Killer diseases of old strike back

Cholera and diphtheria, two diseases thought to have been virtually eradicated from Europe, are returning with a vengeance, particularly in Russia, Ukraine and other former Soviet republics. UN and Red Cross medical experts fear that the diphtheria epidemic could develop into the most serious threat to public health in Europe since the Second World War.

They are predicting that from 150,000 to 200,000 people will contract diphtheria in the former Soviet Union this year, compared with 48,000 in 1994, 15,000 in 1993, 4,000 in 1992 and fewer than 2,000 in 1991. Almost 1 in 25 victims died in 1994, a rate that, if sustained, implies the deaths this year of roughly 6,000 to 8,000 people.

The World Health Organisation, the UN's agency for health affairs, said last week that it had recorded six cases of diphtheria in Germany last year and four in Finland, which borders Russia. These were the first instances of diphtheria in Finland for more than 30 years and suggested that Western European countries which had eliminated it through immunisation were no longer invulnerable.

Swedish medical authorities were reported this week to be offering free diphtheria vaccines to anyone over 40 in the Stockholm region. One specialist, Per Lundbergh, said he feared Stockholm might soon record its first diphtheria cases in years because so many people can travel freely to Russia.

Diphtheria is a disease of the nose and throat that can cause death by suffocation and is passed on mainly by sneezing or coughing. Cholera is spread by contaminated water that causes drastic dehydration.

The problems have been gathering pace since 1991, the year Communist rule collapsed and the Soviet state split into 15 independent republics. An economic crisis and a deterioration in health services accompanied the political upheavals that tore the Soviet Union apart.

According to the WHO, the diphtheria outbreak started in Moscow and St Petersburg but has spread to virtually every former Soviet republic from Latvia and Moldova to Armenia and Kazakhstan. Jo Asvall, the WHO's regional director for Europe, said diphtheria had reappeared partly because vaccination programmes for children had not been thorough.

The cholera crisis has not yet reached last year's levels, when thousands caught it not only in Ukraine and southern Russia but in eastern European countries such as Albania and Romania. Several dozen people died of cholera in the Ukrainian-ruled peninsula of Crimea, the Russian republic of Dagestan and Albania.

But last year's cholera outbreak appeared to reach its peak in August and September, and there are signs that a similar trend is developing this year. Since 5 June, 93 people have caught cholera in the southern Ukrainian region of Nikolayev on the Black Sea, and nine are in a serious condition.

Local officials have blamed the outbreak on a decaying sewage system and raw sewage into the Southern Bug river.

Authorities in the western Ukrainian city of Chernivtsi have closed beaches and health resorts on the Prut river after finding the cholera bacterium in it. The microbe has also been discovered in the sewer system of Yevpatoriya, a Crimean town.

In the Belarussian capital, Minsk, an Indian man who arrived by train from Moldova last week was taken to hospital after going down with cholera.