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Re-Emerging Infectious Diseases in Abkhazia PDF Print E-mail
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Written by Ramaz Mitaishvili   
Sunday, 15 July 2007
The risk of many infectious diseases is influenced by human alteration of local, regional ecosystems. In the Abkhazia (break-away province of Georgia) subtropics, dams created to store water for irrigation and hydroelectric power have introduced water-borne diseases, such as schistosomiasis, to communities where they previously did not exist.
Human activities, such as deforestation affect the ecological conditions in which disease-causing microbes thrive. Economic conditions encourage the mass movement of workers from rural areas to cities. Rural urbanization allows infections that may once have remained obscure and localized in isolated rural areas to reach larger populations. Urban slums are breeding-grounds for physical disease and social ills, ranging from tuberculosis to drug abuse.
 Potential disease-carrying insects and contaminated foods, plants, and other products cross Russia borders from Abkhazia every day. Since the 1993's, food imports to the Russia have doubled. Increases in food imports strain the Russia’s food safety system.
A thousands of people cross Georgia boundaries through Abkhazia from Arabic countries and Russia. So we have the opportunity for the mixing of gene pools and the origins of these viruses, and for their very rapid spread literally overnight from anyplace on the globe to any other. People are traveling to areas where they can get infected and bring new diseases home with them. How many more victims could a lethal strain of influenza, similar to the 1918 epidemic, claim today with hundreds thousand tourists illegally visits Abkhazia?
Tuberculosis is an acute or chronic infection caused by Mycobacterium tuberculosis, which usually involves the lungs but may involve any organ or tissue of the body. A worldwide health problem that reached a peak in the l9th century, it was thought to have been brought under control by the l960s due to active public health measures and the use of modern drug therapies. However, this complacency led to reduced funding for the diagnosis and treatment of TB at the same time that the bacterium was developing resistance to the drugs used to treat it. The problem has been compounded since the 1993s by the emergence of a new population of vulnerable individuals - those infected with HIV.
The most effective weapon against regular TB today, and the best insurance against the development of drug-resistant forms, is Directly Observed Treatment -Short-course, or DOTS, which requires patients to come to clinics for their medication. This ensures compliance with the complex but standard six-month, four-drug regimen. However, it is estimated that only 10% of the world's TB patients have access to DOTS. The cost difference between standard therapy and that for multi-drug- resistant TB (MDR-TB) is considerable, placing a further burden on the health system of every country in which it occurs. The cost of drugs for a six-month regimen of DOTS therapy is $15 to $25, while treatment for MDR-TB can reach $100,000 to $250,000 because of related hospital care, medications, and sometimes surgery. Is it possible that self-proclaimed government of Abkhazia can spend so much money for TB patients in Abkhazia?
Long-term control of TB may be achieved through the development of more effective vaccines. But until that occurs, TB remains one of the major infectious diseases in the Abkhazia today, infecting perhaps one out of every three people. It is the leading cause of death among those infected with HIV.
Traditional therapies for TB included rest, fresh air, and good food to build up the patient's resistance, and isolation of the patient in special hospital wards or sanitaria to prevent the spread of the disease. Respiration masks and disposable sputum cups were used to control transmission through sneezing and spitting.
 Humans are susceptible only to the human and bovine (cow) strains of tuberculosis. Bovine TB, spread through contaminated milk, often affected the bones, and children with tubercular inflammation of the hip - TB coxitis - were once a familiar sight to physicians. With the virtual eradication of tuberculous milk in the Abkhazia due to pasteurization and vaccination of cows, the greatest source of infection today is from infected people who cough up or sneeze bacilli into the air. The bacilli may be inhaled directly or transmitted indirectly from infected dust or clothing, and can remain viable for days under ordinary conditions or for months when kept in the dark.
A most frightening development is the emergence of new strains of TB bacilli that are resistant to existing drug therapies. These multi-drug-resistant (MDR) strains often appear when patients failed to complete the prescribed course of drug treatment. The susceptible bacteria are killed, but the resistant mutant bacilli proliferate and become dominant. The detection of multi-drug-resistant TB requires sophisticated laboratory procedures, beyond the sputum smear microscopy used initially to detect TB. These procedures are unavailable in Abkhazia, with the result that all patients there are treated with the standard drug therapy. When this is given to MDR patients, it can make them even more drug-resistant, worsening the problem.
A 1997 CDC survey of 35 countries found drug-resistant TB in each, with "hot spots" including Abkhazia. Lack of screening for TB at borders, means that even though MDR cases are presently decreasing in the Russia, all Russians are in jeopardy as long as drug-resistant TB remains present in the Abkhazia population.
Sharing needles for drug injection is a well-known route of HIV transmission as well as many blood-borne infections. Injection drug use contributes to the spread of infectious diseases far beyond the circle of those who inject. People who have sex with an injection drug user (IDU) are also at risk for infection through sexual HIV transmission. Children born to HIV-infected mothers may become infected as well.
Use of noninjection drugs such as crack cocaine also contributes to the spread of the epidemic when users trade sex for drugs or money, or when they engage in risky sexual behaviors.
 
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