Update: Acquired Immunodeficiency Syndrome -- Europe
As of September 30, 1985, 1,573 cases of acquired immunodeficiency syndrome (AIDS) were reported to the World Health Organization (WHO) European Collaborating Centre on AIDS by the 21 countries corresponding with the Centre (Table 1). The new cases represent an average increase of 27 cases per week. Of the 1,573 patients, 792 are reported to have died (case-fatality rate: 50%) (Table 2, Figure 1).
The greatest increases in numbers of cases were observed in: the Federal Republic of Germany--75 (five to six per week); France--74 new cases (five to six per week); the United Kingdom--49 (three to four per week); and Italy--40 (three per week). In each of four countries (Belgium, Netherlands, Spain, and Switzerland), an increase of one to two cases per week was noted. Five countries (Czechoslovakia, Hungary, Iceland, Poland, the Union of Soviet Socialist Republics) had not reported any cases.
AIDS cases per million population were calculated using 1985 population estimates (Institut National d'Etudes D}mographiques, Paris). The highest rates were noted in: Switzerland--11.8; Denmark--11.2; and France--8.5. These rates are low compared to the U.S. rate of 60.0 (1). DISTRIBUTION BY DISEASE CATEGORY AND PATIENT SEX
A total of 1,025 patients (65%) presented with one or more opportunistic infections; 309 (20%) had Kaposi's sarcoma (KS) alone; and 212 (13%) had opportunistic infections with KS. The category "Other" (27 cases) includes four cases of progressive multifocal leukoencephalopathy (France--three; Denmark--one), six cases of isolated cerebral lymphoma (the United Kingdom--two; France--three, Switzerland--one), three cases of isolated Burkitt lymphomas of the brain (Denmark--one; the Federal Republic of Germany--two); 10 cases of B-cell non-Hodgkin's lymphomas (the Federal Republic of Germany--four; the Netherlands--three); and Luxembourg, Norway, and Switzerland--one each); and four unknown (Sweden). The highest case-fatality rate (59%) was noted for patients with both KS and opportunistic infections. The case-fatality rate for opportunistic infections alone was 56%; for KS alone, 25%.
Males accounted for 92% of the cases (Table 3). The male:female ratio was 11:1. Forty-two percent of cases occurred in the 30- to 39-year age group. Thirty-six pediatric cases (children under 15 years old) have been reported in 10 European countries. Twenty-four (67%) children either had parents with AIDS or parents in a group at high risk for AIDS; for 10 pediatric patients (five with hemophilia and five with blood transfusions), transmission was linked to contaminated blood or blood products. In two of the pediatric patients, no risk factor was reported. DISTRIBUTION BY GEOGRAPHIC ORIGIN
Total cases were distributed geographically and by risk group as follows (Table 4):
Europeans* (1,330 cases (85% of total)). A total of 1,288 (97%) patients were living in Europe before onset of the first symptoms; 42 (3%) were living in non-European countries: United States--13; Zaire--12; Haiti--three; and one each in Bermuda, Brazil, Burundi, Congo, Gabon, Ghana, Malaysia, Morocco, Nicaragua, South Africa, Togo, and Venezuela; the country of residence was not specified for two patients.
Of the 1,330 European patients, 1,031 (78%) were homosexual or bisexual. Ninety (7%) patients were IV drug abusers, and 21 (2%), both homosexual and IV drug abusers. These 111 cases were diagnosed in: Italy--45; Spain--26, the Federal Republic of Germany--14; France--11; Switzerland--seven; Austria--four; the United Kingdom--three; and Sweden--one. Fifty-two (4%) of the reported patients had hemophilia and were diagnosed in: the Federal Republic of Germany--21; Spain--12; the United Kingdom--nine; France--three; Sweden--two; and one each in Austria, Denmark, Greece, Italy, and Norway. One German patient with hemophilia was reported as being homosexual and an IV drug abuser. Thirty (2%) patients, for whom the only risk factor found was blood transfusion, were diagnosed in: France--15; Belgium, the Netherlands, and the United Kingdom--four each; the Federal Republic of Germany--two; and Italy--one. Among these 30 cases, five had received blood transfusions outside Europe: one diagnosed in the Netherlands had undergone heart surgery in the United States; one diagnosed in France had received blood transfusions in Haiti and Martinique; and two diagnosed in Belgium had received transfusions in Zaire. One child diagnosed in the United Kingdom had received a blood transfusion in the United States. For 90 patients (7%), no risk factor was found (male:female ratio 2:1). Risk-factor information was not obtained for 16 patients.
Caribbeans (39 (2%)). Thirty-seven patients were living in Europe before the onset of the first symptoms: 32 Haitians were diagnosed in France; one, in Belgium; and one, in Switzerland; one Dominican and one Jamaican were living in the United Kingdom; one patient of unspecified origin was living in Switzerland. Two Haitian patients diagnosed in France were living in Haiti.
Of the Caribbean patients, four were homosexual, and no risk factors were identified for 34 (male:female ratio 3:1). Risk-factor information was not obtained in one case.
Africans (157 (10%)). These persons were diagnosed in eight European countries and originated from 22 African countries (63% from Zaire and 10% from the Congo). Among the remaining 20 countries, the number of cases varied from one to five. Eighty-six patients (55%) were living in Europe before onset of the first symptoms. Sixty-six resided in Africa, and one, in the United States. Two patients from Zaire and one each from Burundi and Rwanda were living in other parts of the world.
Of the 157 Africans, 11 were homosexuals; five had received blood transfusions; and one was both homosexual and an IV drug abuser. No risk factors were identified for 124 (male:female ratio 2:1); and for 16, information was not obtained.
Other origins (47 cases (3%)). Most of these patients originated from the American continents: the United States--23; Argentina--four; Brazil--three; and one each from Canada, Chili, Nicaragua, Peru, and Uruguay. One patient each originated from Australia, Egypt, Lebanon, New Zealand, Pakistan, Thailand, and Turkey; the origins of four were unknown. Fourteen of these patients were not living in Europe before the onset of the first symptoms (the United States--10; Canada and Africa--one each; unknown--two).
Among the 47 patients, 39 were homosexual; two were both homosexual and IV drug abusers (one Canadian diagnosed in the United Kingdom and one American diagnosed in Spain). One American diagnosed in Sweden had hemophilia. Two did not present any risk factors. Information was not obtained in three cases. DISTRIBUTION BY RISK GROUP
It is not possible to compare precisely the situations in the various European countries because of differences that may exist in the methods of data collection. Furthermore, in countries where AIDS is still rare, distribution may be modified with the increase in number of cases. However, some observations can be made:
Male homosexuals. AIDS patients belonging to this risk group accounted for 60%-100% of the total number of cases in 12 of 16 countries. In four other countries (Belgium, Greece, Italy, and Spain), male homosexuals accounted for fewer than 50% of cases.
IV drug abusers. The spread of AIDS in Europe has been particularly marked in this group. In October 1984, IV drug abusers represented only 2% of the total number of European cases and were reported by three countries. By September 30, 1985, they represented 8% of all European cases and were reported by nine countries, a significant increase (p 0.001). Italy and Spain together accounted for 63% of the IV drug abusers with AIDS in Europe. Forty-five (49%) of the 92 Italian patients and 23 (37%) of the 63 Spanish patients were members of this risk group.
Cases related to transfusion of blood and blood products. Ten countries have reported AIDS among hemophilia patients, and six have reported cases among blood transfusion recipients.
Patients not belonging to any of the above risk groups. This group contributed the second largest number of cases. In four countries (Belgium, France, Greece, and Switzerland), a high proportion of patients originated from regions where most AIDS patients have not belonged to any of the above risk groups but where heterosexual transmission is thought to be a major factor. In Belgium, 72% of the patients originated from equatorial Africa; in France, 11% originated from the same region, and 8% from Haiti; in Switzerland, 12% originated from equatorial Africa). REVIEW OF PUBLIC HEALTH MEASURES RELATED TO BLOOD DONORS
A questionnaire on public health measures related to blood transfusion was sent to the 21 European countries corresponding with the Centre and to Portugal. Except for the Union of Soviet Socialist Republics, all the countries answered this questionnaire.
Systematic screening of blood donors for lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) antibodies became effective in 16 of 21 countries between June and November 1985. In 13 countries, the screening is compulsory. In three others (Italy, the Netherlands, and Sweden),
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