Date: Fri 25 August 2017
Source: Romania Insider [edited]
<https://www.romania-insider.com/measles-kills-iraqi-refugee/>

The ongoing measles outbreak keeps making victims in Romania. A 10 month old girl, who was a refugee from Iraq, became the 33rd person to die of the infection, reports local Digi24. The girl arrived in Romania on [7 Jul 2017] with her family, and the doctors diagnosed her with measles in August. They also discovered that the child was suffering from malnutrition and severe psychomotor retardation.

The measles outbreak is still a major problem in Romania, with more than 8900 cases reported across the country until [25 Aug 2017], including 33 deaths, according to data from the National Center for Surveillance and Control of Communicable Diseases (CNSCBT). Most deaths were registered in Timis (9), Dolj (7), and Arad (6) counties.

Measles is a highly contagious respiratory infection caused by a virus. It causes a total-body skin rash and flu-like symptoms, including fever, cough, and runny nose. According to information posted on WHO's website, the virus is highly contagious, spreading by coughing and sneezing, close personal contact, and direct contact with infected nasal or throat secretions. Unvaccinated young children pose the highest risk of measles and its complications, including death.

The Romanian Government adopted earlier this month [August 2017] a draft bill on the organization and financing of population vaccination [<https://www.romania-insider.com/romania-draft-bill-vaccination/>]. The project was sent to the Parliament for approval and could come into force in January 2018.  [byline: Irina Marica]
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[Measles tends to be more severe in children who are malnourished, especially children who are also vitamin A deficient. And complications are commoner and more serious in malnourished children. Because of complications such as diarrhoea, measles may lead to failure to thrive. Infection with measles virus may lead to kwashiorkor or marasmus in children who are underweight at the time that they get infected. Therefore, measles may result in, or aggravate, malnutrition.

Maps of Romania can be found at
<http://www.geoatlas.com/medias/maps/countries/romania/ro111aa/romania_pol.jpg>
and <http://healthmap.org/promed/p/122>. - ProMED Mod.LK]
Date: 10 Aug 2017
Source: Romania Insider [edited]
<https://www.romania-insider.com/two-romanians-anthrax/>

Two Romanians, husband and wife, were admitted to the Victor Babes Infectious Diseases Hospital in Craiova, after laboratory tests showed that they were infected with anthrax, local News.ro has reported.

The 2 went to the Emergency County Hospital, Craiova on 4 Aug 2017 with several hand injuries. They were admitted to the hospital, and tests later confirmed that both of them were infected with anthrax.

The doctors decided to transfer them to the hospital of infectious diseases, where they are receiving the appropriate treatment.

The authorities will conduct an epidemiological investigation at their home, as it is believed that the 2 got sick after coming into contact with infected animals.

Anthrax is a serious infectious disease caused by gram-positive, rod-shaped bacteria known as _Bacillus anthracis_, according to information posted on the website of the Centers for Disease Control and Prevention. Although it is rare, people can get sick with anthrax if they come into contact with infected animals or contaminated animal products. Signs and symptoms can range from skin sores to vomiting and shock. Rapid treatment with antibiotics can cure most anthrax infections.  [Byline: Irina Marica]
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[Maps of Romania can be seen at <http://www.geoatlas.com/medias/maps/countries/romania/ro111aa/romania_pol.jpg> and <http://healthmap.org/promed/p/61081>. There are 2 Craiova's in Romania, which makes it hard to place: in Arad <http://www.fallingrain.com/world/RO/02/Craiova.html>; and in Dolj <http://www.fallingrain.com/world/RO/17/Craiova.html>. As the latter is in central Romania and the former in the northwest, where anthrax cases are more frequently seen, I would guess it is the Arad Craiova.

With hand lesions, this is a typical scenario for 2 people butchering an animal sick or dead from anthrax. As multiple animals were affected, as indicated in this report ("sick animals"), they were probably sick sheep. - ProMED Mod.MHJ]
Date: Mon 24 Jul 2017
Source: Romania Insider [edited]
<https://www.romania-insider.com/measles-outbreak-romania/>

The number of measles deaths in Romania has reached 32 since the onset of the outbreak last year [2016]. A 29-year old person from Dolj county died last week [week of 16-22 Jul 2017], according to the National Center for Surveillance and Control of Communicable Diseases (CNSCBT).

The person's disease was confirmed in February this year [2017], but the 1st symptoms of the post-measles complication occurred in June.

The measles outbreak began last fall. Some 8246 measles cases were registered until [Fri 21 Jul 2017], and 32 people died during this period, according to CNSCBT.

Last week [week of 16-22 Jul 2017], the Health Ministry and the Interior Ministry started a vaccination campaign against measles.

There are about 180 000 unvaccinated kids in Romania, according to the Health Ministry. Only 10 percent refuse vaccination, whereas the rest of them don't even reach a doctor. The Health Ministry currently has over 500 000 measles vaccine doses, which should be enough until the end of the year.
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[A Healthmap / ProMED map of Romania can be found at
<http://healthmap.org/promed/p/122>]
Date: Fri, 23 Jun 2017 17:07:04 +0200

Bucharest, June 23, 2017 (AFP) - A measles outbreak affecting several European countries has killed 30 people in Romania, most of them children, health authorities in Bucharest said on Friday.   More than 7,200 people in the European Union's second-poorest country have contracted the illness since late 2016, Romania's contagious disease monitoring centre said.

There was also a 31st suspected fatality.   The respiratory disease, characterised by high fever and small red spots, usually triggers only mild symptoms, but it remains one of the leading causes of death among young children globally.   The World Health Organisation recommends two doses of vaccination, the first by a child's first birthday, to ensure immunity and prevent outbreaks, saying they should cover 95 percent of the population.

But in Romania, due not only to poverty but also a lack of vaccines and poor access to health care, the rate is only 80 percent for the first shot and 50 percent for the second.   The Romanian government is currently pushing through legislation that would make vaccination obligatory in order for children to be allowed to go to school.   Compounding the problem, a growing number of parents are refusing to have their children immunised with religious groups and public figures also launching anti-vaccination campaigns.

The WHO warned in March about a rising number of measles cases in Europe, with the largest outbreaks in Romania and Italy. France, Germany, Poland, Switzerland and Ukraine were also affected.   On Thursday a six-year-old boy with leukaemia died from measles in Italy. He had an 85-percent chance of being cured of his leukaemia but his parents refused to have him vaccinated for measles, Italian authorities said.   They said that at least 3,074 measles cases have been recorded this year, 40 percent of whom had to be hospitalised. The WHO said on Tuesday that 43 percent of cases in Europe were in Italy.
Date: Mon 19 Jun 2017
Source: Romania Insider [edited]
<https://www.romania-insider.com/romanian-teenager-meningitis-dies-hospital-2017/>

A 17-year-old Romanian student diagnosed with bacterial meningitis died last week [15 Jun 2017] at the Pediatric Hospital in Brasov, central Romania, while 18 other teenagers were hospitalized with similar symptoms. The classmates of the young Romanian who died on [15 Jun 2017], as well as other people he came into contact with, were sent to the doctor for consultations. Their number reached 200 by [18 Jun 2017], reports local News.ro. Moreover, 18 young people were admitted to the Hospital for Infectious Diseases in Brasov, on suspicion of meningitis. One of them was diagnosed with this disease.

Meanwhile, the authorities disinfected the high school where the young boy was a student, as well as the Pediatric Hospital, which doesn't have a department for infectious diseases. The 17-year-old student who died last week [15 Jun 2017] was from the Tarlungeni commune, in Brasov county. He and his friends had attended a party in the Purcareni village [Brasov county] tone week before. The students started to feel bad after this party. Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling.

However, injuries, cancer, certain drugs, and other types of infections can also cause meningitis, according to information posted on the website of the Centers for Disease Control and Prevention. Meningitis symptoms include sudden onset of fever, headache, and stiff neck, but there are also other symptoms such as nausea, vomiting, photophobia (increased sensitivity to light), and altered mental status (confusion). [Byline: Irina Marica]
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[The news report above says that one teenage boy has died of bacterial meningitis and 18 of his friends were hospitalized with suspected meningitis; this diagnosis was subsequently confirmed in one. However, the bacterial species that caused the disease is not specified. Acute bacterial meningitis is a rapidly progressive disease.

In a patient with suspected acute bacterial meningitis, blood and cerebrospinal fluid (CSF) cultures will indicate the causative organism and its antibiotic susceptibilities. An empiric intravenous antibiotic regimen that has a spectrum broad enough to cover the most likely bacterial pathogens is started as quickly as possible until the specific bacterial aetiology is known.

It is vital to begin treatment as early as possible in the course of the disease, as delay may contribute significantly to morbidity and mortality. Adjunctive dexamethasone is also given before or with the 1st antibiotic dose. Once a pathogen is known, the antibiotic regimen can be tailored to the antibiotic susceptibilities of the pathogen. Common causes of bacterial meningitis vary by age group. Outbreaks of meningitis in the community are often due to _Neisseria meningitidis_.

More information on this outbreak would be appreciated from knowledgeable sources. Brasov is a city with a population of 253,200 residents in Romania and the administrative centre of Brasov County (<https://en.wikipedia.org/wiki/Brașov>).

Tarlungeni is a commune with a population of 7820 residents in Brasov County; it is composed of 4 villages: Carpinis, Purcareni, Tarlungeni and Zizin
(<https://en.wikipedia.org/wiki/Tărlungeni>).

A map showing the location of Tarlungeni can be found at
<https://www.google.com/maps/place/Tărlungeni+507220,+Romania>.

A HealthMap/ProMED-mail map of Romania can be accessed at
<http://healthmap.org/promed/p/6163>. - ProMED Mod.ML]
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