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HIV and AIDS Continued

An evaluation of the level of public participation and potential self-selection bias is being undertaken. Provisional data from the AIDS information questionnaire administered as part of the National Health Interview Survey in August and September 1987 indicate that 71% of the 3,097 adults queried were willing to have their blood tested with assurances of privacy of test results (5). Other surveys have shown that a high percentage of infected persons is concentrated in the minority of persons who are not willing to be tested. A recent study of childbearing women in New York City found that voluntary testing failed to

detect 86% of the women who were infected with HIV-1 (6). D. Human Immunodeficiency Virus Type 2 (HIV-2) • The first reported case of AIDS caused by HIV-2 in the United States was

diagnosed in December 1987 (7). The patient was a recent visitor from West Africa, where HIV-2 was originally described, and denied sexual intercourse, use

of nonsterile needles, or donation of blood while in the United States. • Since 1987, CDC, the Food and Drug Administration, and others have tested

nearly 23,000 specimens from 8,500 blood donors and 14,500 persons at increased risk for HIV infection. No evidence of HIV-2 infection has been found. Because the modes of transmission are the same as those for HIV-1, the same

preventive measures have been recommended. E. Comparison of AIDS Mortality and Years of Potential Life Lost (YPLL) with Other Major Diseases

1986 data on heart disease, all cancers, and cerebrovascular diseases (including stroke) show that these conditions each killed 10 to 50 times as many Americans as AIDS (8). However, AIDS is the only major disease in the United States where mortality is substantially increasing; the impact on mortality for men 25–44 years of age, for minorities, and for selected cities is much higher than the national average. In YPLL before age 65 years, AIDS increased in rank among diseases from 13th in 1984 to 8th in 1986, a change that reflects the

young age of those it kills and the increasing number of deaths. Reported by: AIDS Program, Center for Infectious Diseases, CDC. References 1. Centers for Disease Control. Human immunodeficiency virus infection in the United States.

MMWR 1987;36:801-4. 2. Centers for Disease Control. Human immunodeficiency virus infection in the United States: a

review of current knowledge. MMWR 1987;36(suppl S-6). 3. Centers for Disease Control. Revision of the CDC surveillance case definition for acquired

immunodeficiency syndrome. MMWR 1987;36(suppl 1S). 4. Morgan WM, Curran JW. Acquired immunodeficiency syndrome: current and future trends.

Public Health Rep 1986;101:459-65. 5. Dawson DA, Cynamon M, Fitti JE, National Center for Health Statistics. AIDS knowledge and

attitudes for September 1987: provisional data from the National Health Interview Survey. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-1250. (Advance data from vital and health statistics;

no. 148). 6. Krasinski K, Borkowski W, Bebenroth D, Moore T. Failure of voluntary testing for human

immunodeficiency virus to identify infected parturient women in a high-risk population

(Letter). N Engl J Med 1988;318:185. 7. Centers for Disease Control. AIDS due to HIV-2 infection - New Jersey. MMWR 1988;37:33-5. 8. Centers for Disease Control. Table V. Estimated years of potential life lost (YPLL) before age

65 and cause-specific mortality, by cause of death - United States, 1986. MMWR 1988;37:163.

Notice to Readers

National Conference on Clustering of Health Events

On February 16–17, 1989, the National Conference on Clustering of Health Events will be held in Atlanta, Georgia, at the Hotel InterContinental Atlanta. This conference will provide a forum for the comprehensive consideration of the phenomenon of clustering events as it relates to public health. The purpose is to furnish public health workers, the media, and others with a theoretical and practical basis for dealing with clusters of health events such as cancers, suicides, infectious diseases, birth defects, or pneumoconioses.

Investigators are invited to submit abstracts of original work concerning one or more of the following topics: public health approaches to reports of clusters, risk perception and public information, epidemiologic considerations in disease aggregation, statistical considerations in the aggregation of events, and cluster investigations. Abstracts must be submitted on official Abstract Reproduction Forms and postmarked by July 30, 1988. For forms or other comments and questions, contact either Karen Steinberg, Ph.D., (1404) 488-4026) or Martha S. Brocato ([404) 488-4251), Center for Environmental Health and Injury Control, Centers for Disease Control, Atlanta, Georgia 30333

The conference, which is free and open to the public, is sponsored by the Centers. for Disease Control, the Agency for Toxic Substances and Disease Registry, and the Association of State and Territorial Health Officials.

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The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. Director, Centers for Disease Control

Editor James O. Mason, M.D., Dr.P.H.

Michael B. Gregg, M.D. Director, Epidemiology Program Office

Managing Editor Carl W. Tyler, Jr., M.D.

Gwendolyn A. Ingraham U.S. Government Printing Office: 1988-530-111/60071 Region IV

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April 22, 1988 / Vol. 37 / No. 15
229 Update: Acquired Immunodeficiency

Syndrome and Human
Immunodeficiency Virus Infection

Among Health-Care Workers
239 Passive Smoking: Beliefs, Attitudes,

and Exposures – United States, 1986

241 Update on Influenza Activity – United PUBLIC HEALTH

States and Worldwide, with

Recommendations for Influenza

Vaccine Composition for the 1988–89

V.37 No.15

MAY 27

The University 22 Apr.1988

of Michigan
. .

Public Health
Epidemiologic Notesyhd Me Abne LIBRARY



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Update: Acquired Immunodeficiency Syndrome and Human

Immunodeficiency Virus Infection Among Health-Care Workers Acquired immunodeficiency syndrome (AIDS) among health-care workers in the United States results primarily from human immunodeficiency virus (HIV) infections that occur outside of the health-care setting. However, a small number of health-care workers have been infected with HIV through occupational exposures, and one such worker has developed AIDS after documented seroconversion. This report summarizes and updates both national surveillance data for AIDS among health-care workers and data from prospective studies on the risk of HIV transmission in the health-care setting. Health-Care Workers with AIDS

The AIDS case report form used by CDC requests that state and local health departments collect information on employment since 1978 in a health-care or clinical laboratory setting. For surveillance purposes, any person who indicates such employment is classified as a health-care worker.

As of March 14, 1988, a total of 55,315 adults with AIDS had been reported to CDC. Occupational information was available for 47,532 of these persons, 2,586 (5.4%) of whom were classified as health-care workers. A similar proportion (5.7%) of the U.S. labor force was employed in health services (1).

Forty-six states, the District of Columbia, and Puerto Rico have reported healthcare workers with AIDS. Like other AIDS patients, health-care workers with AIDS had a median age of 35 years. Males accounted for 91.6% of health-care workers with AIDS and 92.4% of other patients with AIDS. The majority of health-care workers with AIDS (62.8%) and of other AIDS patients (60.5%) were white of MICH

Ninety-five percent of the health-care workers with AIDS were classified into significantly less likely than others with AIDS to be intran

Anh AIDS were

drug abusers and more likely to be homosexual or bisexual men. They were also less likely to have a known risk factor reported (p <0.001).

Documents Center



AIDS and HIV Continued

To determine the possible cause of HIV infection, state and local health departments investigate those AIDS patients reported as having no identified risk. As of March 14, 1988, investigations had been completed for 121 of the 215 health-care workers initially reported with undetermined risk. Risk factors were identified for 80 (66.1%) of these. Of the 135 health-care workers who remain in the undetermined-risk category, 41 (30.4%) could not be reclassified after follow-up; 20 (14.8%) had either died or refused to be interviewed; and 74 (54.8%) are still under investigation.

Overall, 5.3% of health-care workers with AIDS had an undetermined risk. When examined by year of report to CDC, the proportion of such health-care workers appears to have increased from 1.5% in 1982 to 6.2% in 1987. However, 71 of the 135 health-care workers for whom risk is still undetermined have been reported since March 1987, and 80.0% of these 71 cases are still under investigation. The proportion of other AIDS patients with an undetermined risk has also increased over time. However, previous experience suggests that other risk factors for HIV infection will be identified for many of these persons when investigations have been completed (2). Ten percent of all reported AIDS patients with undetermined risk are health-care workers; this proportion has not changed over time.

A health-care worker reported to have developed AIDS after a well-documented occupational exposure to blood and HIV seroconversion is included among the 80 health-care workers who were reclassified after follow-up. The worker was accidentally self-injected with several milliliters of blood from a hospitalized patient with AIDS while filling a vacuum collection tube. Investigation revealed no other risk factors for this health-care worker.

Forty-one health-care workers could not be reclassified after investigation; 68.3% were men. In contrast, 23.0% of individuals employed in hospitals and health services in the United States are men (1). These 41 health-care workers comprised eight physicians, four of whom were surgeons; one dentist; five nurses; eleven nursing assistants or orderlies; seven housekeeping or maintenance workers; four clinical laboratory technicians; one respiratory therapist; one paramedic; one mortician; and two others who had no contact with patients or clinical specimens. A comparison of

TABLE 1. Comparison of health-care workers with AIDS and other AIDS patients reported to CDC, by transmission category through March 14, 1988



Health-Care Workers with AIDS Other AIDS Patients Transmission Category



No. (%) Homosexual or Bisexual Male


(74.1)* 28,820 (64.1) Heterosexual Intravenous Drug Abuser 161

(6.2)* 8,263 (18.4) Homosexual or Bisexual Male and Intravenous Drug Abuser



3,267 (7.3) Hemophilia/Coagulation Disorder


451 (1.0) Heterosexual



1,772 (3.9) Blood/Blood Component Recipient



1,105 (2.5) Other


0 (0.0) Undetermined


(5.3)* 1,268 (2.8) Total


(100.0) 44,946 (100.0) *p<0.001, chi square analysis. *Represents health-care worker who seroconverted to HIV and developed AIDS after documented needlestick exposure to blood. Sincludes patients who are under investigation, who died or refused interview, or for whom no risk was identified after follow-up.

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