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Rabies - Continued

References

1. Immunization Practices Advisory Committee. Rabies prevention-United States, 1984. MMWR 1984;33:393-402,407-8.

2. Immunization Practices Advisory Committee. Rabies prevention: supplementary statement on the preexposure use of human diploid cell rabies vaccine by the intradermal route. MMWR 1986;35:767-8.

Epidemiologic Notes and Reports

Update: Influenza Activity United States

Influenza A(H3N2) is the most frequently reported influenza virus so far this season (Figure 1). For the report week ending January 9, 1988, seven states reported regional outbreak activity.* Widespread activity has not yet been reported this season. Sporadically occurring cases of influenza B have been reported from five states.* Reported by: Participating State and Territorial Epidemiologists and State Laboratory Directors. WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

*Kansas, Montana, Nebraska, South Dakota, Texas, Utah, and Wisconsin. *Arizona, Hawaii, New York, Ohio, and Tennessee.

FIGURE 1. States reporting isolates of influenza A(H3N2)
October 19, 1987 – January 15, 1988

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Isolates reported
No isolates reported

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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.

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The first reported case of AIDS caused by human immunodeficiency virus type 2 (HIV-2) in the United States was diagnosed in December 1987. The patient, a West African, came to the United States in 1987. In December, the patient visited a physician because of a 3-year history of weight loss and recent onset of neurologic symptoms. A CAT scan of the head revealed mass lesions that biopsy showed to be caused by Toxoplasma gondii. Biopsy of a lymph node revealed acid-fast bacteria.

The patient did not give a history of sexual intercourse, use of nonsterile needles, or donation of blood while in the United States. All family members and household contacts, both in the United States and abroad, are reported to be well.

Because the diagnosis of cerebral toxoplasmosis without other underlying cause of immunodeficiency fits the CDC surveillance definition for AIDS, laboratory evidence of infection with HIV was sought. Testing of the patient's serum revealed a negative enzyme immunoassay (EIA) for antibody to HIV-1 with an indeterminate HIV-1 Western blot. However, EIA for antibodies to HIV-2 (Genetic Systems Corporation, Seattle, Washington [research test kit]) was repeatedly reactive and HIV-2 Western blot revealed bands for antibodies to gag (p26), pol (p34), and env (gp140) proteins. DNA amplification by the polymerase chain reaction technique with HIV-1specific and HIV-2-specific DNA probes (1) revealed HIV-2 DNA but not HIV-1 DNA in the patient's lymphocytes and confirmed the diagnosis of HIV-2 infection.

Reported by: SH Weiss, MD, J Lombardo, MD, PhD, J Michaels, MD, LR Sharer, MD, M Tayyarah,
MD, J Leonard, MD, A Mangia, MD, P Kloser, MD, S Sathe, MD, R Kapila, MD, New Jersey
Medical School, Univ of Medicine and Dentistry of New Jersey, Newark; NM Williams, MD,
R Altman, MD, MPH, J French, MA, WE Parkin, DVM, State Epidemiologist, New Jersey State
Dept of Health. Genetic Systems Corp, Seattle, Washington. AIDS Program, Center for Infectious
Diseases, CDC.

Editorial Note: This patient represents the only documented case of HIV-2 infection
in the United States. HIV-2 is closely related to HIV-1 and was first reported to be
associated with AIDS in 1986 in West Africa, where the virus is believed to be
endemic (2-8). Several well-documented cases of HIV-2 infection have also been
reported among Europeans and among West Africans residing in Europe (3,4,8). The
spectrum of disease and modes of transmission of HIV-2 are similar to those of HIV-1
(2-5). These modes of transmission include sexual intercourse; however, infected

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE

U.G. DEPOSITORYFEB 26 1988

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persons present no risk to nonsexual household contacts (9). The present case undoubtedly represents infection acquired in West Africa since illness began before the patient's arrival in the United States. The patient has had no known activities that would have exposed others in this country to HIV-2.

Because of the reports of HIV-2 infection in West Africa and Europe, CDC and the Food and Drug Administration (FDA) initiated surveillance for HIV-2 in the United States in January 1987. To date, CDC, FDA, and collaborating investigators have screened 22,699 serum samples with anti-HIV-2 EIA (10). Of these specimens, 14,196 (63%) were from individuals whose activities placed them at increased risk for HIV-1 infection and who would, therefore, potentially be at risk for HIV-2 infection. The remaining 8,503 were from asymptomatic blood donors randomly selected from three areas of the United States, two of which have reported large numbers of AIDS patients. Overall, 35 (0.2%) of the serum samples were reactive by anti-HIV EIA using HIV-2 antigens but not by anti-HIV EIA using HIV-1 antigens. However, none of these EIAs could be confirmed when tested by HIV-2-specific Western blot. An additional 70 (0.3%) of the samples were reactive by Western blot with gag, pol, and env antigens of both HIV-1 and HIV-2. All of the dually reactive specimens were from individuals whose activities placed them at increased risk for HIV-1 infection. None were from the randomly selected blood donors. Sera from these dually reactive subjects were studied for the presence of type-specific neutralizing antibody to HIV-1 or HIV-2, antibody to synthetic peptides specific for HIV-1 or HIV-2 (Genetic Systems Corporation, Seattle, Washington [research test kit]), or HIV-1 and HIV-2 DNA by DNA amplification (1). Sixty of the subjects were shown to be infected with HIV-1 but not HIV-2. Ten are still under investigation.

It is reassuring that HIV-2-specific tests on sera from 22,699 persons, including 8,503 randomly selected U.S. blood donors, failed to reveal HIV-2 infection. However, the occasional presence of this virus in the United States, as in Europe, should be anticipated. The anti-HIV-1 EIA tests currently used for screening all U.S. blood donors are estimated to detect 42% to 92% of HIV-2 infections (4,11). Surveillance for HIV-2 in the United States is being continued to monitor the frequency of infection. Because the modes of transmission of HIV-1 and HIV-2 are similar, preventive measures for these related viruses are the same (12).

References

1. Ou C-Y, Kwok S, Mitchell SW, et al. DNA amplification for direct detection of HIV-1 in DNA of peripheral blood mononuclear cells. Science 1988;239:295-7.

2. Clavel F, Guétard D, Brun-Vézinet F, et al. Isolation of a new human retrovirus from West African patients with AIDS. Science 1986;233:343-6.

3. Brun-Vézinet F, Rey MA, Katlama C, et al. Lymphadenopathy-associated virus type 2 in AIDS and AIDS-related complex: clinical and virological features in four patients. Lancet 1987;1:128-32.

4. Clavel F, Mansinho K, Chamaret S, et al. Human immunodeficiency virus type 2 infection associated with AIDS in West Africa. N Engl J Med 1987;316:1180-5.

5. Brun-Vézinet F, Rey MA, Dazza MC, et al. LAV-2/HIV-2 infection: clinical, epidemiological and virological features (Abstract no. THP.33]. In: Abstracts of the third international conference on acquired immunodeficiency syndrome (AIDS). Washington, DC: US Department of Health and Human Services, Public Health Service, World Health Organization, 1987:169. 6. Antunes F, Odete Santos Ferreira M, Lourenco MH, Costa C, Pedro M. HIV infections in rural areas of West Africa (Guinea Bissau) [Abstract no. THP.88]. In: Abstracts of the third international conference on acquired immunodeficiency syndrome (AIDS). Washington, DC: US Department of Health and Human Services, Public Health Service, World Health Organization, 1987:178.

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7. Katlama C, Harzic M, Kourouma K, Dazza MC, Brun-Vézinet F. Seroepidemiological study of HIV1 and HIV2 infection in Guinea-Conakry [Abstract no. THP.75]. In: Abstracts of the third international conference on acquired immunodeficiency syndrome (AIDS). Washington, DC: US Department of Health and Human Services, Public Health Service, World Health Organization, 1987:176.

8. Clavel F. HIV-2, the West African AIDS virus. AIDS 1987; 1:135-40.

9. Friedland GH, Saltzman BR, Rogers MF, et al. Lack of transmission of HTLV-III/LAV infection to household contacts of patients with AIDS or AIDS-related complex with oral candidiasis. N Engl J Med 1986; 314:344-9.

10. Schochetman G, Schable CA, Goldstein LC, Epstein J, Zuck TF. Screening of U.S. populations for the presence of LAV-II [Abstract no. THP.52]. In: Abstracts of the third international conference on acquired immunodeficiency syndrome (AIDS). Washington, DC: US Department of Health and Human Services, Public Health Service, World Health Organization, 1987:172.

11. Denis F, Leonard G, Mounier M, et al. Efficacy of five enzyme immunoassays for antibody to HIV in detecting antibody to HTLV-IV. Lancet 1987; 1:324-5.

12. Public Health Service. Surgeon General's report on acquired immune deficiency syndrome. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

Current Trends

Continuing Increase in Infectious Syphilis

United States

Through the first 46 weeks of 1987, 31,323 cases of infectious (primary and secondary) syphilis were reported to CDC through the MMWR Morbidity Surveillance System. This total exceeds the number of cases reported for the same period in 1986 by 32%. The projected annual incidence of infectious syphilis for 1987 is 14.7/100,000, which would be the highest rate since 1950. While 56% of all cases and 83% of the increase were reported from Florida, New York City (NYC), and California, 25 of the other 49 reporting areas also had increases. Nine areas had absolute increases of over 100 cases; in two of these areas, the relative increases were over 100% (Table 1). With the exception of Oregon and Connecticut, areas with high incidence rates experienced the greatest increases. Texas, with a 22% decrease in reported cases, and Louisiana, with a 9% decrease, were notable exceptions to the overall pattern of increase.

Fourteen areas reporting increases and five reporting decreases during the first 8 months of 1987 were asked to provide data on patients' race, sex, and sexual preference for further analysis. Overall, the areas providing this supplementary information contain 51% of the U.S. population and 79% of the syphilis cases reported through the first 46 weeks of 1987.

In the 14 areas reporting increases (13 states and NYC), relative increases were greatest for females and heterosexual males of all racial/ethnic backgrounds (Table 2). The greatest absolute increases occurred among blacks. The increase for males occurred among heterosexual males, and the decrease among homosexual/ bisexual males occurred primarily among white males (1). Exceptions to this overall

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