International Notes Update: Acquired Immunodeficiency Syndrome -- Europe

As of March 31, 1985, 940 cases of acquired immunodeficiency syndrome (AIDS) have been reported to the World Health Organization (WHO) Collaborating Centre on AIDS (Table 1). One hundred seventy-eight new cases were reported by the 17 countries corresponding with the Centre since December 31, 1984 (1), an average increase of 14 cases per week.

The greatest increases in the number of cases were observed in: France--47 new cases (three to four per week); United Kingdom--32 (two to three/week); and the Federal Republic of Germany--27 (two to three/week). In four countries (Belgium, Netherlands, Spain, and Switzerland), an increase of one case/week was noted; for the other 10 countries, zero to eight new cases were reported from January through March.

AIDS cases per million population were calculated from 1983 population data (Institut National d'Etudes Demographiques, (INED), Paris). The highest rates were noted in Denmark--8.0; Switzerland--7.9; and France--5.6. These rates are low compared to the U.S. rate of 40.9 (April 1, 1985). The situation in Belgium is special, since 77% of the cases originate from Africa.

A total of 468 deaths were reported for the 940 cases (case-fatality rate: 50%). Fifty-two percent of the AIDS patients diagnosed 1 year ago and 86% of those diagnosed 3 years ago have died (Figure 2). Six hundred three patients (64%) presented with one or more opportunistic infections; 188 (20%) had Kaposi's sarcoma (KS) alone; and 143 (15%) had opportunistic infections with KS (Table 2). The category "Other" (six cases) includes three cases of progressive multifocal leukoencephalopathy (France--two; Denmark--one); two cases of isolated cerebral lymphoma (Switzerland and United Kingdom--one each), and one isolated Burkitt lymphoma of the brain (Federal Republic of Germany). The highest case-fatality rate (65%) was noted for patients with both opportunistic infection and KS. The case-fatality rate for opportunistic infection alone was 54%, and for KS alone, 24%.

Males accounted for 92% of the cases (Table 3). The male to female ratio was 11:1, compared with 15:1 for the United States. Forty-five percent of cases occurred in the 30- to 39-year age group.

Cases were geographically distributed as follows (Table 4): European*: 756 cases (80% of total). Seven hundred twenty-five patients were living in Europe before the onset of the first symptoms, and 31 (4%) were living overseas (Zaire--10; United States--nine; Haiti--two; and one each in Bermuda, Burundi, Congo, Gabon, Ghana, Nicaragua, South Africa, Togo, and Venezuela). The country of residence was not specified for one patient.

Caribbean: 32 cases (3%). Thirty patients were living in Europe before the onset of the first symptoms: 26 Haitians diagnosed in France and one in Belgium; one Dominican and one Jamaican were living in the United Kingdom; one of unspecified origin was living in Switzerland. Two other Haitians diagnosed in France were living in Haiti.

African: 124 cases (13%). These cases were diagnosed in seven European countries and originated from 18 African countries. Sixty-five percent were from Zaire, and 10%, from the Congo. Among the remaining 16 countries, the number of cases varied from one to four. Two patients were of unknown origin. Sixty-seven patients (54%) were living in Europe before the onset of the first symptoms. Fifty-five resided in Africa, and one, in the United States; the country of residence was unknown in one case.

Other origins: 28 cases (3%). Most of these patients originated from the American continent: United States--18; Canada--one; two each from Argentina and Brazil; and one each from Nicaragua, Peru, and South America (country unknown). One patient originated from Australia, and, one, from Pakistan. Twelve of these patients were not living in Europe before the onset of the first symptoms (United States--nine; Africa--one; unknown--two).

Among the 756 European AIDS patients, 627 (83%) were homosexual or bisexual. Twenty-five patients (3%) were drug abusers, and 10 (1%), both homosexual and drug abusers (Table 4); these 35 cases were diagnosed in: Federal Republic of Germany--11; Spain--10; France and Italy--five each; Austria--two; and Switzerland and United Kingdom--one each.

Twenty-seven (3%) were hemophilia patients diagnosed in: Federal Republic of Germany--11; Spain--six; United Kingdom--four; France--three; and one each in Austria, Greece, and Sweden. One German hemophilia patient was reported as being both homosexual and a drug abuser.

For 11 patients (1%), the only risk factor found was blood transfusion. These cases were diagnosed in: France--seven; Belgium--two; and Netherlands and United Kingdom--one each. Four of these 11 patients had received blood transfusions overseas: one diagnosed in the Netherlands had undergone 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.

For 51 patients (5%), no risk factor was found, and the information was not obtained in five cases.

The AIDS epidemic continues to spread in Europe. The distribution of patients by age, sex, and geographic origin is the same as in the previous reports. Homosexuals are still the major risk group, but cases among intravenous drug abusers have now been reported in seven countries.

AIDS cases related to the use of clotting factor or to blood transfusions are also increasing. Cases among hemophilia patients have been reported in seven European countries. In some of these countries, hemophilia patients account for a high percentage of the total number of AIDS cases reported at a national level: Spain--21% (six of 29 cases); Greece--14% (1/7); Austria--8% (1/13); Federal Republic of Germany--7% (11/162); Sweden--5% (1/22); United Kingdom--3% (4/140); and France--1% (3/307). Among the hemophiliac population of these countries, AIDS cases vary from one to three per thousand. All seven countries have imported blood products from the United States in the past few years.

Two countries have reported cases among recipients of blood collected through the respective national blood banks (France--seven; United Kingdom--one). This indicates that, in European countries in which an AIDS focus is developing, the use of local blood products is not sufficient to ensure the safety of transfusions. Other measures recognized by the WHO Collaborating Centre on AIDS that can be taken to improve safety are: (1) preferential use, when possible, of cryoprecipitates rather than concentrates of factor VIII; (2) use of heat-treated products; (3) selection of blood donors according to identified risk groups; and (4) screening anti-lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III)-carrier blood donors.

Finally, it is important to note that AIDS cases related to transfusion of blood or blood components are mainly the consequence of the dissemination of the AIDS virus in the general population. The transmission of LAV/HTLV-III by sexual contact is, at present, the principal route of dissemination. Health education programs (information on subjects in exposed populations, training health-care workers with respect to problems created by AIDS) are essential to set up public health strategies. These strategies must be selected by each country depending on the respective epidemiologic characteristics, sociocultural conditions and the available resources.

Editorial Note

Editorial Note: As of March 31, 1985, 17 countries were participating in the surveillance of AIDS in Europe by reporting their respective data to the Centre, which uses the CDC case definition. One source per country, recognized by the respective national health authorities, provides the information. The national data are noted on standard tables; therefore, each source is responsible for the quality of the data provided. Reported by JB Brunet, MD, R Ancelle, MD, Institut de Medecine et d'Epidemiologie Africaines et Tropicales (WHO Collaborating Centre on AIDS), Paris, France; Federal Ministry of Health and Environmental Protection, Vienna, Austria; Conseil Superieur de l'Hygiene Publique, Ministere de la Sante, Brussels, Belgium; Institute of Virology, Bratislava, Czechoslovakia; Statens Serum Institute, Copenhagen, Denmark; Institute of Biomedical Sciences, Tampere, Finland; Direction Generale de la Sante, Paris, France; Robert Koch Institute, West Berlin, Federal Republic of Germany; Ministry of Health, Athens, Greece; General Direction of Public Health, Reykjavik, Iceland; Istituto Superiore di Sanita, Rome, Italy; Staatstoezicht op de Volksgezondheid, Leidshendam, Netherlands; National Institute of Public Health, Oslo, Norway; National Institute of Hygiene, Warsaw, Poland; Ministerio de Sanidad y Consumo, Madrid, Spain; National Bacteriological Laboratory, Stockholm, Sweden; Office Federale de la Sante Publique, Berne, Switzerland; Communicable Disease Surveillance Centre, London, United Kingdom.

Reference

1. WHO. Acquired immune deficiency syndrome (AIDS). Report on the situation in Europe as of 31 December 1984. Weekly Epidemiological Record 1985;60:85-92. *The word European refers to the patients originating from one of the

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