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International Notes Update: Acquired Immunodeficiency Syndrome -- Europe

As of October 15, 1984, 559 cases of acquired immunodeficiency syndrome (AIDS) had been reported to the World Health Organization (WHO) Collaborating Centre on AIDS. One hundred thirty new cases were noted in the 10 countries corresponding with the Centre at the time of the previous report (July 15, 1984), an average increase of 10 cases per week (Table 1).

The greatest increases were observed in France, with 41 new cases (three to four per week); United Kingdom--34 new cases (two to three per week); and Federal Republic of Germany--31 new cases (two to three per week). In the other seven countries, the increase was less--two to five cases between July and October. Among the five new participating countries, three (Czechoslovakia, Iceland, and Poland) said no AIDS cases had ever been reported, and two (Finland and Norway) reported four cases each.

AIDS cases per million population were calculated from 1983 population data provided by the Institut National d'Etudes D}mographiques (INED), Paris, France. The highest rate was observed in Denmark--six cases per million population; Switzerland--five per million; and France--four per million. These rates are low compared to that in the United States: 27.6 per million population as of October 1, 1984.

Of the total 559 cases, 255 (46%) deaths were reported (Table 2). The primary diseases were opportunistic infections alone for 62% (348/559) of the patients; Kaposi's sarcoma (KS) for 23% (127/559); and opportunistic infection with KS for 14% (79/559). Category "other" includes three cases of progressive multifocal leukoencephalitis (France--two; Denmark--one) and two cases of cerebral lymphoma alone (United Kingdom--one; Federal Republic of Germany--one).

The highest case-fatality rates (70%) were noted for patients with KS and opportunistic infection; the case-fatality rate for opportunistic infection alone was 49%, and for KS alone, 22%.

Ninety-four percent (525/559) of the cases were among men. The male-to-female ratio was 15.4, compared with 14.5 for the United States. Forty-nine percent of the cases occurred in the 30- to 39-year age group (Table 3).

Four groups of differing geographic origin of birth were noted (Table 4).

European: 479 cases (86% of total). Four hundred sixty-five patients lived in Europe (including European countries not yet collaborating with the Centre) before the onset of the first symptoms. Fourteen patients (3% of cases occurring among Europeans) lived outside Europe (United States--three; Zaire--two; Haiti--two; Gabon--one; Nicaragua--one; Venezuela--one; South Africa--one; Ghana--one; Congo--one; unknown--one).

Caribbean: 21 cases (4%). Nineteen patients lived in Europe (17 Haitians living in France; one Dominican and one Jamaican living in the United Kingdom). Two Haitian patients diagnosed in France lived in Haiti.

African: 45 cases (8%). These patients originated from: Zaire--19 patients; Congo--10; Gabon--three; Mali--two; Cameroon--two; Zambia--two; Madagascar--one; Cape Verde--one; Chad--one; Algeria--one; Ghana--one; Togo--one; Uganda--one. These cases were diagnosed in six reporting countries: France--33 patients; Switzerland--six; United Kingdom--two; Federal Republic of Germany--two; Greece--one; Italy--one. Seventy-three percent (33/45) of these patients resided in Europe before the onset of the first symptoms. Eleven resided in Africa, and one, in the United States.

Other origins: 14 cases (3%). Most of these originated from the American continents: United States--nine; Canada--one; Argentina--one; Nicaragua--one; Peru--one. One was from Pakistan. Of these, nine were not living in Europe before the onset of symptoms (United States--six; Argentina--one; Canada--one; Pakistan--one).

Among the Europeans, 87% (415/479) were male homosexuals or bisexuals (Table 4). Two percent (7/479) were intravenous (IV) drug abusers, and 1% (3/479) were both IV drug abusers and homosexual. These cases were diagnosed in the Federal Republic of Germany--six; Spain--three; France--one. Four percent (17/479) were hemophilia patients diagnosed in: Federal Republic of Germany--eight; Spain--four; United Kingdom--three; France--two. For 1% (3/479) of patients, all diagnosed in France, the only risk factor noted was blood transfusion. One was transfused in Haiti, and a few days later, in Martinique (French West Indies); one was transfused in Paris; and the third was a resident of Italy, who was transfused in France. For 7% (33/479), no known risk factors were noted.

Among the Caribbeans, two of 21 patients were homosexual. Nineteen did not present any known risk factors. Among the Africans, four (9%) of 45 were homosexual; 41 did not present any known risk factors. Among the 14 patients of other origins, 11 were homosexual, and two were both homosexual and IV drug abusers diagnosed in the United Kingdom and Spain. One did not present any known risk factors.

Figure 4 indicates the progression of cases and deaths by half year of diagnosis (diagnosis being the date of positive biopsy or culture confirming the disease fitting the CDC case definition) since 1981. (Before 1981, 17 cases, including nine deaths, were reported.) Fifty-two percent of the patients diagnosed 1 year ago and 72% of the patients diagnosed 2 years ago have died. Although there is no information on this point, it appears that more cases diagnosed before 1981 have been lost to follow-up.

Editorial Note

Editorial Note: The WHO Regional Bureau for Europe consists of 32 European countries. By July 15, 1984, 10 of these countries participated in the AIDS surveillance by reporting to the Centre. By October 15, 1984, an additional five countries had been accepted to collaborate: Czechoslovakia, Finland, Iceland, Norway, and Poland. AIDS is presently a notifiable disease in four of the 15 reporting countries: Denmark, Iceland, Norway, and Sweden.

One of the main features of the European situation is the number of cases occurring among persons originating from equatorial Africa. Because Belgium has not yet reported, the picture of the situation is incomplete. (The participation of this country is expected for the next report.)

Zaire has drawn special attention in recent publications. The occurrence among the African patients diagnosed in Europe of a number of cases originating from other African countries, and also of cases among Europeans having stayed in these countries, shows that Zaire may not be the only African focus of this disease. The lack of reported cases probably reflects lack of surveillance in other countries of this area. Reported by JB Brunet, MD, R Ancelle, Institut de M}decine et D'Epid}miologie Tropicales, Hopital Claude Bernard (WHO Collaborating Centre on AIDS), Paris, France; Institute of Virology, Bratislava, Czechoslovakia; Statens Serum Institute, Copenhagen, Denmark; Institute of Biomedical Sciences, Tampere, Finland; Direction G}n}ral de la Sant}, Paris, France; Ministerio de Sanidad y Consumo, Madrid, Spain; Robert Koch Institute, West Berlin, Federal Republic of Germany; Ministere de la Sante, Athens, Greece; General Direction of Public Health, Reykjavik, Iceland; Institute Superiore di Sanita, Rome, Italy; Staatstoezicht op de Volksgezondheid, Leidfehendam, Netherlands; National Institute of Public Health, Oslo, Norway; National Institute of Hygiene, Warsaw, Poland; National Bacteriological Laboratory, Stockholm, Sweden; Office Federal de la Sante Publique, Berne, Switzerland; Communicable Disease Surveillance Center, Colindale, London, United Kingdom.

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