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Current Trends World Health Organization Workshop: Conclusions and Recommendations on Acquired Immunodeficiency Syndrome

An international conference on acquired immunodeficiency syndrome (AIDS), sponsored by the U.S. Department of Health and Human Services and the World Health Organization (WHO), was held in Atlanta, Georgia, April 15-17, 1985. It was attended by over 3,000 participants from 50 countries and was followed on April 18-19 by a WHO consultation to review the information presented at the conference and to assess its international implications.

The group of WHO consultants concluded that information is now sufficient to permit health authorities to take actions that may decrease the incidence of AIDS among certain risk groups. The group submitted the following conclusions and recommendations:

  1. WHO should:

    1. Establish a network of collaborating centers with special expertise in the field. The centers should assist in training staff members and providing reference panels of sera, evaluation of diagnostic tests, and provision of advice on the production of working reagents. They should also assist in preparing educational material and organizing studies to determine the natural history of the disease and the extent of infection in different parts of the world.

    2. Coordinate global surveillance of AIDS using a compatible reporting format and the currently accepted case definition. WHO should disseminate these data and other important developments on the disease as widely and as rapidly as possible.

    3. Assist in developing an effective vaccine, and when appropriate, developing international requirements for the vaccines. WHO should take an active role in facilitating the evaluation of candidate vaccines.

    4. Encourage and assist in periodic serologic studies in countries where AIDS has yet to be recognized and should ensure the collection of comparable data and representative selections of sera, since lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) infection precedes AIDS in an individual or a community, early recognition will require serologic studies in groups with potential risk of infections.

  2. Member countries should:

    1. Inform the public that LAV/HTLV-III infection is acquired through heterosexual and homosexual intercourse, needle-sharing by intravenous drug abusers, transfusion of contaminated blood and blood products, transmission by infected mothers to their babies, and probably repeated use of needles and other unsterile instruments used for piercing skin/mucous membranes. Information should be provided about the risk of LAV/HTLV-III infection and AIDS, especially to those men and women who may be at increased risk because of multiple sexual partners. There is currently no evidence of spread of LAV/HTLV-III by casual social contact even within households. Provision of timely and accurate information on these points is recommended to allay inappropriate public concern.

    2. Ensure that health-care workers are informed about AIDS and LAV/HTLV-III infection, modes of transmission, clinical spectrum, available programs of management (including psychosocial support), and methods for prevention and control.

    3. Assess the risk that AIDS poses to each country's population and establish methods of diagnosis, surveillance, and laboratory testing, including specific tests for LAV/HTLV-III.

    4. Screen, where feasible, potential donors of blood and plasma for antibody to LAV/HTLV-III, and not use positive units for transfusion or for the manufacture of products where there is a risk of transmitting infectious agents. Potential donors should be informed about the testing in advance of the donation.

    5. Reduce the risk of transmission of LAV/HTLV-III by factor VIII and IX concentrates by treating them by heat or other proven methods of inactivation. The use of such products is recommended.

    6. Inform potential donors of organs, sperm, or other human material about AIDS, and encourage groups at increased risk of infection to exclude themselves from donating. Whenever possible, serologic testing should be performed before these materials are used. This is particularly important when donor material is collected from an unconscious or deceased patient on whom relevant information may be absent.

    7. Refer individuals with positive tests for antibody to LAV/HTLV-III for medical evaluation and counseling. Such people should be encouraged to inform their health-care attendants of their status.

    8. Develop guidelines for the total care of patients and for handling their specimens in hospital and other settings. These guidelines should be similar to those that have been effective for care of patients with hepatitis B.

      1. Develop codes of good laboratory practice to protect staff against risk of infection. Such recommendations may be based on those found in the Laboratory Biosafety Manual published by WHO (1). The level of care required for work with specimens from patients infected with LAV/HTLV-III is similar to that required with hepatitis B. The use of class II biologic safety cabinets is recommended. These cabinets are adequate for containment of other agents, such as herpes and hepatitis viruses, mycobacteria, and protozoa, that may be present in the specimens. For work involving production and purification of LAV/HTLV-III, P3 biosafety containment levels must be employed. j. Collect and store serum samples from representative

        laboratory workers at the time of employment and at regular intervals thereafter, to be able to assess the risk of laboratory acquired infection and effectiveness of biosafety guidelines. Countries should provide this information to WHO for collation and dissemination. Provision of samples and testing should be carried out with the informed consent of the subjects. k. Be aware of the importance of keeping confidential

        information about the results of serologic testing and the identity of AIDS patients. Serologic testing should be undertaken with the informed consent of the subject.

Abstracted from WHO Weekly Epidemiological Record 1985;60:129-39.

Reference

  1. WHO. Biological safety. Weekly Epidemiological Record 1983;58:289-90.



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