Surveillance Seasonal Program. Antibiotic Resistance of Pathogenic Agents Isolated From Children With Acute Gastroenteritis, in a Region of North-East Romania.

The acute gastroenteritis is a population health problem, frequently met everywhere in the world. In Romania, for certain etiologies the reporting is compulsory. Also, these infections are reported in the TESSy system, too (The European Surveillance System). In this context, antibiotics therapy and antibiotics resistance have a particular importance. The study aim was to assess the prevalence of bacterial pathogens involved in the etiology of acute gastroenteritis (AGE) on the Iasi County, Romania and the surrounding areas and the determination of the profile of resistance to the antibiotics for the identified agents. Material and methods: 72 strains of isolated and identified bacterial agents involved in the acute gastroenteritis (AGE) in the case of children (0-14 years), with the exception of the Campylobacter spp., in the municipality of Iasi and its surrounding areas were studied in 2012, during the surveillance period of AGE (May to October). Results: The most frequent has been the Salmonella spp. (63.9%) from which the S. enterica Thyphimurium in 21 cases (29.2%) and S. enteritidis in 7 cases (9.7%), followed by E. coli (20.8%) from which E. coli O:127 in 3 cases (4.2%), Shigella sonnei S (13.9%) and Yersinia enterocolitica (1.4%). In the case of the children from the group of 0-1 year, the Salmonella enterica Thyphimurium has been the pathogenic agent most frequently encountered (6 cases ­ 29.2%), followed by Salmonella Colindale, S. enteritidis, Shigella sonnei S, E. coli O:127 registered with a frequency of 5.6%. The antibiotic resistance rates are high in the case of ampicillin (43.1%), tetracycline (31.9%), amoxicillin ­ clavulanic acid (26.4%), trimethoprim/ sulfametoxazole (22.2%), sulfonamides (11.1%). Conclusions: The antibiotic resistance rates are high in the case of ampicillin, tetracycline, amoxicillin ­ clavulanic acid, trimethoprim/ sulfametoxazole, sulfonamides.

Epidemiological assessments on incidence of acute gastroenteritis in 0-14 aged children, in the Iasi County, Romania, between 2009-2012.

UNLABELLED: The study aim was to assess the epidemiological potential of acute gastroenteritis (AGE) in children between 2009 and 2012. MATERIAL AND METHODS: We studied two groups; first, a lot of 7237 cases (group A) recorded in the Iasi County through passive surveillance system, reported monthly by the network of primary health care, the assisted outpatients, respectively, those reported by hospitals. The second group (group B) was composed of 4191 hospitalized cases reported also in the passive surveillance system m by telephone, weekly, during only June/end of May to October/beginning of November. Structural peculiarities of the two groups are due to different reporting methodology, so that they were analyzed separately. RESULTS: AGE cases come from urban or rural areas in relatively stable proportions and slightly increased in rural areas compared to urban. The distribution by sex of cases from the group B is maintained at the same shape from one year to another, with a slight predominance in males. The best represented age group in every studied was 0-3 (54.3% of all cases), followed by children between 5 and 10 years with 17.5%). Laboratory investigations have enabled the etiologic diagnosis for hospitalized cases, which ranged from 15.3 to 17.5%, with the exception of 2009 when the diagnosis was noted for almost half of the discharged patients (47.5%). CONCLUSIONS: AGE remains a public health problem in the Iasi County and Romania also, by affecting all age groups, but especially children under 3, an insufficient knowledge of the etiology, and economic losses insufficiently evaluated.

Viral meningitis admitted to an infectious diseases hospital: a retrospective case series.

UNLABELLED: Given its epidemic potential and development of severe forms of disease, viral meningitis (VM) is a serious public health problem. AIM: to characterize the main clinical, epidemiologic features, the etiology and treatment of VM cases admitted to the Iasi Infectious Diseases Hospital, in 2012. MATERIAL AND METHODS: We retrospectively analyzed the medical records of the patients admitted for viral meningitis at the Iasi "St. Parascheva" Infectious Diseases Hospital in the interval January 1- December 31, 2012 (98 cases). The etiologic diagnosis was made by determining the IgM/IgG antibodies against Coxsackie virus and/or West Nile virus in blood/CSF. RESULTS: There was a fourfold increase in the number of cases as compared to the average for the years 2009-2011. Most cases (73.5%) were children aged 1 to 14 years. 61.8% of patients were males, 51.7% from urban areas. The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases. In43.5% of the 39 patients serologically investigated a Coxsackie virus infection was confirmed and 1/20 was positive for West Nile virus; three varicella-zoster virus infections and one mumps infection were diagnosed clinically. 68.3% of the patients received first-line antibiotic treatment. CONCLUSIONS: The illness mainly affected children, fever and neck stiffness being sometimes absent. The etiology was known in 22.4% of cases; enter viruses being the most frequent causative agent. Most patients received antibiotic therapy. The course was favorable in all cases.

[Clinical epidemiological study of acute gastro-enteritis outbreak recorded in a children community, in Iasi, May, 2009]. / Studiu clinico-epidemiologic asupra unui focar de gastroenterita acuta înregistrat într-o gradinita cu program prelungit, din municipiul Iasi, în luna mai 2009.

UNLABELLED: Acute diarrheal disease affect all demographic structures and it is considered a major cause of morbidity and mortality for young age groups; underreporting is due to clinical and epidemiological diversity, everywhere, including the developed countries. MATERIAL AND METHODS: The authors present an epidemic outbreak of acute gastroenteritis by rotavirus in a community of 240 children. Processing and interpretation of collected data was done by statistical, mathematical and computerized methods. RESULTS: A number of 17 cases of acute gastroenteritis caused by rotaviruses were detected and confirmed, mostly in children older than 5 years (92%), with a tendency to focus on large group "A", 40%. All cases showed mild forms evolving medium. CONCLUSIONS: The 17 cases of infection with rotaviruses were the second episode of acute gastroenteritis with the same etiology, reported over two months. Extensivity of the epidemic outbreak was moderate, with the predominant age group affected over six years (58%). Developing and implementing preventive measures included daily cleaning and decontamination standards.

[Assessment of the congenital syphilis prevention programs]. / Evaluari asupra programelor de preventie a sifilisului congenital.

UNLABELLED: The Romanian program for the management and screening of syphilis includes the recording, follow-up, and antenatal care of pregnant women. It aims at testing all pregnant women for syphilis with the help of VDLR (Venereal Disease Research Laboratory) or RPR (Rapid Plasma Reagin) tests, and in the women with positive tests to confirm the results by treponemal tests (treponemal antibodies): THPA (Treponema Pallidum Hemagglutination), FTA-Abs (Fluorescent Treponemal Antibody with Absorption), ELISA-Captia-IgM, and Western Blotting-IgM. In the pregnant women with positive tests two doses of 2.4 million units of penicillin G benzathine were administered at 5 days interval. These pregnant women are in the evidence of a specialist (obstetrician, dermatologist), and District Department of Public Health, and required to come for another serology test in 3 months. In case they still test positive, the same treatment is applied at the beginning of the third trimester of pregnancy. AIM: To assess the outcome of congenital syphilis prevention programs in lasi, Romania. MATERIAL AND METHODS: In the interval 2005-2011, in the Iasi town, 84 RPR positive pregnant women were recorded. There was no significant difference in the number of pregnant women residing in urban as compared to rural areas. Most of these women were from poor social environments and had a low level of education. The diagnosis of acquired syphilis was made by serological tests as most pregnant women presented in the period of syphilis latency, being asymptomatic. All pregnant women followed the treatment, and were tested periodically. Ultrasound examination was normal in all women (no changes suggestive of fetal malformations). RESULTS: Free clinical, laboratory, and ultrasound investigations, history taking, psychological assessment, sex education, rapid identification of contacts of known patients, follow-up of the interaction between health care providers and syphilitic pregnant women, booklets, and leaflets altogether made that in the last 3 years (2008-2010) no new case of congenital syphilis to be reported in the study area. CONCLUSIONS: Encouraging women to attend antenatal care early in their pregnancy is essential, this way all pregnancy-related problems (syphilis included) could be managed.

[Syphilis in pregnancy]. / Unele observatii privind infectia sifilitica la gravide.

UNLABELLED: Inadequately treated, maternal syphilis often results in serious sequels for the fetus/newborn. Poor prenatal care is a major risk factor for the development of congenital syphilis. AIM: To determine the results of syphilis screening and followup programs on the incidence of syphilis in pregnant women and their offspring. MATERIAL AND METHODS: Data on the incidence of syphilis, new syphilis cases, pregnant women diagnosed with syphilis and newborns confirmed with congenital syphilis in the Iasi district in the interval 2000-2009 have been collected. RESULTS: In the interval 2000-2010 the incidence of syphilis in the lasi district has decreased from 47.5/100,000 inhabitant in 2001 to 10.5% in 2009, and the new syphilis cases from 627 in 2001 to 87 in 2009. The highest number of pregnant women infected with syphilis was recorded in 2006 (74), and the lowest in 2010 (26). Most newborns confirmed with congenital syphilis were also recorded in 2006 (6), in the interval 2008-2010 no such case being recorded. CONCLUSIONS: All pregnant women have to be subjected to a serological screening test for syphilis at least twice during pregnancy: early during the first trimester and after week 28. Moreover, the women at risk for syphilis have to be examined serologically at delivery. All women who miscarry after 20 weeks of gestation have to be tested for syphilis. All newborns whose mothers' serological status for syphilis was not determined during pregnancy have to be tested before discharge.

[Clinico-epidemiological features and antimicrobial resistance pattern in gonococcal infection]. / Aspecte clinico-epidemiologice si particularitati ale sensibilitatii la antibiotice în infectia gonococica.

AIM: To analyze clinical and epidemiological features in patients with gonococcal infection attended Dermato-Venerology Clinic in Iasi and regional dermato-venerology offices and to evaluate gonococcal antimicrobial resistance pattern. METHODS: The study was carried out on 129 patients clinically diagnosed and bacteriologically confirmed with gonococcal infection who were subsequently submitted to a questionnaire. We studied their demographic characteristics (sex, age, nationality, marital status), clinical features (site of infection, symptoms, concurrent STI, previous history of gonorrhoea) and behavioral aspects (education, number and type of sexual partners, safe sexual practices). RESULTS: We found in our patients a strong association of gonorrhoea with young male individual, poor educational level and with clinical symptoms of urethritis. The level of antimicrobial resistance is higher than in other European countries. CONCLUSIONS: The poor health-seeking behavior, symptoms not specific enough, resistance pattern, lack of accessible and sensitive diagnostic methods lead to undiagnosed and probably mistreated gonorrhoea.

[Trends in epidemiological evolution of viral hepatitis B and C , in children , Romania and Iasi county between 1990-2009]. / Tendinte ale evolutiei epidemiologice a hepatitelor acute virale B si C la copil, in România si judetul Iasi, in perioada 1990-2009.

UNLABELLED: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the frequent causes of acute and chronic hepatitis worldwide and the leading causes for hepatic cirrhosis and liver cancer. There is a distinct geographical variation in VHB and VHC incidence in adult and child. AIM: To assess the evolution trend of VHB and VHC incidence in child, in Romania and Iasi County, during the last two decades. MATERIAL AND METHODS: Data were obtained using information from the Reporting National System for acute viral hepatitis A, B, and C, from various geographical areas of Romania. Some systematical errors of information were identified, without significant influence of results and conclusions. RESULTS: Results highlighted an incidence peak of VHB in Romania, in 1989, and in Iasi county, in 1991 (43.1, respectively 41.2 per thousand inhabitants). The VHB incidence trend decreased after the implementation of vaccination programme, especially in children < 4 years old. CONCLUSIONS: The study remarked the necessity of viral hepatitis surveillance programme continuity in Romania and the importance of prevention measures including, for VHB, an optimal vaccination.

[Efficiency of seasonal influenza vaccine in persons older than 65 in Romania. Pilot case-control study I-MOVE, 2008-2009]. / Eficacitatea vaccinului gripal sezonier la persoanele cu vârsta peste 65 de ani din România. Studiul pilot caz-martor I-MOVE, 2008-2009.

Cantacuzino Institute conducted between September 2008 and June 2009, a pilot case-control study to monitor the influenza vaccine effectiveness on people over 65 years of age from Romania. This study is part of the I-MOVE project "Monitoring the vaccine effectiveness during seasonal and pandemic influenza in EU/EEA member states, 2008-2009", coordinated by EpiConcept, France and financed by European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. Forty seven family doctors and epidemiologists from Bucharest and seven influenza sentinel districts were selected to participate in this project, based on epidemiological and geographical criteria. Family doctors swabbed all people over 65-years-old consulting for influenza like illness (ILI). Influenza confirmed cases (classified as cases) were compared to influenza negative controls. Influenza vaccine effectiveness (IVE) was obtained using the formula: 1 - odds ratio, with 95% confidence interval (CI). One hundred and three ILI patients were enrolled in the study. Ninety nine from them (96.1%) were swabbed in the first 7 days after the onset, met the inclusion criteria and case definition and were included in analysis. Thirty (30.3%) were ILI flu positive and were classified as cases, sixty nine (69.7%) were ILI flu negative and classified as controls. Influenza vaccine effectiveness adjusted for the predefined set of confounders (age, sex, chronic diseases, smoking, previous influenza vaccination, functional status) was 86.8% (95% CI, 38.0, 97.2); influenza vaccine coverage in people older than 65 years was 49.4%. The result of the study showed a high influenza vaccine effectiveness in the elderly. In order to achieve a greater precision, the national and also the European samples should be extended for the next season.

[Seroepidemiology studies on population immune background to viral hepatitis B]. / Cercetari seroepidemiologice privind configuratia fondului imunitar fata de hepatita virala B.

MATERIAL AND METHOD: The studies have been carried out in 855 males and females aged over 20 years belonging to the general population and health care profession included in the European Sero-Epidemiology Network (ESEN) Programme aimed at assessing the population immune background against hepatitis B virus. The serological markers, represented by HBsAg, antibodies to HBsAg (anti-HBsAg) and HBcAg (anti-HBcAg) were investigated by the methods widely used in seroepidemiology studies. The patients were divided into 4 subgroups. RESULTS: In the blood serum of a subgroup of 220 individuals, HBsAg was found in 33.2%, anti-HBs in 41.3%, and anti-HBc in 25.4%. In another subgroup of 219 individuals, significantly increased levels of the anti-HBs were recorded in 50.2%. In the subgroup of 168 individuals, IgG anti-HBc were present in 84.6% of those aged over 40 years who had acute HBV infection. In the subgroup of 248 healthcare professionals the prevalence of anti-HBs carriers was 50-80%, result of vaccine-prevention.

[Prevalence of HBsAg carriers in Iasi County in 2001-2005 period. Epidemiological, clinical and laboratory study]. / Cercetari epidemiologice, clinice si de laborator asupra prevalentei purtatorilor de AgHBs in judetul Iasi, in perioada 2001-2005.

UNLABELLED: The complex epidemiological process of viral hepatitis B is dominated, maintained and spreading out as a consequence of the high prevalence of the sources represented by HBsAg carriers. RESULTS: In the interval 2001-2005, the prevalence of HBsAg carriers in the Iasi County was close to the national average level of about 6%. In the age group 5-9 years, the prevalence is higher in males. During the study interval prevalence was higher in the age group 10-14 years and especially after the age 24-25 years. Among blood donors the prevalence of HBsAg carriers is significantly higher in the occasional and first-time donors. The medical staff, other than physicians, working in different medical units and belonging to various age groups have not shown significant differences in the prevalence of HBsAg carriers.

[The co-infection with hepatitis virus B and D--cases admitted in the infectious diseases hospital from Iasi, Romania (2003-2005)]. / Co-infectia cu virusurile hepatitice B si D--cazuri internate în clinica de boli infectioase Iasi (2003-2005).

Despite the major medical advance, over 350 million people worldwide still have chronic infection with hepatitis B virus and HBV-associated liver disease remains a major cause of morbidity and mortality. 15-50% of patient VHB infected have serological markers for VHD co-infection. We retrospectively studied 252 cases of acute hepatitis B (AHB) admitted in our hospital between 2003-2005; 12 of them (4.76%) had a co-infection with hepatitis D virus. Most of the patients were young males with an urban origin. The route of transmission was unknown in 8/12 cases. Abdominal pain was more frequent during the onset of the disease than in AHB (p < 0.05). A cholestatic pattern was noted in 9 cases. The frequency of severe/ fulminant cases was greater then in AHB. The HBsAg was absent in 3 patients, and the HBV-DNA was present at low levels in 3/12 patients tested. Two patients had HBsAg present 6 month later.

[Epidemiology of viral hepatitis B in the Iasi County in the interval 1990-2005]. / Aspecte din epidemiologia hepatitei virale B, în judetul Iasi, în perioada 1990-2005.

Viral hepatitis and especially hepatitis B (HVB) continue to represent major health problems. In Romania, the morbidity from HVB is still 3 to 5 times higher than in Western Europe and North America. In the Iasi County, the effectiveness of the preventive measures is proven by a curve of morbidity values close to or even below those recorded at national level. As a result of the preventive interventions, in the interval 1996-2005, the morbidity from HVB was lower in all age groups as compared to the interval 1990-1995. The significant decrease in morbidity following the introduction of a vaccination program and the preservation of a constantly descending trend reflect the favourable change in the epidemiological process of HVB.

[Clinical epidemiological research on the evolution of rubella cases recorded in some collectives of institutionalized children]. / Cercetari clinico-epidemiologice privind evolutia cazurilor de rubeola raportate în colectivitati de asistenta medico-sociala a copiilor.

Authors present the results of a retroprospective study to assess the number of rubella cases recorded in medical social assistance units for children, in two districts of Moldavia, Romania, between 1993-2003. The age distribution highlighted a predominance of 11-19 age groups in Botosani and 5-14 in Iasi; and sex distribution, a predominance in females, but with no significant difference. The rubella epidemic peak of year 2003 was observed in both districts. The necessity of Immunization National Program spreading for rubella and rubella congenital syndrome prevention is a reality, taking into consideration the high incidence of this disease in institutionalized children also.

[Chlamydia infections and tubal infertility]. / Infectia cu Chlamidia si infertilitatea tubara.

This is a screening study for chlamydial infections (1153 patients females). In the number of 272 cases (23.59%) chlamydial infection was confirmed by ELISA blood tests. We purpose to determine the risk factors for tubal infertility, because Chlamydia trachomatis (CT) is the most important cause of pelvic inflammatory disease (PID) and permanent tubal damage. High correlations (correlation coefficient-"r") of chlamydial infection with hygienic level (r=0.51), avoided use of condoms (r=0.58) or number of abortions (r=0.65) were noticed. Results with primary prevention through sexual education have been disappointing, so is necessary preventing or limiting sequelae of chlamydial infection, such as PID and tubal infertility.

[Tetanus in childhood--experience at the Infectious Disease Hospital Iasi, January 1980-October 2003]. / Tetanosul la copil. Experienta Clinicii de Boli Infectioase Iasi în perioada 1980-2003.

The aim of our study is to present the tetanus pediatric cases for almost 24 year period. We analyzed epidemiologically, clinico-biologically and the treatment from the patients' files. In above mentioned period were admitted 8 children with tetanus, 4 cases in 1980-1990; 5 patients were female, mainly came from suburban area; 12-15 year old group of age was mainly involved-3 cases. A point of entry was certified in 7 cases, the mean incubation period was 9.2 days, all the cases had a typical form of the disease. The complications were: bronchopneumonia, ileus (1 case). The performed treatment--antitetanic serum, antibiotics, sedatives, curare for 3 patients; no patient died. A rare disease for the pediatric age, tetanus could be a severe disease, with severe complications.

[Prospective epidemiologic research on the morbidity with epidemic parotitis, in the Iasi district, between 1982-2003]. / Cercetari epidemiologice retroprospective privind evolutia morbiditatii prin parotidita epidemica, în Judetul Iasi, în perioada 1982-2003.

Authors present the results of an epidemiological prospective study, carried out on a sample of 35981 cases of epidemic parotitis, recorded in the Iasi District, between 1982-2003. The study highlights the fact that epidemic parotitis represents a major health problem, with important medical consequences, unfavourable both because of its morbidity, sometimes epidemics, and because of its complications. Epidemic parotitis was spotted both in the urban and rural area, having an increased incidence during the seasons with low temperature and affecting especially the 5-9-year age group. For lack of vaccination, the epidemiological process of this disease developed naturally.