International Notes Update: Acquired Immunodeficiency Syndrome -- Europe

As of December 31, 1984, 762 cases of acquired immunodeficiency syndrome (AIDS) have been reported to the World Health Organization (WHO) Collaborating Centre on AIDS. During 1984, 417 cases were diagnosed--over half those reported since the disease was first reported and nearly twice the number reported in 1983 (235 cases). The number reported during the last quarter should be considered provisional because of the time lapse between date of diagnosis and notification to the national surveillance centers (Table 1).

For the last 6 months, the greatest increases in the number of cases were observed in France--80 cases (three per week); Federal Republic of Germany--56 cases (two/week); United Kingdom--54 cases (two/week); Netherlands--21 cases (one/week); and Switzerland--13 cases (one/2 weeks).

The 15 countries collaborating with the Centre for the last report (1) have reported 125 new cases, an increase of 11 cases per week.

Two countries, Austria and Belgium, have just joined the Centre. Austria had reported seven cases at the first European Meeting on AIDS held in Aarhus, Denmark, in October 1983 and now reports 13 cases (six additional cases); Belgium, which had reported 38 cases, now reports 65 cases (27 additional cases).

The highest rates of AIDS cases per million population (1983 populations, Institut National D'Etudes Demographics (INED), Paris) were observed in Belgium and Denmark (7/million). However, 83% of the Belgian patients (54/65) were Africans, of whom only 18 lived in Belgium before the onset of the first symptoms, in contrast with Denmark, where no African or Caribbean patients have been registered. The rate in Switzerland was six per million; France--five per million; Netherlands--three per million; Federal Republic of Germany and United Kingdom--two per million.

Among the 762 AIDS patients, 376 deaths were reported, for a case-fatality rate of 49% (Table 2). Sixty-one percent of the patients diagnosed 1 year ago and 83% diagnosed 3 years ago have died. Sixty-four percent (484/762) of the patients presented with one or more opportunistic infections; 20% (151/762) had Kaposi's sarcoma (KS) alone; 16% (121/762) opportunistic infection with KS. The category "Other" includes three cases of progressive multifocal leukoencephalitis (France--two; Denmark--one) and three cases of cerebral lymphoma alone (one each in Federal Republic of Germany, Switzerland, and the United Kingdom). The case-fatality rate was 67% in the category "Other"; 60% for opportunistic infection with KS; 55% for opportunistic infection alone; and 24% for KS alone (Table 2).

Ninety-two percent of the patients were men (Table 3). The sex ratio was 11.7, compared with 15.3 at the last report and can be explained by 20 new cases among women diagnosed in Belgium. Forty-six percent of the patients belonged to the 30- to 39-year age group. The 0- to 1-year age group comprised: one boy from Burundi and one from Zaire diagnosed in Belgium; one French girl with a Zairian father, one Haitian boy, and one Zairian boy diagnosed in France. Two children with hemophilia in the 10- to 14-year age group were diagnosed in France. The 15- to 19-year age group comprised: two hemophilia patients (one each in Austria and Spain); one homosexual (France); and one unspecified case (Federal Republic of Germany).

Cases were geographically distributed as follows (Table 4): European*: 605 cases (79% of total). Five hundred seventy-eight patients lived in Europe before the onset of the first symptoms of AIDS, and 27 (4%) of the 605 patients lived outside Europe (United States--six; Zaire--four; Haiti--three; and one each in Togo, Gabon, Nicaragua, Venezuela, Ghana, South Africa, Burundi, and Bermuda). For six patients, the country of residence was not specified.

Caribbean: 24 cases (3%). Twenty-two patients lived in Europe before the onset of the first symptoms: 18 Haitians diagnosed in France and one in Belgium; one Dominican and one Jamaican lived in the United Kingdom; one of unspecified origin lived in Switzerland. Two other Haitian patients diagnosed in France lived in Haiti.

African: 111 cases (15%). In the previous report, 8% of the patients were Africans; the increase is due to the participation of Belgium. These cases were diagnosed in seven European countries and originated from 18 African countries. Sixty-seven percent were from Zaire, and 11%, from the Congo. Among the 16 other countries, the number of cases diagnosed in Europe varied from one to three. This distribution cannot be considered representative of the AIDS situation in Africa. The majority (52%) of these patients lived in Europe before the onset of the first symptoms.

Other origins: 22 cases (3%). Most of these patients originated from the American continent: United States--16; and one each in Nicaragua, Argentina, Peru, and Canada. One patient originated from Pakistan, and one, from Australia. Thirteen of these patients did not live in Europe before the onset of the first symptoms.

Among the Europeans: 85% (514/605) were homosexual or bisexual (Table 4); 2% (11/605) were drug abusers; and 1% (9/605), both homosexual and drug abusers. The latter 20 cases were diagnosed in the Federal Republic of Germany--nine; Spain--three; France--three; Austria--two; Italy--two; Switzerland--one.

Three percent (20/605) were hemophilia patients. For four of the 605 European patients, the only risk factor found was blood transfusion. For 7% (44/605), no risk factor was found. The information was not obtained for three patients.

Among the Caribbean patients, two of 24 were homosexual; 21 presented no risk factors; for one, the information was not obtained.

The overall presentation of the progress of the AIDS situation in Europe does not take into account the important differences between the countries. Furthermore, the total increase in the number of cases in each country is only of informative value if it is related to the total population of the country. Figure 1 shows the variation in the rates per million population per half year for each country where cases have been diagnosed. This figure is difficult to interpret given the qualitative differences in the national surveillance systems. Nevertheless, three situations stand out: for six countries (Denmark, France, Netherlands, Federal Republic of Germany, Switzerland, United Kingdom) the general trend of these rates show a constant increase (the data of the second half of 1984 should be considered provisional).

The situation in Belgium is different; stable in 1981 and 1982, it showed an increase in 1983 and a decrease in 1984. This is explained by the arrival of African patients, mainly from Zaire, for treatment in 1983. In 1984, facilities were set up in Zaire for these patients, hence the decrease in the number of cases in Belgium for that year. Of the 65 cases reported, only seven originated from Belgium. For the third group of countries (Austria, Finland, Greece, Italy, Norway, Spain, and Sweden), the half-year trends do not clearly indicate an increase. If the African cases were excluded, Belgium would come into this group.

Editorial Note

Editorial Note: As of December 31, 1984, 17 countries were taking part in the surveillance of AIDS in Europe by reporting their respective data to the Centre. Since the last report (October 15, 1984) (1), two more countries, Austria and Belgium, have provided data. The Centre used the CDC case definition. One source per country, recognized by the respective national health authorities, provides the information, and each source is responsible for the quality of the data provided. Reported by JB Brunet, MD, Institut de Medecine et D'Epidemiologie Tropicales, Hopital Claude Bernard (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; Ministere de la Sante, Athens, Greece; General Direction of Public Health, Reykjavik, Iceland; Instituto Superiore di Sanita, Rome, Italy; Staatstoezicht op de Volksgezondheid, Leidfehendam, 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 Federal de la Sante Publique, Berne, Switzerland; Communicable Disease Surveillance Centre, London, United Kingdom.

Reference

1. CDC. Update: acquired immunodeficiency syndrome--Europe. MMWR 1985;34:21-2, 28-31. *The word European refers to the patients originating from one of the 32 countries belonging to the WHO European region.

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