Severe acute respiratory infections surveillance in Romania - is it any gain to public health?

UNLABELLED: This article aims to present the operation and usefulness of severe acute respiratory infection (SARI) surveillance in Romania. Material and methods : The information obtained from surveillance data analysis using Epilnfo program revealed a greater severity of influenza in the second post-pandemic season (2011/2012) compared to the previous one (2010/2011). Detected risk factors were evidence-based arguments for recommending preventive measures in certain population groups. CONCLUSIONS: This surveillance system has proven useful, being able to provide information on the severity of influenza and other etiologies involved in severe acute respiratory infections.

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.

[Considerations in an outbreak of viral acute gastroenteritis, Cisnadie 2009]. / Consideratii asupra unui focar de gastroenterita acuta virala, Cisnadie 2009.

Frequent cause of morbidity and mortality in the whole world, viral gastroenteritis represent about 80% of infectious gastroenteritis. In non-industrialised countries it mostly affects small children,while in those industrialised it represents a significant cause of morbidity in all age groups. During 30.04--17.06.2009 we registered 315 cases of gastroenteritis in Cisnadie. All age groups were concerned, but 78.9% of cases were children less than 14 years old. We registered cases belonging to the same family. The clinical forms of the disease were mild or moderate. Identification of enteroviruses (Coxsackie A9 and non-typable EVNP) in 2 stool samples and in the water sample gathered from the residual water tank of the City Hospital in Cisnadie demonstrates the enterovirus circulation. 7 cases were confirmed with rotavirus. For the rotaviral etiology could also plead the information received from the District Hospital Sibiu concerning a series of cases diagnosed with rotaviral infection in children, during the months preceding the onset of this outbreak. Regarding the transmission of the agent we excluded a hydric outbreak, the most probable transmission being the direct one.

Ki67 index in intracranial ependymoma: a promising histopathological candidate biomarker.

AIMS: The Ki67 tumour cell proliferation index is an independent prognostic factor in ependymoma patients. Essential prerequisites for validation of the Ki67 index as a histopathological biomarker are the reproducibility of this factor and its prognostic influence by different observers (proof of objective clinical and analytical performance). To this end, the aim was to analyse systematically inter- and intraobserver agreement and reproducibility of the prognostic impact of the Ki67 index in intracranial ependymoma. METHODS AND RESULTS: The study cohort contained 78 cases of intracranial ependymoma. In all cases, the Ki67 index was assessed by four experienced observers (EOs) and by four inexperienced observers (IOs) using the manual hot-spot method. There was considerable agreement on Ki67 index assessment. There was higher observer agreement among EOs compared with IOs. For each observer, survival analysis showed significant association of low Ki67 index with favourable patient outcome. CONCLUSIONS: Our data show that the Ki67 index in intracranial ependymoma is a reproducible and robust prognostic factor and can be considered a promising histopathological candidate biomarker. Attainment of biomarker status requires further translational studies in the context of prospective therapeutic trials.

[Poliomyelitis eradication in areas with armed conflict: the case of Afghanistan]. / La eliminación de la poliomielitis en zonas en conflicto: el caso de Afganistán.

The aim of this study was to describe fieldwork to erradicate poliomyelitis from Afghanistan and particularly from the Mazar Region. From 1997-1999, 365 cases of acute flaccid paralysis were detected. Of these, 216 cases (59.2%) were classified as poliomyelitis. The rate of acute flaccid paralysis improved from 0.1 in 1997 to 0.8 in 1999. Fieldwork in the Mazar region revealed under-notification and the need to improve surveillance methods. However, massive use of the services of traditional healers and extreme transport difficulties reduced the efficacy of the interventions. The case of Afghanistan suggests that epidemiological surveillance systems are feasible in countries with armed conflict, although such systems require considerable resources.

Risk factors for West Nile virus infection and meningoencephalitis, Romania, 1996.

In 1996, an epidemic of 393 cases of laboratory-confirmed West Nile meningoencephalitis occurred in southeast Romania, with widespread subclinical human infection. Two case-control studies were performed to identify risk factors for acquiring infection and for developing clinical meningoencephalitis after infection. Mosquitoes in the home were associated with infection (reported by 37 [97%] of 38 asymptomatically seropositive persons compared with 36 [72%] of 50 seronegative controls, P<.01) and, among apartment dwellers, flooded basements were a risk factor (reported by 15 [63%] of 24 seropositive persons vs. 11 [30%] of 37 seronegative controls, P=.01). Meningoencephalitis was not associated with hypertension or other underlying medical conditions but was associated with spending more time outdoors (meningoencephalitis patients and asymptomatically seropositive persons spent 8.0 and 3.5 h [medians] outdoors daily, respectively, P<.01). Disease prevention efforts should focus on eliminating peridomestic mosquito breeding sites and reducing peridomestic mosquito exposure.

West Nile encephalitis epidemic in southeastern Romania.

BACKGROUND: West Nile fever (WNF) is a mosquito-borne flavivirus infection endemic in Africa and Asia. In 1996, the first major WNF epidemic in Europe occurred in Romania, with a high rate of neurological infections. We investigated the epidemic to characterise transmission patterns in this novel setting and to determine its origin. METHODS: Hospital-based surveillance identified patients admitted with acute aseptic meningitis and encephalitis in 40 Romanian districts, including Bucharest. Infection was confirmed with IgM capture and indirect IgG ELISAs. In October, 1996, we surveyed outpatients in Bucharest and seven other districts to estimate seroprevalence and to detect infected patients not admitted to hospital. We also measured the rates of infection and seropositivity in mosquitoes and birds, respectively. RESULTS: Between July 15 and Oct 12, we identified 393 patients with serologically confirmed or probable WNF infection, of whom 352 had acute central-nervous-system infections. 17 patients older than 50 years died. Fatality/case ratio and disease incidence increased with age. The outbreak was confined to 14 districts in the lower Danube valley and Bucharest (attack rate 12.4/100000 people) with a seroprevalence of 4.1%. The number of mild cases could not be estimated. WN virus was recovered from Culex pipiens mosquitoes, the most likely vector, and antibodies to WN virus were found in 41% of domestic fowl. INTERPRETATION: The epidemic in Bucharest reflected increased regional WNF transmission in 1996. Epidemics of Cx pipiens-borne WNF could occur in other European cities with conditions conducive to transmission.

Natural propolis extract NIVCRISOL in the treatment of acute and chronic rhinopharyngitis in children.

In the work there are shown the results of a "case control" study carried out in a children collectivity (preschool children and school-children), regarding the action of an aqueous propolis extract, NIVCRISOL, in acute and chronic inflammatory diseases of the upper airways. The preparation, which had a rich content of flavonoids, was administered to a group of preschool children and school-children treated during the whole cold season 1994-1995. The monitoring of the subgroups investigated was performed by clinical observation of the health state and recording of the incidence of symptoms characteristic to acute or chronic rhinopharyngeal diseases, as well as by a periodical laboratory examination for the detection and characterization of viral, microbial and fungal germs carriage. The analysis of the data obtained pointed out the favourable effects of this local treatment, expressed by lowering of the number of cases with acute or chronic symptoms, and decrease and sometimes suppression of the viral-microbial flora carriage of the upper airways. These positive results, the good tolerance of the preparation, the advantages of the therapy with natural products and more economic criteria entitle us to propose the administration of this preparation as an adjuvant medication in the local treatment of some clinical forms of acute or chronic rhinopharyngeal diseases.

Risk factors for HIV infection among abandoned Romanian children.

OBJECTIVE: To determine risk factors for HIV infection among abandoned Romanian infants and children living in a public institution. METHODS: A cross-sectional study was conducted in June 1990 among 101 children between 0 and 4 years of age living in an orphanage. Orphanage and hospital records were reviewed and a blood specimen for hepatitis B and HIV serologic testing obtained from each child. A case-control study was conducted using data from the cross-sectional study. Cases were HIV-positive children; one HIV-negative control, matched by age, was selected for each case. RESULTS: Overall, 20 (20%) children were HIV-positive, 88 (87%) tested positive for antibody to hepatitis B core antigen, and 32 (32%) were hepatitis B surface antigen-positive. In the case-control study, HIV-positive children had received more therapeutic injections [mean, 280; median, 231] than age-matched HIV-negative children [mean; 142, median, 155; P = 0.02]. Cases were more likely than controls to have received over 200 lifetime injections (odds ratio, 5.7; 95% confidence interval, 1.2-32.7). Blood transfusions and mother-to-child transmission were excluded as routes of HIV transmission. By reviewing sterilization records and interviewing local health-care workers, we determined that needles and syringes were often re-used without proper disinfection in the orphanage. CONCLUSIONS: These data provide strong epidemiologic evidence that indiscriminate injections with contaminated needles and syringes were responsible for HIV transmission in this population.

Hepatitis B virus infection among pregnant women in northeastern Romania.

We conducted a serological survey of pregnant women attending prenatal clinics in northeastern Romania to determine the prevalence of hepatitis B virus (HBV) infection in this population. Overall, 162 (28%) of 573 women had evidence of past or current HBV infection, and 48 (8.4%) were carriers. The prevalence of past or current infection rose with age, but did not differ by educational level, occupation, or rural versus urban residence. Integration of hepatitis B vaccine into routine childhood immunization schedules, with the first dose given at birth, may have a substantial impact on HBV infection in Romania by preventing both perinatal and early childhood transmission.

PIP: Blood-borne pathogens like hepatitis B virus (HBV) have been a major cause of human sickness and significant economic drain worldwide. Current vaccination programs are based on levels of infection in the population. Romanian orphanages were found to have children with high levels of HBV. This paper reports the findings of a serological survey for HBV in pregnant Romanian women. Blood was taken from 573 women surveyed. Each blood sample was tested for antibodies to the HBV core antigen by radioimmunoassay. Data were statistically assessed using the Z-test, the Chi-square, and the Chi-square for trend. 162/573 women (28%) had a current or past HBV infection. 48/573 women (8.4%) were considered HBV carriers, as they tested positive for hepatitis B surface antigen (HBsAg). In Romania, HBV infections are common in women giving birth. It is for this reason that a large-scale vaccination program should be a major public health priority. HBV vaccination could be incorporated into the existing routine childhood immunization schedules.

Acquired immunodeficiency syndrome in Romania.

After the initial description of acquired immunodeficiency syndrome (AIDS) in Romania in late 1989, national AIDS case surveillance was established with a modified version of the World Health Organisation (WHO) clinical case definition. This modified case definition requires that AIDS cases have both clinical and serological evidence of human immunodeficiency virus (HIV) infection. Before December, 1989, Romania had reported 13 AIDS cases to WHO. By Dec 31, 1990, 1168 AIDS cases were reported to Romania's Ministry of Health, of which 1094 (93.7%) occurred in children less than 13 years of age at diagnosis. Of these, 1086 (99.3%) were in infants and children less than 4 years of age, and 683 (62.4%) in abandoned children living in public institutions at the time of diagnosis. By Dec 31, 1990, 493 (45.1%) mothers of children with AIDS had been located and tested, and 37 (7.5%) were positive for HIV; 423 (38.7%) cases were in children who had received transfusions of unscreened blood, and 6 (0.5%) were in children with clotting disorders. HIV transmission through the improper use of needles and syringes is strongly suspected in most of the remaining 628 (57.4%) children with AIDS, most of whom had received multiple therapeutic injections. This outbreak demonstrates the serious potential for HIV transmission in medical facilities that intensively and improperly use parenteral therapy and have poor sterilisation technique.

PIP: As a recently established AIDS surveillance system has revealed, the overwhelming majority of AIDS cases in Romania have occurred among children. Before December 1989, Romania had reported only 13 cases of AIDS to the World Health Organization (WHO). But following the change in government at the end of 1989, the newly organized Ministry of Health requested emergency assistance from WHO is setting up a surveillance system, having heard reports of large numbers of children with HIV infection. Prior to the 1989 revolution, many parents would abandon their newly born infants, and many of these children would became wars of the state. The infants were cared for in either orphanages or chronic-care hospitals for malnourished children. By December 1990, the surveillance had uncovered 1168 AIDS cases, 1094 (93.7%) of whom were children under 13 years of age. This figure surpasses the total number of AIDS cases among children in all other European countries combined since 1981. Among Romania's infected children, 1086 (99.3%) were infants under 4 years of age, and 683 (62.4%) were wards of the state. As of December 1990, researchers had located and tested 493 (45.1%) of the mothers of children with AIDS. 37 (7.5%) of them tested HIV- positive. Researchers also found that 423 (38.7%) of the children had become infected through transfusion of unscreened blood, and that 6 (0/5%) cases were among children with clotting disorders. The surveillance experts suspect that the remaining 628 (57.4%) of the cases are among children who received multiple therapeutic injections, indicating the serious potential for HIV transmission in medical facilities that improperly use parenteral therapy and have poor sterilization techniques.