International Notes Update: Acquired Immunodeficiency Syndrome -- Europe

As of March 31, 1990, 35,376 cases of acquired immunodeficiency syndrome (AIDS) had been reported to the World Health Organization (WHO) Collaborating Centre on AIDS in Paris by 32 countries in the European Region (EURO).* This number represented an increase of 61.9% (13,519 new cases) in the total number of cases reported since March 1989 (Figure 1, Table 1) (4).

Of the 35,376 cases, 16,170 (45.7%) occurred in homosexual/bisexual men; 10,660 (30.1%) in intravenous-drug users (IVDUs); 2822 (8.0%) in persons reporting heterosexual contact with a person either infected with human immunodeficiency virus (HIV) or at risk for HIV infection; 1390 (3.9%) in transfusion recipients; 1151 (3.3%) in persons with coagulation disorders (e.g., hemophilia); 702 (2.0%) in male homosexual/bisexual IVDUs; 596 (1.7%) in children born to HIV-infected women; and 1885 (5.3%) in persons whose exposure was classified as "other/unknown."

Of the 34,177 cases in adults (persons greater than or equal to 13 years of age), 4335 (12.7%) occurred in women. Of these, 2438 (56.2%) were in IVDUs; 1142 (26.3%), in women reporting heterosexual contact with a man either infected with HIV or at risk for HIV infection; 507 (11.7%), in transfusion recipients; 18 (0.4%), in women with coagulation disorders; and 230 (5.3%), in women whose exposure was classified as "other/unknown."

Cumulative AIDS incidence rates per million population were highest in Switzerland (190.2), France (173.2), Spain (135.1), Denmark (112.4), and Italy (105.3). In comparison, the cumulative incidence rate in the United States was 515.7 per million population (5). Countries in Eastern Europe reported few cases, and rates in those countries were less than 6 per million (except in Romania, where the rate was 20 per million). In northern European countries, including Denmark, the Federal Republic of Germany, the Netherlands, Norway, Sweden, and the United Kingdom, at least 70% of reported cases occurred among homosexual/bisexual men; in 2 southern European countries,--Italy and Spain,--66% and 63% of cases, respectively, occurred among IVDUs.

Countries in EURO reported 1199 pediatric AIDS cases, including 560 (46.7%) from three countries--France, Italy, and Spain--and 428 (35.7%) from Romania. Vertical transmission (i.e., from mother to infant) was the principal mode of transmission in France (79%), Italy (89%), and Spain (70%); for these cases, 47% of mothers were IVDUs. In Romania, 241 (56.3%) pediatric cases occurred in children with histories of multiple hospitalizations and multiple injections, 169 (39.5%) in transfusion recipients, 13 (3.0%) in children born to HIV-infected mothers, and five (1.2%) in children with coagulation disorders; many of the transfusion recipients also had histories of multiple hospitalizations and multiple injections. Adapted from WHO Wkly Epidemiol Rec 1990;65:239-43 as reported by: RA Ancelle-Park, MD, JB Brunet, MD, E Couturier-Moren, MD, WHO Collaborating Centre on AIDS, Paris, France. F Popovici, R Apetrei, N Beldescu, Romanian Ministry of Health. Surveillance Br, Div of HIV/AIDS, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: In EURO, since March 1989, the countries reporting the largest relative annual percent increases in AIDS cases have been in Eastern Europe (Romania, 4680%; Poland, 338%; Union of Soviet Socialist Republics, 271%; and Bulgaria, 133%). Factors that may account for these recent relative increases may include the later introduction and recognition of HIV in these countries and/or improved AIDS surveillance and reporting. In Romania, a large outbreak of nosocomially transmitted HIV infection accounted for most AIDS cases reported in that country (6).

The outbreak in Romania represents the second report of a major nosocomial outbreak of HIV transmission (6,7). Most AIDS patients in Romania appear to have acquired HIV infection through transfusions of unscreened blood and through reuse of inadequately sterilized needles and syringes, which resulted from shortages of injection and sterilization equipment (6). This outbreak further demonstrates the serious potential for HIV transmission in medical facilities that lack sufficient medical supplies and have inadequate sterilization practices.

WHO, with technical assistance from CDC, has assisted the Romanian Ministry of Health in establishing national AIDS surveillance and HIV sentinel surveillance systems and in designing and conducting epidemiologic studies to further clarify the magnitude and patterns of HIV transmission among Romanian children. Information obtained from HIV/AIDS surveillance and from these studies is being used to help target, enhance, and evaluate AIDS prevention activities in Romania.

References

1. WHO. Acquired immunodeficiency syndrome (AIDS). Wkly Epidemiol Rec 1990;65:329-31.

2. WHO. Acquired immunodeficiency syndrome (AIDS)--WHO/CDC case definition for AIDS. Wkly Epidemiol Rec 1986;61:69-76.

3. WHO. Report on the meeting of the technical working group on HIV/AIDS in childhood. Geneva: World Health Organization, February 27-March 1, 1989.

4. WHO. Acquired immunodeficiency syndrome (AIDS) report of the epidemiologic situation in Europe as of 31 March 1989. Wkly Epidemiol Rec 1989;64:221-4.

5. CDC. HIV/AIDS surveillance report, April 1990. Atlanta: US Department of Health and Human Services, Public Health Service, 1990.

6. Beldescu N, Apetrei R, Calumfirescu A. Nosocomial transmission of HIV in Romania (Abstract). VI International Conference on AIDS. Vol I. San Francisco, June 20-24, 1990:159.

7. Pokrovsky VV, Eramova EU. Nosocomial outbreak of HIV infection in Elista--USSR (Abstract). V International Conference on AIDS. Montreal, June 4-9, 1989:63.

• As of June 30, 1990, 38,314 cases of AIDS had been reported to

WHO (1); however, these data do not include risk-factor information or the number of AIDS cases reported in France since March 1990.

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