[Acute infectious diarrheal disease in Romania: 1993-1998]

The decrease of morbidity-mortality caused by gastroenteritis is in relation to the factors largely responsible for the fall in infant mortality and mortality from communicable diseases in developing countries. Nevertheless, diarrhea is still a considerable public health problem in these countries, especially among children under 5 years old. 98% of all deaths in children younger than 15 years are in the developing world. Five of the ten leading killers are communicable, perinatal, and nutritional disorders largely affecting children. The knowledge of the etiology and epidemiology of childhood diarrhea in a given area is needed to plan any measure designed to prevent or ameliorate diarrheal illness and to develop practical guidelines for the most appropriate examination procedures. In Romania, although the real data of morbidity by acute diarrhea are not known, the reports show a significant decrease in the past 10 years. In 1993, 420.2 cases at 100,000 inhabitants were reported, the most commonly affected being the children age 0-4 years. The incidence decreased to 338.5 cases at 100,000 inhabitants in 1997 (and a quite similar incidence for the first 11 month of 1998). Between 1993-1998, 527,977 cases were reported (58.1% in urban area), with a higher frequency in spring-autumn season. Antibiotics are not required in case of acute diarrhea with little or no fever. Antibiotics could be discussed for cholera-like diarrhea and are required in case of invasive bacterial diarrhea, shigellosis, cholera, and Clostridium difficile as well as diarrhea with fever and sanguinolent stools in infants or salmonella-induced diarrhea with signs of extradigestive complications. Importance of oral rehydration solution in the treatment of diarrhoeal diseases is well known. It can be applied to all types of diarrhoea, practically, without any side effects, complications, such aas hypernatraemia is avoidable. It has proved to be effective for dehydration caused by diarrhoea and for diarrhoea, too. There is a need for effective infection control policies, which include appropriate training of staff; simple surveillance systems and readily available expert advice to ensure that outbreaks are rapidly controlled. Approaches to prevention include education about risk factors, which often fails to lead to modification of risky behavior. Further regional epidemiological studies are necessary to develop more appropriate management guidelines.