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! !
! Health Info-Com Network !
! Medical Newsletter !
+------------------------------------------------+
Editor: David Dodell, D.M.D.
10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
Telephone +1 (602) 860-1121
FAX +1 (602) 451-6135
Compilation Copyright 1994 by David Dodell, D.M.D. All rights Reserved.
License is hereby granted to republish on electronic media for which no
fees are charged, so long as the text of this copyright notice and license
are attached intact to any and all republished portion or portions.
The Health Info-Com Network Newsletter is distributed biweekly. Articles
on a medical nature are welcomed. If you have an article, please contact
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joining the automated distribution system, please contact the editor.
E-Mail Address:
Editor:
Internet: david@stat.com
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FAX Delivery = Contact Editor for information
----------------------------------------------------------------------
Date: Sun, 02 Jan 94 08:48:38 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR 24 Dec 93] Improper Infection Control During Employee
Vaccination
Message-ID: <RF9iFc1w165w@stat.com>
Epidemiologic Notes and Reports
Improper Infection-Control Practices
During Employee Vaccination Programs --
District of Columbia and Pennsylvania, 1993
The improper use of needles and syringes and contamination of multidose
medication vials can result in transmission of bloodborne pathogens (e.g.,
hepatitis B virus [HBV] and human immunodeficiency virus [HIV]) and other
infectious agents from patient to patient (1-6). Since September 1993, CDC has
received reports from health-care providers and public health departments in
two U.S. cities regarding improper infection-control practices during
vaccination of employees at worksite vaccination programs. These practices
could potentially have exposed vaccine recipients to infectious agents. This
report summarizes the preliminary findings of an ongoing investigation of
these reports.*
District of Columbia. A company occupational health officer reported that
a physician retained to administer influenza vaccine to employees had been
observed reusing needles to subsequently vaccinate other employees.
Investigation by the local health department confirmed that the physician
vaccinated a series of employees by using the following routine: the physician
first aspirated several doses of vaccine from a multidose vial into a syringe,
inoculated an employee, and then, after wiping the needle with an alcohol
swab, used the same needle and syringe to subsequently inoculate another
employee.
Pennsylvania. A supervisor at a worksite reported that a physician
retained to administer influenza and pneumococcal vaccines to employees had
been observed puncturing multidose vials of vaccine with needles that had been
used previously to inoculate patients. Investigation by the local health
department confirmed that the physician first aspirated a dose of influenza
vaccine into a syringe and inoculated an employee; then, using the same
syringe and needle, aspirated pneumococcal vaccine from a multidose vial of
that vaccine and inoculated the same person. Although a new syringe and needle
were used for each employee, the physician repeatedly punctured the multidose
vials containing pneumococcal vaccine with used needles.
Follow-up. Persons who received vaccinations at these worksites have been
counseled and offered serotesting for bloodborne pathogens (e.g., HBV and
HIV). Further investigation and follow-up of the vaccine recipients are
ongoing.
Reported by: M Levy, MD, District of Columbia Commission of Public Health. M
Moll, MD, BR Jones, DVM, Pennsylvania Dept of Health. HIV Infections Br,
Hospital Infections Program, and Hepatitis Br, Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases; National Immunization
Program; National Institute for Occupational Safety and Health, CDC.
Editorial Note: This report describes examples of improper use of needles,
syringes, and multidose vials that could potentially result in patient-to-
patient transmission of infectious agents. For example, bacteria can survive
in and have been transmitted to patients through contaminated multidose vials
and syringes (1,2,7). HBV has been transmitted by contaminated multidose
medication vials and reuse of contaminated needles and syringes (3,4). In
addition, nosocomial patient-to-patient transmission of HIV has occurred when
needles and syringes were reused without being properly sterilized (5) or were
inadvertently reused between patients (6). Finally, in a laboratory simulation
of improper clinical use, syringes and multidose vials became contaminated
with viruses (8).
Reports of transmission of infectious agents by a single injection with a
contaminated needle and syringe or from a multidose vial have been limited.
However, the frequency with which injections are administered in health-care
settings increases the likelihood of infection transmission if proper
infection-control practices are not followed when medications, vaccines, and
other parenteral substances are injected. The following infection-control
principles are consistent with previous CDC recommendations and should be
adhered to by health-care providers and all other persons who administer
parenteral substances by injection (9,10):
o A needle or syringe that previously has been used to inoculate a patient
is considered contaminated and should not be used to aspirate medication
or vaccine from a multidose vial if any of the contents of the vial will
subsequently be administered to another patient.
o All hypodermic needles, as well as the lumens of syringes used to
administer parenteral substances, should be sterile. Needles and
syringes manufactured for single use only should be discarded and should
not be reprocessed or reused on a different patient because the
reprocessing method may not sterilize the internal surfaces and/or may
alter the integrity of the device.
o Reusable needles and syringes should be cleaned and then sterilized by
standard heat-based sterilization methods (e.g., steam autoclave or
dry-air oven) between uses. Reprocessing of reusable needles and
syringes by use of liquid chemical germicides cannot guarantee sterility
and is not recommended.
o Used needles should never be recapped or otherwise manipulated using
both hands or any other technique that involves directing the point of
a needle toward any part of the body. Either a one-handed "scoop"
technique or a mechanical device designed for holding the needle sheath
should be used if recapping is necessary. Used needles and syringes
should be disposed of in puncture-resistant containers located as close
as practical to where the needles and syringes are used.
References
1. Stetler HC, Garbe PL, Dwyer DM. Outbreaks of group A streptococcal
abscesses following diphtheria-tetanus toxoid-pertussis vaccination.
Pediatrics 1985;75:299-303.
2. CDC. Postsurgical infections associated with an extrinsically contaminated
intravenous anesthetic agent--California, Illinois, Maine, and Michigan, 1990.
MMWR 1990;39:426-7,433.
3. Alter MJ, Ahtone J, Maynard JE. Hepatitis B transmission associated with a
multiple-dose vial in a hemodialysis unit. Ann Intern Med 1983;99:330-3.
4. Oren I, Hershow RC, Ben-Porath E, et al. A common-source outbreak of
fulminant hepatitis B in a hospital. Ann Intern Med 1989;110:691-8.
5. Hersh BS, Popovici F, Apetrei RC, et al. Acquired immunodeficiency syndrome
in Romania. Lancet 1991;338:645-9.
6. CDC. Patient exposures to HIV during nuclear medicine procedures. MMWR
1992;41:575-8.
7. Highsmith AK, Greenhood GP, Allen JR. Growth of nosocomial pathogens in
multidose parenteral medication vials. J Clin Microbiol 1982;15:1024-8.
8. Plott RT, Wagner RF, Tyring SK. Iatrogenic contamination of multidose vials
in simulated use: a reassessment of current patient injection technique. Arch
Dermatol 1990;126:1441-4.
9. Garner JS, Favero MS. Guidelines for handwashing and hospital environmental
control. Am J Infect Control 1986;14:110-26.
10. CDC. Recommendations for prevention of HIV transmission in health-care
settings. MMWR 1987;36(no. 2S).
*Single copies of this report will be available free until December 17, 1994,
from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-
6003; telephone (800) 458-5231.
------------------------------
Date: Sun, 02 Jan 94 08:49:31 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Respiratory Syncytial Virus Activity
Message-ID: <9g9iFc2w165w@stat.com>
Current Trends
Update: Respiratory Syncytial Virus Activity --
United States, 1993
Respiratory syncytial virus (RSV), a common cause of communitywide
outbreaks of acute respiratory disease, is associated with an estimated 90,000
hospitalizations and 4500 deaths from lower respiratory tract disease in both
infants and young children in the United States (1). Outbreaks usually occur
from late fall or early winter through spring. Since 1989, RSV activity in the
United States has been monitored by the National Respiratory and Enteric Virus
Surveillance System (NREVSS), a voluntary, laboratory-based system. This
report summarizes surveillance results from NREVSS for RSV detections from
July 1, 1993, through December 11, 1993, and assesses trends in RSV from July
1, 1990, through December 11, 1993.
A total of 69 laboratories (hospital-based, public health, and free-
standing) that participate in NREVSS in 39 states report weekly to CDC the
number of specimens tested for RSV by the antigen-detection and virus-
isolation methods and the number of positive results. Onset of RSV activity is
defined by NREVSS as the first of 2 consecutive weeks when at least half of
participating laboratories reported any RSV detections or isolations.
As of November 30, 1993, 36 (59%) of the 61 laboratories reporting
detections noted an increase in RSV-positive results, indicating the onset of
outbreak activity for the 1993-94 winter season. By December 11, the median
percentage positive had increased to 16.7%.
During the three preceding seasons (i.e., 1990-91, 1991-92, and 1992-93),
nationwide onset of RSV outbreak activity began during the last week of
October through mid-December; activity peaked during January-February (Figure
1). Although the timing of the peak in the percentage of specimens positive
for individual laboratories varied, these peaks usually occurred within 1
month of the national peak.
Reported by: Emory Univ School of Public Health, Atlanta. National Respiratory
and Enteric Virus Surveillance System laboratories. Respiratory and Enteric
Virus Br, Div of Viral and Rickettsial Diseases, National Center for
Infectious Diseases, CDC.
Editorial Note: With the onset of the 1993-94 RSV season, health-care
providers should consider the role of RSV as a cause of acute respiratory
disease in both children and adults. Most severe manifestations of infection
with RSV (e.g., pneumonia and bronchiolitis) occur in infants aged 2-6 months;
however, children of any age with underlying cardiac or pulmonary disease or
who are immunocompromised are at risk for serious complications from this
infection. Because natural infection with RSV provides limited protective
immunity, RSV may cause repeated symptomatic infections throughout life. In
adults, RSV usually causes upper respiratory tract manifestations but may
cause lower respiratory tract disease--especially in the elderly and in
persons with compromised immune systems.
RSV is a common, but preventable, cause of nosocomially acquired
infection; the risk for nosocomial transmission is increased during community
outbreaks. Sources for nosocomially acquired infection include infected
patients, staff, visitors, or contaminated fomites. Nosocomial outbreaks or
transmission of RSV can be controlled with strict attention to contact-
isolation procedures (2). In addition, chemotherapy with ribavirin is
indicated for some patients (e.g., those at high risk for severe complications
or who are seriously ill with this infection) (3); prophylaxis with
intravenous RSV immunoglobulin for high-risk patients may become available
during future RSV seasons (4).
References
1. Institute of Medicine. Appendix N. In: Institute of Medicine. New vaccine
development: establishing priorities. Vol 1. Diseases of importance in the
United States. Washington, DC: National Academy Press, 1985:397-409.
2. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals.
Infect Control 1983;4(suppl):245-325.
3. Committee on Infectious Diseases, American Academy of Pediatrics. Ribavirin
therapy of respiratory syncytial virus. In: American Academy of Pediatrics.
Report of the Committee on Infectious Diseases. 22nd ed. Elk Grove Village,
Illinois: American Academy of Pediatrics, 1991:581-7.
4. Groothuis JR, Simoes EAF, Levin MJ, et al. Prophylactic administration of
respiratory syncytial virus immune globulin to high-risk infants and young
children. N Engl J Med 1993;329:1524-30.
------------------------------
Date: Sun, 02 Jan 94 08:51:14 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Status of Public Health in Bosnia & Herzegovina
Message-ID: <4J9iFc3w165w@stat.com>
International Notes
Status of Public Health -- Bosnia and Herzegovina,
August-September 1993
Since 1991, civil strife in the former Yugoslav republics (Figure 1) has
resulted in more than 150,000 war-related casualties (1), approximately 3.5
million displaced persons (2), widespread destruction of the health
infrastructure, disruption of food production and distribution, and other
increased risks to public health. The impact of the war has been especially
severe in Bosnia and Herzegovina (1991 population: 4.3 million) (1). To assist
in targeting humanitarian aid to the region, in August 1993, the U.S. Agency
for International Development's Office of Foreign Disaster Assistance asked
CDC to assess the public health status and needs of Bosnia and Herzegovina.
This report summarizes the results of that assessment and focuses on three
central Bosnian regions.
This assessment was based on interviews with local public health
officials and international humanitarian aid workers; reviews of data
collected by local public health institutions and results of surveys conducted
by United Nations (UN) agencies and nongovernment organizations (NGOs); and
observations in central Bosnia (regions of Sarajevo, Zenica, and Tuzla) and
Herzegovina. Because of security and time constraints, primary data could not
be collected.
The principal public health impact of the war has been injuries resulting
from war-related trauma. In Sarajevo, the war accounted for more than 6800
deaths from trauma (57% of all reported mortality) and 16,000 wounded persons
during April 1992-March 1993 (3). In addition, the increase in the crude
mortality rate reported in Sarajevo (2.9 deaths per 1000 population in April
1993 compared with 0.8 per month in 1991) was attributed to these casualties
(3). In the Zenica Provincial Hospital, the proportion of surgical cases
associated with trauma increased from 22% in April 1992 (the month the war
began) to a peak of 78% in December 1992 and declined to 40% in August 1993.
Overall, 60% of surgical cases from July 1992 through August 1993 were war-
related injuries.
Based on estimates of the Office of the United Nations High Commissioner
for Refugees (UNHCR), the number of persons displaced from their homes in
Bosnia and Herzegovina from January 1993 through August 1993 increased from
810,000 to approximately 2 million (2). In August 1993, approximately 90% of
displaced persons were living in private homes, and 10% were housed in
collective centers maintained by local and international humanitarian aid
agencies.
Although increased numbers of displaced persons and the disruption of
local agricultural production have intensified needs for international food
aid, military forces representing different factions have intermittently
blocked access by UN food convoys to central Bosnia. In August 1993, UNHCR was
able to transport only 57% of basic food requirements for beneficiaries in the
Zenica region and only 39% of requirements for the Tuzla region. Despite these
limited rations, nutrition surveys conducted by the World Health Organization
(WHO) in central Bosnia in July 1993 did not detect an increased prevalence of
protein-energy malnutrition--even though the mean weight loss for adults in
Sarajevo since April 1992 has been 10-12 kg per person (4,5).
The incidence of diagnosed cases of hepatitis A and other enteric
diseases has increased in all areas of central Bosnia since the beginning of
the war (Republic Institute for Public Health of Bosnia and Herzegovina,
unpublished data, 1993; 6) (Table 1). The increased occurrence of enteric
diseases reflects deterioration in the quantity and quality of water supplies
that has resulted from diverted water sources, cracked water pipes, lack of
diesel to run water pumps, and frequent losses of water pressure that, in
turn, permit cross-contamination by sewage. In August 1993, for example, piped
water supplies in Sarajevo were restricted to an average of 5 liters per
person per day (WHO recommends daily provision of 20 liters per person to
maintain health).
Although some elements of the public health system continue to function,
in most areas, routine prevention programs have been curtailed. For example,
in central Bosnia from June 1991 through July 1993, 33% of children aged 13-25
months had been vaccinated against measles compared with coverage rates of
90%-95% in 1990 (4). However, since April 1992, no outbreaks of measles had
been reported (6). In Sarajevo, during April 1992-July 1993, inadequate
prenatal-care services contributed to increases in spontaneous abortions (64%)
and perinatal mortality (70%) and a 19% decrease in average birthweight (S.
Simic, MD, Kosevo Hospital, Sarajevo, personal communication, 1993).
These prevention and other primary-care programs have been limited
because of decreased access to the population, damaged health-care facilities,
and inadequate supplies and resources. An especially critical supply hindered
by the military blockade has been diesel, which cost $36 U.S. per gallon on
the illegal market in Sarajevo in August 1993. Because of this fuel shortage,
water pumps cannot function, health-care workers cannot travel to rural
clinics, and some public health programs (e.g., garbage collection and
vaccination campaigns) have been curtailed.
Reported by: Republic Institute for Public Health of Bosnia and Herzegovina,
Sarajevo, Zenica, and Tuzla. Office of the World Health Organization, Regional
Office for Europe, Special Representative of the Regional Director, Zagreb,
Croatia. US Office of Foreign Disaster Assistance, Washington, DC. Technical
Support Div, International Health Program Office, CDC.
Editorial Note: During war-related emergencies in developing countries,
infectious diseases consistently have been reported as the leading cause of
morbidity and mortality in the affected civilian populations (7). However, the
proportion of deaths in the civilian population attributed to war-related
injuries in Bosnia is among the highest documented in recent humanitarian
emergencies related to civil war (7). By comparison, population surveys in
central and southern Somalia determined that trauma deaths accounted for 4%-
11% of mortality during April 1992-January 1993 (CDC, unpublished data, 1993).
Although increases in enteric disease-related mortality have not been
reported, the fivefold to 16-fold increases in the incidence rates of
diarrheal disease and hepatitis A from 1990 through 1993 in three central
Bosnian regions underscore the urgent need for improvements in water and
sanitation. Rates of infectious diseases in Bosnia are lower than those
reported in civil wars in developing countries and may reflect at least five
factors: 1) disease reporting has been incomplete; 2) most displaced persons
are residing in private homes rather than in mass camps; 3) elements of a
previously well functioning local public health system are still operating; 4)
public health efforts of UN agencies and NGOs have supplemented local
programs; and 5) a well educated, resourceful population has maintained
relatively high standards of personal hygiene (S. Sahadzic, United Nations
Children's Fund, Sarajevo, personal communication, 1993).
The limited occurrence of vaccine-preventable diseases in Bosnia and
Herzegovina may reflect high prewar vaccination rates and the relative absence
of crowded camps that have characterized other refugee emergencies. However,
measles epidemics have occurred in countries with measles vaccine coverage
levels of 70% or higher (8) and the potential for such outbreaks remains high
in central Bosnia.
Even though the availability and distribution of food rations have been
limited in Bosnia, WHO surveys suggest low prevalences of acute malnutrition.
This finding may reflect a combination of four factors: 1) the presence of
substantial household food reserves in 1992 (3); 2) a baseline (i.e. prewar)
prevalence of elevated body mass index (9); 3) effective food distribution
efforts by UNHCR from 1992 until July 1993 (2); and 4) food deliveries by
commercial trucks through regular trade routes from Croatia and Serbia until
April 1993 (3).
This assessment was limited by the degree of underreporting and
diminished sensitivity of currently operating surveillance systems. Because
reports of health status provided by government sources under such
circumstances may be subject to bias, independent public health surveillance
and assessments should be conducted to ensure the accuracy of such reports.
Priorities for relief efforts in Bosnia and Herzegovina may differ from
those usually recommended for complex disasters in developing countries (7).
Moreover, during 1994, the public health of residents of this region may be
further threatened by lack of access by international relief agencies, limited
food and fuel reserves, a likely increase in the nutritionally vulnerable
population (especially children, the elderly, and pregnant women), and the
severity of the winter. In addition to the identification of secure routes of
access and transportation of diesel into central Bosnia, recommendations for
immediate action by appropriate UN agencies and NGOs have included
strengthening of programs for water and sanitation, childhood vaccination, and
prenatal care and expansion of the WHO health monitoring and nutritional
surveillance system.
References
1. Toole MJ, Galson S, Brady W. Are war and public health compatible? Lancet
1993;341:1193-6.
2. Office of the United Nations High Commissioner for Refugees. Information
notes on former Yugoslavia, August 1993. Split, Croatia: Office of the United
Nations High Commissioner for Refugees, 1993.
3. Medecins Sans Frontieres/Holland. Report of a household survey in Sarajevo,
Bosnia-Herzegovina, April 1993. Amsterdam: Medecins Sans Frontieres, 1993.
4. World Health Organization Nutrition Unit, Zagreb. Summary report of
nutritional health surveys carried out in Bosnia-Herzegovina during June/July
1993. Zagreb, Croatia: World Health Organization, 1993.
5. Black ME, Healing TD. Communicable diseases in former Yugoslavia and in
refugees arriving in the United Kingdom. Communicable Disease Report
1993;3:R87-R90.
6. Healing TD. End of mission report on the health monitoring program in the
war affected areas of former Yugoslavia. London: Communicable Disease
Surveillance Center, 1993.
7. Toole MJ, Waldman RJ. Refugees and displaced persons. JAMA 1993;270:600-5.
8. Cutts FT, Henderson RH, Clements CJ, Chen RT, Patriarca PA. Principles of
measles control. Bull World Health Organ 1991;69:1-7.
9. World Health Organization Nutrition Unit, Zagreb. Eighteenth report:
nutrition report from 1st-31st July. Zagreb, Croatia: World Health
Organization, 1993.
------------------------------
Date: Sun, 02 Jan 94 08:52:02 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Acyclovir Resistant Genital Herpes Found Person Healthy Immune System
Message-ID: <FL9iFc4w165w@stat.com>
Acyclovir-Resistant Genital Herpes Found in
Person with Healthy Immune System
National Institute of Allergy and Infectious Diseases
NATIONAL INSTITUTES OF HEALTH
December 8, 1993
Researchers at the National Institute of Allergy and Infectious Diseases
(NIAID) report the first documented case of recurrent genital herpes in a
person with a healthy immune system whose repeated outbreaks were not
suppressed by oral acyclovir, the standard therapy for preventing
recurrences.
The study revealed the patient's virus to be resistant to the drug, which
suggests that acyclovir-resistant strains of the herpes virus may pose
problems for healthy patients as well as for people with compromised immune
systems.
The research report appears in the Dec. 9 issue of The New England
Journal of Medicine. Genital herpes, a contagious viral infection caused by
the herpes simplex virus (HSV), affects an estimated 30 million Americans.
Each year, as many as 500,000 new cases may occur. Once a person is infected,
the virus remains in the body and causes new outbreaks. While some people
recognize only one or two recurrences in a lifetime, others may experience
several outbreaks a year.
"Acyclovir has safely and effectively suppressed frequent genital herpes
recurrences in people with healthy immune systems for more than a decade,"
says Anthony S. Fauci, M.D., NIAID director. "This study, however, signals a
limitation in the current treatment of this disease and underscores the need
for new preventative and therapeutic strategies."
"The possibility that resistance to acyclovir could occur in people with
healthy immune systems has long been a concern," says Stephen E. Straus, M.D.,
chief of the Laboratory of Clinical Investigation (LCI) for NIAID and lead
researcher on the study. "Viral resistance has been documented in animal
models and already is a problem in people with compromised immune systems such
as individuals with HIV infection."
"While acyclovir-resistant genital herpes may be rare in people with
healthy immune systems, the current study suggests that resistance to the drug
may be emerging," Dr. Straus adds.
In an earlier NIAID study of long-term treatment to suppress outbreaks of
genital herpes in people with healthy immune systems, investigators found
evidence of acyclovir resistance, but could not link these findings to
patients' outbreaks.
The current report describes a 24-year-old man who since November of 1990
has had frequent, symptomatic outbreaks of genital herpes despite increasing
doses of oral acyclovir of up to 4.8 grams per day, which is six times the
amount usually required to suppress recurrences. The patient's immune system
has prevented the outbreaks from becoming severe or longlasting, the authors
note.
"Intravenous acyclovir or other antiviral therapies might suppress this
patient's recurring disease, but the potential cost, side effects and probable
temporary benefit that they would provide preclude consideration of these
treatments," says Dr. Straus.
Study investigators acknowledge that this patient may have acquired an
acyclovir-resistant virus through sexual contact with an HIV-infected partner
known to be taking acyclovir. They suggest, however, that resistance also may
have developed during the course of his therapy.
Dr. Straus' co-authors include Rhonda G. Kost, M.D., also of LCI, Edgar
L. Hill, M.S., of the Division of Virology at Burroughs Wellcome Company,
Research Triangle Park, N.C., and Michael Tigges, Ph.D., of Chiron
Corporation, Emeryville, Calif.
NIAID, a component of the National Institutes of Health, supports
research on AIDS, tuberculosis and other infectious diseases as well as
allergies and immunologic diseases. NIH is an agency of the U.S. Public
Health Service, part of the U.S. Department of Health and Human Services.
------------------------------
Date: Sun, 02 Jan 94 08:52:33 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Seeking Help and Information Regarding Chronic ITP
Message-ID: <am9iFc5w165w@stat.com>
"Seeking Help and Info Regarding Chronic ITP"
Please address your responses to mjw@texaco.com
I'm writing on behalf of my 4-year old son who has Chronic ITP. This is a
relatively rare disorder, and treatment is extremely limited for patients that
don't spontaneously recover on their own. I'm looking for other families with
Chronic ITP children to correspond with, concerning how to deal with
developmental problems that may occur in future years. I'm also seeking
information regarding any success with experimental treatments for this
disorder. We've tried steroids and high-dose IVIGG, and most recently,
immunizations for pneumococcal, meningococcal and hemophilus B, hoping to
trigger an auto-immune response that might also have a positive effect on the
ITP. The've talked about trying Interferon, but haven't yet. Splenectomy
seems to be considered as a last-resort for Chronic ITP patients, but we keep
hearing how dangerous this is for children. I would very much appreciate
hearing from anyone having additional information about any of this. Thanks
in advance!
Please e-mail your reply to mjw@texaco.com (using subject *Matt*).
------------------------------
Date: Sun, 02 Jan 94 08:53:01 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Neurosciences Internet Resource Guide
Message-ID: <3m9iFc6w165w@stat.com>
===================================================
NEUROSCIENCES INTERNET RESOURCE GUIDE
===================================================
December 1993, version 1.0
Compiled by
Steve Bonario and Sheryl Cormicle
nirg@umich.edu
School of Information and Library Studies,
University of Michigan
---------------------------------------------------
After considerable effort and plenty of invaluable input and advice from the
Internet's neuroscience community, we are happy to announce the availability
of The Neurosciences Internet Resource Guide, version 1.0. This document aims
to be a guide to existing, free, Internet-accessible resources helpful to
neuroscientists of all stripes. We are pleased and proud to present the first
fruits of our labor, a snapshot of what we found on the Internet between
September and December of 1993. This is not a static document -- we expect it
to change and you can help change it. Let us know what we missed
<nirg@umich.edu>.
HOW TO GET IT
-------------
An **ASCII text version** (86K) is available in the
Clearinghouse of Subject-Oriented Internet Resource Guides as
follows:
anonymous FTP:
host: una.hh.lib.umich.edu
path: /inetdirsstacks
file: neurosci:cormbonario
gopher:
via U. Minnesota list of gophers
menu: North America/USA/Michigan/Clearinghouse.../
All Guides/Neurosciences
WWW:
gopher://una.hh.lib.umich.edu/00/inetdirsstacks/
neurosci:cormbonario
We are also creating a **hypertext version** of the guide intended for viewing
using Mosaic, the World Wide Web browser from NCSA. This version is under
construction, but accessible. Check it out and give us feedback! The URL is:
http://http2.sils.umich.edu/Public/nirg/nirg1.html
QUESTIONS OR COMMENTS? nirg@umich.edu
------------------------------
Date: Sun, 02 Jan 94 08:53:28 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: CancerNet Update
Message-ID: <sN9iFc7w165w@stat.com>
+----------------------------------------------+
| NATIONAL INSTITUTE |
| C A N C E R |
| INTERNATIONAL INFORMATION |
| C E N T E R |
+----------------------------------------------+
| CancerNet@icicb.nci.nih.gov |
+-------------------------------+
********************************** HELP************************************
* *
* *
* The National Cancer Institute (NCI) has undertaken a pilot study of *
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------------------------------
Date: Sun, 02 Jan 94 08:54:09 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Institute of Tropical Medicine Epidemiological Bulletin 12/11/93
Message-ID: <yo9iFc8w165w@stat.com>
IPK - EPIDEMIOLOGICAL BULLETIN Vol 3e / No.49
Date: 12/11/93
Institute of Tropical Medicine "Pedro Kouri"
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------------
Cuba. Cases and Cumulative of selected notifiable diseases. Week
ending 12/11/93. (49th week)
-------------------------------------------------------------------
DISEASES IN THIS WEEK CUMULATIVE RATES+
1992 1993 1992 1993 1992 1993
------------------------------------------------------------------
TYPHOID FEVER 2 * 48 207 0.4 2.0
TUBERCULOSIS 14 16 549 608 5.3 5.9
HANSEN DISEASE 5 2 279 167 2.7 1.9
PERTUSSIS * * 1 11 0.0 0.1
SCARLET FEVER * 4 582 340 5.7 3.3
TETANUS * * 3 2 0.0 0.0
ASEPTIC MEN. 59 38 3945 3250 38.7 31.5
BACTERIAL MEN. 24 38 1653 1116 16.2 10.8
VARICELLA 263 205 103290 40123 1015.8 389.9
VIRAL HEPATITIS 349 187 30380 14200 298.7 138.0
MALARIA * 8 11 8 0.1 0.0
LEPTOSPIROSIS 34 80 602 824 5.9 8.0
MENINGOCOCCAL D. 5 2 144 68 1.4 0.6
SYPHILIS 234 234 10400 8710 102.2 84.6
GONORRHEA 377 359 24660 17924 242.5 174.2
ACUMINATA COND. 42 35 2311 1786 22.7 17.3
MEASLES * * 11 * 0.1 *
RUBELLA * * 6 * 0.0 *
MUMPS * 1 3 1 0.0 0.0
ACUTE AMEB. D. 25 6 793 1452 7.8 14.2
------------------------------------------------------------------
Source: 1992, MND (Written Report) EIG-IPK.
1993, MND (Phone Report) EIG-IPK.
* Means 0 reported case.
+ Period adjusted rate.
Medical Consultations of Acute Diarrhoeal Diseases by age groups.
Cases and Cumulative. Week ending 12/11/93 (49th week).
------------------------------------------------------------------
IN THIS WEEK CUMULATIVE
AGE CASES MEDIAN 1992 1993
GROUPS 1992 1993 (1986-1992)
------------------------------------------------------------------
<1 2969 3502 3892 183719 154403
1 - 4 3467 4298 3685 207641 191350
5 - 14 2148 3130 2336 133278 139000
15 - 64 6840 7989 6405 467508 473263
> 65 764 907 637 48135 49058
------------------------------------------------------------------
Source: MND (Phone Report).
Acute Respiratory Infections. Cuba, Weekly Index by age groups.
Week ending 12/11/93 (49th week)
-------------------------------------------------------
AGE WEEKLY EPIDEMIC EPIDEMIC
GROUPS INDEX INDEX THRESHOLD
-------------------------------------------------------
< 1 412 613 728
1 - 4 250 337 420
5 - 14 88 95 120
15 - 64 26 36 46
> 65 22 29 36
ALL AGES 56 72 84
-------------------------------------------------------
Source: MND (Phone Report). Index x 10000 inhabitants.
Notified Outbreaks. Week 12/09/93 - 12/15/93.
-----------------------------------------------------------------
DISEASES NUMBER OF OUTBREAKS CASES PROVINCES
-----------------------------------------------------------------
F.T.D. 6 154 CIENFUEGOS 5/56
VILLA CLARA 1/98
------------------------------------------------------------------
A.R.I. 1 15 HOLGUIN
------------------------------------------------------------------
A.D.D. 1 18 HOLGUIN
-----------------------------------------------------------------
Source: DIS.
Meningococcal Disease. Cuba. More important indexes. Week ending
12/15/93.
-------------------------------------------------------------------
AGE MORBIDITY MORTALITY LETHALITY
GROUPS CASES RATES DEATHS RATES RATES
1992 1993 1992 1993 1992 1993 1992 1993 1992 1993
------------------------------------------------------------------
0-5 95 39 9.0 3.6 18 8 1.7 0.7 18.6 20.5
6-14 14 8 1.3 0.6 2 1 0.1 0.0 14.2 12.5
>15 35 21 0.4 0.2 13 9 0.1 0.1 37.1 42.8
ALL AGES 144 68 1.4 0.6 33 18 0.3 0.1 22.9 26.4
------------------------------------------------------------------
Source: DIS, EIG-IPK
Cumulative and period adjusted rate x 100000 inhabitants.
Lethality expressed as percentage.
_________________________________________________________________
This bulletin was prepared with the 53% of provinces-days-
information. The provinces: Villa Clara, Cienfuegos and Holguin
have contributed with the 100% provinces-days-information.
The offered indexes are provisionals and were taken from the daily
report of the Direct Information System (DIS) remitted by
Provincial Centers of Hygiene and Epidemiology, from the weekly
phone report of Mandatory Notifiable Diseases (MND) remitted by
National Statistics Division of the Ministry of Public Health, and
from the Reference Laboratories of the Institute of Tropical
Medicine "Pedro Kouri".
_________________________________________________________________
This is the weekly IPK-Epidemiological Bulletin emitted via
Electronic Mail. The numbering plan agree with the IPK-
Epidemiological Bulletin edited by Institute of Tropical Medicine
"Pedro Kouri" and it is an abbreviated version.
If you are interested in receiving this bulletin, please send your
electronic address to:
Lic. Andres M. Alonso
Institute of Tropical Medicine "Pedro Kouri"
ipk-b@infomed.cu
------------------------------
Date: Sun, 02 Jan 94 08:54:54 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: HIV/AIDS Quarterly Surveillance Report Nov 1993
Message-ID: <8P9iFc9w165w@stat.com>
HIV/AIDS Surveillance Report
Monday November 1, 1993
Suggested Citation:
Centers for Disease Control and Prevention. HIV/AIDS Surveillance
Report, November 1993
Report Description
The U.S. AIDS case data presented below are extracted from the
"HIV/AIDS/ Survillance Report", published each quarter by the
Division of HIV/AIDS, Center for Infectious Diseases, Centers for
Disease Control and Prevention, Atlanta, GA 30333. In addition to
the data presented here, the printed report contains maps, figures,
and technical notes. Single copies of the printed report are
available from:
CDC National AIDS Clearinghouse
P.O. Box 6003
Rockville, MD 20849-6003
Table 1. AIDS cases and annual rates per 100,000 population, by
state, reported October 1991 through September 1992, October 1992
through September 1993;(1) and cumulative totals, by state and age
group, through September 1993,(2) United States
Oct. 1991- Oct. 1992-
Sept. 1992 Sep. 1993
State of residence No. Rate No. Rate
Alabama 465 11.4 705 17.0
Alaska 18 3.2 60 10.2
Arizona 408 10.9 1,202 31.3
Arkansas 237 10.0 420 17.5
California 8,641 28.4 17,474 56.4
Colorado 415 12.3 1,193 34.5
Connecticut 538 16.3 1,693 51.4
Delaware 126 18.5 346 49.9
District of Columbia 724 121.0 1,370 232.3
Florida 5,007 37.7 9,613 70.6
Georgia 1,348 20.4 2,597 38.4
Hawaii 175 15.4 324 27.9
Idaho 36 3.5 71 6.6
Illinois 1,842 16.0 3,005 25.8
Indiana 370 6.6 831 14.6
Iowa 86 3.1 196 7.0
Kansas 188 7.5 335 13.3
Kentucky 207 5.6 316 8.4
Louisiana 829 19.5 1,172 27.4
Maine 50 4.0 126 10.2
Maryland 1,096 22.6 2,353 47.6
Massachusetts 767 12.8 2,532 42.4
Michigan 784 8.4 1,752 18.6
Minnesota 237 5.3 624 13.9
Mississippi 231 8.9 468 17.9
Missouri 650 12.6 1,679 32.3
Montana 22 2.7 35 4.3
Nebraska 68 4.3 179 11.1
Nevada 235 18.3 601 44.0
New Hampshire 48 4.3 99 9.0
New Jersey 2,051 26.4 4,390 56.3
New Mexico 90 5.8 307 19.4
New York 8,232 45.6 16,031 88.4
North Carolina 648 9.6 1,059 15.5
North Dakota 4 0.6 4 0.6
Ohio 696 6.4 1,490 13.5
Oklahoma 228 7.2 716 22.3
Oregon 283 9.7 732 24.4
Pennsylvania 1,338 11.2 2,556 21.2
Rhode Island 102 10.2 305 30.3
South Carolina 347 9.7 1,395 38.4
South Dakota 8 1.1 23 3.2
Tennessee 442 8.9 967 19.2
Texas 2,944 17.0 7,164 40.4
Utah 145 8.2 270 14.9
Vermont 26 4.6 60 10.5
Virginia 606 9.6 1,590 24.9
Washington 573 11.4 1,459 28.2
West Virginia 61 3.4 78 4.3
Wisconsin 224 4.5 700 13.9
Wyoming 4 0.9 36 7.7
Subtotal 44,900 17.8 94,703 37.0
Guam 1 0.7 2 1.5
Pacific Islands, U.S. - - - -
Puerto Rico 1,796 50.5 2,621 73.1
Virgin Islands, U.S. 19 18.6 42 40.8
Total 46,716 18.2 97,368 37.5
Cumulative totals
Adults/ Children
adolescents < 13 years old Total
Alabama 2,275 43 2,318
Alaska 154 2 156
Arizona 3,059 14 3,073
Arkansas 1,239 21 1,260
California 62,201 356 62,557
Colorado 3,516 18 3,534
Connecticu 4,415 98 4,513
Delaware 830 7 837
District of Columbia 5,231 78 5,309
Florida 32,008 751 32,759
Georgia 9,255 87 9,342
Hawaii 1,250 10 1,260
Idaho 203 2 205
Illinois 10,522 140 10,662
Indiana 2,443 17 2,460
Iowa 577 6 583
Kansas 1,031 5 1,036
Kentucky 1,148 13 1,161
Louisiana 4,811 67 4,878
Maine 427 4 431
Maryland 7,187 152 7,339
Massachusetts 7,238 132 7,370
Michigan 4,904 62 4,966
Minnesota 1,829 13 1,842
Mississippi 1,483 20 1,503
Missouri 4,626 33 4,659
Montana 134 2 136
Nebraska 469 4 473
Nevada 1,641 15 1,656
New Hampshire 368 6 374
New Jersey 18,106 423 18,529
New Mexico 831 2 833
New York 63,660 1,321 64,981
North Carolina 3,735 75 3,810
North Dakota 32 - 32
Ohio 4,944 68 5,012
Oklahoma 1,795 15 1,810
Oregon 2,233 9 2,242
Pennsylvania 9,086 120 9,206
Rhode Island 842 9 851
South Carolina 3,022 38 3,060
South Dakota 57 2 59
Tennessee 2,734 26 2,760
Texas 23,572 213 23,785
Utah 818 20 838
Vermont 176 2 178
Virginia 4,710 82 4,792
Washington 4,765 18 4,783
West Virginia 359 5 364
Wisconsin 1,705 19 1,724
Wyoming 91 - 91
Subtotal 323,747 4,645 328,392
Guam 12 - 12
Pacific Islands, U.S 2 - 2
Puerto Rico 10,436 256 10,692
Virgin Islands, U.S. 147 5 152
Total 334,344 4,906 339,250
(1) Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
(2) During the third quarter of 1993, CDC received reports of
23,664 cases and 9,951 deaths among adults/adolescents and 196
cases and 105 deaths among children.
Table 2. AIDS cases and annual rates per 100,000 population, by
metropolitan area with 500,000 or more population, reported October
1991 through September 1992, October 1992 through September 1993;1)
and cumulative totals, by area and age group, through September
1993, United States
Oct. 1991- Oct. 1992-
Sept. 1992 Sept. 1993
Metropolitan
area of residence(2) No. Rate No. Rate
Akron, Ohio 36 5.4 46 6.9
Albany-Schenectady, N.Y. 106 12.2 217 24.7
Albuquerque, N.M. 58 9.6 186 30.2
Allentown, Pa. 32 5.3 122 20.0
Ann Arbor, Mich. 29 5.8 63 12.4
Atlanta, Ga. 956 31.3 1,773 56.4
Austin, Tex. 241 27.6 586 65.0
Bakersfield, Calif. 50 8.8 161 27.3
Baltimore, Md. 669 27.7 1,628 66.6
Baton Rouge, La. 92 17.1 135 24.7
Bergen-Passaic, N.J. 267 20.9 677 52.8
Birmingham, Ala. 116 13.7 259 30.2
Boston, Mass. 659 11.6 2,268 40.2
Buffalo, N.Y. 69 5.8 198 16.5
Charleston, S.C. 70 13.4 259 47.9
Charlotte, N.C. 118 9.9 245 20.1
Chicago, Ill. 1,614 21.5 2,619 34.5
Cincinnati, Ohio 112 7.3 230 14.7
Cleveland, Ohio 199 9.0 458 20.6
Columbus, Ohio 158 11.5 336 24.1
Dallas, Tex. 759 27.7 1,805 64.4
Dayton, Ohio 67 7.0 132 13.7
Denver, Colo. 335 20.1 1,010 58.9
Detroit, Mich. 606 14.1 1,233 28.7
El Paso, Tex. 46 7.5 116 18.3
Fort Lauderdale, Fla. 848 65.9 1,165 88.4
Fort Worth, Tex. 160 11.5 404 28.2
Fresno, Calif. 99 12.7 173 21.5
Gary, Ind. 47 7.7 78 12.6
Grand Rapids, Mich. 37 3.9 126 13.0
Greensboro, N.C. 128 12.0 151 14.0
Greenville, S.C. 62 7.4 255 29.8
Harrisburg, Pa. 46 7.7 78 12.9
Hartford, Conn. 167 14.8 565 50.2
Honolulu, Hawaii 124 14.6 256 29.6
Houston, Tex. 1,023 29.8 2,587 72.8
Indianapolis, Ind. 170 12.1 397 27.7
Jacksonville, Fla. 327 35.0 910 94.7
Jersey City, N.J. 313 56.6 619 111.8
Kansas City, Mo. 314 19.6 736 45.4
Knoxville, Tenn. 35 5.8 78 12.7
Las Vegas, Nev. 180 19.5 468 46.9
Little Rock, Ark. 82 15.8 171 32.6
Los Angeles, Calif. 3,327 37.1 5,557 61.1
Louisville, Ky. 90 9.4 166 17.2
Memphis, Tenn. 174 17.1 414 40.1
Miami, Fla. 1,324 67.0 2,423 120.1
Middlesex, N.J. 217 21.1 354 34.2
Milwaukee, Wis. 127 8.8 361 24.8
Minneapolis-Saint Paul, Min. 204 7.9 550 20.9
Monmouth-Ocean City, N.J. 111 11.1 366 36.4
Nashville, Tenn. 125 12.5 269 26.3
Nassau-Suffolk, N.Y. 370 14.1 1,010 38.4
New Haven, Conn. 318 19.5 987 60.4
New Orleans, La. 476 36.8 612 46.9
New York, N.Y. 7,163 83.8 13,288 155.3
Newark, N.J. 838 43.8 1,540 80.6
Norfolk, Va. 105 7.2 325 21.9
Oakland, Calif. 563 26.7 1,225 57.2
Oklahoma City, Okla. 113 11.6 310 31.5
Omaha, Neb. 49 7.5 136 20.6
Orange County, Calif. 553 22.6 717 29.0
Orlando, Fla. 331 26.1 870 66.3
Philadelphia, Pa. 1,005 20.3 2,110 42.5
Phoenix, Ariz. 292 12.8 863 36.9
Pittsburgh, Pa. 148 6.2 214 8.9
Portland, Oreg. 249 15.9 655 40.3
Providence, R.I. 96 10.5 285 31.1
Raleigh-Durham, N.C. 128 14.5 189 20.8
Richmond, Va. 140 15.9 385 42.9
Riverside-San Bernardino, Calif. 435 16.0 1,045 36.6
Rochester, N.Y. 76 7.1 243 22.4
Sacramento, Calif. 287 20.7 453 31.5
Saint Louis, Mo. 290 11.6 841 33.3
Salt Lake City, Utah 129 11.7 241 21.3
San Antonio, Tex. 217 16.1 426 31.1
San Diego, Calif. 631 24.8 1,474 56.7
San Francisco, Calif. 1,896 116.9 4,592 279.8
San Jose, Calif. 183 12.2 502 33.2
San Juan, P.R. 1,075 57.9 1,638 87.3
Sarasota, Fla. 90 18.0 148 28.9
Scranton, Pa. 26 4.1 54 8.4
Seattle, Wash. 424 20.4 1,043 49.1
Springfield, Mass. 92 15.3 210 35.0
Stockton, Calif. 34 6.9 109 21.6
Syracuse, N.Y. 71 9.5 168 22.2
Tacoma, Wash. 38 6.3 137 21.9
Tampa-Saint Petersburg, Fla. 535 25.5 1,421 66.6
Toledo, Ohio 33 5.4 90 14.6
Tucson, Ariz. 93 13.7 258 37.6
Tulsa, Okla. 70 9.7 236 32.1
Ventura, Calif. 73 10.8 130 19.0
Washington, D.C. 1,345 31.3 2,560 58.7
West Palm Beach, Fla. 529 59.7 787 86.5
Wichita, Kansas 62 12.6 96 19.2
Wilmington, Del. 93 17.8 261 49.1
Youngstown, Ohio 23 3.8 29 4.8
Metropolitan areas with
500,000 or more population 39,112 24.8 81,352 50.9
Metropolitan areas with
50,000 to 500,000 population 4,821 10.5 10,306 22.0
Non-metropolitan areas 2,587 4.9 5,288 10.0
Total (3) 46,716 18.2 97,368 37.5
Cumulative totals
Adults/ Children
Area of residence(2) adolescents < 13 years old Total
Akron, Ohio 214 - 214
Albany-Schenectady, N.Y. 672 14 686
Albuquerque, N.M. 490 1 491
Allentown, Pa. 314 4 318
Ann Arbor, Mich. 194 4 198
Atlanta, Ga. 6,836 43 6,879
Austin, Tex. 1,705 14 1,719
Bakersfield, Calif. 357 3 360
Baltimore, Md. 4,548 113 4,661
Baton Rouge, La. 469 7 476
Bergen-Passaic, N.J. 2,425 51 2,476
Birmingham, Ala. 716 11 727
Boston, Mass. 6,510 117 6,627
Buffalo, N.Y. 653 8 661
Charleston, S.C. 611 5 616
Charlotte, N.C. 747 10 757
Chicago, Ill. 9,251 125 9,376
Cincinnati, Ohio 768 11 779
Cleveland, Ohio 1,414 27 1,441
Columbus, Ohio 1,085 6 1,091
Dallas, Tex. 5,867 24 5,891
Dayton, Ohio 481 8 489
Denver, Colo. 2,918 13 2,931
Detroit, Mich. 3,484 45 3,529
El Paso, Tex. 303 1 304
Fort Lauderdale, Fla. 5,114 109 5,223
Fort Worth, Tex. 1,350 15 1,365
Fresno, Calif. 519 4 523
Gary, Ind. 240 2 242
Grand Rapids, Mich. 326 3 329
Greensboro, N.C. 631 11 642
Greenville, S.C. 521 2 523
Harrisburg, Pa. 313 6 319
Hartford, Conn. 1,397 17 1,414
Honolulu, Hawaii 946 6 952
Houston, Tex. 9,225 87 9,312
Indianapolis, Ind. 1,178 5 1,183
Jacksonville, Fla. 2,140 49 2,189
Jersey City, N.J. 2,933 68 3,001
Kansas City, Mo. 2,197 9 2,206
Knoxville, Tenn. 238 2 240
Las Vegas, Nev. 1,260 14 1,274
Little Rock, Ark. 485 9 494
Los Angeles, Calif. 21,704 146 21,850
Louisville, Ky. 509 8 517
Memphis, Tenn. 1,007 9 1,016
Miami, Fla. 9,303 260 9,563
Middlesex, N.J. 1,515 33 1,548
Milwaukee, Wis. 914 12 926
Minneapolis-Saint Paul,
Minn. 1,619 10 1,629
Monmouth-Ocean City, N.J. 1,253 35 1,288
Nashville, Tenn. 844 10 854
Nassau-Suffolk, N.Y. 3,200 66 3,266
New Haven, Conn. 2,654 77 2,731
New Orleans, La. 2,868 37 2,905
New York, N.Y. 54,716 1,183 55,899
Newark, N.J. 7,229 184 7,413
Norfolk, Va. 1,006 22 1,028
Oakland, Calif. 4,138 26 4,164
Oklahoma City, Okla. 825 1 826
Omaha, Neb. 343 1 344
Orange County, Calif. 2,811 21 2,832
Orlando, Fla. 2,249 42 2,291
Philadelphia, Pa. 7,082 87 7,169
Phoenix, Ariz. 2,236 9 2,245
Pittsburgh, Pa. 1,026 6 1,032
Portland, Oreg. 943 6 1,949
Providence, R.I. 791 8 799
Raleigh-Durham, N.C. 787 18 805
Richmond, Va. 1,006 13 1,019
Riverside-San Bernardino,
Calif. 2,727 27 2,754
Rochester, N.Y. 742 8 750
Sacramento, Calif. 1,490 14 1,504
Saint Louis, Mo. 2,224 21 2,245
Salt Lake City, Utah 726 14 740
San Antonio, Tex. 1,591 14 1,605
San Diego, Calif. 4,877 32 4,909
San Francisco, Calif. 17,397 27 17,424
San Jose, Calif. 1,514 11 1,525
San Juan, P.R. 6,577 168 6,745
Sarasota, Fla. 570 12 582
Scranton, Pa. 188 3 191
Seattle, Wash. 3,536 10 3,546
Springfield, Mass. 574 15 589
Stockton, Calif. 307 8 315
Syracuse, N.Y. 497 6 503
Tacoma, Wash. 360 7 367
Tampa-Saint Petersburg,
Fla. 3,781 53 3,834
Toledo, Ohio 271 4 275
Tucson, Ariz. 619 5 624
Tulsa, Okla. 549 5 554
Ventura, Calif. 378 1 379
Washington, D.C. 9,366 138 9,504
West Palm Beach, Fla. 2,916 107 3,023
Wichita, Kansas 276 2 278
Wilmington, Del. 617 6 623
Youngstown, Ohio 148 - 148
Metropolitan areas with 500,000
or more population 284,441 4,131 288,572
Metropolitan areas with 50,000
500,000 population 31,977 485 32,462
Non-metropolitan areas 16,621 268 16,889
Total (3) 334,344 4,906 339,250
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 Based on Metropolitan Statistical Areas (MSA) revised June 1993.
3 Totals include 1,327 persons whose area of residence is unknown.
Table 3. AIDS cases by age group, exposure category, and sex,
reported October 1991 through September 1992, October 1992 through
September 1993;(1) and cumulative totals, by age group and exposure
category, through September 1993, United States
Males
Oct. 1991- Oct. 1992-
Sept. 1992 Sept. 1993
Adult/adolescent
exposure category No. (%) No. (%)
Men who have sex with men 24,334 (61) 46,025 (56)
Injecting drug use 8,621 (22) 19,142 (23)
Men who have sex with men and inject drugs 2,638 ( 7) 5,353 ( 7)
Hemophilia/coagulation disorder 317 ( 1) 990 ( 1)
Heterosexual contact: 1,613 ( 4) 3,328 ( 4)
Sex with injecting drug user 703 1,102
Sex with bisexual male - -
Sex with person with hemophilia 3 10
Born in Pattern-II(3) country 271 607
Sex with person born
in Pattern-II country 14 43
Sex with transfusion recipient
with HIV infection 18 59
Sex with HIV-infected person,
risk not specified 604 1,507
Receipt of blood transfusion,
blood components, or tissue(4) 385 ( 1) 695 ( 1)
Other/risk not identified(5) 1,925 ( 5) 6,174 ( 8)
Adult/adolescent subtotal 39,833 (100) 81,707 (100)
Pediatric (< 13 years old)
exposure category
Hemophilia/coagulation disorder 23 ( 6) 18 ( 4)
Mother with/at risk for HIV
infection: 329 (89) 397 (91)
Injecting drug use 114 126
Sex with injecting drug user 54 68
Sex with bisexual male 7 5
Sex with person with hemophilia 5 1
Born in Pattern-II country 19 22
Sex with person born
in Pattern-II country 3 3
Sex with transfusion recipient
with HIV infection 1 1
Sex with HIV-infected person,
risk not specified 31 45
Receipt of blood transfusion,
blood components, or tissue 12 16
Has HIV infection,
risk not specified 83 110
Receipt of blood transfusion,
blood components, or tissue 12 ( 3) 15 ( 3)
Risk not identified 5 ( 1) 7 ( 2)
Pediatric subtotal 369 (100) 437 (100)
Total 40,202 82,144
Females
Oct. 1991- Oct. 1992-
Sept. 1992 Sept. 1993
Adult/adolescent
exposure category No. (%) No. (%)
Men who have sex with men - -
Injecting drug use 2,815 (46) 6,891 (47)
Men who have sex with men and inject drugs - -
Hemophilia/coagulation disorder 6 ( 0) 27 ( 0)
Heterosexual contact: 2,588 (42) 5,545 (37)
Sex with injecting drug user 1,474 2,474
Sex with bisexual male 177 423
Sex with person with hemophilia 20 61
Born in Pattern-II(3) country 165 324
Sex with person born
in Pattern-II country 15 31
Sex with transfusion recipient
with HIV infection 49 101
Sex with HIV-infected person,
risk not specified 688 2,131
Receipt of blood transfusion,
blood components, or tissue(4) 278 ( 5) 496 ( 3)
Other/risk not identified(5) 466 ( 8) 1,833 (12)
Adult/adolescent subtotal 6,153 (100) 14,792 (100)
Pediatric (< 13 years old)
exposure category
Hemophilia/coagulation disorder - -
Mother with/at risk for HIV
infection: 347 (96) 417 (97)
Injecting drug use 144 138
Sex with injecting drug user 62 65
Sex with bisexual male 8 4
Sex with person with hemophilia 2 2
Born in Pattern-II country 12 15
Sex with person born
in Pattern-II country 2 2
Sex with transfusion recipient
with HIV infection 3 2
Sex with HIV-infected person,
risk not specified 21 51
Receipt of blood transfusion,
blood components, or tissue 10 7
Has HIV infection,
risk not specified 83 131
Receipt of blood transfusion,
blood components, or tissue 6 ( 2) 9 (2)
Risk not identified 8 ( 2) 6 (1)
Pediatric subtotal 361 (100) 432 (100)
Total 6,514 15,224
Totals
Oct. 1991- Oct. 1992- Cumulative
Sept. 1992 Sept. 1993 total2
Adult/adolescent
exposure category No. (%) No. (%) No. (%)
Men who have sex with men 24,334 (53) 46,025 (48) 183,344 (55)
Injecting drug use 11,436 (25) 26,033 (27) 80,713 (24)
Men who have sex with men
and inject drugs 2,638 ( 6) 5,353 ( 6) 21,142 (6)
Hemophilia/coagulation disor 323 ( 1) 1,017 ( 1) 2,963 (1)
Heterosexual contact: 4,201 ( 9) 8,873 ( 9) 24,358 (7)
Sex with injecting
drug user 2,177 3,576 11,750
Sex with bisexual male 177 423 1,250
Sex with person
with hemophilia 23 71 193
Born in Pattern-II(3)
country 436 931 3,758
Sex with person born
in Pattern-II country 29 74 279
Sex with transfusion recipient
with HIV infection 67 160 456
Sex with HIV-infected person,
risk not specified 1,292 3,638 6,672
Receipt of blood transfusion,
blood components,
or tissue(4) 663 ( 1) 1,191 ( 1) 5,984 (2)
Other/risk not
identified(5) 2,391 ( 5) 8,007 ( 8) 15,840 (5)
Adult/adolescent subtotal 45,986 (100) 96,499 (100) 334,344 (100)
Pediatric (< 13 years old)
exposure category
Hemophilia/coagulation
disorder 23 ( 3) 18 ( 2) 202 (4)
Mother with/at risk for HIV
infection: 676 (93) 814 (94) 4,328 (88)
Injecting drug use 258 264 1,920
Sex with injecting drug user 116 133 846
Sex with bisexual male 15 9 88
Sex with person with
hemophilia 7 3 21
Born in Pattern-II country 31 37 305
Sex with person born
in Pattern-II country 5 5 23
Sex with transfusion recipient
with HIV infection 4 3 19
Sex with HIV-infected person,
risk not specified 52 96 275
Receipt of blood transfusion,
blood components, or tissue 22 23 98
Has HIV infection,
risk not specified 166 241 733
Receipt of blood transfusion,
blood components, or tissue 18 ( 2) 24 ( 3) 327 (7)
Risk not identified 13 ( 2) 13 ( 1) 49 (1)
Pediatric subtotal 730 (100) 869 (100) 4,906
(100)
Total 46,716 97,368 339,250
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 Includes 7 persons known to be infected with human
immunodeficiency virus type 2 (HIV-2). See JAMA 1992;267:2775-9.
3 See technical notes.
4 Twenty-seven adults/adolescents and 2 children developed AIDS
after receiving blood screened negative for HIV antibody. Six
additional adults developed AIDS after receiving tissue or organs
from HIV-infected donors. Three of the 6 received tissues or
organs from a donor who was negative for HIV antibody at the time
of donation. See N Engl J Med 1992;326:726-32.
5 "Other" refers to 11 health-care workers who developed AIDS after
occupational exposure to HIV-infected blood, as documented by
evidence of seroconversion; to 4 patients who developed AIDS after
exposure to HIV within the health-care setting, as documented by
laboratory studies; to 1 person who acquired HIV infection
perinatally and was diagnosed with AIDS after age 13; and to 1
person with intentional self-inoculation of blood from an
HIV-infected person. "Risk not identified" refers to persons whose
mode of exposure to HIV is unknown. This includes persons under
investigation; persons who died, were lost to follow-up, or
declined interview; and persons whose mode of exposure to HIV
remains unidentified after investigation.
Table 4. Male adult/adolescent AIDS cases by exposure category and
race/ethnicity, reported October 1992 through September 1993,(1)
and cumulative totals, through September 1993, United States
White, not
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Men who have sex with men 30,094 (73) 125,392 (78)
Injecting drug use 4,285 (10) 12,670 ( 8)
Men who have sex with men
and inject drugs 3,001 ( 7) 11,959 ( 7)
Hemophilia/coagulation disorder 794 ( 2) 2,349 ( 1)
Heterosexual contact: 607 ( 1) 1,654 ( 1)
Sex with injecting drug user 227 804
Sex with person with hemophilia 6 13
Born in Pattern-II(2) country 1 8
Sex with person born
in Pattern-II country 10 52
Sex with transfusion recipient
with HIV infection 25 72
Sex with HIV-infected person,
risk not specified 338 705
Receipt of blood transfusion,
blood components, or tissue 431 ( 1) 2,519 ( 2)
Risk not identified(3) 2,032 ( 5) 4,380 ( 3)
Total 41,244 (100) 160,923 (100)
Black, not
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Men who have sex with men 9,614 (37) 34,166 (42)
Injecting drug use 9,667 (37) 29,762 (36)
Men who have sex with men
and inject drugs 1,568 ( 6) 5,974 ( 7)
Hemophilia/coagulation disorder 110 ( 0) 260 ( 0)
Heterosexual contact: 2,125 ( 8) 6,279 ( 8)
Sex with injecting drug user 682 2,118
Sex with person with hemophilia 1 4
Born in Pattern-II(2) country 605 2,571
Sex with person born
in Pattern-II country 31 86
Sex with transfusion recipient
with HIV infection 26 51
Sex with HIV-infected person,
risk not specified 780 1,449
Receipt of blood transfusion,
blood components, or tissue 157 ( 1) 606 ( 1)
Risk not identified(3) 2,807 (11) 5,127 ( 6)
Total 26,048 (100) 82,174 (100)
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Men who have sex with men 5,638 (42) 21,475 (45)
Injecting drug use 5,094 (38) 18,143 (38)
Men who have sex with men
and inject drugs 712 ( 5) 3,021 ( 6)
Hemophilia/coagulation disorder 68 ( 1) 224 ( 0)
Heterosexual contact: 570 ( 4) 1,375 ( 3)
Sex with injecting drug user 185 599
Sex with person with hemophilia 2 4
Born in Pattern-II(2) country - 10
Sex with person born
in Pattern-II country 2 11
Sex with transfusion recipient
with HIV infection 6 28
Sex with HIV-infected person,
risk not specified 375 723
Receipt of blood transfusion,
blood components, or tissue 91 ( 1) 385 ( 1)
Risk not identified(3) 1,234 ( 9) 2,728 ( 6)
Total 13,407 (100) 47,351 (100)
Asian/Pacific
Islander
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Men who have sex with men 445 (74) 1,583 (79)
Injecting drug use 28 ( 5) 79 ( 4)
Men who have sex with men
and inject drugs 22 ( 4) 57 ( 3)
Hemophilia/coagulation disorder 12 ( 2) 35 ( 2)
Heterosexual contact: 15 ( 2) 29 ( 1)
Sex with injecting drug user 6 12
Sex with person with hemophilia - -
Born in Pattern-II country - 3
Sex with person born
in Pattern-II country - 1
Sex with transfusion recipient
with HIV infection 2 2
Sex with HIV-infected person,
risk not specified 7 11
Receipt of blood transfusion,
blood components, or tissue 12 ( 2) 72 ( 4)
Risk not identified 69 (11) 152 ( 8)
Total 603 (100) 2,007 (100)
American Indian/
Alaska Native
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Men who have sex with men 158 (63) 388 (63)
Injecting drug use 23 ( 9) 62 (10)
Men who have sex with men
and inject drugs 42 (17) 107 (17)
Hemophilia/coagulation disorder 6 ( 2) 16 ( 3)
Heterosexual contact: 4 ( 2) 10 ( 2)
Sex with injecting drug user 1 5
Sex with person with hemophilia - -
Born in Pattern-II country - -
Sex with person born
in Pattern-II country - -
Sex with transfusion recipient
with HIV infection - -
Sex with HIV-infected person,
risk not specified 3 5
Receipt of blood transfusion,
blood components, or tissue 1 ( 0) 5 ( 1)
Risk not identified 15 ( 6) 26 ( 4)
Total 249 (100) 614 (100)
Cumulative
totals(4)
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Men who have sex with men 46,025 (56) 183,344 (62)
Injecting drug use 19,142 (23) 60,835 (21)
Men who have sex with men
and inject drugs 5,353 ( 7) 21,142 ( 7)
Hemophilia/coagulation disorder 990 ( 1) 2,890 ( 1)
Heterosexual contact: 3,328 ( 4) 9,361 ( 3)
Sex with injecting drug user 1,102 3,539
Sex with person with hemophilia 10 22
Born in Pattern-II country 607 2,597
Sex with person born
in Pattern-II country 43 150
Sex with transfusion recipient
with HIV infection 59 154
Sex with HIV-infected person,
risk not specified 1,507 2,899
Receipt of blood transfusion,
blood components, or tissue 695 ( 1) 3,596 ( 1)
Risk not identified 6,174 ( 8) 12,474 ( 4)
Total 81,707 (100) 293,642 (100)
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 See technical notes.
3 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown. This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
4 Includes 573 men whose race/ethnicity is unknown.
Table 5. Female adult/adolescent AIDS cases by exposure category
and race/ethnicity, reported October 1992 through September
1993,(1) and cumulative totals, through September 1993, United
States
White, not
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Injecting drug use 1,718 (46) 4,459 (43)
Hemophilia/coagulation disorder 14 ( 0) 48 ( 0)
Heterosexual contact: 1,387 (37) 3,595 (35)
Sex with injecting drug user 586 1,703
Sex with bisexual male 199 627
Sex with person with hemophilia 50 140
Born in Pattern-II(2) country 3 5
Sex with person born
in Pattern-II country 4 15
Sex with transfusion recipient
with HIV infection 49 176
Sex with HIV-infected person,
risk not specified 496 929
Receipt of blood transfusion,
blood components, or tissue 223 ( 6) 1,398 (14)
Risk not identified(3) 398 (11) 793 ( 8)
Total 3,740 (100) 10,293 (100)
Black, not
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Injecting drug use 3,861 (48) 11,386 (52)
Hemophilia/coagulation disorder 7 ( 0) 15 ( 0)
Heterosexual contact: 2,884 (36) 7,864 (36)
Sex with injecting drug user 1,191 4,101
Sex with bisexual male 150 428
Sex with person with hemophilia 9 21
Born in Pattern-II(2) country 316 1,143
Sex with person born
in Pattern-II country 26 110
Sex with transfusion recipient
with HIV infection 27 63
Sex with HIV-infected person,
risk not specified 1,165 1,998
Receipt of blood transfusion,
blood components, or tissue 167 ( 2) 571 ( 3)
Risk not identified(3) 1,089 (14) 1,892 ( 9)
Total 8,008 (100) 21,728 (100)
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Injecting drug use 1,265 (44) 3,907 (47)
Hemophilia/coagulation disorder 5 ( 0) 9 ( 0)
Heterosexual contact: 1,192 (41) 3,377 (41)
Sex with injecting drug user 667 2,337
Sex with bisexual male 60 162
Sex with person with hemophilia 1 7
Born in Pattern-II(2) country 4 11
Sex with person born
in Pattern-II country 1 4
Sex with transfusion recipient
with HIV infection 17 51
Sex with HIV-infected person,
risk not specified 442 805
Receipt of blood transfusion,
blood components, or tissue 88 ( 3) 349 ( 4)
Risk not identified(3) 327 (11) 631 ( 8)
Total 2,877 (100) 8,273 (100)
Asian/Pacific
Islander
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Injecting drug use 15 (15) 34 (15)
Hemophilia/coagulation disorder 1 ( 1) 1 ( 0)
Heterosexual contact: 57 (58) 104 (45)
Sex with injecting drug user 15 31
Sex with bisexual male 13 28
Sex with person with hemophilia - 2
Born in Pattern-II country 1 1
Sex with person born
in Pattern-II country - -
Sex with transfusion recipient
with HIV infection 8 11
Sex with HIV-infected person,
risk not specified 20 31
Receipt of blood transfusion,
blood components, or tissue 16 (16) 59 (26)
Risk not identified 10 (10) 32 (14)
Total 99 (100) 230 (100)
American Indian/
Alaska Native
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Injecting drug use 17 (37) 52 (50)
Hemophilia/coagulation disorder - -
Heterosexual contact: 20 (43) 32 (31)
Sex with injecting drug user 12 21
Sex with bisexual male 1 3
Sex with person with hemophilia 1 1
Born in Pattern-II country - -
Sex with person born
in Pattern-II country - -
Sex with transfusion recipient
with HIV infection - -
Sex with HIV-infected person,
risk not specified 6 7
Receipt of blood transfusion,
blood components, or tissue 2 ( 4) 8 ( 8)
Risk not identified 7 (15) 11 (11)
Total 46 (100) 103 (100)
Cumulative
totals(4)
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Injecting drug use 6,891 (47) 19,878 (49)
Hemophilia/coagulation disorder 27 ( 0) 73 ( 0)
Heterosexual contact: 5,545 (37) 14,997 (37)
Sex with injecting drug user 2,474 8,211
Sex with bisexual male 423 1,250
Sex with person with hemophilia 61 171
Born in Pattern-II country 324 1,161
Sex with person born
in Pattern-II country 31 129
Sex with transfusion recipient
with HIV infection 101 302
Sex with HIV-infected person,
risk not specified 2,131 3,773
Receipt of blood transfusion,
blood components, or tissue 496 ( 3) 2,388 ( 6)
Risk not identified 1,833 (12) 3,366 ( 8)
Total 14,792 (100) 40,702 (100)
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 See technical notes.
3 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown. This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
4 Includes 75 women whose race/ethnicity is unknown.
Table 6. Pediatric AIDS cases by exposure category and
race/ethnicity, reported October 1992 through September 1993, and
cumulative totals, through September 1993, United States
White, not
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Hemophilia/coagulation disorder 13 ( 9) 141 (14)
Mother with/at risk for HIV
infection: 118 (84) 663 (68)
Injecting drug use 38 290
Sex with injecting drug user 22 132
Sex with bisexual male 4 39
Sex with person with hemophilia 2 13
Born in Pattern-II1 country - 3
Sex with person born
in Pattern-II country - -
Sex with transfusion recipient
with HIV infection 1 6
Sex with HIV-infected person,
risk not specified 10 45
Receipt of blood transfusion,
blood components, or tissue 6 29
Has HIV infection,
risk not specified 35 106
Receipt of blood transfusion,
blood components, or tissue 9 ( 6) 167 (17)
Risk not identified(2) 1 ( 1) 9 ( 1)
Total 141 (100) 980 (100)
Black, not
Hispanic
Oct. 1992-
Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Hemophilia/coagulation disorder 1 ( 0) 24 (1)
Mother with/at risk for HIV
infection: 489 (97) 2,556 (95)
Injecting drug use 153 1,133
Sex with injecting drug user 70 390
Sex with bisexual male 2 28
Sex with person with hemophilia - 5
Born in Pattern-II1 country 37 300
Sex with person born
in Pattern-II country 5 22
Sex with transfusion recipient
with HIV infection 1 5
Sex with HIV-infected person,
risk not specified 57 148
Receipt of blood transfusion,
blood components, or tissue 12 43
Has HIV infection,
risk not specified 152 482
Receipt of blood transfusion,
blood components, or tissue 6 ( 1) 74 (3)
Risk not identified(2) 8 ( 2) 29 (1)
Total 504 (100) 2,683(100)
Hispanic
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Hemophilia/coagulation disorder 4 ( 2) 33 ( 3)
Mother with/at risk for HIV
infection: 197 (93) 1,074 (90)
Injecting drug use 69 483
Sex with injecting drug user 40 318
Sex with bisexual male 3 20
Sex with person with hemophilia 1 3
Born in Pattern-II(1) country - 2
Sex with person born
in Pattern-II country - 1
Sex with transfusion recipient
with HIV infection 1 8
Sex with HIV-infected person,
risk not specified 27 77
Receipt of blood transfusion,
blood components, or tissue 5 25
Has HIV infection,
risk not specified 51 137
Receipt of blood transfusion,
blood components, or tissue 7 ( 3) 76 ( 6)
Risk not identified(2) 4 ( 2) 11 ( 1)
Total 212 (100) 1,194 (100)
Asian/Pacific
Islander
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Hemophilia/coagulation disorder - 3 (14)
Mother with/at risk for HIV
infection: 2 (50) 10 (45)
Injecting drug use 1 3
Sex with injecting drug user - 2
Sex with bisexual male - 1
Sex with person with hemophilia - -
Born in Pattern-II country - -
Sex with person born
in Pattern-II country - -
Sex with transfusion recipient
with HIV infection - -
Sex with HIV-infected person,
risk not specified 1 1
Receipt of blood transfusion,
blood components, or tissue - 1
Has HIV infection,
risk not specified - 2
Receipt of blood transfusion,
blood components, or tissue 2 (50) 9 (41)
Risk not identified - -
Total 4 (100) 22 (100)
American Indian/
Alaska Native
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Hemophilia/coagulation disorder - 1 ( 7)
Mother with/at risk for HIV
infection: 2 (100) 13 (93)
Injecting drug use 1 6
Sex with injecting drug user 1 2
Sex with bisexual male - -
Sex with person with hemophilia - -
Born in Pattern-II country - -
Sex with person born
in Pattern-II country - -
Sex with transfusion recipient
with HIV infection - -
Sex with HIV-infected person,
risk not specified - 2
Receipt of blood transfusion,
blood components, or tissue - -
Has HIV infection,
risk not specified - 3
Receipt of blood transfusion,
blood components, or tissue - -
Risk not identified - -
Total 2 (100) 14 (100)
Cumulative
totals(3)
Oct. 1992- Cumulative
Sept. 1993 total
Exposure category No. (%) No. (%)
Hemophilia/coagulation disorder 18 ( 2) 202 ( 4)
Mother with/at risk for HIV
infection: 814 (94) 4,328 (88)
Injecting drug use 264 1,920
Sex with injecting drug user 133 846
Sex with bisexual male 9 88
Sex with person with hemophilia 3 21
Born in Pattern-II country 37 305
Sex with person born
in Pattern-II country 5 23
Sex with transfusion recipient
with HIV infection 3 19
Sex with HIV-infected person,
risk not specified 96 275
Receipt of blood transfusion,
blood components, or tissue 23 98
Has HIV infection,
risk not specified 241 733
Receipt of blood transfusion,
blood components, or tissue 24 ( 3) 327 ( 7)
Risk not identified 13 ( 1) 49 ( 1)
Total 869 (100) 4,906 (100)
1 See technical notes.
2 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown. This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
3 Includes 13 children whose race/ethnicity is unknown.
Table 7. AIDS cases in adolescents and adults under age 25, by sex
and exposure category, reported October 1991 through September
1992, October 1992 through September 1993,(1) and cumulative totals
through September 1993, United States
13-19 years old
Oct. 1991- Oct. 1992- Cumulative
Sept. 1992 Sept. 1993 total
Male
exposure category No. (%) No. (%) No. (%)
Men who have sex with men 36 (35) 91 (28) 319 (33)
Injecting drug use 4 ( 4) 14 ( 4) 62 ( 6)
Men who have sex with men
and inject drugs 5 ( 5) 8 ( 2) 45 ( 5)
Hemophilia/coagulation disorder 47 (46) 172 (52) 440 (45)
Heterosexual contact: 3 ( 3) 13 ( 4) 29 ( 3)
Sex with injecting drug user 1 6 11
Sex with person with
hemophilia - 1 1
Born in Pattern-II(2)
country - 1 8
Sex with person born
in Pattern-II country - - 1
Sex with transfusion recipient
with HIV infection - - -
Sex with HIV-infected person,
risk not specified 2 5 8
Receipt of blood transfusion,
blood components, or tissue 5 ( 5) 12 ( 4) 42 ( 4)
Risk not identified(3) 2 ( 2) 19 ( 6) 40 ( 4)
Male subtotal 102 (100) 329 (100) 977 (100)
Female
exposure category
Injecting drug use 12 (20) 14 ( 8) 86 (20)
Hemophilia/coagulation
disorder 1 ( 2) 1 ( 1) 5
( 1)
Heterosexual contact: 34 (58) 105 (62) 236 (54)
Sex with injecting drug user 20 37 127
Sex with bisexual male 1 7 11
Sex with person with
hemophilia 2 1 6
Born in Pattern-II country 1 4 11
Sex with person born
in Pattern-II country - 1 2
Sex with transfusion recipient
with HIV infection - 2 3
Sex with HIV-infected person,
risk not specified 10 53 76
Receipt of blood transfusion,
blood components, or tissue 1 ( 2) 14 ( 8) 41( 9)
Risk not identified 11 (19) 36 (21) 67(15)
Female subtotal 59 (100) 170 (100) 435 (100)
Total 161 499 1,412
20-24 years old
Oct. 1991- Oct. 1992- Cumulative
Sept. 1992 Sept. 1993 total
Male
exposure category No. (%) No. (%) No. (%)
Men who have sex with men 694 (63) 1,489 (60) 6,485 (64)
Injecting drug use 146 (13) 282 (11) 1,245 (12)
Men who have sex with men
and inject drugs 110 (10) 204 ( 8) 1,063 (11)
Hemophilia/coagulation
disorder 42 ( 4) 154 ( 6) 385 ( 4)
Heterosexual contact: 55 ( 5) 118 ( 5) 363 ( 4)
Sex with injecting
drug user 24 40 135
Sex with person with
hemophilia - - 1
Born in Pattern-II(2)
country 8 17 98
Sex with person born
in Pattern-II country - 2 2
Sex with transfusion recipient
with HIV infection 1 4 9
Sex with HIV-infected person,
risk not specified 22 55 118
Receipt of blood transfusion,
blood components, or tissue 6 ( 1) 22 ( 1) 85 ( 1)
Risk not identified(3) 53 ( 5) 220 ( 9) 445 ( 4)
Male subtotal 1,106 (100) 2,489 (100) 10,071 (100)
Female
exposure category
Injecting drug use 123 (32) 283 (30) 931 (35)
Hemophilia/coagulation
disorder 1 ( 0) 4 ( 0) 9 ( 0)
Heterosexual contact: 206 (54) 483 (51) 1,329 (50)
Sex with injecting drug
user 118 233 754
Sex with bisexual male 14 32 108
Sex with person with
hemophilia 2 7 27
Born in Pattern-II country 5 11 64
Sex with person born
in Pattern-II country - 1 12
Sex with transfusion recipient
with HIV infection - 2 7
Sex with HIV-infected person,
risk not specified 67 197 357
Receipt of blood transfusion,
blood components, or tissue,12 ( 3) 19 ( 2) 81 (3)
Risk not identified 40 (10) 167 (17) 291 (11)
Female subtotal 382 (100) 956 (100) 2,641 (100)
Total 1,488 3,445 12,712
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 See technical notes.
3 "Risk not identified" refers to persons whose mode of exposure
to HIV is unknown. This includes persons under investigation;
persons who died, were lost to follow-up, or declined interview;
and persons whose mode of exposure to HIV remains unidentified
after investigation.
Table 8. AIDS cases by sex, age at diagnosis, and race/ethnicity,
reported through September 1993,(1) United States
White, not Black, not
Hispanic Hispanic Hispanic
Male
Age at diagnosis (years) No. (%) No. (%) No. (%)
Under 5 329 ( 0) 1,167 ( 1) 478 ( 1)
5-12 248 ( 0) 183 ( 0) 155 ( 0)
13-19 473 ( 0) 299 ( 0) 186 ( 0)
20-24 4,735 ( 3) 3,282 ( 4) 1,938 ( 4)
25-29 23,298 (14) 12,067 (14) 7,742 (16)
30-34 37,653 (23) 19,017 (23) 11,723 (24)
35-39 35,879 (22) 19,483 (23) 10,671 (22)
40-44 25,717 (16) 13,213 (16) 7,088 (15)
45-49 15,223 ( 9) 6,869 ( 8) 3,793 ( 8)
50-54 8,173 ( 5) 3,800 ( 5) 2,012 ( 4)
55-59 4,671 ( 3) 2,121 ( 3) 1,174 ( 2)
60-64 2,775 ( 2) 1,155 ( 1) 587 ( 1)
65 or older 2,328 ( 1) 869 ( 1) 437 ( 1)
Male subtotal 161,502 (100) 83,525 (100) 47,984 (100)
Female
Age at diagnosis (years)
Under 5 320 ( 3) 1,143 ( 5) 455 ( 5)
5-12 81 ( 1) 189 ( 1) 106 ( 1)
13-19 102 ( 1) 262 ( 1) 68 ( 1)
20-24 672 ( 6) 1,347 ( 6) 594 ( 7)
25-29 1,875 (18) 3,801 (16) 1,699 (19)
30-34 2,455 (23) 5,618 (24) 2,126 (24)
35-39 1,918 (18) 5,094 (22) 1,707 (19)
40-44 1,093 (10) 2,826 (12) 988 (11)
45-49 594 ( 6) 1,187 ( 5) 472 ( 5)
50-54 359 ( 3) 706 ( 3) 273 ( 3)
55-59 344 ( 3) 381 ( 2) 168 ( 2)
60-64 249 ( 2) 248 ( 1) 87 ( 1)
65 or older 632 ( 6) 258 ( 1) 91 ( 1)
Female subtotal 10,694 (100) 23,060 (100) 8,834 (100)
Total (2) 172,196 106,585 56,818
Asian/Pacific American Indian/
Islander Alaska Native Total(2)
Male
Age at diagnosis (years) No. (%) No. (%) No. (%)
Under5 8 ( 0) 8 ( 1) 1,992 (1)
5-12 7 ( 0) 1 ( 0) 594 (0)
13-19 11 ( 1) 11 ( 2) 980 (0)
20-24 75 ( 4) 23 ( 4) 10,071 (3)
25-29 267 (13) 123 (20) 43,576 (15)
30-34 420 (21) 173 (28) 69,100 (23)
35-39 443 (22) 126 (20) 66,742 (23)
40-44 346 (17) 85 (14) 46,548 (16)
45-49 218 (11) 34 ( 5) 26,191 ( 9)
50-54 108 ( 5) 17 ( 3) 14,140 ( 5)
55-59 62 ( 3) 9 ( 1) 8,066 ( 3)
60-64 20 ( 1) 10 ( 2) 4,551 ( 2)
65 or older 37 ( 2) 3 ( 0) 3,680 ( 1)
Male subtotal 2,022 (100) 623 (100) 296,231(100)
Female
Age at diagnosis (years)
Under 5 1 ( 0) 5 ( 5) 1,933 (4)
5-12 6 ( 3) - 384 (1)
13-19 1 ( 0) 1 ( 1) 435 (1)
20-24 12 ( 5) 10 ( 9) 2,641 (6)
25-29 23 (10) 23 (21) 7,430 (17)
30-34 48 (20) 34 (31) 10,300 (24)
35-39 38 (16) 14 (13) 8,792 (20)
40-44 37 (16) 9 ( 8) 4,961 (12)
45-49 21 ( 9) 5 ( 5) 2,286 (5)
50-54 14 ( 6) 2 ( 2) 1,356 (3)
55-59 8 ( 3) 1 ( 1) 903 ( 2)
60-64 12 ( 5) 3 ( 3) 599 ( 1)
65 or older 16 ( 7) 1 ( 1) 999 ( 2)
Female subtotal 237 (100) 108 (100) 43,019(100)
Total (2) 2,259 731 339,250
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 Includes 575 males and 86 females whose race/ethnicity is
unknown.
Table 9. AIDS cases, case-fatality rates,(1) and deaths, by
half-year and age group, through September 1993,(2) United States
Adults/adolescents
Cases diagnosed Case-fatality Deaths occurring
Half-year during interval rate during interval
Before 1981 92 81.5 30
1981 Jan. - June 98 89.8 37
July - Dec. 208 91.3 87
1982 Jan. - June 407 92.6 155
July - Dec. 707 91.1 290
1983 Jan. - June 1,312 93.2 526
July - Dec. 1,654 93.2 939
1984 Jan. - June 2,581 92.8 1,406
July - Dec. 3,408 92.8 1,981
1985 Jan. - June 4,970 92.0 2,825
July - Dec. 6,379 91.6 3,904
1986 Jan. - June 8,413 90.4 5,109
July - Dec. 10,026 88.3 6,568
1987 Jan. - June 13,115 88.6 7,613
July - Dec. 14,574 85.7 8,013
1988 Jan. - June 16,836 83.4 9,397
July - Dec. 17,425 83.1 10,764
1989 Jan. - June 20,096 78.7 12,379
July - Dec. 20,434 76.5 14,231
1990 Jan. - June 22,629 70.8 14,404
July - Dec. 22,128 66.3 15,265
1991 Jan. - June 25,769 58.7 15,902
July - Dec. 27,410 49.4 17,497
1992 Jan. - June 30,925 36.1 17,431
July - Dec. 31,177 23.4 17,555
1993 Jan. - June 27,847 11.4 14,787
July - Sept. 3,724 5.5 2,410
Total (3) 334,344 60.3 201,775
Children < 13 years old
Cases diagnosed Case-fatality Deaths occurring
Half-year during interval rate during interval
Before 1981 6 66.7 1
1981 Jan. - June 11 81.8 2
July - Dec. 5 100.0 6
1982 Jan. - June 13 84.6 9
July - Dec. 16 81.3 5
1983 Jan. - June 32 100.0 13
July - Dec. 42 90.5 16
1984 Jan. - June 51 84.3 26
July - Dec. 62 87.1 22
1985 Jan. - June 99 76.8 45
July - Dec. 128 82.8 69
1986 Jan. - June 138 81.9 65
July - Dec. 189 70.9 91
1987 Jan. - June 218 72.0 117
July - Dec. 257 67.7 168
1988 Jan. - June 258 64.7 134
July - Dec. 338 61.2 174
1989 Jan. - June 352 60.2 171
July - Dec. 333 57.4 184
1990 Jan. - June 357 52.9 191
July - Dec. 377 43.0 190
1991 Jan. - June 357 42.3 163
July - Dec. 325 35.7 199
1992 Jan. - June 384 32.3 168
July - Dec. 318 27.0 197
1993 Jan. - June 213 18.3 161
July - Sep. 27 7.4 26
Total (3) 4,906 53.3 2,615
1 Case-fatality rates are calculated for each half-year by date of
diagnosis. Each 6-month case-fatality rate is the number of
deaths ever reported among cases diagnosed in that period
(regardless of the year of death), divided by the number of total
cases diagnosed in that period, multiplied by 100. For example,
during the interval January through June 1982, AIDS was diagnosed
in 407 adults/adolescents. Through September 1993, 377 of these
407 were reported as dead. Therefore, the case fatality rate is
92.6 (377 divided by 407, multiplied by 100).
The case-fatality rates shown here may be underestimates because
of incomplete reporting of deaths. Reported deaths are not
necessarily caused by HIV-related disease.
2 Includes 9 months of data collected under the 1993 AIDS
surveillance case defintions for adults and adolescents.
3 Death totals include 270 adults/adolescents and 2 children known
to have died, but whose dates of death are unknown.
Table 10. AIDS cases by year of diagnosis and definition category,
diagnosed through September 1993,(1) United States
Period of diagnosis
Before Oct. 1989- Oct. 1990-
Sept. 1989 Sept. 1990 Sept. 1991
Definition category No. (%) No. (%) No. (%)
Pre-1987 definition 106,479 (79) 28,634 (64) 29,523 (58)
1987 definition 26,788 (20) 13,559 (30) 16,078 (31)
1993 definition(2) 1,610 ( 1) 2,402 ( 5) 5,467 (11)
Severe HIV-related
immunosuppression(3) 1,181 2,021 4,669
Pulmonary tuberculosis 362 333 706
Recurrent pneumonia 55 44 85
Invasive cervical cancer 16 8 13
Total 134,877 (100) 44,595 (100) 51,068 (100)
Period of diagnosis
Oct. 1991- Oct. 1992- Cumulative
Sept. 1992 Sept. 1993 total
Definition category No. (%) No. (%) No. (%)
Pre-1987 definition 28,340 (47) 13,876 (29) 206,852 (61)
1987 definition 17,521 (29) 9,537 (20) 83,483 (25)
1993 definition(2) 15,032 (25) 24,404 (51) 48,915 (14)
Severe HIV-related
immunosuppression(3) 13,587 22,718 44,176
Pulmonary tuberculosis 1,195 1,115 3,711
Recurrent pneumonia 223 541 948
Invasive cervical cancer 38 48 123
Total 60,893 (100) 47,817 (100) 339,250 (100)
1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 Persons who meet only the 1993 AIDS case definition and whose
date of diagnosis is before January 1993 were diagnosed
retrospectively. The sum of diagnoses listed for the four
conditions under the 1993 definition do not equal the 1993
definition total because some persons have more than one diagnosis
from the added conditions of pulmonary tuberculosis, recurrent
pneumonia, and invasive cervical cancer.
3 Defined as CD4+ T-lymphocyte count of less than 200 cells/uL or
a CD4+ percentage less than 14 in persons with laboratory
confirmation of HIV infection.
Table 11. Health-care workers with documented and possible
occupationally acquired AIDS/HIV infection, by occupation, reported
through September 1993, United States(1)
Documented Possible
occupational occupational
transmission(2) transmission(3)
occupation No. No.
Dental worker, including dentist - 6
Embalmer/morgue technician - 3
Emergency medical technician
/paramedic - 8
Health aide/attendant 1 9
Housekeeper/maintenace worker 1 6
Laboratory technician, clinical 15 14
Laboratory technician,nonclinical 1 1
Nurse 13 15
Physician, nonsurgical 5 8
Physician, surgical - 2
Respiratory therapist 1 2
Technician, dialysis 1 1
Technician, surgical 1 1
Technician/therapist,
other than those listed above - 3
Other health-care occupations - 2
Total 39 81
1 Health-care workers are defined as those persons, including
students and trainees, who have worked in a health-care, clinical,
or HIV laboratory setting at any time since 1978. See MMWR
1992;41:823-5.
2 Health-care workers who had documented HIV seroconversion after
occupational exposure: 34 had percutaneous exposure, 4 had
mucocutaneous exposure, 1 had both percutaneous and mucocutaneous
exposures. Thirty-six exposures were to blood from an HIV-infected
person, 1 to visibly bloody fluid, 1 to an unspecified fluid, and
1 to a concentrated virus in a laboratory. Eleven of these
health-care workers have developed AIDS.
3 These health-care workers have been investigated and are without
identifiable behavioral or transfusion risks; each reported
percutaneous or mucocutaneous occupational exposures to blood or
body fluids, or lab oratory solutions containing HIV, but HIV
seroconversion specifically resulting from an occupational exposure
was not documented.
Table 12. Adult/adolescent AIDS cases by single and multiple
exposure categories, reported through September 1993, United States
AIDS cases
Exposure category No. (%)
Single mode of exposure
Men who have sex with men 176,793 (53)
Injecting drug use 68,029 (20)
Hemophilia/coagulation disorder 2,212 ( 1)
Heterosexual contact 23,536 ( 7)
Receipt of transfusion(1) 5,978 ( 2)
Receipt of transplant of tissues/organs(2) 6 ( 0)
Other(3) 16 ( 0)
Single mode of exposure subtotal 276,567 (83)
Multiple modes of exposure
Men who have sex with men;injecting drug use 18,885 ( 6)
Men who have sex with men;
hemophilia/coagulation disorder 82 ( 0)
Men who have sex with men;heterosexual contact 3,718 ( 1)
Men who have sex with men;receipt of
transfusion/transplant 2,554 ( 1)
Injecting drug use;hemophilia/
coagulation disorder 88 ( 0)
Injecting drug use;heterosexual contact 11,003 ( 3)
Injecting drug use;receipt of
transfusion/transplant 1,114 ( 0)
Hemophilia/coagulation disorder;
heterosexual contact 29 ( 0)
Hemophilia/coagulation disorder;
receipt of transfusion/transplant 704 ( 0)
Heterosexual contact;receipt of
transfusion/transplant 822 ( 0)
Men who have sex with men;
injecting drug use;hemophilia/
coagulation disorder 20 ( 0)
Men who have sex with men;injecting drug use;
heterosexual contact 1,764 ( 1)
Men who have sex with men;injecting drug use;
receipt of transfusion/transplant 392 ( 0)
Men who have sex with men;hemophilia/coagulation
disorder;heterosexual contact 4 ( 0)
Men who have sex with men;hemophilia/coagulation
disorder;receipt of transfusion/transplant 27 ( 0)
Men who have sex with men;heterosexual contact;
receipt of transfusion/transplant 163 ( 0)
Injecting drug use;hemophilia/coagulation
disorder;heterosexual contact 20 ( 0)
Injecting drug use;hemophilia/coagulation
disorder;receipt of transfusion/transplant 28 ( 0)
Injecting drug use;heterosexual contact;
receipt of transfusion/transplant 421 ( 0)
Hemophilia/coagulation disorder;heterosexual
contact;receipt of transfusion/transplant 18 ( 0)
Men who have sex with men;injecting drug use;
hemophilia/coagulation disorder;heterosexual contact 4 ( 0)
Men who have sex with men;injecting drug use;
hemophilia/coagulation disorder;
receipt of transfusion/transplant 5 ( 0)
Men who have sex with men;
injecting drug use;heterosexual contact; receipt of
transfusion/transplant 71 ( 0)
Men who have sex with men;
hemophilia/coagulation disorder;heterosexual contact;
receipt of transfusion/transplant 3 ( 0)
Injecting drug use;hemophilia/
coagulation disorder;heterosexual contact;
receipt of transfusion/transplant 10 ( 0)
Men who have sex with men;injecting drug use;
hemophilia/coagulation disorder;heterosexual contact;
receipt of transfusion/transplant 1 ( 0)
Multiple modes of exposure subtotal 41,950 (13)
Risk not identified(4) 15,823 ( 5)
Total 334,344 (100)
1 Includes 27 adult/adolescents and 2 children who developed AIDS
after receiving blood screened negative for HIV antibody.
2 Six adults developed AIDS after receiving tissue from
HIV-infected donors. Three of the 6 received tissue or organs from
a donor who was negative for HIV antibody at the time of donation.
See N Engl J Med 1992;326:726-32.
3 "Other" refers to 11 health-care workers who developed AIDS after
occupational exposure to HIV-infected blood as documented by
evidence of seroconversion; to 4 patients who developed AIDS after
exposure to HIV within the health-care setting, as documented by
laboratory studies; to 1 person who acquired HIV infection
perinatally and was diagnosed with AIDS after age 13; and to 1
person with intentional self-inoculation of blood from an HIV-infected person.
4 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown. This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
TECHNICAL NOTES: HIV/AIDS SURVEILLANCE REPORT
Surveillance and Reporting of AIDS
All 50 states, the District of Columbia, U.S dependencies and possessions,
and independent nations in free association with the U.S. (1) report AIDS
cases to CDC using a uniform case definition and case report form. The
original definition was modified in 1985 (MMWR 1985;34:373-5) and
again in 1987 (MMWR 1987;36 [suppl. no. 1S]:1S-15S). The revisions
incorporated a broader range of AIDS indicator diseases and conditions and
used human immunodeficiency virus (HIV) diagnostic tests to improve the
sensitivity and specificity of the definition. For persons with laboratory-
confirmed HIV infection, the 1987 revision incorporated HIV
encephalopathy, wasting syndrome, and other indicator diseases that are
diagnosed presumptively (i.e., without confirmatory laboratory evidence of
the opportunistic disease). AIDS cases that meet the criteria of both the pre-
1987 and 1987 definitions are classified in the pre-1987 definition category.
Compared with patients who meet the pre-1987 case definition, a higher
proportion of patients who meet only the 1987 case definition were female,
black, or Hispanic, or were intravenous drug users (MMWR 1989;38:229-
36).
Each issue of this update includes information received and tabulated by
CDC through the last day of the previous month. Data are tabulated by date
of report to CDC unless otherwise noted. Data for U.S. dependencies and
possessions and for associated independent nations are included in the totals.
Age group tabulations are based on the person's age at diagnosis of AIDS:
adult/adolescent cases include persons 13 years of age and older; pediatric
cases include children under 13 years of age. Age group tabulations in
Table 13 (only included in the year-end edition) are based on age at death.
Metropolitan areas are defined as the Metropolitan Statistical Areas (MSA)
for all areas except the 6 New England states. For these states, the New
England County Metropolitan Areas (NECMA) are used. Metropolitan areas
are named for a central city in the MSA or NECMA, may include several
cities and counties, and may cross state boundaries. For example, AIDS
cases and annual rates presented for the District of Columbia in Table 1
include only persons residing within the geographic boundaries of the
District. AIDS cases and annual rates for Washington, D.C., in Table 2
include persons residing within several counties in the metropolitan area.
State or metropolitan data tabulations are based on the person's residence at
diagnosis of the first AIDS-indicator disease(s). The cities and counties
which comprise each metropolitan area in Table 2 are listed in the Bureau of
Census publication, "State and Metropolitan Area Data Book, 1986."
Data in this report are provisional. Fifty percent of patients are reported to
CDC within 3 months of diagnosis. However, reporting delays vary widely
and have been as long as several years for some cases. The median delay in
reporting appears to have increased, from about 2 months in 1982 to about 3
months in 1988; however, recent analyses suggests that reporting delay may
be decreasing.
Completeness of reporting of diagnosed cases to state and local health
departments varies by geographic region and patient population; however,
mortality studies suggest that 70 to 90 percent of HIV-related deaths in men
25-44 years old are identified through national surveillance of AIDS
(MMWR 1989;38:561-3). In addition, multiple routes of exposure,
opportunistic diseases diagnosed after the initial case report was submitted
to CDC, and vital status may not be determined or reported for all cases.
Caution should be used in interpreting case-fatality rates because reporting
of deaths is known to be incomplete.
Exposure Categories
For surveillance purposes, AIDS cases are counted only once in a hierarchy
of exposure categories. Persons with more than one reported mode of
exposure to HIV are classified in the exposure category listed first in the
hierarchy, except for persons with a history of both homosexual/bisexual
contact and intravenous drug use. They make up a separate exposure
category.
"Homosexual/bisexual contact" cases include men who report sexual contact
with other men. "Heterosexual contact" cases include persons who report
either specific heterosexual contact with a person with, or at increased risk
for, HIV infection (e.g., an intravenous drug user), or persons presumed to
have acquired HIV infection through heterosexual contact because they were
born in countries with a distinctive pattern of transmission termed "Pattern
II" by the World Health Organization (MMWR 1988;37:286-8, 293-5).
Pattern II transmission is observed in areas of sub-Saharan Africa and in
some Caribbean countries. In these countries, most of the reported cases
occur in heterosexuals and the male-to-female ratio is approximately 1:1.
Intravenous drug use and homosexual transmission either do not occur or
occur at a low level.
"Undetermined" cases are persons with no reported history of exposure to
HIV through any of the routes listed in the hierarchy of exposure categories.
Undetermined cases include persons who are currently under investigation
by local health department officials; persons whose exposure history is
incomplete because of death, refusal to be interviewed, or loss to follow-up;
and persons who were interviewed or for whom follow-up information was
available and no exposure mode was identified. Persons who have an
exposure mode identified at the time of follow-up are reclassified into the
appropriate exposure category.
Rates
Rates are on an annual basis per 100,000 population. The denominator for
computing rates in Table 1 and Table 2 are extrapolations based on U.S.
Bureau of Census data from the 1980 census and from 1988 post-census
estimates. Each 12-month rate is the number of cases for a 12 month period
divided by the 1989 or 1990 extrapolation, multiplied by 100,000.
The denominators for computing race-specific rates (Table 9, included only
in the year-end edition) are based on 1990 census projections published in
U.S. Bureau of Census publications, "Projections of the Population of the
United States, by Age, Sex, and Race, 1988 to 2080," and "Projections of
the Hispanic Population, 1983 to 2080." Race-specific rates are the number
of cases reported for a particular race/ethnicity during the preceding 12-
month period divided by the 1990 census projection for that race/ethnicity,
multiplied by 100,000.
Case-fatality rates are on a semiannual basis by date of diagnosis. Each 6-
month case-fatality rate is the number of fatal cases reported, divided by the
number of total cases, diagnosed in that period, multiplied by 100.
Trends in AIDS Incidence
Tabulations of AIDS cases by date of report give a general description of
AIDS cases, but analyses by date of diagnosis give a more accurate
description of trends. Delays in reporting, however, can have a substantial
impact on tabulated numbers of cases diagnosed in recent time periods.
About half of all cases are reported within 3 months of diagnosis, but about
15% are reported more than 1 year after diagnosis. Delays are substantially
longer for pediatric cases and for transfusion-associated cases in adults.
Figure 5 (included only in the year-end edition report) shows trends in AIDS
incidence by month of diagnosis. The points on the plot show the estimated
numbers of cases diagnosed, after adjusting for estimated reporting delays.
The smooth curve is computed using the Lowess procedure (J.M. Chaber,
W.S. Cleveland, B. Kleiner, and P.A. Tukey. "Graphical Methods for Data
Analysis." Duxbury Press, Boston, 1983, Chapter 4).
Reporting delays were estimated by a maximum likelihood statistical
procedure for each HIV exposure category (J.M. Karon, O.J. Devine, and
W.M. Morgan "Predicting AIDS incidence by extrapolating from recent
trends." In: C. Castillo-Chavex, ed. "Mathematical and Statistical
Approaches to AIDS Epidemiology. Lecture Notes in Biomathematics," vol.
83, Springer Verlag, Berlin, 1989). The adjusted incidence used in Figure 5
is the sum of the adjusted incidences for each HIV exposure group.
The Lowess procedure makes no assumption about the overall trends in the
data. A fitted value is computed for each month by weighted least squares
regression using only the adjusted number of cases diagnosed during an
interval about the month (in Figure 5, the 30% of months closest to the
chosen month); the weights decrease for times further from the chosen
month. The procedure assumes that incidence during the interval about each
month is approximately a linear function of time. Lowess tends to produce
a curve that is linear at each end, as observed in the figure; predictions of
future numbers of cases should not be made by extrapolating the Lowest
curve.
The Lowess curve should be considered a description of the overall trend in
AIDS cases. This curve emphasizes that the rate of increase in incidence
slowed during the middle of 1987. See MMWR 1990:39:81-86.
(1) Included among the dependencies, possessions, and independent nations
are Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the
Republic of Palau, the Republic of the Marshall Islands, the Commonwealth
of the Northern Mariana Islands, and the Federated States of Micronesia.
The latter 5 comprise the category "Pacific Islands, U.S." listed in Table 1.
------------------------------
End of HICNet Medical News Digest V06 Issue #58
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