cii;itt.'.dfi Rapport hebdomadaire des Canada Diseases maladies au

cii;itt.'.dfi Rapport  hebdomadaire  des Canada Diseases maladies  au
Rapport hebdomadaire des
maladies
au cii;itt.'.dfi v t...r"
.
Canada Diseases
Weekly Report
i ; : :\ .
Date of Publlcatlon: May 20, 1989
Datedepubllcatlon: 20mal1989
ISSN 0382-232X
IVJAY () 0 1989
Vol.15·20
CONTAINED IN THIS ISSUE:
CONTENU DU PRESENT NUMERO:
Results of Serological Testing for HIV Infection In Manitoba • • • • • • • 105
Errata: Canadian Immunization Gulde, Third Edition, 1989 ••••••• 108
Resultals de la detection stlrologlque de !'Infection VIH au Manitoba ••••••. 105
Errata: Gulde canadlen d'lmmunlsatlon, trolsleme edition· 1989 ••••••••• 108
RESULTS OF SEROLOGICAL TESTING
FOR HIV INFECTION IN MANITOBA
RESULTATS DE LA DETECTION SEROLOGIQUE DE
L'INFECTION VIH AU MANITOBA
The results of testing anonymous sera submitted to the Cadham
Provincial Laboratory (CPL) for the diagnosis of HIV infection over
a period of 3 years in Manitoba are reported. This information is
presented in order to show the trends in the results of diagnostic testing. We believe that these data, providing early information, will supplement the AIDS surveillance program, as the median incubation
period from seropositivity to the onset of AIDS symptoms may be 10
years. For comparison purposes, during these 3 years in Manitoba, 31
cases of AIDS were reported, 16 of whom have died<1>.
Le present article fait etat des resultats d'epreuves obtenus en 3 ans au
Manitoba sur des serums anonymes envoyes au Laboratoire provincial de
Cadham (!:£L) des fins de diagnostic de l'infection VIH, dans le but
d'en degager les tendances. Comme !'incubation mediane entre la
seropositivire etl'installation de symptomes de sida peutdurer 10 ans, nous
crayons que le fait d'avoir ces donnees des maintenant servira de
complement au programme de surveillance du sida. Precisons titre de
comparaison que 31 cas de sida ont ere recenses au Manitoba pendant la
periode visee et que 16 d'entre eux sont dec:OOes(l>.
In Manitoba, all serum samples are submitted for HIV testing by
Au Manitoba, taus les prelevements seriques sont presentes pour recherche du VIH par des medecins et doivent etre accompagnes d'une formule
de demande precise ou sont consignes l' annee de naissance du patient, son
sexe, son lieu de residence, la symptomatologie, et des facteurs de risque
epidemiologiques. Le protocole suivant s'applique tous les serums
analyses: 1) 2 epreuves ELISA (provenant de 2 fabricants distincts) sont
d. abord pratiquees sur cheque serum; 2) tous les serums limites et positifs
sont ensuite analyses de nouveau par ELISA et confirmes par immunofluorescence indirecte; 3) quant aux serums indetermines, ils sont
reexamines par Wes tern blot (WB ), envoyes au Centre federal sur le SIDA,
ou analyses I' aided' antigenes recombinants. Les donnees sur le nombre
d. echantillons analyses et le nombre de resul tats positifs sont classees la
main chaque mois, pour chacune des principales categories de risque.
Toutes les donnees recueillies sont enregistrees sur ordinateurpour pouvoir
etre consultees facilement. Une personne qui utilise des codes multiples
peut apparfiltre plus d'une fois dans la base de donnees. Comme il utilise
le meme mecanisme de collecte de donnees depuis le debut de la recherche de l'anticorps anti-VIH en 1985, le CPL a done des renseignements
detailles sur des sujets anti-VIH positifs et negatifs.
physicians and must be accompanied by a specific requisition form
indicating the patient's year of birth, sex, geographic location of
residence, symptomatology, and epidemiologic risk factors. All sera
are processed according to the following protocol: 1) 2 ELISA tests
(obtained from 2 different commercial manufacturers) are carried out
first on each serum; 2) all those sera that are borderline and positive
are thenretested by ELISA and confirmed by indirect immunofluorescence; 3) indeterminate sera are further tested by Western blot (WB),
referred to the Federal Centre for AIDS, or tested using recombinant
antigens. Data on the number of samples tested and the number of
positives, for each of the major risk categories, are tabulated manually on a monthly basis. All collected data are stored on computer for
easy retrieval. An individual who uses multiple codes may appear in
the database more than once. Thus, the CPL has detailed information
on anti-HIV positive and negative individuals, using a consistent data
gathering mechanism since HIV antibody testing began in 1985.
From 1December1985 to 31December1988, a total of7079 diagnostic sera were tested at the CPL, and 184 (2.6%) had antibodies to
HIV-1. Both the number of sera tested and the percentage of positives
are very low compared to the figures obtained by diagnostic
laboratories in Ontario and British Columbia (Provincial Laboratory
Directors: personal communications, 1988). During this period of
time, there has been a decrease in the number of new seropositives,
particularly noticeable between 1986and1987(Table1). A decrease
in positivity is also noticed among the homosexuals/bisexuals tested
during this 3-year period, 13.8% in 1986 compared to 6.5% in 1988.
a
a
a
a
a
a
al'
Du 1er decembre 1985 au 31 decembre 1988, le !'.:£1 a procede
analyse
diagnostique de 7 079 serums, dont 184 (2,6%) presentaient des anticorps
contre le VIH-1. Le nombre de serums examines et le pourcentage de
positifs sont taus 2 tres faibles.comparativement aux. chiffres obtenus en
Ontario et en Colombie-Britannique par des laboratoires de services diagnostiques (directeurs de laboratoireprovincial: communications personnelles, 1988). Au cours de la periode, on a observe une baisse du nombre de
nouveaux seropositifs, tout particulierement entre 1986 et 1987 (Tableau
1). La positivite a aussi dirninue chez les sujets homosexuels et bisexuels
examines pendantces 3 ans, passant de 13,8% en 1986 6,5% en 1988. On
a
founicr do la dcux~tm clu1e • Bn.rcgistrcmmt n° 5670
~t<Olld Clan Mall Rogilb:ationNo. 5610
105
Health and Welfare
Canada
Santa et
Canada
Bien~tre
social
Canada
In addition, requests to test individuals at low risk of acquiring
HIV-1 have increased, 38% of the total number of samples tested in
1986 compared to 71% in 1988.
aen outre observe une augmentation des demandes d' analyse concemant
des sujets 8. faible risque pour le VIH-1: comptant pour 38% des
echantillons analyses en 1986, ell es representaient 71 % du total en 1988.
A total of 1606 homosexuals/bisexuals were tested during this 3-year
period (Table 1); 16.4% of this group, who were also intravenous drug
users (IVDU), were positive and had a significantly higher HIV-1 antibody-positive rate than those with the single risk factor ofIVDU (3
of 544 or 0.5%, p<0.001) or homosexual/bisexual (138 of 1606 or
8.6%, p.<0.05).
Parmi Jes 1 606 homosexueJs et bisexuels examines au cours de ces 3 ans
(Tableau 1), on comptait 16,4% de sujets positifs etant aussi des
utilisateurs de drogue i.v. (UDIV). Chezces demiers, le taux de positivite
8. l'egard de l'anticorps anti-VIH-1 etait beaucoup plus eleve que chez
Jes sujets ne presentant qu'un seul facteur de risqµe, qu'il s'agisse
d'UDIV (3/544 ou 0,5%, p<0,001) ou d'homosexuels/bisexuels
(138/1606 OU 8,6%, p<0,05),
Table 1. Serodlagnosls of HIV Infection In Manitoba, 1 December 1985 • 31 December 1988/
a
Tableau 1. Serodlagnostlc de l'infectlon VIH au Manitoba, du 1°r decembre 1985 au 31decembre1988
NUMBER POSITIVE/NUMBER TESTED(% POSITIVE) I
POSITIFS/SUJETS TESTES (% POSITIFS)
Risk Factor Category/
Categorle de facteur de rlsque
1 December 1985·
31 December t986/
1er decembre 1985
au 31decembre1986
1987
1988
TOTAL
Homosexuals/Bisexuals/
Homosexuels/bisexuels
61/442
43/p48
34/516
138/1606 (8.6%)
Intravenous Drug Users (IVDU)/
tilisateurs de drogue i.v. (UDIV)
0(25
0(237
3(282
3/544
(0.6%)
Homosexuals/Bisexuals/IVDUI
Homosexuels/bisexuels/UDIV
2/9
4(26
5/32
11/67
(16.4%)
Hemophiliacs/Hemophiles
5/7
6/48
0/47
11/102
(10.7%)
Individuals from Endemic Areas/
Sujets originaires d'une region d'endemie
2/15
2(27
1/51
5/93
(5.3%)
Other/Autre
2/308
5(2088
9(2271
16/4667
(0.3%)
TOTAL.
72/806
(8.9%)
60/3074
(2.0%)
52/3199
(1.6%)
184/7079
(2.5%)
The first positive IVDUs were diagnosed only in 1988; 1 was a
heterosexual male and the other 2 were females, 1 from Quebec and
the other from Ontario.
Les premiers UDIV positifs n'ont ete diagnostiques qu'en 1988, en
!'occurrence un homme Mterosexuel et 2 femmes, l'une du Quebec et
l' autre de !'Ontario.
The 16 persons positive for anti-HIV listed under the category "other"
in Table 1 had the following risk factors: 1 was a male blood donor
referred by the Red Cross; 3 were infected via blood transfusions prior
to 1985; 1 was a female prostitute and IVDU from Quebec; 1 was a
male who claimed to have been infected via a dental procedure done
in New York in 1982; 1 was a female who attended her son dying of
AIDS; 1 had no knownriskfactor (also had a repeatedly indeterminate
WB); and 8 were infected via heterosexual contact (4 males and 4 unlinked females). Included in this category were also 619 persons
tested because of an accidental parenteral exposure in the health-care
work place and 64 patients with other sexually transmitted diseases.
No positives were recorded in eitherof these 2 groups. Only3 (0.5%)
of 592 persons tested because of a history of receiving blood transfusions prior to 1985 had antibodies to HIV. Of 1465 persons tested
Les 16 sujets anti-VIH positifs classes dans la categorie "autre" du
Tableau 1 presentaient les facteurs de risque suivants: 1 donneur de sang
de sexe masculin adresse par la Croix-Rouge; 3 sujets infectes par des
transfusions sanguines avant 1985; 1 prostituee UDIV du Quebec; 1
homme affirmant avoir ete infecte par un acte dentaire pratique New
York en 1982; 1 femme ayant soigne son fils mourant du sida; 1 sujet
sans facteur de risque connu (chez qui l'epreuve WB s'est revelee
indeterminee 8. maintes reprises); et 8 sujets infectes par contact
h6terosexuel (4 hommes et 4 femmes ne presentant aucun lien entre eux).
Ont aussi ete inclus dans cette categorie 619 travailleurs sanitaires ayant
subi des tests en raison d'une exposition parenterale accidentelle en
milieu de travail, et 64 patients atteints d'autres maladies transmises
sexuellement. Aucun resultat positif n 'a ete signale dans ces 2 groupes.
Surles 592 personnes examinees en raison d'antecooents de transfusion
a
106
because of suspicious heterosexual sex contacts, 8 (0.5%) were positive.
sanguine anterieurs a1985, 3 seulement (0,5%) presentaientdes anticorps
contre le VIH; et parmi les 1 465 personnes examinees en raison de relations Mrerosexuelles suspectes, 8 (0,5%) se sont revelees positives.
In Manitoba, HIV infection is still mainly a disease of males. One Au Manitoba, le VIH se retrouve encore principalement chez l 'homme.
hundred and seventy-four (4.2%) of 4140 males tested during the Surles 4140hommes examines aucours de laperiode visee, 174 (4,2%)
period under review had antibodies to HIV. While only 9 (0.3%) of etaient anti-VIH positifs. Cependant, meme si la positivire n'a ete
2740 females tested were positive, the number of positive females has demontree que chez 9 (0,3%) des 2 740 femmes examinees, le nombre
been increasing over time: 0/145 in 1985/86, 3/1232 in 1987, and des femmes positives augmente d'une annee a l'autre: 0/145 en 19856/2704 in 1988. The risk categories of the positive females were as 1986, 3/1 232 en 1987 et 6/2 704 en 1988. Les categories de risque des
follows: 1 had a blood transfusion; 1 was exposed to her son dying femmes positives etaient les suivantes: 1 ar~u une transfusion sanguine;
of AIDS; 1 was an IVDU and prostitute; 1 was an IVDU; 1 had 1 a ere exposee ason fils mourant du sida; 1 etait ala fois prostituee et
received no known risk factor; 2 were infected heterosexually by their UDIV; 1 etait UDIV; 1 ne presentait aucun facteur de risque connu; et 4
husbands who were positive; 1 was infected heterosexually by her avaient ere infectees par contactMterosexuel- 2 avec leur marl positif, 1
husband who admitted
Table 2.
avec son mari, lequel a
having had limited
Geographic Distribution of HIV Infection In Manitoba,
admis avoireu unecertaine
homosexual activities 10
1 December 1985. 31 December 1988
activite homosexuelle 10
years prior to their marans avant son mariage, et 1
riage; and 1 was infected
Tableau 2.
avec un ami bisexuel qui
heterosexually by a
Repartition geographlque de l'infectlon VIH au Manitoba,
etaitegalementUDIV.
bisexual boyfriend who
du 1er decembre 1985 au 31decembre1988
was also an IVDU.
a
Comparativement aux
Number Tested/Number Positive ( %)
Manitoba Health Region/
Patients with
sujets asymptomatiSujets testes/positifs ( % )
Region sanltaire du Manitoba
ques, les patients dont
symptoms
comles symptomes corpatible with an HIV
infection are more 1---------------------------------1 respondentaceuxd'une
infection a VIH sont
likely to be antibody
(2.7%)
Winnipeg
157/5659
plus susceptibles de
positive than those
(2.6%)
Westman
9/337
who are asymppositivire a l'anticorps,
(2.2%)
2/88
Parkland
tomatic, particularly
surtout s'ils sont de sexe
(2.2%)
Norman
1/44
masculin. Cependant, il
if they are males.
(1.6%)
Interlake
3/182
However, the number
y avait presque autant
(1.5%)
Central
3/190
de sujets anti-VIH .
of HIV antibodyEastman
0/91
positive individuals
positifs dans les
(1.3%)
Thompson
1/76
was almost equal in
categories symptomatiOut-of-Province/
the symptomatic and
que et asymptomatique.
(8.4%)
Hors de la province
8/95
asymptomatic
Cet etat de chose
0{317
Not Given I Non communique
s 'explique peut-etre par
categories. This may
.___ _ _ _ _ _ _ _ _ _ _ _ _ _ _,......_ _ _ _ _ _ _ _ _ _ _ _ _ _ ___, lemomentoul'epreuve
be an artifact attributed to the timing of testing during the course of the HIV infec- a ere pratiquee pendant le COUTS de I 'infection a VIH OU par un biais de la
tion, a bias in the selection of patients to be tested, or may illustrate selection des patients devant faire l 'objet de tests; il peut aussi demontrer
that there is a relatively small pool of asymptomatically infected in- que le reservoir des sujets infect& asymptomatiques est relativement
dividuals. During the period under study, 85 (7.7%) of 1090 restreint. Au COUTS de la periode visee, des anticorps contre le VIH-1 ont
symptomatic and 98 (1.7%) of 5754 asymptomatic persons tested had ete mis en evidence chez 85 (7,7%) des 1 090 sujets symptomatiques.
antibodies to HIV-I. The percentage of males who were positive was examines et chez 98 (1,7%) des 5 754 sujets asymptomatiques. Au total,
10.2 in those who were symptomatic and 2.7 in those asymptomatic. 10,2% des hommes symptomatiques se sontreveles positifs et2,7% des·
This was lower in females, i.e., 2.7 in symptomatic and 0.2 in hommes asymptomatiques. Chez les femmes, ces poUTcentages etaient
plus bas, asavoir: 2,7% des symptomatiques et 0,2% des asymptomatiasymptomatic women.
ques.
In Manitoba, HIV infection is diagnosed mainly in young adults. A
total of296 babies (under the age of 1 year) were tested and none had
antibodies. Of 97 children tested between the ages of 1 and 9 years,
2 were seropositive for HIV; 1 was a hemophiliac and the other had
received a blood transfusion prior to 1985. A total of 404 persons
aged 10 to 19 were also tested and 10 were found to have antibodies
to HIV. Nine of these were hemophiliacs and the tenth was
homosexual. Sixty-eightpercentoftherequestsfortestingcamefrom
persons aged 20 to 40. In this group, 144 (2.9%) of the 4833 tested
had antibodies, representing 77. 7% of the total 184 reported positives.
In those over 40, 28 (0.8%) of the 3272 tested had antibodies to
HIV-1.
Au Manitoba, I 'infection aVIH est diagnostiquee surtout chez de jeunes
adultes. Aucun des 296 bebes (de moins de 1 an) examines ne presentait
d'anticorps. Parmi les 97 enfants de 1a9 ans ayant fait l'objet de tests, 2
etaient VIH positifs: 1 etaitMmophile et l' autre avaitrec;:u une transfusion
sanguine avant 1985. Chez les 10 a19 ans, 404 sujets ont aussi subi des
tests; 10 se sontreveles anti-VIH positifs (9 Mmophiles et 1 homosexuel).
Au total, 68% des demandes de recherche de l' anticorps concernaient des
20 a 40 ans. Chez ce groupe, 144 (2,9%) des 4 833 sujets examines
presentaient des anticorps, soit 77 '7% des 184 resultats positifs signales.
Parmi les 3 272 sujets de plus de 40 ans examines, 28 (0,8%) etaient antiVIH-1 positifs.
107
As shown in Table 2, most of the sera tested was collected from persons living in Winnipeg (5659/7079 or 80%) and most of those who
were antibody positive were from this city (157/184 or 85%).
However, the percentage who were positive in those tested in Winnipeg does not differ significantly from that fmmd in the rest of the
province. HIV infection has been reported from all but one of
Manitoba's health regions.
This infonnation, from specimens submitted for anti-HIV antibody
testing, cannot be considered seroprevalence data, but it does provide
. infonnation on the use of the testing programs and trends that may be
important. Because of the long incubation period of HIV infection,
several of these trends can be expected to antedate the AIDS surveillance data in Manitoba, and perhaps other parts of Canada.
Comme le demontre le Tableau 2, des habitants de Winnipeg etaientrepresentes
dans la plupart des serums analyses (5 659/7 079 OU 80%) et la plupart des
resultats positifs (157/184 OU 85%). Cependant, iln 'ya pas d' ecartmarqu~ dans
le pourcentage des resultats positifs observe parmi !es serums analyses aWinnipeg et ceux du reste de la province. L'infection aVIH aete signaleepar toutes
!es regions sanitaires du Manitoba, une exception pres.
a
Ces renseignements, obtenus a partir de prelevements presentes pour recherche de 1' anticorps anti-VIH, ne peuvent etre consideres comme des doMees de
seroprevalence, mais ils peuvent etre utiles en ce qui a trait aI 'application de
programmes de depistage et aux tendances. Etant doIUle la longueur de
I' incubation de !'infection, ii ya des chances pour que plusieurs de ces tendances soient anterieures aux donnees de surveillance du sida au Manitoba et peutetre dens d' autres regions du Canada.
Reference:
Reference:
1. Federal Centre for AIDS. Surveillance update: AIDS in Canada,
1. Centre federal sur le SIDA. Mise ajour: Surveillance du SIDA au Canada,
17 avril 1989.
17 April 1989.
SOURCE:
L Selda, MD, G HatllmfJnd, MD, Cadham Provincial
Laboratory, Winnipeg, Manitoba.
SOURCE:
D" L Sekla el G Hammond, Cadham Proyjncja/Laboratory. Winnipeg
(Manitoba).
Errata: Canadian Immunization Guide, Third Edition -1989,
enclosed with CDWR, Vol. 15-16, April 22, 1989.
Errata: Guide .canadien d'immunisation, troisieme edition - 1989,
joint au RHMC, vol.15-16, 22avril1989.
On page 98 of the Guide in the section entitled "Management of
Animals Involved in Biting Incidents" and in the Footnote, the 2
references to the Food Protection and Inspection Branch, Agriculture
Canada, should read Food Production and Inspection Branch.
A la page 113 du Guide, sous «Conduite a suivre vis-a-vis des animaux
suspects» et «Note», lire Direction generate de la production et de
I' inspection des aliments d' Agriculture Canada et non pas Direction
generale de la protection et de! 'inspection des aliments.
In the Footnote, the address and telephone number of the Saskatchewan Regional Office of Food Production and Inspection
Branch should read as follows: 330-2100 Broad Street, Regina, Saskatchewan, S4P 4E5, telephone (306) 780-5210.
Dans la note, I' adresse et le numero de telephone du Bureau regional de
la Saskatchewan de la Direction generale de la production et de
l'inspection des aliments devraientse lire comme suit: 330-2100 Broad
Street, Regina, Saskatchewan, S4P 4E5, telephone: (306) 780-5210.
The Canada Diseases Weekly Rr.poit presents curn:nt information on infectious and
other diseases forsurveillancepurposes and is available free of charge upon request.
Many of the articles contain preliminary information and funher confumation may
be obtained from the sources quoted. The Department of National Health and Welfare does not assume responsibility for accuracy or authe.nticity. Contributions are
welcome(in the official language of your choice) from anyone working in the health
field and will not preclude publication elsewhere.
Le Rapport hebdomadaire des maladies au Canada, qui foumit des donnees pertinentes
our Jes maladies infectieuses et Jes autres maladies dans le but de faciliter leur surveillance, peut litre obtenu gratuitement sur demande. Un grand nombre d'articles ne conticnnentque des donnees sommaires mais des rcnseignements complementaires peuvent
etre obtenus ens' adress ant aux sources citees. Le ministere de la Sante nationale et du
Bien-etre social ne peut l!tre responsable del' exactitude, ni de I' authcnticite des articles.
Toute personne oeuvrant dans ledomaine de la sante est invitee acollaborer (dans la langue officielle de son choix) et la publication d'un article dans le present Rapport n'en
empeche pas la publication ailleurs.
Sclenllfic Advisor:
Editor:
Circulation:
Desktop Publishing:
Dr. S. E. Acres
Eleanor Paulson
Dolly Riggins
Joanne Regnier
Bureau of Communicable Disease Epidemiology
Laboratory Centre for Disease Control
Tunney'sPasture
<YITAWA, Ontario
Canada KIA Ol.2
(613) 957-0325
(613) 957-1788
(613) 957-0841
(613) 957-7845
Conselller sclentlfique:
RMaclrlce en chef:
Distribution:
Edlllque:
D' S.E. Acres
Eleanor Paulson
Dolly Riggins
Joanne Regnier
Bureau d'epidfutlologie des maladiea transmissibles
Laboratoire de lutte contre la maladio
Pre Tunney
Ottawa (Ontario)
Canada KIA 01..2
108
(613) 957-0325
(613) 957-1788
(613) 957-0841
(613) 957-7845
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