HIV and AIDS - Continued of this estimate. The Public Health Service will reexamine estimates of the prevalence and rate of spread of HIV-1 infection and projected trends of AIDS in preparing subsequent quarterly reports as new test data and modeling techniques become available. C. Status of HIV-1 Antibody Surveys Implementation of the Comprehensive Family of HIV Surveys. Since November 30, 1987, plans to implement the family of HIV-1 antibody surveys have proceeded rapidly. Effective January 29, 1988, funds were awarded to support over 420 different surveys in 30 major metropolitan areas. • Childbearing Women. HIV-1 antibody prevalence for childbearing women has been measured by using blinded serologic testing of blood samples collected on filter paper from newborns to measure maternal antibody. In the state of New York, preliminary results of 52,326 tests indicate an overall HIV-1 antibody prevalence of 0.8%. In New York City, one woman in 61 giving birth had HIV-1 antibody. An estimated 40% of these women passed the infection to their newborns. This survey was instrumental in promoting the recent institution of a New York policy to encourage counseling all women of childbearing age and to offer both counseling and testing to women contemplating pregnancy or in the early stages of pregnancy. Sentinel Hospitals. HIV-1 antibody prevalence among hospital patients without AIDS or associated conditions is measured in CDC's blinded surveys in sentinel hospitals. In the first four institutions enrolled (all from the Midwest), overall prevalence was 0.3% for the first 12,000 individuals tested. HIV-1 antibody prevalence was highest for adults in the 25- to 44-year age group, higher for black and Hispanic minorities than for whites, and higher for men than for women. A total of 40 sentinel hospitals in 30 cities is expected to be enrolled by September 1988. Prison Surveys. The Federal Bureau of Prisons implemented an HIV-1 testing program in June 1987. Of 29,193 inmates tested, 843 (2.9%) were positive for HIV-1. CDC and the National Institute of Justice are contracting with a major university to conduct a serosurvey of 10,000 inmates in ten state prisons beginning in June 1988. • College Students. A cooperative agreement was awarded on April 1, 1988, to enable 15 private and public colleges each to perform blinded tests on approximately 1,000 blood specimens drawn for routine diagnostic purposes at college health clinics. Testing is expected to begin in April 1988. National Household Seroprevalence Survey. A contract will be awarded by the end of April to initiate a nationwide household-based sample survey. The survey will be conducted in two phases, a pilot phase followed by a national survey, if the pilot phase indicates that this would be feasible. Results of the first of the pilot studies are projected to be available by October 1, 1988, and results from the second and third pilot studies, by February 1 and June 1, 1989, respectively. The pilot studies will begin with a sample of 800 persons in one community, followed by two samples of 1,500 persons. If the national survey is conducted, it will start in June 1989, and results would be expected in June 1990. 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., ([404] 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. 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. AEpidemiologic Notes and Reports Update: Acquired Immunodeficiency Syndrome and Human 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. Ninety-five percent of the health-care workers with AIDS were classified into known transmission categories (Table 1). Health-care workers with AIDS were significantly less likely than others with AIDS to be intravenous 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). UNIV. of MICH. MAY 1 2 1988 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE Documents Center |