In connection with the spread of dangerous infections in the regions of the North and the growing damage caused by this, the international community has begun to pay more attention to this issue. In 1998, for the joint fight against them the Arctic Council Sustainable Development Working Group ICS project - Circumpolar surveillance was initiated, involving the Arctic regions.
In the next decade, more and more attention was dedicated to the problem of the spread of tuberculosis in the North that prompted hitherto not participating regions to engage in international activities. In 2006, taking into account the high levels of concern about the frequency of tuberculosis in the Arctic, the ICS
Steering Committee established the working group on tuberculosis. The working group includes Greenland, Northern Canada, Northern Sweden, northern regions of Russia and the Arctic region of the United States (Alaska). In 2008 the Northern Forum joined the work with the new project "Infectious diseases monitoring".
Currently, the project is carried out on the basis of medical facilities of member regions of the Northern Forum, as well as with the participation of specialists from the former member of the Northern Forum - St. Petersburg. Despite the fact that the project started with the expectation of coverage of common infectious threats, over time the focus shifted to the problem of tuberculosis; therefore, a working group of the Northern Forum of the same name was created.
Today, within the framework of the project:
- • The aims and objectives of the Work group on TB are set.
- • The governing body of the Work group and the research plan are formed.
- • Almost all the countries of the circumpolar region are involved in the activities of the Work group on TB.
- • The main issues on the part of the international framework for TB data and position data transmission between the participants of the Work group are resolved
- • The goal of the joint study on tuberculosis in the Nordic territories is formulated.
Currently, the aim of collaborative TB research in the northern territories has been determined.
2.3.1 Drug-resistant TB infection monitoring in circumpolar regions of Russia
Aleksandr F. Kravchenko, Director, Applied Research Centre for Phthisiatry, member of the International Circumpolar Surveillance Tuberculosis Working Group (ICS-TB).
- • Sakha Republic (Yakutia) leading region: project head Aleksandr Kravchenko, Director, Applied Research Centre for Phthisiatry, executive Maria Vinokurova, Deputy Director for Science, Applied Research Centre for Phthisiatry
- • Kamchatka Krai: executive Gromov Andrey - Chief Physician of Kamchatka Krai TB Dispensary
- • Arkhangelsk Oblast - Andrey O. Maryandyshev, chief phthisiatrist of the North-Western FD, head of the department of phthisiopneumology of the Northern State Medical University, MD, professor, Corresponding Member of the Russian Academy of Sciences, member of the ICS-TB Working Group, research director of Arkhangelsk Regional TB Dispensary.
With the support of the NF since 2011 the Applied Research Centre for Phthisiatry, together with phthisiatricians of the Arkhangelsk Oblast and the Khanty-Mansiysk Autonomous Okrug, participates in the International Circumpolar Surveillance Tuberculosis (ICS-TB) Working Group project, which aims to study the epidemiological surveillance system for TB among the population of circumpolar regions with common geographic and social issues for developing more effective approaches to the strategy to combat tuberculosis in harsh conditions of the Arctic.
The international ICS project started in 1998 for the epidemiological surveillance of infectious diseases in the Arctic regions, and since 2006 a TB team has been established: Greenland, northern Canada, northern Sweden, the northern regions of the Russian Federation and the Arctic region of the United States (Alaska) to identify trends in TB epidemiology development, raising awareness and cooperation in the field of scientific research.
The Applied Research Centre for Phthisiatry participates in the events of the Northern Forum - Infectious Diseases Control Seminar (USA, Alaska, Fairbanks, 2012) in the program of the 15th International Congress on Circumpolar Health; in 2013 in the work of the 11th Assembly of the Northern Forum in Moscow; in October 2014 in the 2nd Assembly of the Arctic Circle (Reykjavik, Iceland), the 16th International Congress on Circumpolar Medicine held in Finland in 2015. There was also a meeting of the ICS-TB Working Group. A joint project on comparative analysis of tuberculosis monitoring systems in circumpolar regions, 12 regions, incl. 3 regions of Russia (Sakha Republic (Yakutia), Arkhangelsk Oblast, Khanty-Mansiysk Autonomous Okrug) has been completed. The ICS-TB Regulations for 2015-16 have been discussed, the work plan has been agreed upon, the situation of tuberculosis monitoring in Greenland, Denmark, Alaska, Canada, and Yakutia has been reported. The following joint projects are planned, especially to study outbreaks in previously well-off areas.
In September 2015, with the support of the NF and the Ministry of Foreign Affairs, a Symposium was held with international participation in the framework of the 12th Assembly of the Northern Forum. Representatives of WHO, ICS-TB, chief phthisiologists from Federal Districts, having northern regions, representatives of the regions.
In 2016, members has made reports at the International Conference on the Tuberculosis, HIV and Sexually Transferred Infection Issues in the Arctic Regions of the Russian Federation (Arkhangelsk) and exchanged experience in practical work. Presented a report on the interregional research conference “Modern methods of TB diagnosis and treatment” (Petropavlovsk-Kamchatsky). These Arctic regions support cooperation in the framework of the NF Project "Infectious Diseases Monitoring".
To implement the resolution of the Symposium 2015, a zonal meeting on "Improving the organization of anti-tuberculosis care for the population in the modern conditions of the Arctic and Northern regions" was held in March 2016.
An overview paper on the systems and practices of TB surveillance in circumpolar regions was published by the international project Bourgeois AC, Zulz T. , Soborg B., Koch A. Int J Circumpolar Health. 2016 Jan; 75 (1): 30322. doi: 10.3402 / ijch.v75.30322. PMID: 28156382.
The goal of the project is collaborative data collection on determining the characteristics of the development of a tuberculosis infection with multiple and broad drug resistance (M/XDR) pathogens in circumpolar regions in modern socio-economic conditions.
- To study the main epidemiological indicators for tuberculosis in the circumpolar regions of the Russian Federation, the project participants.
- To study demographic, ethnic and biomedical characteristics of patients with pulmonary tuberculosis with M/XDR.
- Compare the features and trends in the development of tuberculosis infection with M/XDR in the circumpolar regions for their use in epidemiological studies and in the development of regional programs of anti-TB activities.
Activity in 2017:
The activity includes the analysis of data collected, also the dynamics of the main indicators of tuberculosis in the 2 northern regions of the Russian Federation for 2012-2016 was studied. The results show that during this period positive dynamics of the main epidemiological indicators of tuberculosis was noted.
The dynamics show a decrease in the incidence of the general population in both regions, but the incidence of a decrease for children in the Kamchatka Territory is 2 times higher than in the SR(Y) (Table 1). The incidence rate of tuberculosis with MDR in the Kamchatka Territory, in the RS (Y) has increased significantly on an equal level. The decrease in the prevalence of tuberculosis in the RS (Y) is somewhat higher than in the Kamchatka Krai, incl. with MDR. Mortality declined in both regions by more than 1.5 times. There is an increase in the proportion of MDR TB among the contingent with bacterial excretion, while among new cases in the Kamchatka Krai the increase was 1.4 times, in the SR (Y) a slight decrease, up to 1.2 times (Table 2). It should be noted a significant increase in the proportion of patients with TB and HIV among contingents, and especially among new cases in the SR(Y),which is a very negative fact in the future.
In February 2017, by the suggestion of the NF, they participated in a meeting of the Arctic Council’s AMAP working group (Yakutsk) with a report on the TB Monitoring Project.
In September 2017, they made a presentation at the interregional Scientific and Practical Conference "Childrens’ and Teenagers’ TB Issues" (Petropavlovsk-Kamchatsky).
The Interregional Scientific and Practical Conference "Medico-social issues of multidrug-resistant tuberculosis in the Arctic" planned for October 2017 with international participation (within the framework of the Northern Forum project) in connection with the Order of the Ministry of Health of Sakha Republic (Yakutia) No.01-07/980 dated 08.06.2017 on state budget expenditures efficiency was excluded from the Plan of the main organizational measures of the MH of SR(Y) for 2017.
In November 2017, the Research Conference "Actual Issues of Infectious Diseases" was held in the framework of the VIII Congress of the NEFU with international participation "Ecology and human health in the North".
There were business trips to the northern districts of Yakutia: Eveno-Bytantaisky, Nizhnekolymskiy, Verkhoyansky, the situation was studied, practical assistance was provided.
Activities in 2018:
In 2018 ICS-TB Working Group began collecting the best practices of tuberculosis prevention in the Northern Circumpolar regions from 2007 to 2017. Applied Research Centre for Phthisiatry prepared and submitted two projects: one on public awareness and another one on detection, diagnosis and treatment of tuberculosis with M/XDR. We also submitted the project application to the Northern Forum Call for Projects – “Strengthening Cooperation between Circumpolar Regions for the Goals Set by the End TB Strategy” with involvement of other Arctic regions from Russia and Finland.
The 17th International Congress on Circumpolar Health (ICCH 17) took place on 12-15 August 2018 in Copenhagen (Denmark). The researchers of Sakha Republic Applied Research Centre for Phthisiatry participated in science program with three reports. The report on TB Causative Agent Circulating in Sakha Republic (Yakutia) was marked as the best research poster. Sascha Wilk Michelsen, ICS-TB Chair, MD, PhD, (Denmark Department of Infectious Disease Immunology) led a meeting of ICS-TB Working Group that identified the priority work areas.
On 19-21 November 2018 the Applied Research Centre for Phthisiatry, Phthisiatrists Association of Sakha Republic (Yakutia) with the support of Sakha Republic Ministry of Healthcare, Northern Forum, and M.K. Ammosov NEFU held the Interregional Research Conference “Preventing the Spread of Tuberculosis Infection in Russian Circumpolar Regions. Co-infection Current Issues (HIV, TB, Hepatitis)”. The events: 19 November 2018 – Roundtable dedicated to the memory of distinguished healthcare actor and researcher, Professor M.A. Tyrylgin, who greatly contributed to healthcare and science development in Sakha Republic (Yakutia) “Preventative, Accessible and Specialized Medical Care for the Population of Regions in the Arctic and North”; 20 November 2018 – Research Conference; 21 November 2018 – Schools for practicing physicians.
Main directions of Conference science program:
- • Special aspects of anti-tuberculosis activities in the conditions of Northern and Arctic territories;
- • Social and legal issues of interaction between medical and public organizations for addressing tuberculosis;
- • Diagnosis and chemotherapy of tuberculosis with multiple and broad drug resistance;
- • Cutting-edge technologies for studying tuberculosis causative agent and its drug resistance.
More than 150 physicians – healthcare actors, phthisiatrists, infectious disease specialists, medical research and general public representatives – took part in the event. Leading Russian TB specialists, leaders of federal research and education institutions, representatives of Arctic and Northern regions were invited to the event. Conference proceedings will be published.
As a result of studies and discussions at the federal, interregional, and republican levels, the need to monitor tuberculosis infection with multiple drug resistance in Russian circumpolar regions was determined. It arises from high epidemiological indicators of tuberculosis in the Northern regions, the increase in the spread of strains of the causative agent of infection with M/XDR, the need to assess the trend of their spread and raise awareness in other regions with common problems.
The revealed significant differences in the level and dynamics of epidemiological indicators in the Northern regions are connected to differences in the degree of medical care accessibility and quality of anti-tuberculous activities: prevention, detection, bacteriological diagnosis, treatment and dispensary observation of tuberculosis patients.
All this urges the need to develop the improved organizational forms of combating tuberculosis adjusted for geographic and climatic features, socio-economic, material and technical differences, degree of anti-tuberculosis services staffing in the Northern regions of Russia.
Work Plan for 2019:
- • To encourage Magadan and Sakhalin Oblasts to participate in the project;
- • To continue data collecting;
- • Participating in TB research conferences of the Northern regions to discuss related issues and to share experience;
- • In order to hold interregional research conference in Yakutsk and to encourage Arctic regions to join the NF project, there is a need of financial support by means of NF grants for expenses related to improved TB infection monitoring development, education and training activities, sharing experience, organizing issue-related symposiums and workshops.