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.