[The prevalence of viral hepatitis markers in patients hospitalized in infectious disease wards with a diagnosis of acute viral hepatitis]. / Prevalenta markerilor hepatitelor virale la bolnavii internati în sectiile de boli infectioase cu diagnosticul de hepatita acuta virala.

According with Romanian public health surveillance system, the acute viral hepatitis is nominal reportable disease for what hospital admission is compulsory (Ord. MS 638/1978 and Ord. MS 386/1985); that why, for this condition controlling purpose, only the hospital admitted cases are reported. The acute viral hepatitis statistics do not reflect the morbidity in general population but in hospitalized population; these statistics are very dependent if ill people are hospitalized or not, and in the same time by the lack possibilities of laboratory diagnosis. The objective's study were: a) to describe the structure of laboratory-based diagnostics (using ELISA kits), b) to compare this one with diagnostics established for admitted ill people in infectious wards or clinics, using electroimmunodiffusion (EID) test. The most important findings reveal that from a total of 121 cases about three quarters has been identified as type B viral hepatitis, 20% as type A viral hepatitis and 8.3% were neither type A nor type B viral hepatitis (ELISA kits for hepatitis C diagnosis there was not available for us). According with our findings we think EID technique as etiologic diagnosis for acute viral hepatitis, have to be changed. We need instead a more sensitive and timeliness test; in the same time this has to be permissive from the financial point of view.

[The prevalence of viral hepatitis B in pregnant women in an area of southern Romania]. / Prevalenta hepatitei virale B la gravide, în zona de sud a României.

In Romania, the acute hepatitis B virus (HBV) infections are considered to be a public health problem. One of the most effective routes of transmission is from infected mothers to newborns both perinatal and in early childhood. That for, this study objective was to estimate the prevalence of hepatitis B în pregnant women. We used the cluster sampling method with a sample size of 1356 pregnant women. Finally our study was based on 1298 blood samples coming from 19 clusters (obstetrics wards/hospitals) selected from those 108 obstetrics wards/hospitals in the south of Romania. Overall, 31.8% (95% C.I. 27.3%-36.4%) of pregnant women admitted for birth in southern Romania had the evidence of past or current HBV infection (anti HBc, AgHBs). In a study done in 1990, Bradley A. Woodruff et al. has reported a prevalence of past or current HBV infection of 36.7% among pregnant women in northeastern Romania.

[The prevalence of viral hepatitis markers in the general population]. / Prevalenta markerilor hepatitelor virale în populatia generala.

The study objective was to measure the characteristic serological markers prevalence for viral hepatitis A, viral hepatitis B and viral hepatitis Delta in a representative group from apparent healthy general population. Viral hepatitis infections represent through their frequency and gravity a public health problem, in our country. A total of 860 subjects from 13 districts sided in the south part of the country were investigated. The sample were distributed by 9 age group. By using a certain work algorithm we examined the following serological markers: HBs Ag, anti HBs, AgHBe/antiHBe, AgHD/antiHD. For the serologic investigation we used ELISA test with Wellcozyme and Sanofi Diagnostics Pasteur Kits. The results of our study confirm high prevalence values for HAV and HBV (65.8% respectively 44.9%). We could estimate that 73.5% from the population has passed through either HAV infection or HBV infection and 29.1% to 37.7% has passed through both infections. The study also proved a very high HBs Ag carriage (10.5% to 30.9%). The HBe Ag were detected only in HBs Ag carrier children (4.5% to 13%). The presence of anti HBe was 31.4%. From the investigated persons 10% had hepatitis Delta virus infection.

[An evaluation of the antidiphtheria protection in the general population]. / Evaluarea protectiei antidifterice în populatia generala.

The assessment of the antidiphtheria protection in healthy population is common for a surveillance system within any National Program of Immunization. Our study is intending to measure the antidiphtheria immunity level in apparently healthy peoples living in the southern Romania. Our study were carried out on 8594 healthy subjects. Sample were stratified by nine age groups being representative for the above mentioned area. The titration of diphtheria antitoxin in our laboratory were performed by passive hemagglutination assay (PHA) and in vivo neutralization test (NT). In our study, we had considered as "protective immunity level" an antitoxin titers equal or above 1/640. The overall prevalence of protected peoples was 88.1% (C.I. 95%: 87.4%-88.8%). The prevalence of protected people against diphtheria decrease by age from 94.5% (1-9 years of age) to 82.4% (60 years and over). We think that overall, our national strategy for diphtheria control is quite efficient, but need to be sustained by specific actions concerning some high risk population groups.

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.