EPIDEMIOLOGY

On a worldwide scale, infectious diseases still account for about 25% of all deaths, only surpassed by cardiovascular diseases.¹ The picture, however, is dissimilar when industrialised and developing countries are compared. In Germany, for example, only 1% of all deaths are due to infectious diseases, whereas in developing countries—for example, in sub-Saharan Africa 49% of all deaths are due to infections. Mycobacterium tuberculosis is the second biggest killer world wide, with only HIV/AIDS responsible for more deaths. Tuberculosis notification rates in the year 2000 in many developing countries reached 100 or more per 100 000 population.² A relatively high rate of underreporting has to be assumed for many countries, and estimates reach as high as more than 500 new infections per 100 000 people. In general, tuberculosis is a disease of the poor: the less developed health systems are, the higher the rates of new cases of tuberculosis (fig 1).

One third of the world population has been infected by M tuberculosis. From this pool, almost nine million acute cases developed in 2000, leading to two million deaths. Twenty two high burden countries in the developing areas of the world carry about 80% of the disease burden. Owing to HIV/AIDS, we see, especially in high burden countries in sub-Saharan Africa, an increase of up to 10% of new tuberculosis infections a year. More than 95% of all cases and 98% of all deaths occur in developing countries.

In the European region, tuberculosis notification rates per 100 000 population are the highest in Russia and the other successor states to the Soviet Union.³ Prisons in Russia are a particular focus of tuberculosis.⁴ There are about 1.1 million prisoners in Russia, of whom …