Acquired immunodeficiency syndrome in Romania

Area of Science:

• Epidemiology
• Public Health
• Infectious Diseases

Background:

• Acquired immunodeficiency syndrome (AIDS) was first described in Romania in late 1989.
• National AIDS case surveillance was initiated using a modified World Health Organisation (WHO) clinical case definition requiring both clinical and serological evidence of human immunodeficiency virus (HIV) infection.

Purpose of the Study:

• To describe the epidemiology of AIDS cases in Romania following its initial description.
• To identify the transmission routes of HIV in a pediatric population.

Main Methods:

• National surveillance data collection for AIDS cases.
• Modified WHO clinical case definition for AIDS diagnosis.
• Investigation of potential HIV transmission routes including blood transfusions, clotting disorders, and parenteral therapy.

Main Results:

• By December 31, 1990, 1168 AIDS cases were reported, with 93.7% occurring in children under 13.
• A majority of pediatric cases (99.3%) were in children under 4 years old, and 62.4% were in abandoned children in institutions.
• Identified transmission routes included transfusions of unscreened blood (38.7%) and suspected transmission via improper needle/syringe use in therapeutic injections (57.4%).

Conclusions:

• The Romanian AIDS outbreak disproportionately affected young children, particularly those in institutional care.
• Unsafe medical practices, including the intensive and improper use of parenteral therapy and poor sterilization techniques in healthcare facilities, were major drivers of HIV transmission.
• This situation underscores the critical need for stringent infection control measures and safe injection practices in medical settings to prevent iatrogenic HIV transmission.