Evil empire's fall spawns a deadly legacy

GLENDA COOPER

Diphtheria, cholera and tuberculosis are making a European comeback in an "incredible" resurgence of contagious diseases that once seemed conquered, says the World Health Organisation.

Their dramatic rise follows the breakdown of what Ronald Reagan once dubbed "the evil empire" - the former Soviet Union. The fragile economies of the new states led to a neglect of mass immunisation and increased migration.

A diphtheria epidemic sweeping the independent states of the former USSR has been declared an international health emergency by the WHO and Unicef. Europe now accounts for 80 per cent of diphtheria cases reported world-wide. In 1994 over 47,000 people in thesecountries contracted the disease - a 250 per cent increase over the previous year - and there were 55,000 cases in 1995.

Although the majority of diphtheria cases were in the former Soviet Union, it has spread. From 1993-94 around 20 cases were imported to other European nations - 10 in Germany, 10 in Poland, four in Finland and one in Norway.

Dr Sieghart Dittman, co- ordinator of the WHO's immunisation and vaccine programme, commented: "This is an incredible re-emergence of infectious diseases which we thought we had conquered."

The number of registered cholera cases in the WHO European region increased nine times from 1993 to 1994. In 1995 17 of the 50 member states reported at least one imported case of cholera. Tuberculosis strains resistant to drugs are increasing and the downward trend of reported cases of the disease in western Europe has levelled off. Malaria, a nearly forgotten disease in 1980s Europe, has exploded in recent years from 20,000 cases in 1992 to more than 100,000 last year.

In Britain there have been 25 cases of diphtheria imported between 1990 and 1994, and nearly 40 cases of imported cholera from 1993 to 1995. Tuberculosis has remained constant at around 5,500 to 6,000 cases reported per year. Robert George, a director of the Public Health Laboratory Service, said: "We have to be absolutely aware to be ready. The UK is not under major threat at the moment but there is no cause for complacency."

In western Europe communicable diseases are responsible for 7 per cent of deaths andmore than 60 per cent of all acute illnesses. Elsewhere in Europe those percentages are much higher.

The main causes of the resurgence in such diseases is found in the collapse of the former Soviet Union. With the unrest and economic fragility that followed, vaccination programmes often suffered. Economic and social difficulties also led to breakdowns in sanitary infrastructures and water supplies. Dr Jo Asvall, regional director of the WHO, said: "As late as 1994 all these countries which came out of the former Soviet Union lost 15 per cent of their gross national product. The national economy crumbled and this had a disastrous effect on health care systems ... It is a huge problem and will continue to grow if something serious isn't done about it." The WHO wants a comprehensive strategy to be implemented immediately across Europe. Mass immunisation should be strengthened, particularly in the newly independent states. Surveillance of the early stages of emerging and re-emerging diseases should be improved with a network of national laboratories, and aid should be supplied to improve basic hygiene and water quality.