According to the International Commission on Trichinellosis, Romania accounted for the most cases of trichinellosis reported worldwide in 2004. The following report summarizes the evolution of trichinellosis in Romania over a 140-year period (1868-2007). The sylvatic cycle, such as the consumption of meat from wild boar and bear, has been implicated in human cases. However, 95% of human trichinellosis cases originate from specific cultural food practices involving pork consumption. The first report of human and pig trichinellosis in Romania dates back to 1868. After the political changes of 1989, the annual incidence increased from between 0.1 and 4.1 cases per 100,000 inhabitants during the communist period (1963-1989) to 6.2 cases per 100,000 inhabitants, with a range of 2-15.9 per 100,000 between 1990 and 2007. Trichinellosis is a major public health issue in Romania that requires that policies be put forth to advance efficient prevention and control strategies.