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Update: Acquired Immunodeficiency Syndrome -- United States

As of August 10, 1987, physicians and health departments in the United States had reported 40,051 patients (39,493 adults and 558 children) meeting the current case definition for national reporting of the acquired immunodeficiency syndrome (AIDS) (1-3). Of these patients, 23,165 (58% of the adults and 65% of the children) are known to have died. The number of AIDS cases reported per year continues to increase in all patient groups (Table 1). AIDS cases have been reported from all 50 states, the District of Columbia, and four U.S. territories.

AIDS surveillance is conducted by health departments in each state, territory, and the District of Columbia. Most areas employ multifaceted active surveillance programs that include four major sources of AIDS information: hospitals and hospital-based physicians, physicians in nonhospital practices, public and private clinics, and medical records systems (death certificates, tumor registries, hospital discharge abstracts, and communicable disease reports). Epidemiologic and clinical AIDS patient information is reported through state and local health departments to CDC on a standard, confidential case report form. The median interval between diagnosis of an AIDS case and notification of CDC is 2 months. At present, an estimated 6,000 to 8,000 AIDS cases (15% to 20% of the total number of cases) have been diagnosed and will be reported soon to CDC.

In late 1985, a 3-month review of death certificates was conducted in four major U.S. cities to assess the completeness of AIDS case reporting (4). Data from this review suggest that 11% of AIDS cases are not reported to state and local public health departments, primarily because of breakdowns in established reporting procedures (e.g., absence of the individual responsible for reporting when the case was diagnosed). Reported by: State and Territorial Epidemiologists. AIDS Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note:

In comparison to many reportable diseases, the reporting level for AIDS has been high (5). Previous AIDS validation studies conducted in New York City and San Francisco showed that the level of reporting exceeded 95% (6,7). The major reporting sources employed in active surveillance (hospitals and hospital-based physicians, physicians in nonhospital practice, public and private clinics, and medical records systems) frequently complement each other. Thus, an AIDS patient not identified by one source may be identified by another.

As described in the MMWR supplement being released this week, CDC, in consultation with state and local public health officials and clinical specialists, has revised the case definition for national reporting of AIDS (8). With this revision, AIDS cases involving patients with presumptively diagnosed indicator diseases, which were previously not reportable because they lacked biopsy or other specific confirmation required by the former surveillance case definition, will now be reportable. Inclusion of this category will allow for national reporting of an estimated 10% to 15% of patients not previously eligible for reporting (4). Because, historically, most health departments have not required reporting of the additional manifestations of human immunodeficiency virus (HIV) infection included in the expanded case definition (HIV dementia complex, chronic wasting syndrome, etc.), the number of cases that will be added to existing case counts as a result of this revision is unknown. Since most patients with the wasting syndrome and HIV dementia develop the opportunistic diseases included in the previous AIDS case definition, addition of these conditions to the case definition may result in earlier reporting without adding substantially to the ultimate case count.

To evaluate the impact of the revised case definition on long-term trends of overall reporting, future data analyses will include separate tallies for cases meeting the previous and the revised case definitions.

Targeted epidemiologic surveys and serologic studies as well as prompt and complete reporting are essential for effectively monitoring the HIV epidemic. They are also necessary for projecting trends and health-care costs; for identifying patterns of infection; for formulating and targeting prevention strategies; and for providing timely guidelines for risk-reduction and other information to the public, the scientific and public health communities, and members of high-risk groups.

References

  1. CDC. Update: acquired immunodeficiency syndrome (AIDS)--United States. MMWR 1983;32:688-91.

  2. Selik RM, Haverkos HW, Curran JW. Acquired immune deficiency syndrome (AIDS) trends in the United States, 1978-1982. Am J Med 1984;76:493-500.

  3. CDC. Revision of the case definition of acquired immunodeficiency syndrome for national reporting--United States. MMWR 1985;34:373-5.

  4. Hardy AH, Starcher ET, Morgan WM, et al. Review of death certificates to assess completeness of AIDS case reporting. Public Health Rep 1987;102:386-91.

  5. Marier R. The reporting of communicable diseases. Am J Epidemiol 1977;105: 587-90.

  6. Rauch KJ, Rutherford GW, Badran C, Neal DP, Mayer NM, Echenberg DF. Surveillance of acquired immunodeficiency syndrome in San Francisco: evaluation of the completeness of reporting (Abstract). Paris, France: International Conference on AIDS, June 23-25, 1986.

  7. Chamberland ME, Allen JR, Monroe JM, et al. Acquired immunodeficiency syndrome in New York City: evaluation of an active surveillance system. JAMA 1985;254:383-7.

  8. CDC. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36(1S).



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