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The objective of the study: to analyze lethal cases of tuberculosis in children and adolescents in Siberian and Far Eastern Federal Districts, to determine the causes that contributed to lethal outcomes.Subjects and methods. Reports on 9 lethal outcomes of tuberculosis in children (n = 8) and adolescents (n = 1) in 2018 were retrospectively analyzed in 8 regions of Siberian and Far Eastern Federal Districts.Results. All the deceased lived in socially disadvantaged families. It was found out that parents failed to fulfill their obligations in providing care for the child. All children, except one, were vaccinated with BCG. No one had been diagnosed with HIV infection. Children under 7 years old prevailed. In 63% of cases, exposure to tuberculosis was detected. Immunodiagnosis of tuberculosis was not carried out or was irregular in the majority of cases (75% of lethal cases). All children died within 1 year of follow-up by a TB unit. Tuberculosis with lesions of the central nervous system was registered in 87.5% of lethal cases.Conclusion. The main causes contributing to the death of children due to tuberculosis were the socially disadvantaged families and the lack of attention from social service specialists, defects in the work of physicians from primary health services on the early detection of tuberculosis among children, and defects in the work of phthisiologists in the nidi of tuberculosis infections.

The article presents results of multi-dimensional analysis of 83 rates, calculated on the basis of federal and sectoral reports on tuberculosis in 21 regions of Siberian and Far Eastern Federal Districts, which were collected from 2006 to 2016. For statistic processing of data, a distance matrix was used with its consecutive analysis by principal coordinates analysis, which allowed detecting the closest correlations between rates. It has been proved that main factors of successful tuberculosis control are the following: improvement of the organizational quality of treatment and diagnostics, provision with qualified medical personnel, early detection through expansion of coverage of population with fluorography screening. The principal coordinates method also allowed performing a multilateral evaluation of epidemic situation in all regions and defining the ones with the most favorable tuberculosis situation.

Новосибирский НИИ туберкулеза Минздрава России (ННИИТ) имеет богатую историю научных достижений в самых разнообразных областях фтизиатрии, в том числе в исследовании эпидемиологических закономерностей распространения инфекции, в хирургии легочного и внелегочного туберкулеза, разработки новых методов фармакотерапии и фундаментальных исследованиях патогенеза туберкулезной инфекции. В настоящей статье рассмотрены четыре перспективных направления исследований, которые ННИИТ инициировал недавно и уже получил первые результаты: исследование распространения латентной туберкулезной инфекции (ЛТИ) у взрослого населения и ее роли в эпидемическом процессе; изучение малоизученных штаммов M. tuberculosis, таких как B0/W148; исследование механизмов локальной иммуносупрессии в зоне туберкулезного очага, в том числе потенциальной роли мезенхимальных стволовых клеток (МСК), аккумулирующихся в туберкулезных воспалительных инфильтратах; разработка новых лекарственных форм противотуберкулезных препаратов, представленных в виде наноаэрозолей для ингаляционного введения.

The article describes changes in the main tuberculosis epidemiological indicators in Siberian and Far Eastern Federal Districts over the last decade. The rate of changes was analyzed for 21 regions within two districts, total number and structure of those followed up by phthisiologists in 2007-2016 were compared. TB situation has not significantly improved since the drug resistance and HIV infection become more and more frequent, providing an indirect impact on the epidemiological indicators. It is very difficult to treat such categories of patients and these difficulties do not allow enhancing treatment efficiency and cause an abrupt growth of the costs per one patient, both financial and organizational ones.

Basing on the data about achievement of targeted rates for efficiency evaluation of the actions aimed at tuberculosis mortality reduction in 2015 and statistic rates for 2014-2015 in 12 regions within Siberian Federal District, the impact of organizational medical activities performed by primary medical services and tuberculosis control services was analyzed in the respect of tuberculosis mortality rate. The article presents results of ranging of regions within Siberian Federal District as per tuberculosis mortality rate and indicators providing impact on the number of those died of tuberculosis.

The article describes the attempt to find common consistent patterns in the spread of infection, typical of Russia. Actions of the Russian Tuberculosis Control Service are compared to the ones of similar services in the world. It has been shown that the comparative cost-effectiveness per one tuberculosis patient in Russia is disparate regarding the changes in epidemiological rates. Changes in quality management parameters are slow. Increase of funding for TB services without optimization of the cost structure and revision of certain positions within the service is not sufficient for successful operation.

Efficiency of tuberculosis control measures was comprehensively evaluated in the Russian regions (totally 21 regions) within Siberian and Far Eastern Federal Districts by means of ranging the sets of indicators. Three sets of indicators were used; these indicators reflected the epidemic situation and main rates of operation in the territories upon the outcomes of 2015. Totally 34 indicators were analyzed. The situation varies in different regions of Siberian and Far Eastern Federal Districts, the analyzed indicators significantly differ in the regions depending on the annual results, which first of all witnesses of differences in the quality and efficiency of tuberculosis control activities. Ranging as per indicators' set demonstrates the correlation between the epidemic situation and quality of tuberculosis control activities and stability of their level.

The rate of spread of multiple drug resistant strains is much higher in Siberian and Far Eastern Federal Districts compared to the rest of Russia. In the meantime due to the lack of the unified monitoring system for this group of patients it is impossible to evaluate treatment outcomes.Basing on the data submitted by 21 regions of Siberia and Far East the treatment e`ciency has been analyzed for patients suwering from multiple drug resistance for all these regions in general and specifically for each region, and the main factors providing the impact on the outcome have been identified.Half of the registered patients do not receive adequate treatment with second line drugs for various reasons. Treatment e`ciency for the patients enrolled into treatment is almost the same as in the cohorts in the regions where the projects approved by Green Light Committee (WHO) were implemented.

В г. Новосибирске, в Доме ученых Академгородка, с 18 по 20 июня 2014 г. прошла юбилейная научно-практическая конференция «Эффективное решение проблем туберкулеза: от научной идеи до медицинской практики», объединившая 353 участника.

The paper assesses post-Soviet changes in the Russian tuberculosis (TB) service. It shows its role and place in the public health system and in the provision of epidemic safety, particularly under the current conditions of major reforms. It is noted that the TB service that has always perfectly fitted into the Soviet and Russian healthcare system hardly corresponds to it now and at times does not fit at all into the healthcare reforms that are being carried out. As of now, it may be stated that Russian phthisiology is in crisis. At the same time the country with a fairly high TB incidence needs an effective TB service. The fate and place of the TB service under the current conditions are questioned. The paper gives scenarios for the further development of the situation and characteristics of the urgent choice facing phthisiology today.

The authors analyze the epidemic situation associated with tuberculosis concurrent with HIV infection in the subjects of the Siberian Federal District (SFD) in 2010-2012. There was a further overall (1.4-fold) increase in the detection of coinfection in the district; at the same time the rate of its increase decreased as compared to the previous years. In spite of the lower incidence of tuberculosis in SFD in the years under study, the proportion of patients of HIV-associated tuberculosis increased in the structure of new cases. No stabilization of the epidemics of HIV infection makes unfavorable the prognosis of further spread of tuberculosis concurrent with HIV infection. The timely detection of patients with HIV infection, as well as antiretroviral therapy and adequate tuberculosis chemoprophylactic coverage of patients with already detected HIV infection will be able to reduce the tense epidemic situation.

The children and adolescents of the Siberian Federal District continue to have high tuberculosis morbidity rates that are 1.5-1.7 times greater than the average Russian rate. The severe clinical pattern of tuberculosis is noted among new tuberculosis cases. Preventive measures are insufficiently effective.To improve the quality of antituberculosis care to the children and adolescents of the Siberian Federal District, it is necessary to coordinate the work of a specialized and general health service on the specific prevention and early detection of tuberculosis among the children and adolescents; to solve the problem associated with discontacts in the everyday foci of tuberculosis infection; to improve the material and technical basis of children’s sanatoria; to observe infection control measures in children’s hospitals and units (to allow for the reconstruction of existing buildings and the construction of new ones); and to brisk up the work on sanitary education of the population.

The paper characterizes the laboratory service that carries out microbiological tests to diagnose tuberculosis in 12 and 9 subjects of the Siberian and Far Eastern Federal Districts, respectively.The efficiency of tuberculosis detection was evaluated by light microscopy of Ziehl-Neelsen- stained smears during primary health care for the population. There were changes in the efficiency of detection using different microbiological diagnostic methods in the bacteriological laboratories of tuberculosis facilities in 2008 to 2012.Emphasis is laid on the topical moments in laboratory service work, which require further improvement and optimization.