Spatio-Temporal Pattern of Tuberculosis Distribution in Romania and Particulate Matter Pollution Associated With Risk of Infection.

The study proposes a dynamic spatio-temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012-2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio-economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.

Obesity as key challenge for the health systems resilience during the COVID-19 pandemic.

The COVID-19 pandemic affected 62 million people and caused more than 1.4 million deaths globally till the end of November 2020. Our study aimed to explore the association between obesity and the negative outcomes of COVID-19 worldwide. The prevalence of obesity and overweight per country was extracted from the World Health Organization information system and, for measuring the COVID-19 negative outcomes, we calculated the cumulated notification rate and the mortality for the interval since starting of pandemic till the 29th of November 2020. We explored the linear relationship between COVID-19 and obesity by a bivariate Spearman rank correlation, interpreted using the rule of thumb for 95% level of confidence. We found globally a positive, moderate, and statistically significant correlation between prevalence of obesity and overweight and the negative outcomes of COVID-19. Some of the results found at global level were confirmed in the disaggregated analysis per WHO regions. Due to the linear association of obesity with the COVID-19 negative outcomes, effective actions are needed for keeping the health systems resilience during the COVID-19. Preventing the obese and overweight people to be infected, prioritizing access to vaccination and to adequate care and treatment could be effective.

Transmission and molecular characterisation of wild measles virus in Romania, 2008 to 2012.

Molecular characterisation of measles virus is a powerful tool for tracing transmission. Genotyping may prove the absence of endemic circulation of measles virus, i.e. transmission for more than 12 months, which is one of the criteria for verifying elimination of the disease. We have genetically characterised measles viruses detected in Romania from 2008 to 2012, focusing on the recent outbreaks from 2010 to 2012 that affected mainly groups with limited access to healthcare and schools. The findings emphasise the importance of genotyping during the different phases of an outbreak. A total of 8,170 cases were notified, and 5,093 (62%) of the 7,559 possible cases were serologically confirmed. RT-PCR was performed for 104 samples: from the 101 positive samples obtained from sporadic measles cases or clusters from different counties, 73 were genotyped. Sporadic measles cases associated with D4 and D5 viruses were observed from2008 to 2009. Genotype D4-Manchester was predominant in 2011 and 2012. In addition, the related variant D4-Maramures and MVs/Limoges.FRA/17.10[D4] and a few D4-Hamburg strains were detected. The detection of several distinct MV-D4 genotypes suggests multiple virus importations to Romania. The outbreak associated with D4 genotype is the second largest outbreak in Romania in less than 10 years.

Seroepidemiology of mumps in Europe (1996-2008): why do outbreaks occur in highly vaccinated populations?

Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5-12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01-0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P < 0·001), as did an interval of 4-8 years between doses (OR 0·08, 95% CI 0·01-0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4-8 years between doses.

Ongoing rubella outbreak among adolescents in Salaj, Romania, September 2011-January 2012.

A rubella outbreak has been ongoing in Salaj, Romania since September 2011 involving 1,840 probable and confirmed cases among mainly unvaccinated adolescents. The index case had onset of illness on 6 September 2011. The highest number of cases was recorded among 10­14-year-olds and 15­19-year-olds. Complications were recorded for 11 cases and included meningitis and arthritis. Although the peak has passed, surveillance is being maintained in the region.

Comparative hepatitis A seroepidemiology in 10 European countries.

The WHO recommends hepatitis A virus (HAV) immunization according to level of transmission and disease burden. We aimed to identify susceptible age groups by standardized serosurveys to inform HAV vaccination policy in participating countries: Belgium, Czech Republic, England, Finland, Germany, Italy, Lithuania, Malta, Romania, and Slovakia. Each country tested national serum banks (n = 1854-6748), collected during 1996-2004, for anti-HAV antibodies. Local laboratory results were standardized to common units. Forty-one per cent of those aged <30 years and 6% of those aged ≥30 years were susceptible to HAV in Romania; compared to 70-94% and 26-71%, respectively, elsewhere. Romania reported high HAV incidence in children and young adults. Other countries reported HAV disease primarily in older risk groups. The results suggest low level of HAV transmission in most of Europe. Romania, however, appeared as an area with intermediate transmission. Vaccination of risk groups in countries with high susceptibility of young and middle-aged adults needs to be continued.

Two cases of infection with Bacillus anthracis, Romania, October 2011.

A cluster of two confirmed cases of anthrax were reported in October 2011 from a small village with a population of 3,400 people, in south-eastern Romania.One was a fatal case of cutaneous and anthrax meningoencephalitis, while the other had cutaneous anthrax. Both cases had been exposed to one Bacillus anthracis-infected cow via consumption of its meat or being involved in its slaughter.

Ongoing measles outbreak in Romania, 2011.

Since January 2011 Romania has been experiencing a measles outbreak with 2,072 cases notified in 29 of the 42 Romanian districts. Most cases occurred in the north-western part of the country among unvaccinated children with the highest number of cases (893 cases) registered in children aged one to four years. This report underlines once more the need for additional measures targeting susceptible populations to achieve high vaccination coverage with two doses of measles-mumps-rubella vaccine.

Outbreak of West Nile virus infection in humans, Romania, July to October 2010.

A total of 57 cases of West Nile virus infection (54 with neuroinvasive infection and three with fever) were identified in Romania between July and October 2010.The median age of the cases was 53.4 years, with the highest incidence in the age group 60­69 years.The case fatality rate was 8.8%. Cases were distributed in 19 districts in the southern, western, central and eastern parts of the country. Molecular investigation revealed lineage 2 West Nile virus, related to the Volgograd 2007 strain.

Spotlight on measles 2010: An ongoing measles outbreak in the district of Neamt, Romania, August - September 2010.

We report an outbreak of measles that has been ongoing in the district of Neamt, Romania, since 22 August 2010. As of 21 September, 17 of 21 suspected cases have been laboratory-confirmed and there was one measles-related fatality.

A summer school on vaccinology: Responding to identified gaps in pre-service immunisation training of future health care workers.

Immunisation is one of the corner stones of public health. Most health care consumers see the health care worker as their major source of information on immunisation and vaccine safety. Doctors, nurses and midwives should be appropriately and timely trained for that role. Within the Vaccine Safety, Attitudes, Training and Communication (VACSATC) EU-project a specific work package focused on the possible improvements of pre-service training of future health care workers. Surveys to assess current pre-service training about knowledge, skills and competences towards immunisation were distributed to students and curriculum managers of medical schools, universities and nursing training institutions in seven EU countries. In all responding institutions training on vaccines and immunisation is disseminated over a wide range of courses over several academic years. Topics as immunology and vaccine-preventable diseases are well covered during the pre-service training but major gaps in knowledge and competences were identified towards vaccine safety, communication with parents, addressing anti-vaccine arguments and practical skills. This assessment underlined the rationale for adequate pre-service training and identified opportunities for improvement of pre-service training. A prototype of an accurate pre-service immunisation curriculum was developed, implemented and evaluated in the summer of 2009 with a group of 36 students from 19 countries during a summer school on vaccinology at the Antwerp University, Belgium.

Trends in hepatitis B incidence in Romania, 1989-2005.

In the early 1990s, Romania had a high incidence of hepatitis B, with over 30 cases per 100,000 population annually. The disease represented a serious public health problem, especially for children. As a result, public health measures were introduced during the 1990s such as the enforcement of the use of single-use needles and a routine vaccination programme for children and health workers. This paper describes the change in incidence of HBV infection in Romania from the late 1980s until 2005, and demonstrates the impact of those measures. They have lead to a dramatic decrease in hepatitis B incidence across the country: overall, the incidence has decreased from 43 per 100,000 in 1989 to 8.5 per 100,000 in 2004. The decrease has been most prominent in children under 15, dropping from 81 to 11 per 100,000 population and year during that period.

A large rubella outbreak, Romania--2003.

Romania experienced a large rubella outbreak in 2002-03, with more than 115,000 reported cases nationwide, and an incidence of 531 reported cases per 100,000 population. The incidence was highest in children of school age. The cohorts of adolescent girls vaccinated in 1998 and 2002 (when a rubella-containing vaccine was available) had significantly lower incidence rates (p<0.001) compared with those in boys in the same age groups who were not vaccinated. In 2003, of the 150 suspected congenital rubella syndrome (CRS) cases reported, seven (4.6%) were confirmed by positive rubella IgM antibodies. In the absence of available rubella containing vaccine for outbreak control, an outbreak response plan to improve the detection of cases and to limit rubella virus transmission was developed. The following activities were conducted: surveillance of pregnant women with suspected rubella or history of exposure to rubella virus was implemented, with follow up of pregnancy outcomes; surveillance for CRS was strengthened; existing infection control guidelines to prevent disease transmission within healthcare facilities were reinforced; and a communication plan was developed. In May 2004, Romania is introducing measles, mumps and rubella (MMR) vaccine for routine vaccination of children aged 12 to 15 months, while continuing vaccination of girls in the 8th grade of school (13-14 years of age) with rubella-only vaccine.