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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
CDC. Update: acquired immunodeficiency syndrome (AIDS)--United
States. MMWR 1983;32:688-91.
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.
CDC. Revision of the case definition of acquired
immunodeficiency
syndrome for national reporting--United States. MMWR
1985;34:373-5.
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.
Marier R. The reporting of communicable diseases. Am J
Epidemiol
1977;105: 587-90.
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.
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.
CDC. Revision of the CDC surveillance case definition for
acquired
immunodeficiency syndrome. MMWR 1987;36(1S).
Disclaimer
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