Characteristics of influenza in elderly patients with and without diabetes, hospitalized for severe acute respiratory infection in a tertiary care hospital from Bucharest Romania - a three-year prospective epidemiological surveillance study.

INTRODUCTION: Patients with diabetes may be at a higher risk of developing complicated influenza. We report the characteristics of influenza in hospitalized elderly patients with and without diabetes, in three consecutive influenza seasons. METHODS: The study included patients admitted for severe acute respiratory infection (SARI) in the National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, during a three-year active epidemiological surveillance study (2015/16, 2016/17, 2017/18), in the I-MOVE+ hospital network. RESULTS: A total of 349 patients were tested by PCR over the duration of the study. The percentage of patients with diabetes was comparable throughout the seasons: 34.7%, 28.3% and 30.4% (p=0.587). Influenza A was the main viral type circulating in 2015/16 and 2016/17 (100% and 97.6%) in our study population, while in 2017/18, B viruses predominated (90.0%). Diabetics presented a higher median number of comorbidities (3 vs. 2) p<0.001, and two-fold higher odds of also associating obesity (OR=2.1, 95%CI:1.3-3.4, p=0.003), compared to those without diabetes. Diabetics also tested positive for influenza more often (p=0.296). Only 6 patients with diabetes (5.4%) from our study had been vaccinated against influenza, and most (n=4) of those who had been vaccinated tested negative for influenza. CONCLUSIONS: Our study is the first to describe the circulation of influenza viral types in elderly diabetic patients hospitalized for SARI. The results reinforce the national and international recommendation to vaccinate against influenza all patients with diabetes.

The influenza season 2016/17 in Bucharest, Romania - surveillance data and clinical characteristics of patients with influenza-like illness admitted to a tertiary infectious diseases hospital.

BACKGROUND: Influenza continues to drive seasonal morbidity, particularly in settings with low vaccine coverage. OBJECTIVES: To describe the influenza cases and viral circulation among hospitalized patients. METHODS: A prospective study based on active surveillance of inpatients with influenza-like illness from a tertiary hospital in Bucharest, Romania, in the season 2016/17. RESULTS: A total of 446 patients were tested, with a balanced gender distribution. Overall, 192 (43%) patients tested positive for influenza, with the highest positivity rate in the age groups 3-13 years and >65 years. Peak activity occurred between weeks 1 and 16/2017, with biphasic distribution: A viruses were replaced by B viruses from week 9/2017; B viruses predominated (66.1%). Among the 133 (69.3%) subtyped samples, all influenza A were subtype H3 (n=57) and all influenza B were B/Victoria (n=76). Patients who tested positive for influenza presented fewer comorbidities (p=0.012), except for the elderly, in whom influenza was more common in patients with comorbidities (p=0.050). Disease evolution was generally favorable under antiviral treatment. The length of hospital stay was slightly longer in patients with influenza-like illness who tested patients negative for influenza (p=0.031). CONCLUSIONS: Distinctive co-circulation of A/H3 and B/Victoria in Bucharest, Romania in the 2016/17 influenza season was found. While the A/H3 subtype was predominant throughout Europe that season, B/Victoria appears to have circulated specifically in Romania and the Eastern European region, predominantly affecting preschoolers and school children.

The influenza season 2016/17 in Bucharest, Romania - surveillance data and clinical characteristics of patients with influenza-like illness admitted to a tertiary infectious diseases hospital

ABSTRACT Background: Influenza continues to drive seasonal morbidity, particularly in settings with low vaccine coverage. Objectives: To describe the influenza cases and viral circulation among hospitalized patients. Methods: A prospective study based on active surveillance of inpatients with influenza-like illness from a tertiary hospital in Bucharest, Romania, in the season 2016/17. Results: A total of 446 patients were tested, with a balanced gender distribution. Overall, 192 (43%) patients tested positive for influenza, with the highest positivity rate in the age groups 3-13 years and >65 years. Peak activity occurred between weeks 1 and 16/2017, with biphasic distribution: A viruses were replaced by B viruses from week 9/2017; B viruses predominated (66.1%). Among the 133 (69.3%) subtyped samples, all influenza A were subtype H3 (n = 57) and all influenza B were B/Victoria (n = 76). Patients who tested positive for influenza presented fewer comorbidities (p = 0.012), except for the elderly, in whom influenza was more common in patients with comorbidities (p = 0.050). Disease evolution was generally favorable under antiviral treatment. The length of hospital stay was slightly longer in patients with influenza-like illness who tested patients negative for influenza (p = 0.031). Conclusions: Distinctive co-circulation of A/H3 and B/Victoria in Bucharest, Romania in the 2016/17 influenza season was found. While the A/H3 subtype was predominant throughout Europe that season, B/Victoria appears to have circulated specifically in Romania and the Eastern European region, predominantly affecting preschoolers and school children.

Management of accidental exposure to HCV, HBV and HIV in healthcare workers in Romania.

INTRODUCTION: Accidental blood exposure in healthcare workers is an important issue worldwide. We present a study which analyzed the route of exposure, the source of infection and the post-exposure prophylaxis treatment administered. METHOD: We performed retrospective study of occupational exposure to HBV, HCV and HIV and the subsequent post-exposure prophylaxis among healthcare workers at the National Institute of Infectious Diseases "Prof.Dr. Matei Bals", Bucharest, Romania, from December 2002 to December 2011. RESULTS: Sixty healthcare workers with a mean age of 36 reported an occupational exposure during a period of 9 years, 54 (90%) were females and 6 (10%) were males. 48 (80%) exposed healthcare workers were nurses, 7 (11.6%) were doctors and 5 (8.3%) were medical assisting staff. In 49 (81.6%) cases the exposure was percutaneous and in 11 (18.3%) cases the exposure was mucosal/corneal. Ten (16.6%) exposed healthcare workers had insufficient levels of antibody (HBsAb) response, (below 10 mIU/mL), 6 (10%) had titers between 11 and 500 mIU/mL, 31 (51.6%) between 501-1000 mIU/mL, and 13 (21.6%) above 1000 mIU/mL). DISCUSSION: The exposure events analysis in this study yielded similar results compared to other previous parallel studies. Minimizing risks to HCWs for acquisition of blood-borne pathogens and correct and rapid post-exposure prophylaxis treatment in case of exposure should be an integral part of the infection control and occupational health programs in all healthcare facilities.

[Effect of air pollution upon the hospitalization for acute lower respiratory tract infections among the Bucharest municipality's residents]. / Efectul poluarii aeriene asupra frecventei spitalizarii pentru infectii acute ale cailor respiratori inferioare în populatia municipiului Bucuresti.

OBJECTIVE: Assessment of the short-term association between exposure to outdoor air pollution and hospitalization for lower respiratory tract infections (LRTI) in the Bucharest municipality'spopulation. MATERIALS AND METHODS: Relation exposure--health effect has been explored through linear regression upon time series, where the independent variable was represented by daily levels of nitrogen dioxide (NO), carbon monoxide (CO), sulfur dioxide (SO2) and ozone (O3) from atmospheric air of Bucharest municipality whereas the dependent variable has been represented by daily frequency, by age groups, of Bucharest municipality residents, hospitalized during the year 2007for LRTI (ICD-10 codes: J12-J22). RESULTS: In the year 2007, through linear regression we found high correlations (p < 0.01) between the following variables: (a) daily atmospheric concentrations of NO2, CO and SO2, (b) daily frequencies of hospitalizations for LRTI by age group and (c) daily air levels of three of the above mentioned pollutants and the age-specific frequencies of patient hospitalization for LRTI. The O3 daily air levels have been correlated (p < 0.01) only with the daily air levels of SO2 and CO but wasn't correlated to NO2 air level or with the health effect studied CONCLUSIONS: in the Bucharest municipality, the study demonstrated robust associations between the atmospheric pollutants' levels and daily frequencies of hospital admissions for LRTI. Through inference the results suggests that the interventions for environment control which will result in decreasing of the pollution level with NO2, CO and SO2 might be associated with decreasing the frequency of hospitalization for LRTI and consequently with preserving the resources allocated for health.