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HICNet Medical News Digest Thu, 30 Jun 1994 Volume 07 : Issue 30 Today's Topics: Institute of Tropical Medicine Epidemology Bulletin AIDS Daily News Summary +------------------------------------------------+ ! ! ! 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) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD 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 the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA Lawrence Lee Miller, B.S. Biological Sciences, UCI Dr K C Lun, National University Hospital, Singapore W. Scott Erdley, MS, RN, SUNY@UB School of Nursing Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis TN Stephen Cristol, M.D., Dept of Ophthalmology, Emory Univ, Atlanta, GA Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Thu, 30 Jun 94 21:39:24 MST From: mednews (HICNet Medical News) To: hicnews Subject: Institute of Tropical Medicine Epidemology Bulletin Message-ID: <DgPRoc9w165w@stat.com> IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.19 Date: 05/14/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 05/14/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER 2 4 11 19 SHIGELLOSIS * * 86 66 AMEBIAN D. 30 2 1523 123 TUBERCULOSIS 12 25 257 318 HANSEN DISEASE 2 4 77 72 PERTUSSIS * * 4 * SCARLET FEVER 11 7 178 139 MENINGOCOCCAL M.(1) 3 * 30 23 MENINGOCCEMIES(1) 1 * 6 8 TETANUS * * * 1 VIRAL M. 50 173 869 1693 BACTERIAL M. 5 20 382 466 VARICELLA 2146 1733 28664 24385 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 326 349 6338 5871 MUMPS * * * * MALARIA * * 3 1 LEPTOSPIROSIS 18 18 181 343 SYPHILIS 190 205 3537 4054 GONORRHEA 338 661 7365 9430 ACUMINATA COND. 44 43 806 689 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 05/12/94 - 05/18/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ F.T.D. 6 257 PINAR DEL RIO 2/150 VILLA CLARA 3/104 GUANTANAMO 1/3 ------------------------------------------------------------ VIRAL HEP. 1 3 CIEGO DE AVILA ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 79% of 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. Lic. Andres M. Alonso ipk-b@infomed.cu IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.20 Date: 05/21/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 05/21/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER 3 4 14 23 SHIGELLOSIS 2 3 88 69 AMEBIAN D. 27 7 1550 130 TUBERCULOSIS 25 21 282 339 HANSEN DISEASE 2 2 79 74 PERTUSSIS 5 * 9 * SCARLET FEVER 14 5 192 144 MENINGOCOCCAL M.(1) 2 1 32 24 MENINGOCCEMIES(1) * * 6 8 TETANUS * * * 1 VIRAL M. 54 274 923 1967 BACTERIAL M. 12 30 394 496 VARICELLA 2041 1451 30705 25836 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 303 410 6341 5281 MUMPS * * * * MALARIA * * 3 1 LEPTOSPIROSIS 30 19 211 362 SYPHILIS 170 214 3307 4468 GONORRHEA 422 641 7787 10071 ACUMINATA COND. 55 35 861 724 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 05/19/94 - 05/25/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ F.T.D. 1 6 CAMAGUEY ------------------------------------------------------------ VIRAL HEP. 1 3 HOLGUIN ------------------------------------------------------------ A.D.D. 2 35 HOLGUIN ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 57% of 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. Lic. Andres M. Alonso ipk-b@infomed.cu ------------------------------ Date: Thu, 30 Jun 94 21:40:05 MST From: mednews (HICNet Medical News) To: hicnews Subject: AIDS Daily News Summary Message-ID: <iHPRoc10w165w@stat.com> AIDS Daily Summary The Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse makes available the following information as a public service only. Providing this information does not constitute endorsement by the CDC, the CDC Clearinghouse, or any other organization. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC Clearinghouse should be cited as the source of this information. Copyright 1994, Information, Inc., Bethesda, MD Topics in this issue: - "Preventing HIV: Have We Lost Our Way?" - "AIDSLine: Does Smoking Affect My T-Cell Count?" - "Study Sees a New Threat in Tuberculosis Infections" - "J&J Seeks Approval of HIV Self-Test Kit" - "Prenatal Testing for H.I.V. Hasn't Worked in New York State" - "Tests Postponed for 2 AIDS Vaccines" - "FDA to Consider Home Test Kit for HIV" - "AIDS Digest" - "Caesarean Section and Risk of Vertical Transmission of HIV-1" - "New In-Home AIDS Blood Test Needs Further Study" ***************************************************************************** "Preventing HIV: Have We Lost Our Way?" Lancet (05/28/94) Vol. 343, No. 8909, P. 1306 (Lifson, Alan R.) With an estimated 13 million HIV-infected people worldwide, response to the epidemic is crucial. Alan R. Lifson of the University of Minnesota's School of Public Health suggests that priorities and control efforts be reevaluated, with five guiding principles in mind. First, he says, it is time to use the term "advanced HIV disease" in place of "AIDS." This will direct attention to the fact that progression towards illness and death begins not with the development of AIDS symptoms, but when HIV infection first occurs. Second, says Lifson, the No. 1 priority must be prevention of sexually transmitted HIV through better strategies for STD treatment and ways of empowering women to have greater control over barrier methods and risk-reduction techniques. Third, adequate opportunities for drug treatment and innovative strategies to avoid exposure to contaminated needles must be available to avoid HIV among intravenous drug users, says Lifson. Fourth, he continues, prevention programs should be based on, evaluated, and revised according to studies and surveillance data. Finally, Lifson notes the need for comprehensive and aggressive leadership in the second decade of the HIV/AIDS epidemic. "AIDSLine: Does Smoking Affect My T-Cell Count?" Advocate (05/31/94) No. 657, P. 32 (Cohan, Gary R.) Conclusive evidence about the effect of cigarette smoke on HIV patients has yet to be demonstrated. On the other hand, recent HIV-related cigarette warnings may turn out to hold some truth. Royce and Winklestein of the University of California studied a group of recent seroconverters, and reported a faster drop in the T-cell counts of smokers than in those of non-smokers. In a related abstract, the researchers also observed a possible increased rate of AIDS progression independent of T-cells. And a 1993 British study by Nieman et al. found that "cigarette smoking by HIV-1 positive seropositive individuals is associated with a more rapid development of AIDS" because of pneumocystis carinii pneumonia. That study showed that smokers progressed to AIDS faster--on an average of about 8.17 months--while non-smokers progressed at a median of 14.5 months. "Study Sees a New Threat in Tuberculosis Infections" New York Times (06/16/94) P. B3 (Henneberger, Melinda) Two new studies indicate that a significant number of patients in New York City and San Francisco contracted tuberculosis not from latent infections spread a long time ago, but from more recent infections. The findings show that many of the newly infected TB patients were HIV carriers. Because the immune systems of HIV-positive patients are impaired-- and thus more susceptible to disease--researchers say they may be indicative of how TB infection could eventually affect the general population. They conclude that more people are becoming infected today--although many will not develop the disease for years, if at all--and that TB may be a more serious public health threat than previously thought. "J&J Seeks Approval of HIV Self-Test Kit" Advertising Age (05/23/94) Vol. 65, No. 22, P. 1 (Sloan, Pat and DeNitto, Emily) Johnson & Johnson hopes to become the first healthcare marketer to put an HIV self-test kit on the market. The $30 kit, called Confide, would include a lancet with which to draw blood and a smear card to send off to a national laboratory. Results, counseling, and medical referrals would be dispensed by phone. The Food and Drug Administration has denied approval to other test kits, citing concerns such as packing and mailing, false positives, and the need for in-person medical consultations. Johnson & Johnson claims that Confide will provide easy access and total anonymity. An independent survey by the company found that 80 percent of gays and lesbians would be inclined to use the test, and a recent poll from the Centers for Disease Control and Prevention found that one in four Americans would use such a test and counseling service. "Prenatal Testing for H.I.V. Hasn't Worked in New York State" New York Times (06/17/94) P. A30 (Abrams, Elaine J.) Responding to an article about a New York state bill that proposes HIV testing of newborns, Dr. Elaine J. Abrams, director of the pediatric AIDS program at Harlem Hospital, says prenatal testing for HIV has failed in New York. From 1989 to 1992, Abrams notes that intensive efforts to counsel and test pregnant women for the virus only identified about 30 percent of HIV-positive women delivering at Harlem Hospital. Under a pilot testing program, however, pediatric counselors asked to test newborns for HIV antibody. Of 93 babies identified by the state's anonymous testing program, 86 were found through the new program. Abrams says only two women refused care upon learning their own HIV status, and all of the other children are receiving care in HIV programs. She argues, then, that identification of HIV-positive newborns has been a success at Harlem Hospital. "Tests Postponed for 2 AIDS Vaccines" Philadelphia Inquirer (06/18/94) P. A2 (Collins, Huntly) The federal AIDS Research Advisory Committee, which advises the National Institute of Allergy and Infectious Diseases (NIAID) on AIDS, decided that there is not yet sufficient evidence to justify large-scale testing of two proposed AIDS vaccines. The two vaccines are in the midst of a smaller experiment, and were to be tested on several thousand uninfected people next year. But, according to government officials, four volunteers involved in the small, ongoing trials of the vaccines have contracted HIV. This occurrence, which proves that the vaccines are not 100 percent effective, and other scientific uncertainties persuaded the committee to delay large-scale trials for two or three years. The vaccines, made from a genetically engineered protein from HIV's outer coat, have been shown to be safe and capable of stimulating certain kinds of antibodies to HIV. While preliminary studies indicate that the vaccines may protect chimpanzees against HIV, it is a poor indicator for what will happen with humans, since infected chimps do not progress to AIDS. "FDA to Consider Home Test Kit for HIV" Baltimore Sun (06/21/94) P. 10A The Food and Drug Administration this week will tackle the thorny question of whether or not Americans should test themselves for HIV. Three companies have requested the agency's approval to market home HIV testing kits, which would allow users to send samples of dried blood to a laboratory and retrieve the results later by telephone. According to advocates, this would increase the number of people aware of their infections--allowing them to get treated and stop transmitting the disease unwittingly to partners. Critics, however, are concerned that people learning of their HIV-positive status by phone would commit suicide, that children would play with the tests, and that employers might use them to conduct secret, illegal testing of employees. Related Story: Washington Times (06/21) P. A4 "Sheffield Medical Technologies Acquires Rights to HIV/AIDS Vaccine Technology" Business Wire (06/21/94) The United States' Sheffield Medical Technologies Inc. has acquired an option to obtain an exclusive worldwide license from the French National Institute of Health and Medical Research (INSERM) for an HIV/AIDS vaccine being developed by a French professor. Jean-Claude Chermann's technology involves the use of an antibody against beta2 microglobulin that neutralizes HIV and inhibits an early step necessary for HIV replication. As part of the agreement, Sheffield will sponsor up to $600,000 in preclinical research over the next year at Chermann's laboratory. Chermann was one of the first scientists to isolate HIV at the Pasteur Institute in 1983. "AIDS Digest" Washington Blade (06/10/94) Vol. 25, No. 24, P. 31 (van Hertum, Aras) The Centers for Disease Control and Prevention has released updated guidelines to prevent HIV infection through organ and tissue transplants. Copies are available at the U.S. Government Printing Office. In other news, AZT-manufacturer Burroughs Wellcome has donated $225,000 to finance national distribution of the quarterly edition of "Positively Aware," a journal published by the Chicago-based Test Positive Aware Network for HIV patients. "Caesarean Section and Risk of Vertical Transmission of HIV-1" Lancet (06/11/94) Vol. 343, No. 8911, P. 1464 (Giaquinto, C.; Truscia, D.; De Rossi, A. et al.) Because a significant proportion of vertical HIV transmission seems to occur in the late stages of pregnancy or during labor, it is possible that cesarean section may protect the fetus from infection by avoiding direct contact with contaminated blood and cervical secretions. Researchers from the European Collaborative Study examined 1254 HIV-positive women and their children, examining the effects of different modes of delivery on transmission risk. They found that women who underwent cesarean sections had more advanced disease progression, which may cause the protective effect of this type of delivery to be underestimated. With this and other potential confounding factors considered, the researchers calculated that cesarean section cut in half the rate of HIV transmission. "New In-Home AIDS Blood Test Needs Further Study, Say Majority on FDA Panel" Baltimore Sun (06/23/94) P. 3A A Food and Drug Administration advisory committee was split over whether home HIV tests would work, but most panel members recognized the need for national testing to address their questions. While scientists and AIDS activists alike have agreed that the FDA should approve a saliva-based AIDS test, proposed home blood-testing kits have enjoyed only a lukewarm reception. Critics have expressed concern that children could play with the test, employers could misuse it, telephone counseling might not effectively prevent suicide, and testing dried blood samples could yield inaccurate results. Others say the kits, at about $30 each, would be too expensive for the poor and mostly minority population they are supposed to target. Still, former Surgeon General Dr. C. Everett Koop showed his support for the products, saying, "Home access testing is the single most important weapon we could employ to fight AIDS." Related Stories: Washington Post (06/23) P. B1; Washington Times (06/23) P. A5; New York Times (06/23) P. A18; Philadelphia Inquirer (06/23) P. A2. ------------------------------ End of HICNet Medical News Digest V07 Issue #30 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD