[The incidence of tuberculosis in Romania in 1994]

The 1994 TB notification rate structure in Romania was based on the data reported in "New-case/relapse TB notification form", registered between 1.01.-31.12.1994 and stored in "National TB-Register" data base. The 21,422 TB patients notified in 1994 correspond to an annual incidence of 94.2%000, which means an increase of 5.41% as compared with 1993, of 34.6% as compared to 1990 and of 68.8% as compared to 1985. As compared with 1985 tb notifications, this increase supplied a commulative overload of 32,546 patients, out of which, 18,233 only in the last 5 years. Tb notification rate show large differences between districts, varying from 38.9%000 (Harghita district) to 130.2%000 (Giurgiu district). The great variations between the number of the quarterly reported cases for 1994 in different counties, having an alleatory distribution of the extreme values in different periods of the year, could represent an under-diagnosis. This hypothesis could be sustained also by the large differences in the ratio of the pleural tb effusions in various districts (from 16% of the TB-incidence in Braşov district to 1.4% in Satu Mare county) or the ratio of the other extra-pulmonary tb forms (that are dispersed between 1.5% in Salaj county to 8% in Constanţa county). 3,428 patients were registered more than 3 months after the start of the treatment, 500 after more than 6 months and even 24 patients were notified more than 1 year later. Taking into account this delay in reporting and the facts already mentioned, we could suppose a higher number of cases than reported for a given time interval. The ratio of bacteriologicaly prouved pulmonary-TB cases was 76.4% (i.e. 61.6%000), varying in different counties between 48.4% (Argeş) and 95.4% (Sibiu). These variations could rather be explained by the quality of the sputum-examination than by the profile of the registered patients. A large proportion (81%) of the confirmed cases are smear-positive, varying between 47.6% (Argeş) and 88.6% (Bistriţa). The high percentage of the smear-positive cases underscore the large number of "sources" whereas variations between the ratios are perhaps due to the quality of the smear examination. Ratio of pulmonary cases confirmed only by cultures (14.5% in Romania) revealed also teritorial differences, on a scale between 2.9% (Teleorman) and 34.5% (Botoşani). To the number of the smear-positive cases notified during 1994, another 6,136 chronic patients (at the end of 1994) had to be considered. The peak prevalence of sputum positiv cases in 1994 (positive cases at the beginning of the year, plus positive cases added during 1994) was of 24,568 (108%000 inhabitants, 137%000 adults). New notified bacteriologicaly positive TB-cases (13,914) added to all chronic TB-cases (6,136) reported, represent a lower number than "maximal bacilli excretors prevalance" reported. The lacking 4,500 positive patients could represent either cases reported as having no culture results (the culture results could have been registered two months later) or unreported cases. This situation could be corrected by a "double-reporting" with matching of the reports, starting in 1995. The TB notification rate in children was 19.8%000 (949 cases). The 2,405 tb deaths correspond to a TB-mortality of 10.6%000 in 1994. During 1994, 66,779 patients were hospitalised with "pulmonary tb" diagnosis, 44,915 (67.3%) were repeatedly negatives and 1,545 had no examination for mycobacteria reported. Out of the total of 20,248 positive cases, 15,398 became negative whereas 4,834 (23.9%) were released sputum-positive. The number and notification rate of tb cases by sex and age groups, localisation and bacterial confirmation (for pulmonary TB), by districts, are presented in tables and graphs (drown on the same scale), printed as supplement of this issue.