The clinical and epidemiological evolution of varicella in Romania during 2004 and 2013

Introduction. Varicella, a vaccine preventable disease (VPD) is one of the most common communicable diseases in Romania. The objectives of our study were to describe the epidemiological evolution of varicella in Romania between 2004 and 2013 and the clinical characteristics of the cases admitted to NIID between 2011 and 2013. Materials and methods. An epidemiological retrospective study was conducted by using the information reported quarterly by general practitioners and hospitals at the national level. There is no system for the surveillance of severe cases in Romania, so, to describe the clinical characteristics of varicella cases, a second retrospective study was developed, in which the patients hospitalized in the NIID, within the period 2011-2013, were included. Questionnaires were completed by using data from the clinical observation forms. Collected information included demographic, clinical and laboratory data, complications, date of onset and admission, length of stay, admission and discharge diagnosis. Data were processed and analyzed by using Microsoft Excel program. Results. A total of 504,844 cases were reported of at the national level between 2004 and 2013, with a mean incidence of 238.2/ 100,000 inhabitants. The most affected age group was 5-9 years old (incidence 1362.7/ 100,000 inhabitants). The study conducted in NIID, registered 353 patients hospitalized with varicella between 2011 and 2013. Most of the hospitalized cases (88.8%) were under 10 years old and many (72.6 %) attended a community. The majority of cases had rash (98.6%) and fever (79.9%). The main complications were pneumonia (46.2%), bacterial infection (16.1%) and encephalitis (2.5%). Discussions. Varicella is a very common disease in Romania, which may develop complications. A specific surveillance system should be introduced in order to provide accurate epidemiological, clinical and laboratory information to assess whether varicella is a public health problem in Romania and if the introduction of vaccination in NIP is recommended. However, given the large number of current cases in Romania, a solution may be a sentinel surveillance system type.