Neurological Manifestations of Acute SARS-CoV-2 Infection in Pediatric Patients: A 3-Year Study on Differences between Pandemic Waves.

This study analyzed the neurological manifestation profiles of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across pandemic waves in pediatric patients. The study collected data on patients aged between 0 and 18 years, diagnosed with acute SARS-CoV-2 infection, admitted to a pediatric tertiary hospital between 1 March 2020 and 28 February 2023. This study included 1677 patients. Neurological manifestations were noted in 10% (n = 168) of patients with a median age of 3.2 years (interquartile range: 1-11.92). Neurological manifestations were significantly associated with the pandemic waves (p = 0.006) and age groups (p < 0.001). Seizures were noted in 4.2% of cases and reached an increasing frequency over time (p = 0.001), but were not associated with age groups. Febrile seizures accounted for the majority of seizures. Headache was reported in 2.6% of cases and had similar frequencies across the pandemic waves and age groups. Muscular involvement was noted in 2% of cases, reached a decreasing frequency over time (p < 0.001), and showed different frequencies among the age groups. Neurological manifestations of acute SARS-CoV-2 infection exhibit distinct patterns, depending on the pandemic wave and patient age group. The Wuhan and Omicron waves involved the nervous system more often than the other waves.

Influenza Vaccination of Romanian Medical Students during COVID-19 Times: From Knowledge to Behavior.

In Romania, influenza vaccination uptake among healthcare workers decreased over time despite access to the vaccine being constantly improved. The aim of this paper is to provide a comparative analysis of the knowledge and attitudes of Dental Medicine and Medicine students towards recommended vaccinations for healthcare workers, focusing on influenza vaccination. A cross-sectional study was conducted during the entire 2021-2022 academic year. Data were collected using 2 electronic questionnaires which were applied to the students from the Faculty of Medicine (n = 883) and, respectively, the Faculty of Dental Medicine of the Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. The questionnaires were offered to 1187 students and completed by 911 students (response rate = 77%). Out of these, 85% (n = 778) identified the influenza vaccine as recommended; 35% (n = 321) reported getting an annual influenza vaccination; and 37% (333) reported getting an influenza vaccination in the previous season. Overall, 45% (n = 222) of the respondents who completed the questionnaires from October 2021 to February 2022 reported that they intend to get vaccinated against influenza in the 2021-2022 season and approximately 8% (n = 39) reported that they had already been vaccinated. The multivariable analysis showed that the habit of getting annually vaccinated against influenza as well as the knowledge that influenza vaccine is recommended for all healthcare workers were associated with a higher probability of intending to get vaccinated. The current study emphasizes the need to raise awareness among medical students regarding influenza vaccination and to involve medical education institutions, public health authorities, and healthcare facilities in promoting this vaccination among students since the influenza vaccine uptake rate among medical students included in this study was suboptimal.

Hybrid Immunity and the Incidence of SARS-CoV-2 Reinfections during the Omicron Era in Frontline Healthcare Workers.

During the coronavirus disease (COVID-19) pandemic healthcare workers (HCWs) acquired immunity by vaccination or exposure to multiple variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our study is a comparative analysis between subgroups of HCWs constructed based on the number of SARS-CoV-2 infections, vaccination, and the dominant variant of SARS-CoV-2 in the population. We collected and analyzed data using the χ2 test and density incidence of reinfections in Microsoft Excel for Mac, Version 16.84, and MedCalc®, 22.026. Of the 829 HCWs, 70.1% (581) had only one SARS-CoV-2 infection and 29.9% (248) had two infections. Of the subjects with two infections, 77.4% (192) worked in high-risk departments and 93.2% (231) of the second infections were registered during Omicron dominance. The density incidence of reinfections was higher in HCWs vaccinated with the primary schedule than those vaccinated with the first booster, and the incidence ratio was 2.8 (95% CI: 1.2; 6.7). The probability of reinfection was five times lower (95% CI: 2.9; 9.2) in HCWs vaccinated with the primary schedule if the first infection was acquired during Omicron dominance. The subjects vaccinated with the first booster had a density incidence of reinfection three times lower (95% CI: 1.9; 5.8) if the first infection was during Omicron. The incidence ratio in subgroups constructed based on characteristics such as gender, age group, job category, and department also registered significant differences in density incidence. The history of SARS-CoV-2 infection by variant is important when interpreting and understanding public health data and the results of studies related to vaccine efficacy for hybrid immunity subgroup populations.

Botulism Cases in Romania-An Overview of 14-Year National Surveillance Data.

Botulism is a priority disease worldwide because it has a very severe course of evolution that can lead to death. This paper aims to describe the main epidemiological characteristics of botulism cases confirmed in Romania over 14 years (2007-2020). We performed a retrospective study using the publicly available national surveillance data and reported to the National Institute of Public Health. A total of 325 cases of foodborne botulism were reported in Romania, with no infant or wound botulism. Most of the cases (125, 38.5%) were reported among young adults (25-44 years old), over half (205, 63%) of them living in rural areas. The incriminated food item was identified in 161 cases; in most cases (145, 90%) the food item was prepared in the household. The main food category was represented by meat and meat-based products (94, 68.6%). In almost all cases the identified type was BoNT/B (230/231, 99.5%). Fifteen deaths were recorded, and the case fatality rate was 4.6%. Botulism cases were reported annually in Romania. Surveillance data are essential for implementing control measures and adapting educational campaigns according to existing needs.

Epidemiology and Clinical Characteristics of Acute Plant Exposure in Patients Aged between 0 and 18 Years-A Six-Year Retrospective Study.

BACKGROUND: Exposure to plants accounts for approximately 5% of human poisoning cases reported by poison control centers in North America and Europe. The aim of this study was to investigate acute plant poisoning in patients aged 0-18 years admitted to a Romanian pediatric poison center, focusing on epidemiological and clinical aspects. METHODS: A retrospective observational study was conducted between 2017 and 2022, analyzing medical records for demographic information, clinical features, biological findings, and outcomes. Statistical analysis was performed using Microsoft Excel. RESULTS: 71 patients (aged 7 months to 16 years) presented with acute plant poisoning. Most cases were unintentional (92.9%), peaking during the autumn season. Colocasia (18.3%), Dieffenbachia (9.8%), and Ricinus (5%) were the most frequently involved plants. Gastrointestinal symptoms, especially vomiting, predominated. The Poisoning Severity Score classified most cases as mild (52.1%), with no severe or fatal cases. The mean length of hospitalization was 1.8 days. CONCLUSIONS: Unintentional plant exposure, mainly in children under 5 years of age, accounted for more than 90% of cases. Gastrointestinal exposure and symptoms were prevalent, and treatment consisted mainly of symptomatic and supportive measures. Severe and fatal cases were rare, highlighting the generally favorable outcome and low incidence of severe poisoning in the pediatric population.

The Dynamic Risk of COVID-19-Related Events in Vaccinated Healthcare Workers (HCWs) from a Tertiary Hospital in Bucharest, Romania: A Study Based on Active Surveillance Data.

Our study describes the frequency and severity of COVID-19 in HCWs and estimates the dynamic risk of COVID-19-related events. We actively surveyed all HCWs from a tertiary infectious disease hospital from 26 February 2020 to 31 May 2023. Of 1220 HCWs, 62.9% (767) had at least one COVID-19 episode. The under 29 years (p = 0.0001) and 40-49 years (p = 0.01) age groups, nurses (p = 0.0001), and high-risk departments (p = 0.037) were characteristics significantly more frequent in HCWs with COVID-19 history. A higher percentage of boosters (53.2%; p < 0.0001) were registered in the uninfected group. The second episode of COVID-19 was significantly milder than the first. Data regarding clinical outcomes from 31 January 2021 to 31 May 2023 were analyzed in a follow-up study to determine the risk of COVID-19-related events. The Cox regression analysis revealed that HCWs with booster shots had a lower risk of COVID-19 across all events, symptomatic events, and moderate to severe events as adjusted hazard ratio (aHR) were: 0.71 (95%CI: 0.54-0.96), 0.23 (95%CI: 0.12-0.46), and 0.17 (95%CI: 0.07-0.43), respectively. Within the vaccinated subgroup, the HCWs with hybrid immunity and booster had aHR for all followed-up events of 0.42 (95%CI: 0.30-0.58), for symptomatic events of 0.52 (95%CI: 0.36-0.74), and 0.15 (95%CI: 0.03-0.66) for moderate to severe events. The risk of COVID-19 clinical events was lower for HCWs with at least one booster than those completely vaccinated.

Vaccination and Factors Related to the Clinical Outcome of COVID-19 in Healthcare Workers-A Romanian Front-Line Hospital's Experience.

The study aims to describe the frequency of COVID-19 in healthcare workers (HCWs) in a designated hospital for COVID-19 treatment in Bucharest, Romania, and to explore COVID-19 vaccination and other factors associated with the clinical outcome. We actively surveyed all HCWs from 26 February 2020 to 31 December 2021. Cases were laboratory-confirmed with RT-PCR or rapid test antigen. Epidemiological, demographic, clinical outcomes, vaccination status, and co-morbidities data were collected. Data were analyzed using Microsoft Excel, SPSS, and MedCalc. A total of 490 cases of COVID-19 in HCWs were diagnosed. The comparison groups were related to the severity of the clinical outcome: the non-severe group (279, 64.65%) included mild and asymptomatic cases, and the potentially severe group included moderate and severe cases. Significant differences between groups were registered for high-risk departments (p = 0.0003), exposure to COVID-19 patients (p = 0.0003, vaccination (p = 0.0003), and the presence of co-morbidities (p < 0.0001). Age, obesity, anemia, and exposure to COVID-19 patients predicted the severity of the clinical outcomes (χ2 (4, n = 425) = 65.69, p < 0.001). The strongest predictors were anemia and obesity (OR 5.82 and 4.94, respectively). In HCWs, mild COVID-19 cases were more frequent than severe cases. Vaccination history, exposure, and individual risk influenced the clinical outcome suggesting that measures to protect HCWs and occupational medicine are important for pandemic preparedness.

COVID-19 Vaccination in Romania and the Benefits of the National Electronic Registry of Vaccinations.

BACKGROUND: Recording real-time data of vaccinations performed, vaccine stocks, and adverse events following immunization is a particularly useful activity in the effective development of any vaccination campaign or vaccination program, guiding the decisions of public health authorities. The aim of this paper is to present the benefits of the National Electronic Registry of Vaccinations in providing useful information for the optimization of healthcare vaccination policies, specifically related to COVID-19 vaccination. METHODS: We performed a descriptive study using data available in the reports generated from the National Electronic Registry of Vaccinations regarding COVID-19 vaccinations performed between 27 December 2020 and 31 December 2021. RESULTS: A total of 27,980,270 doses of the COVID-19 vaccine were distributed. Of these, 15,757,638 (56%) were administered in 4545 vaccination centers: 7,882,458 as the 1st dose (50%), 5,878,698 as the 2nd dose (37%), and 1,996,482 as the 3rd dose (13%). More than 25% of the total doses were administered to people over 65 years of age. A total of 41% of the population received at least one dose of the COVID-19 vaccine. A total of 4083 adverse events following immunization were reported. CONCLUSIONS: The existence of a National Electronic Registry of Vaccinations containing accurate information on vaccinations performed in Romania offers the opportunity to obtain a clear picture of vaccination status that will significantly contribute to the optimization of vaccination strategies and programs.

The COVID-19 Pandemic in Romania: A Comparative Description with Its Border Countries.

The COVID-19 pandemic continues to be a major public health problem in most countries of the world, especially in developing countries with an underfunded healthcare system. We aim to present a comparative profile of the epidemiological characteristics of the COVID-19 pandemic in Romania and neighboring countries, which have similar onset and a similar socio-cultural pattern. A descriptive comparative study was performed using COVID-19 data collected from various official websites regarding demography, morbidity, mortality, vaccination, and testing capacity. The countries included in the study were Romania, Bulgaria, Hungary, Republic of Moldova, Serbia, and Ukraine. The study period was from week 09/2020 to week 46/2021. Overall, these countries have reported 8,382,441 cases and 216,014 deaths (during the study period). The highest cumulative incidence rate of cases has been recorded in Serbia (17,801.5) and the highest mortality rate has been recorded in Bulgaria (391.0). Romania is in fourth place regarding the cumulative incidence rate of cases/100,000 inhabitants but in third place regarding the mortality due to COVID-19 (case-fatality rate of 3.1%). Although the World Health Organization and EU co-ordinate the COVID-19 response, each state makes its own decisions regarding SARS-CoV-2 mitigation measures, the epidemiological indicators directing us about the effectiveness of responses.

Neurotoxicity and Other Clinical Manifestations of a Common European Adder (Vipera berus) Bite in Romania.

Most cases of envenomation by common European vipers (Vipera berus) have not been reported to have neurotoxic manifestations. However, these manifestations have been demonstrated in some cases of envenomation by subspecies of V. berus, found in the Carpathian Basin region of south-eastern Europe. Here, we report the case of a 5-year-old girl from the south of Romania who presented symptoms of neurotoxicity, as well as other systemic and local symptoms, after being bitten by an adder of the V. berus subspecies. Treatment consisted of monovalent antivenom, a corticosteroid, and prophylactic enoxaparin. Neurotoxic manifestations of envenomation as well as other local and systemic symptoms improved within 5 days of treatment. The presented case shows that venom from V. berus subspecies found in the Carpathian Basin can have neurotoxic effects. This case also confirmed the efficacy of monospecific antivenom treatment in bringing about rapid and complete remission, following envenomation.

mRNA COVID-19 Vaccine Reactogenicity among Healthcare Workers: Results from an Active Survey in a Pediatric Hospital from Bucharest, January-February 2021.

In Romania, health and social workers were prioritized for COVID-19 vaccination. We aimed to describe the vaccine adverse events identified through an active survey (using an electronic questionnaire) conducted among the staff of a pediatric hospital from Bucharest, vaccinated with the mRNA Pfizer-BioNTech vaccine. Data on the frequency and duration of adverse events were collected and analyzed using Microsoft Excel, Epi Info, and MedCalc. The questionnaire was sent to 426 persons. The participation rate was 81.2% after 1st dose and 63.8% after the 2nd dose. Overall, 81.9% were women, median age 42 (IQR 32-50 years). A total of 48 respondents (14.8%) reported no adverse event after the 1st dose and 35 (14.1) after the 2nd dose. No anaphylaxis was reported. The most frequent adverse event was pain at injection site, being reported by 261 responders (80.3%) after 1st dose and 187 (75.1%) after 2nd dose. Fatigue and headache were reported significantly less frequently in our study compared with data provided by the vaccine manufacturer. The current study has shown higher local reactogenicity after the first dose of the vaccine and higher systemic reactogenicity after the second dose. This real-world knowledge of the reactogenicity and safety profile may increase the vaccine's acceptance rate among healthcare workers.

Measles in Romania - clinical and epidemiological characteristics of hospitalized measles cases during the first three years of the 2016-ongoing epidemic.

A large measles epidemic has been ongoing in Romania and many European countries, since 2016. We report case-based surveillance data for all patients (n = 1371) with laboratory-confirmed and epidemiologically-confirmed measles hospitalized in a major infectious diseases hospital in Bucharest Romania during the first three years of the current measles epidemic (July 2016-July 2019). More than half of the patients (57.6%) had ages below 5 years; 6% (n = 82) had preexisting comorbidities. Only 1.5% of the patients had been fully vaccinated, 5.9% had received only one vaccine dose, while 92.8% had not been vaccinated at all against measles. The rate of measles-related complications was 93.4%; complications occurred more frequently among patients who were not eligible for vaccination due to young age or underlying diseases, and among children, who developed pneumonia and enterocolitis more frequently than adults. The median hospital length-of-stay was 6 days. Eight cases (0.6%) required intensive care and mechanical ventilation, and three deaths (0.2%) were recorded. Measles disproportionately affects patient groups who are not eligible for vaccination. During the current epidemic in Romania, 98.5% of the patients hospitalized for measles had not been vaccinated and among these, 75.7% would have been eligible for vaccination. For the remaining pool of unvaccinated children, supplementary immunization activities are urgently needed.

Surveillance of medically-attended influenza in elderly patients from Romania-data from three consecutive influenza seasons (2015/16, 2016/17, and 2017/18).

BACKGROUND: Influenza is an acute infection affecting all age groups; however, elderly patients are at an increased risk. We aim to describe the clinical characteristics and the circulation of influenza virus types in elderly patients admitted for severe acute respiratory infection (SARI) to a tertiary care hospital in Bucharest, Romania, part of the I-MOVE+ hospital network. METHODS: We conducted an active surveillance study at the National Institute for Infectious Diseases "Prof. Dr Matei Balș," Bucharest, Romania, during three consecutive influenza seasons: 2015/16, 2016/17, and 2017/18. All patients aged 65 and older admitted to our hospital for SARI were tested for influenza by PCR. RESULTS: A total of 349 eligible patients were tested during the study period, and 149 (42.7%) were confirmed with influenza. Most patients, 321 (92.5%) presented at least one underlying condition at the time of hospital admission, the most frequent being cardiovascular disease, 270 (78.3%). The main influenza viral subtype circulating in 2015/16 was A(H1N1)pdm09, followed by A(H3N2) in 2016/17 and B influenza in 2017/18. Case fatality was highest in the 2015/16 season (3.7%), 0% in 2016/17, and 1.0% in 2017/18. Vaccination coverage in elderly patients with SARI from our study population was 22 (6.3%) over the three seasons. CONCLUSIONS: Our study has highlighted a high burden of comorbidities in elderly patients presenting with SARI during winter season in Romania. The influenza vaccine coverage rate needs to be substantially increased in the elderly population, through targeted interventions.

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.

[Frequency and severity of rotavirus acute gastroenteritis hospitalized in Bucharest, Romania. Results of a case-control study]. / Frecventa si severitatea gastroenteritei acute rotavirale spitalizate în Bucuresti, România. Rezultatele unui studiu case-control.

BACKGROUND: rotavirus gastroenteritis is an emergent condition of morbidity at global level; WHO is currently recommending integration of rotavirus vaccination into the regions and states where rotavirus infection is identified as a public health priority problem. OBJECTIVE: analyzing the frequency and clinical severity of rotavirus gastroenteritis in pediatric inpatients and commenting the programmatic signification of the analysis' results. METHODS: descriptive retrospective study followed by case-control study upon the cohort of patients hospitalized in the year 2008, for acute diarrhoeal disease (ADD) of infectious nature in the biggest university clinic for children from Bucharest municipality. Rotavirus etiology was sustained on the ground of rotavirus antigen's detection, through immune chromatography assay, in the feces of patients with ADD clinical syndrome. The predictor factor for clinical severity was prolonged hospitalization, defined as any duration of hospitalization longer then the value calculated at 75 percentile, in the studied cohort. For the case-control study each case of rotavirus enteritis (Code ICD-10: A08.0) has been matched by age and gender with one control, selected at random from the list of patients with ADD of different etiology than the case. RESULTS: in 2008 in our clinic, a lot of 684 of children was hospitalized for at least 24 hours, for infectious ADD, in which the median age was 8 months and the prevalence of male gender was 49%. In this lot, the prevalence of rotavirus enteritis was 12.7%. Cases of rotavirus enteritis have been admitted all year round, monthly highest prevalence being of 40%. The risk of prolonged hospitalization in patients discharged with the diagnosis of rotavirus enteritis was 2.36 higher (95% Confidence Interval: 1.17-4.78; p < 0.01) than in the same age and gender children hospitalized for ADD of other etiologies. CONCLUSIONS: our study found an annual prevalence of 2.7%, a monthly maximum prevalence of 40% and a risk of prolonged hospitalization of rotavirus enteritis of 2.36 times higher then in ADD cases of other etiologies. In our opinion, these findings encompass objective arguments sustaining that in Bucharest, the rotavirus infection represents a public health problem, with high priority in allocation of health resources, mainly for surveillance and routine immunization.

[Factors influencing the use of systemic antibiotics in hospitalized pediatric patients in Bucharest, Romania]. / Modulatori ai densitatii ratei de consum a agentilor antimicrobieni sistemici la pacientii pediatrici spitalizati în Bucuresti, România.

BACKGROUND: Formulation of effective strategies for prudent usage of antibacterial agents involves knowing of the factors that are modulating the variability of usage rate. OBJECTIVE: analysis of the factors what modulate the usage rate's variability of antimicrobials prescribed to hospitalized children from Bucharest municipality. METHODS: A statistically representative sample (n=895) has been extracted from the cohort of children discharged during October 2008 from the Bucharest's main pediatric university clinic. Demographic, clinic and pharmacological relevant data, captured by reviewing the subjects' medical charts were entered in an Epi Info database. For each enrolled subject the density rate of antimicrobial consumption has been calculated by dividing the pooled number of hospital days in which the subject received at least one dose of each individual antimicrobial agent, by the number of days of hospitalization. For the analysis of antimicrobials usage rate's variability, a rate higher the value calculated at 75 percentile has been defined as overuse. Personal, clinical and prescription characteristics significantly associated, in univariate analysis, with overuse status, were analyzed lately for independent association, by unconditional logistic regression. RESULTS: to the sample's subjects up to 31 individual antimicrobials owning to the J01 group (antimicrobials for systemic use) of the ATC (Anatomical Therapeutic Chemical) classification promoted by World Health Organization were prescribed. In total, in the sample a number of 2607 days of antimicrobial therapy was cumulated, in 60% of these 5 antimicrobials agents were administered: ceftriaxone, gentamicine, cefoperazone, cefazolin and cefuroxime. Antimicrobials overuse was observed in 37% of subjects. By univariate analysis the overuse was significantly associated (p < 0,05) with the following characteristics of the subjects: age under one, with a trip in ICU, diagnosed with LRTI, with a hospitalization longer than 5 days, exposed to more than two antimicrobials agents during the same hospitalization episode and treated with 3rd generation cephalosporins. However, by multivariate analysis, only factors related to antimicrobials prescribing style remained independently associated with overuse status. CONCLUSIONS: In children hospitalized in Bucharest, the antimicrobial agents' consumption is modulated by factors which are specific for this category of patients, factors broadly internationally recognized. Particularly, through multivariate analysis, we found that the factors related with antimicrobials prescription's style explained with the most fidelity the variation of usage density rate in the child hospitalized in Bucharest. The analysis of the modulators of the usage rate's variability is essential for issuing and evaluation of effective interventions focused on antimicrobials' prudent use.