Russian officials arrested and imprisoned 30 Greenpeace activists who climbed on a GazProm oil rig in the Barents Sea, August 2013.
The activists, after being released, February 2014, as part of President Putin’s attempt to showcase Russia at the Sochi Winter Olympics, immediately reported on the horrific conditions of their detention facilities to world media.
Russian Prisons: a Reservoir of Infection
Russia has a reservoir of extensive, long-term tuberculosis infections. Tuberculosis spreads in the community as prisoners leave, as well as through those who work at the prison, including medical personnel.
Unfortunately, due to globalization, tuberculosis is not just a significant public health concern for Russia – these infections could spread anywhere, thanks to our interconnected intercontinental air travel system.
Tuberculosis takes advantage of compromised immune systems. Large populations, poor nutrition, high stress, and poor living conditions are all contributing factors, and all of these conditions are present in the Russian prison system. In addition, prisoner quarantine keeps the infected people together, which results in re-infection.
In the non-immune (susceptible) host, the bacilli initially multiply unopposed by normal host defense mechanisms, including the macrophage during phagocytosis (when the immune system cell engulfs another cell) and may remain viable for extended periods of time.
The Spread of Tuberculosis
Tuberculosis spreads when an infected person sneezes or coughs. Mycobacterium tuberculosis remains in the air for days and may travel great distances – so once an outbreak starts, it tends to last a long time. Very few tuberculosis cells are necessary for the infection to reach the lungs – which provide a high concentration of oxygen and helps tuberculosis survive.
One person infected with tuberculosis may infect up to 15 people. Family household contacts, especially children in schools who are clearly not immuno-compromised, along with individuals working or living in enclosed environments (hospitals, nursing homes and prisons) with an infected person are at major risk of TB infection.
Now, however, some good may come out of new drug treatments for multi-drug-resistant TB.
Médecins Sans Frontières
According to a 2004 study, published in the Lancet, by Dominique Lafontaine, et al, Médecins Sans Frontières (MSF) started working in Siberian prisons in 1996, where they treated at least 10,000 patients for TB, with the approval of the penal authorities, using the WHO-led DOTS TB treatment strategy. Unfortunately, MSF withdrew from the region in September 2002.
During that six year period, doctors treated many patients with multi-drug-resistant tuberculosis. In Siberian prisons, at least 22% of new cases, and at most 40% of re-treatment cases, were multi-drug-resistant – these are some of the highest multi-drug-resistant TB rates recorded around the world.
MSF applied to treat multiple-drug-resistant TB patients to the Green Light Committee International Authority, using caproemycin, cycloserine and flouoro-quinolones. These antibiotic treatments are reserved for cases involving drug-resistant organisms, treatment failures, extra-pulmonary TB, drug toxicity or patient intolerance to all other agents.
Although the Green Light Committee International Authority approved their application to start using second-line drugs to treat patients in Siberian prisons, the Russian Ministry of Health rejected this application to treat the patients. According to the MSF study, their application was rejected, “on the grounds that the treatment schemes proposed contradicted the regulations of the Russian Pharmaceutical Committee. It therefore classified the DOTS-Plus pilot project as “experimental”, which is forbidden within the penal system under national law.”
Existing Russian drug legislation, imposed by ultra Russian nationalist, President Vladimir Putin, ensured MSF were required to use a Russia-dictated treatment strategy for multiple-drug-resistant tuberculosis. The Russia-approved treatment contradicted the basic treatment principles that the World Health Organization outlines for multi-drug resistant TB. These treatments were crucial for the program to cure recalcitrant TB patients. Regrettably, in September, 2003, MSF pulled their teams out of Siberia and closed down the TB treatment program.
Tuberculosis, Russian Prisons, and Immune-compromised Patients Worldwide
MSF efforts in Russian prisons for six years led to a crisis whereby now, Russian Ministry of Health officials are making concerted efforts to treat multiple-drug-resistant tuberculosis in prisons. Released prisoners harboring latent tuberculosis could threaten AIDS/HIV patients worldwide. Russian prison staff including prison officers, nurses, doctors and inmates regularly contract TB in the course of their working lives.
What’s the answer to this ongoing problem? Application of WHO standards of care in Russian prisons could make all the difference.