VZCZCXRO4967
RR RUEHAG RUEHAST RUEHDA RUEHDBU RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA
RUEHLN RUEHLZ RUEHNP RUEHPOD RUEHROV RUEHSK RUEHSR RUEHVK RUEHYG
DE RUEHTL #0084/01 0901058
ZNR UUUUU ZZH
R 311058Z MAR 09
FM AMEMBASSY TALLINN
TO RUEHC/SECSTATE WASHDC 1083
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE

UNCLAS SECTION 01 OF 02 TALLINN 000084 
 
COPENHAGEN FOR ESTH OFFICE 
DEPT FOR EUR/ACE - DAVID FROMAN 
 
SIPDIS 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: TBIO SOCI KHIV EN
SUBJECT: FIGHT AGAINST TB CONTINUES IN ESTONIA 
 
REFTEL: STATE 17303 
 
¶1. (U) Summary:  Embassy Tallinn marked World 
Tuberculosis (TB) Day with media placements in Russian 
and Estonian-language newspapers, a site visit to 
Tartu University Lung Hospital (TULH), and a DVC for 
Baltic and USG TB experts.  Although Estonia remains a 
hotspot for multi-drug resistant (MDR)-TB in Europe, 
the government provides quality care for patients with 
MDRTB, including drug susceptibility testing for all 
TB patients.  All TB strains are now fingerprinted in 
Estonia which makes the national TB registry an 
excellent resource for cooperative research.  Two of 
Estonia's greatest challenges in treating TB are 
alcoholism and HIV-TB co-infection.  Supporting 
Estonian efforts to prevent, detect and treat 
infectious disease is a Mission priority.  End 
Summary. 
 
World TB Day Outreach: 
 
¶2. (U) In honor of World TB Day (March 24), Embassy 
Tallinn coordinated several events designed to 
increase public awareness of TB in Estonia and improve 
U.S.-Estonian cooperation. 
 
-- On March 12, the Embassy facilitated participation 
by Piret Viiklepp, the Head of the Estonian TB 
Registry, and Kristi Ruutel, an HIV expert from the 
National Institute of Health Development, in a DVC 
hosted by USAID and the Centers for Disease Control 
(CDC).  TB Experts from Riga and Vilnius also took 
part.  Baltic participants identified issues of common 
concern (such as HIV/TB co-infection and alcoholism), 
highlighted achievements and discussed possibilities 
for future cooperation with the U.S. and within the 
region. 
 
-- On March 24, the Embassy facilitated the 
publication of two newspaper articles dedicated to TB. 
The Charge dQAffaires published an OpEd in a local 
Russian-language newspaper (Molodjozh Estonii, 41,000 
readers) which gave an overview of TB's global threat 
and U.S. prevention efforts around the world.  The 
OpEd also praised Estonia's TB screening and treatment 
procedures and encouraged the GOE to focus more 
resources on combating MDR-TB.  A Tallinn city paper 
(Linnaleht, 125,000 readers) also published an article 
focused on World TB day, with input from the Embassy. 
This article highlighted USG contributions over the 
years toward establishing Estonia's TB registry, 
training nurses and combating HIV-TB co-infection in 
Estonia. 
 
-- Also on March 24, Pol-Econ Chief and EST Specialist 
visited the Tartu University Lung Hospital (TULH), one 
of two hospitals where patients with MDR-TB and 
extensively drug-resistant (XDR)-TB are treated in 
Estonia. (NOTE:  Estonia has a total of six hospitals 
licensed to provide TB treatment.  TULH also oversees 
Estonia's National TB Program (NTP).  End note.) 
Emboffs met with NTP Program Manager Dr. Kai Kliiman 
and Directly Observed Therapy System (DOTS) 
Coordinator Dr. Manfred Danilovits, toured the clinic 
and discussed possibilities for increased bilateral 
cooperation. 
 
TB situation in Estonia: successes and challenges 
 
¶3. (U) From 1992-1997, Estonia's TB infection rate 
almost doubled - peaking at more than 10 times the 
rate found in neighboring Nordic countries.  However, 
the GOE's effective response through its National TB 
Programs (first launched in 1998) brought Estonia's 
infection rate down to 26 cases per 100,000 people in 
¶2008.  While this rate is still almost twice as high 
as the EU average, the actual number of cases in 
Estonia is very small and the disease is very well 
mapped.  In 2008, a total of 441 TB cases were 
registered in Estonia, including 353 new cases, 
relapses and retreatment cases.  Of the new cases 
registered, 12.2 percent were MDR (43 cases); of these 
4 cases were XDR. 
 
¶4. (SBU) In order to the address the high prevalence 
of MDR and XTR TB in Estonia, the GOE began 
implementing the DOTS program in 1999 and DOTS plus 
(which includes the use of second line anti-TB drugs) 
in 2001.  The latest version of the GOE's National TB 
 
TALLINN 00000084  002 OF 002 
 
 
Strategy (renewed in 2008) aims to reduce TB incidents 
to 20 cases per 100,000 people by 2012.  The strategy 
places particular focus on addressing the TB epidemic 
among HIV positive patients (there were 39 cases of 
HIV/TB co-infection registered in 2008) and 
controlling the spread of MDR and XDR TB.  The focus 
on HIV co-infection is critical as Estonia has the 
highest rate of HIV infection in Europe and the 
mortality rate for patients with HIV/TB co-infection 
is 20-30 percent higher than average. 
 
¶5. (SBU) In addition to the prevalence of MDR and XDR, 
treating alcoholics presents one of the biggest 
challenges for Estonia's TB program.  According to Dr. 
Kliiman, about half of all TB patients in Estonia have 
problems with alcohol.  Kliiman cited the difficulties 
associated with keeping alcoholics in treatment as one 
of the primary impediments to Estonia reaching the 
WHO's target treatment success rate of 85 percent for 
susceptible TB.  (Note:  Estonia's rate is stable at 
83-84 percent.  End Note.)  The NTP is considering the 
use of court-ordered TB treatment for alcoholics, but 
cannot implement such a policy without changing 
Estonian legislation.  All of our Estonian contacts 
have expressed interest in sharing best practices in 
treating TB in alcoholics with U.S. and regional 
experts. 
 
Opportunities for Cooperation 
 
¶6. (U) Estonia's TB registry was established in 2002 
with the assistance of CDC funding and technical 
support.  (Note:  A USD 62,000 grant from CDC in 2002 
remains the single largest health sector grant from 
the USG to Estonia.  End Note.)  This registry does an 
excellent job of screening and mapping TB cases 
throughout Estonia.  All TB cases are fingerprinted 
here and the database of information is available as a 
resource for cooperative TB research with U.S. and 
other partners. 
 
¶7. (U) Comment:  Helping Estonia prevent, detect and 
treat infectious disease is a Mission priority. 
Tallinn's FY11 MSP specifically requested funding to 
support HIV prevention activities in Estonia.  As 
noted, Estonia not only has the highest HIV growth 
rate in Europe but HIV-TB co-infection rates are 
rising.  The majority of Estonian HIV cases are among 
intravenous drug users - a population that is also 
vulnerable to TB infection.  Assistance funds geared 
toward HIV programs would inherently support Estonian 
TB efforts.  Additionally, while Estonia has a 
comprehensive TB strategy in place, it would benefit 
from additional exchanges of information and best 
practices with the USG on U.S. anti-TB efforts 
targeted to alcoholism and HIV co-infection.  Post is 
also actively seeking opportunities to promote U.S.- 
Estonian cooperative research activities using the 
extensive data from the Estonian TB Registry. 
 
DECKER