB detected among the new smear-positive cases enrolled in the nationwide survey (32.3%) is similar to the corresponding values previously reported in Minsk city (35.3%) 5 and the neighbouring Pskov Oblast in the Russian Federation (28.0%). 12 This high level of MDR-TB among new TB cases indicates enormous on-going transmission of resistant strains of M. tuberculosis in the community.…”

“…In a survey conducted in 2010 in Minsk, the capital city, nearly one out of every two (47.8%) TB patients investigated was found to have MDR-TB; this was the highest prevalence of MDR-TB ever recorded among TB patients worldwide. 5 The Minsk survey was, however, relatively small and limited to a highly urbanized area. The national Ministry of Health therefore decided to conduct a larger, nationwide survey, not only to have a better understanding of the levels of drug resistance throughout Belarus but also to investigate the risk factors for the development of MDR-TB.…”

Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation

“…The highest rates of MDR-TB, up to 26% among new cases and up to 65% among previously treated cases, are seen in the countries of the FSU [14,15], which together had an estimated 31 000 cases in total in 2010 [16].…”

Pulmonary Tuberculosis Management: 2015 Update

“…Overall, 75 countries plus five territories globally reported representative data on the proportion of MDR-TB cases affected by XDR-TB, being 9% (95% CI: 6. We have mentioned above how unsatisfactory the clinical outcome of MDR-TB cases is 1,6,29,30 . In the largest ever-published cohort of 9,153 MDR-TB cases from 32 observational cohorts supporting an individual data meta-analysis, the clinical outcomes were unacceptably poor (treatment success 54%; default 23%; failure/ relapse 8%; death 15%) 31 .…”

“…resistant to any fluoroquinolones and to at least one of the second-line injectable drugs, amikacin, capreomycin, and kanamycin on top of isoniazid and rifampicin) drugs is posing a real threat to global TB control and elimination efforts [2][3][4][5] . The WHO estimated that in 2013, the prevalence of MDR-TB among the new and re-treated cases was, respectively, 3.5 and 20.5%, with 9% of them being XDR-TB 1,6 . Unfortunately, at the global level, out of the estimated 300,000 MDR-TB cases, only 136,000 (45.3%) are diagnosed and 97,000 (32.3%) are treated using adequate regimens based on drug-susceptibility testing (DST).…”