Canada Diseases Report Weekly •

Canada  Diseases Report Weekly •
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ISSN 0382-232X
Canada Diseases
Weekly Report
Rapport hebdomadaire des
maladies au Canada
Date of publication: 27 July 1991
Contained in this issue:
Contenu du present numero:
Update: Trans mission of HIV Infection During Invasive Dental Procedures Florida, United States . . . . . . . .
Update: Acquired Immunodeficiency Syndrome United States, 1981-1990 . . . . . . . . . . . . . . . .
Mise ajour,: Transmission de !'infection aVIH pendant un acte dentaire effractif en
Floride (Etats-Unis) . . . . . . . . . . .
Mi$e ajou~: Syndrome de l'immunodeficience acquise Etats-Ums (1981-1990)
. . . . . . . . .
157
160
International Notes
/
\
Date de publication: 27 juillet 1991
Vol. 17-30
157
160
Notes internationales
UPDATE: TRANSMISSION OF HIV INFECTION DURING INVASIVE
DENTAL PROCEDURES· FLORIDA, UNITED STATES
MISE AJOUR: TRANSMISSION DE L'INFECTION AVIH PENDANT UN
ACTE DENTAIRE EFFRACTIF EN FLORID~ (ETATS-UNIS)
Previous reports from an epidemiologic investigation in Florida
strongly suggested that 3 patients (patients A, B, and C) became ·
infected with human immunodeficiency virus (HIV) while receiving
dental cff5_ from a dentist with acquired immunodeficiency syndrome
(AIDS). • ) This report describes findings that suggest HIV was
transmitted to 2 additional patients (patients E and G). These 2
patients had no other confirmed exposures to HIV, had invasive
procedures performed by the dentist, and are infected with HIV strains
that are closely related genetically to the strains from the 3 previously
~ported patients and from the dentist (Table 1~. In addition, this report
..1escribes the epidemiologic and laboratory investigation of another
,.
HIV-infected patient of the dentist (pat_ient F). •
11 semble fort plausible, quand on lit les comptes rendus anterieurs de
l'enquete epidemiologique menee en Floride que 3 patients (A, Bet C) ont
contracte le virus de l'immunodeficience humaine (VIH) en se faisant traityr )
par un dentiste atteint du syndrome de l'immunodeficience acquise (sida).< ·2
Le present rapport presente les resultats d'une enquete montrant que le VIH
aurait ete transmis a2 autres patients (E et G). Aucune autre exposition au VIH
n 'a ete reconnue dans le cas de ces 2 personnes a·qui ce dentiste avait fait un
traitement effractif et chez qui on a decele des souches etroitement apparentees
du point de vue genetique a celles deja retrouvees chez les patients A, B et C et
chez le dentiste (Tableau 1). Le present article renferme en outre une
description de l 'enquete epidemiologique et biologique touchant un autre
patient du dentiste, egalement infecte par le VIH (patient F).
Table 1/Tableau 1
Characteristics of.an HIV-infected dentist and patients in a dental practice· Florida
Caracteristiques d'un dentiste atteint du VIH et ses patients infectes au cour'S d'un acte dentaire (Floride)
HIV-infected
person
Personne infectee
par le VIH
HIV risk
factor
Facteur de risque
al'egard du VIH
Sex
Sexe
Dentist/Dentiste
DNA sequences closely related
to sequences of dentist's virus
Sequences d'ADN etroitement apparentees
acelles du virus du dentiste
Amino acid
signature pattern*
Schema unique*
des aminoacides
· Male/Homme
Yes/Oui
Not applicable/Non applicable
Yes/Oui
Female/Femme
Female/Femme
Male/Homme
Female/Femme
Male/Homme
Male/homme
"' Male/Homme
No/Non
No/Non
U**/Nc**
No/Non
No/Non
Yes/Oui
Yes/Oui
Yes/Oui
Yes/Oui
Yes/Oui
Yes/Oui
Yes/Oui
No/Non
No/Non
Yes/Oui
Yes/Oui
Yes/Oui
Yes/Oui
Yes/Oui
No/Non
No/Non
Patient/Patient
A
B
c
E
G
D***
F
* A unique pattern of 8 amino acids in the HIV V3 peptide./Un schema unique de 8 aminoacides trouve dans les peptides du VIH de la region V3.
** Unconfirmed/Non confirme.
*** See reference 2Noir la reference 2.
(
Patient E
Patiente E
Patient E, a young woman, contacted CDC after the i8i~\al report
of a possible transmission of HIV in this dental practice. ' She
denied a history of transfusion, receipt of blood products, or injecting
drug use. She did not report a history of an illness compatible with an
1cute retroviral syndrome. She was seropositive for antibody to HIV
when first tested in October 1988; in January 1991, she was
Cette jeune femme a communique avec les CDC ala suite de la parution du
premier rapport indiqua~ la possibilite d'une transmission du VIH chez les
patients de ce dentisteY· ) Elle declare n'avoir aucun antecedent de
transfusion, d'administration de derives sanguins ou de toxicomanie
endoveineuse. Ellene signaly aucun antecedent de maladie compatible avec un
syndrome retroviral aigu. Le depistage de l' anti corps anti-VIH, realise pour la
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asymptomatic, with >0.5 x 10 9IL CD4 lymphocytes; serologic tests
for syphilis and hepatitis B virus infection were negative.
premiere fois en octobre 1988, a montre qu'elle etait seropositive. En 1991
est reste asif,mptomatique; la numeration des lymphocytes CD4 est
>0,5 x 10 IL; la recherche serologique de la syphilis et de l'hCpatite Best
negative.
Patient E's known former sex partners since 1981 were tested
for HIV antibody (except one, who died from non-HIV-related
causes in 1982 and was not known to be at high risk for IDV
infection); one was positive. This man (patient F) was also a patient
of the dentist. Patient E reported infrequent sexual contact with
patient F; the last contact was in the fall of 1988.
Les anciens partenaires sexuels connus de la patiente E depuis 1981 ont
faitl'objet d'un depistage de l'anticorps anti-VIH (sauf un, qui est decede
en 1982 de causes non rattachees au VIH et qui n'etait pas repute presenter
un risque eleve quant a !'infection a VIH). Un d' entre eux s 'est revele
seropositif. Cet homme (patient F) etait egalement un client du dentiste. La
patiente E declare avoir eu des rapports sexuels peu suivis avec le patient F,
le demierremontant al'automne 1988.
Patient F
Patient F
Patient F had tested negative for HIV antibody in October 1988
(when patient E tested seropositive) and December 1988 but tested
positive in December 1990. Review of his medical records
indicated that, in September 1989, he sought medical care for a
1-week history of sore throat, loose stools, and headache; other
symptoms included decreased appetite, fatigue, myalgias, and an
earache. On examination, he was febrile (38.l' C) and had tender
anterior ~ervical adenopathy; hi~ white blood cell count was
3.3 x 10 {!t; (normal: >4.0 x 10 ~with a lymphocyte count of
0.693 x 10 IL (normal: >1.0 x 10 IL). He was diagnosed as having
tonsilitis; throat culture yielded "normal respiratory flora." No
IDV-antibody test was performed at the time, nor is there any
indication that an acute retroviral syndrome was considered. This
illness occurred approximately 1 year after patient F's last reported
dental appointment and his last sexual contact with patient E an"d 9
months after his last negative test for HIV antibody.
Le patientF est anti-VIH negatif en octobre 1988 (au moment ou la
patiente E s'est averee seropositive) et en decembre 1988, mais en 1990 il
est seropositif. L' examen de ses dossiers medicaux montre qu' en
septembre 1989, il consulte un medeciri parce que depuis une semaine il a
un mal de gorge, une diarrhee et des maux de tete; il presente aussi une
perte d' appetit, une lassitude, des douleurs musculaires et une otalgie.
L'examen montre une fievre (38,l 'C), une legere ad~opathie cervicale
anterieure~la numeration leucocytaire est a 3,3 x 10 IL (la IJJDrme etant de
>4,0 x 10 IL et la ~umeration lymphocytaire de 0,693 x 10 IL (la norme
etant de> 1,0 x 10 IL. Le medecin diagnostique alors une amygdalite; une
culture de la gorge revele une "flare respiratoire normale". Aucun
depistage d'anticorps anti-HIV n 'est alors realise, et rien ne perm et de
croire que !'on soupi;:onne a cette epoque la presence d'un syndrome
retroviral aigu. Cette affection est survenue environ un an apres le dernier
rendez-vous chez le dentiste signale par le patient F et apres son dernier
rapport sexuel avec la patiente E, et 9 mois apres le demier depistage de
l'anticorps anti-HIV, dont !es resultats etaient negatifs.
On interview, patient F denied a history of having had sex with
men and injecting drug use. He had no history of blood transfusions
or receipt of blood products. Review of medical and other records,
however, indicated behavioral risk factors for HIV infection
unacknowledged at the time of intirview. In January 1991, his CD4
lymphocyte cou.nt was 0.253 x 10 IL, and serologic tests for
syphilis and hepatitis B were negative.
Lars d'un interrogatoire, le patientF a nie tout antecedent de rapports
homosexuels, de toxicomanie endoveineuse, de transfusion ou
d'administration de derives sanguins. L'examen de ses dossiers medicaux
et d' autres documents pertinents a montre que certains de ses
comportements faisaient de lui un sujet presentant un risque quanta
!'infection a VIH, mais qu'il n'avait pas fait part de cette information au
moment du premier interrogatoire. E.P, janvier 1991, la numeration des
lymphocytes CD4 est de 0,253 x 10 IL; Jes epreuves serologiques de la
syphilis et de l'hCpatite B sont negatives.
Patient G
Patient G
>
Patient G is a young man who contacted GDC after he tested
positive for HIV antibody. In November 1990; he was first
determined to be HIV seropositive when scr~ened for plasma
donation. He denied a history of having had ~ex with men, injecting
drug use since 1977, blood transfusionsi or receipt of blood
products. He did not report a history of an illness compatible with
an acuteretroviral syndrome. Records indicate that when he
donated blood in 1986 he was seronegative for syphilis, hepatitis B,
and HIV. He reported having 2 female sex partners since 1986;
both were seronegative for HIV antibody when tested in March and
April 1991. In May 1991, his CD4 lymphocyte count was
4.0 x 10 9IL, and serologic tests for syphilis and hepatitis B were
negative.
Ce jeune homme communique avec les CDC en apprenant, en
novembre 1990, apres avoir subi un depistage comme donneur possible de
plasma, qu 'il est anti-VIH positif. II nie tout antecedent de rapports
homosexuels, de toxicomanie endoveineuse depuis 1977, de transfusion,
d'administration de derives sanguins ou de maladie compatible avec un
syndrome retroviral aigu. Les dossiers etablissent que lorsqu 'ii a fait don de
son sang en 1986, il etait seronegatif a I' egard de la syphilis, de l'hCpatite B
et du VIH. Il indique avoir eu 2 partenaires sexuelles depuis 1986; toutes 2
sont anti-VIH negatives en mars et en avril 1991. En mai 1991\lla
numeration des lymphocytes CD4 du patient G est de 4,0 x 10 IL; !es
epreuves serologiques de la syphilis et de l'hCpatite B restent negatives.
Additional Information from Patient Interviews
Autres donnees ressortant de l'entrevue des patients
Patients E and F were interviewed under circumstances that
included the presence of other persons. Despite these
circumstances, patients E and F, as well as patient G, reported
nonparenteral use of illicit drugs. None, however, reported
needlesharing or injecting illicit drugs. All of the patients denied
sexual contact with the dentist~' -
Bien que leur interrogatoire se soit deroule en presence d'autres
personnes, ces 3 patients ont admis avoir consomme des drogues illicites
mais non par injection intraveineuse. Aucun n' a <lit avoir utilise une
aiguille ayant servi a d'autres personnes. Tous ont nie avoir eu des rapports
sexuels avec le dentiste.
Dental History of Patients
Antecedents dentaires
Patient records from the dental practice for patients E, F, and G
could not be located. However, patient billing information was
available for some of the reported patient visits.
II n' a pas ete possible de retracer Jes dossiers dentaires de ces patients.
Toutefois, on a pu mettre la ni.ain sur !es registres de facturation applicables
a certaines visites signalees par eux.
Billing information indicated that patient E made at least 10
visits to the dentist for examination, prophylaxis, fluoride treatment,
restorative fillings and crowns, and root canal therapy from June
through December 1988. She received local anesthetic, stated that
the dentist wore gloves and a mask, and did not recall any specific
·incidents that would have exposed her to the dentist's blood (i.e., an
injury to the dentist, such as a needlestick or cut with a sharp
instrument).
De juin a decembre 1988, la patiente E s'est rendue au mains 10 fois
chez le dentiste pour divers types de services: examen, prophylaxie,
traitement au fluorure, obturations, couronnes, et traitement de canal. Elle a
subi des anesthesies locales, et declare que le dentiste portait des gants et
un masque, elle ne se souvient d'aucun incident precis au cours duquel elle
aurait ete exposee au sang du dentiste (par ex. si celui-ci s 'etait blesse par
Une aiguil!e OU Un instrument acere).
..158
(
(
\
Patient F reported having made 5 or 6 visits to the dentist during
July and August 1988 for examination and radio graphs,
prophylaxis, extraction, restorative fillings, and root canal therapy.
However, only one visit could be documented by billing records.
Le patient F affirme avoir rendu 5 ou 6 visites au dentiste au cours de
juillet et aofit 1988, pour divers services: examen, radiographies,
prophylaxie, extraction, obturations et traitement de canal. Les registres de
facturation n'ont permis de retracer qu'une visite.
Medical records and billing information indicate that patient G
nade 2 visits to the dentist in July 1988 for root canal therapy and
Jne restorative filling under local anesthetic. He could not recall
whether the dentist wore gloves and a mask during the visits or any
specific incidents that would have exposed him to the dentist's
blood.
ll ressort des dossiers et des registres de facturation que le patient Ga
rendu 2 visites au dentiste en juillet 1988, pour un traitement de canal et une
obturation sous anesthesie locale. ll est incapable de se rappeler si le
dentiste portait ou non des gants en travaillant ou s 'il s 'est produit un
incident precis qui l' aurait expose au sang du dentiste.
Laboratory Investigation
Examens de laboratoire
This investigation previously included sequencing of HIV
proviral DNA in the lymphocyte samples obtained f{,~f the dentist,
patients A, B, and C, and 7 Florida control patients ' . Proviral
DNA obtained from the lymphocytes from patients E, F, and G and
from 24 additional control patifits in Florida was performed using
previously described methods( ' ) or a modification of these
methods.* The sequences of240 nucleotides from the V3 region of
the gene encoding the viral external envelope glycoprotein, gp120,
were then analyzed at Los Alamos National Laboratory.
On avait pratique en laboratoire' un sequeni;:age de l 'ADN proviral du
VIH present dans ks lvmphocytes du dentiste, des patients A, B et C et de 7
1 2
temoins de Floride' • ~ On a fait de meme avec les lymphocytes des patients
E, F et G ~t de 24 temoins de la Floride al' aide des me tho des deja
decrites<2• ) ou d'une version modifiee de ces methodes. *Les sequences des
240 nucleotides V3 codant la glycoproteine d'enveloppe virale externe
(gp120) onl ensuite ete analysees au Los Alamos National Laboratory.
Based on this analysis, the viral nucleotide sequences from
patients E and G were determined to be closely related to those of
the dentist, with average differences of 2.5% and 4.6%,
respectively. The sequences from patients E and G were distinct
from all sequences of the 31 local controls, with average
differences of9.4% and 11.2%, respectively. In addition, the HIV
V3 peptides of the dentist and patients A, B, C, E, and G shared a
unique pattern of eight noncontiguous amino acids (signature
pattern) that has not been found in any other HIV sequence
published or included in the HIV sequence database at Los Alamos
National Laboratory. Sequence analysis indicated that the virus
from patient F was not closely related to that of the dentist (average
difference of9.2%) nor to those of patients A, B, C, E, or G and
lacked the unique pattern of amino acids identified in the viruses of
the other patients and the dentist.
Les sequences virales proven ant des patients E et G s 'apparentent
fortement a celles du dentiste, l 'ecart moyen observe etant respectivement
de 2,5 % et 4,6 %. Elles se differencient de toutes les sequences des 31
temoins locaux, l'ecart moyen etantrespectivement de 9,4%et11,2 %. En
outre, les peptides de la region V3 du dentiste et des patients A, B, C, E et G
partagent un schema unique (<lit "signature") de 8 aminoacides non contigus
qui n' a ete trouve dans aucune autre sequence du VIH dont fait etat la
banque de donnees sur les sequences du VIH a Los Alamos. L' analyse des
sequences du virus trouve chez le patientF montre qu'il n'est etroitement
apparente ni a celui du dentiste (ecart moyen de 9,2 %), ni a ceux des
patients A, B, C, E ou G; il ne partage pas le schema unique d' aminoacides
propre aux virus des autres patients et du dentiste.
Editorial Note
Note de la redaction
, This investigation strongly suggests that 51Jatients (patients A,
)!, C, E, and G) became infected with HIV while receiying care
from a dentist with AIDS. None of thesi; patients had other
confirmed exposures to HIV, all had irivasive,proc~dures
performed by the dentist, and all were infect~a with HIV strains
that were closely related to each other and to_ the straing infecting
the dentist but distinct from viruses obtained from control patients
living in the same geographic area as the dental practice. In
addition, patient G was known to have been HIV seronegative
before being treated by the dentist.
L'enquete donne fortement a penser que 5 patients (A, B, C, E et G) ont
contracte le VIH en se faisant traiter par un dentiste atteint du sida. Aucune
autre exposition au VIH n' a ete confinnee chez eux. To us ont subi des
interventions effractives pratiquees par le dentiste. L'analyse des souches de
VIH montre une grande similitude entre chacune de ces souches et celle qui
a infecte le dentiste. En outre, ces souches se distinguent de celles qui
proviennent des sujets temoins vivant dans le secteur geographique oil
exeri;:ait le dentiste. Enfin, on sait que le patient G etait anti-VIH negatif
avant d'avoir ete soigne par le dentiste.
Based on the following considerations, patient F does not
appear to have been infected in the dental practice or through
sexual contact with patient E: 1) he is infected with a strain of HIV
that is not closely related genetically to that of the dentist and the
other patients, including patient E; 2) he had other behavioral risk
factors for HIV infection; and 3) he had an illness compatible with
an acute retroviral syndrome approximately 1 year after his last
reported dental visit and his last reported sexual contact with
patientE.
Quant au patient F, il ne semble pas avoir ete infecte par des traitements
dentaires ou lors des rapports sexuels avec la patiente E. En effet, 1) la
souche de VIH observee chez lui n 'est pas etroitement apparentee a celle du
dentiste et des autres patients, y compris la patiente E; 2) il avait eu des
comportements qui le plai;:aient dans la categorie des sujets a risque pour
!'infection a VIH; 3) il a souffert d'une maladie compatible avec un
syndrome retroviral aigu environ un an apres sa derniere visite chez le
dentiste et son dernier rapport sexuel avec la patient E.
In the initial sequencing of th~, HIV proviral DNA from patients E, F,
i\
and G, proviral DNA that had 6een amplified by the polymerase chain
reaction (PCR) was molecularly cloned before it was sequenced.
Unique sequences were included in the PCR primers used for
amplication to distinguish the amplified product of each patient's
specimen. To verify these results, additional blood samples obtained
from patients F and G and a second aliquot of the initial blood sample
from patient E were reanalyzed. In this reanalysis, amplified HIV DNA
was'.S'equenced directly, without molecular cloning. In each case,
·consensus sequences from the reanalysis were virtually identical to the
initial sequence results. Sequencing of amplified prov1ral DNA from 24
control patients was also done directly. None of the proviral sequences
from the dentist, patients A-G, and the 31 local controls were identical,
indicating that the specimens had not been cross-contaminated. In
addition, the proviral sequences from the dentist and the 7 patients were
reproduced in repeat analyses, providing further evidence of absence of
cross-contamination.
*
Lors du premier sequen~ge de l' ADN ~roviral du VIH \lrovenant des patients E,
F, et G, 1' ADN proviral amplifie en chame par la polymerase a d'abord fait
I' objet d'un clonage moleculaire. On a inclus les sequences particulieres achaque
patient clans les amorces utilisees pour 1' amplification afin de bien Jes distinguer.
Pourverifierces resultats, on a reanalyse d'autres prelevements de sang faits
aupres des patients F et G et une seconde aliquote du premier echantillon de sang
obtenu de la patiente E. Pour Jes besoins de cette analyse, on a prati9ue un
sequen~ge direct de 1' ADN amplifie, sans recourir au clonage moleculaire. Dans
chaque cas, les sequences consensuelles obtenues etaient pratiquement identiques
aux resultats des sequences initiales. Pour 1' ADN proviral amplifie provenant des
24 sujets temoins, on a egalement pratique un sequen~age direct. Aucune des
sequences provirales provenant du dentiste, des {'atients A aG, et des 31 temoins
locaux n'est identique aune autre, ce 9ui donne a penser queles echantillons
n 'ont pas subi de contamination croisee. En outre, on a obtenu d'autres sequences
provirales du dentiste et des 7 patients pour de nouvelles analyses, qui ont
confirme l'absence de contamination croisee.
'"159
The dentist's practice opened in 1981; although his first reported
positive HIV test was docume8fed in late 1986, the date of onset of
his HIV infection is unknown . Each of the 5 patients (patients A,
B, C, E, and G) had invasive procedures performed after the dentist
had been diagnosed with AIDS in September 1987; 4 of the 5 made
visits exclusively during a 21-month period (from November 1987
through July 1989). Patients E and G appear to have been infected
in the summer of 1988. Therefore, transmission occurred relatively
late in the course of the dentist's infection.
Le dentiste avait ouvert son cabinet en 1981. Le premier examen ayant
mis en evidence sa seropositive remonte ala [Wide 1986, mais la date du
debut de son infection a VlH n 'est pas connue . Chacun des 5 patients
(patients A, B, C, E et G) a subi des actes effractifs apres qu 'on eut pose
chez lui le diagnostic du sida en septembre 1987; 4 d'entre eux l'ont
consulte exclusivement au cours d'une periode de 21 mois (de novembre
1987ajuillet1989). Les patients E et G semblent avoir ete infectes au cours
de l'ete 1988. On peut done en conclure que la transmission de la maladie
s 'est faite aun stade relativement avance de !'evolution de !'infection chez
le dentiste.
This is the only investigation in which transmission of HIV
from an infected health-care worker to patients during invasive
procedures has been strongly suggested. Neither the precise mode
of HIV transmission to these patients nor the reasons for
transmission to multiple patients in a single practice are known.
However, hepatitis B virus, a bloodborne pathogen that is
transmitted by routes similar to those of HIV, also has been
!f ansmitted to multiple patients in the practices of indivi?J!!Jl
infected health-care workers during invasive procedures
.
Factors that may be associated with transmission of blood borne
pathogens from infected health-care workers to patients may reflect
variations in the procedures performed and techniques used by the
health-care worker, infection-control precautions used, and the titer
of the infecting agent.
II s' agit ici de la seule enquete qui laisse serieusement entrevoir la
possibilite de la transmission du VlH par un professionnel de la sante a ses
patients au cours d'actes effractifs. Ni le mode precis de transmission ni les
raisons d 'une transmission a plusieurs patients par un meme professionnel
ne sont conn us. Cependant, le virus de l'hepatite B, agent pathogene diffuse
par des voies analogues acelles du VIH, a aussi ete transmis a de nombreux
patients Je6s d' actes effractifs pratiques par des professionnels de la sante
infectes< l. Le risque de transmission d' agents pathogenes a diffusion
hematogene par les professionnels de la sante aleurs patients varie sans
doute selon les actes pratiques, des techniques utilisees, des precautions
prises pour prevenir I' infection et du titre de l' agent pa tho gene.
References
1. CDC. Possible transmission of human immunodeficiency virus
to a patient during an invasive dental procedure. MMWR
1990;39:489-93.
2. CDC. Update: transmission of HW infection during an invasive
dental procedure - Florida. MMWR 1991;40:21-7,33.
3. Ou CY, Kwok S, Mitchell SW, et al. DNA amplicationfor
direct detection ofHW-1 in DNA ofperipheral mononuclear
cells. Science 1988;239:295-7.
4. Grob P, Bischof B, NaeffR. Cluster of hepatitis B transmitted
by a physician. Lancet 1981;2:1218-20.
5. Rimland D, Parkin WE, Miller GB, et al. Hepatitis B outbreak
traced to an oral surgeon. N Engl J Med 1977;296:953-8.
6. Ahtone J, Goodman RA. Hepatitis B and denJal personnel:
transmission to patients and prevention issues. J Am Dent
Assoc 1983;106:219-22.
,e
Source: Morbidity and Mortality Weekly Rep'prt, Vot
No 23,
1991.
.'
~
..
References
1. CDC. Possible transmission of human immunodeficiency virus to a
patient during an invasive dental procedure. MMWR 1990;39:489-93.
/o,
\
'~
UPDATE: ACQUIRED IMMUNODEFICIENCY SYNDROME·
UNITED STATES, 1981-1'990
.2. CDC. Update: transmission ofHW infection during an invasive denial
procedure - Florida. MMWR 1991;40:21-7,33.
3. Ou CY, Kwok S, Mitchell SW, et al. DNA amplication for direct
detection ofHW-1 in DNA ofperipheral mononuclear cells. Science
1988;239:295-7.
4. Grob P, BischofB, NaeffR. Cluster of hepatitis B transmitted by a
physician. Lancet 1981;2:1218-20.
5. Rirnland D, Parkin WE, Miller GB, et al. Hepatitis B outbreak traced to
an oral surgeon. N Engl J Med 1977;296:953-8.
6. Ahtone J, Goodman RA. Hepatitis Band denJal personnel: transmission
to patients and prevenJion issues. J Am Dent Assoc 1983;106:219-22.
(
Source: Morbidity and Mortality Weekly Report. Vol 40, n°23,1991.
MISE AJOUR : SYNDROME DE L'IMMUNODEFICIENCE ACQUISE ETATS·UNIS, 1981-1990
In 1981, 189 cases of acquired immunodeficiency syndrome
(AIDS), a newly recognized condition, were reported to CDC from
15 states and the District of Columbia; 76% of cases were reported
from New York and California. Ninety-seven percent of cases
reported were among men, 79% of whom reported being
homosexuaVbisexual (i.e., having had sex with other men); no cases
were reported among children. In contrast, in 1990, more than
43,000 cases were reported, representing all states, the District of
Columbia, and the U.S. territories; nearly two-thirds were reported
from outside New York and California; more than 11 % of
adolescent and adult cases were in women; and nearly 800 cases
were in children <13 years of age. Theses differences between 1981
and 1990 highlight the dramatic growth and increasing complexity
of the AIDS epidemic. This report summarizes trends in the
epidemiology of AIDS cases from 1981 through 1990 in the United
States and updates AIDS cases'in 1990.
En 1981, 189 cas de syndrome d'immunodeficience acquise (sida),
maladie nouvellement reconnue, etaient signales aux Centers for Disease
Control (CDC) par 15 Etats et le District de Columbia, dont 76 p. 100
provenaient des Etats de New York et de la Californie. II s 'agissait, dans 97
p. 100 des cas, d'hommes dont 79 p. 100 declaraient etre homosexuels OU
bisexuels. II n'y avait pas d'enfants. Par comparaison, en 1990, plus de
43 000 cas ont ete signales, representant tous les Etats, par le District de
Columbia et les Territoires des Etats-Unis. Pres des 2 tiers de ces cas
proviennent d' autres Etats que New York et la Californie. Parmi les
adolescents et les adultes, plus de 11 % sont des femmes; on denombre 800
cas chez les enfants de moins de 13 ans. Les differences constatees entre
1981et1990 mettent en lumiere la croissance spectaculaire de l'epidemie
de sida et sa complexite de plus en plus grande. On resumera ici les
tendances de 1981 a 1990 dans l'epidemiologie du sida aux Etats-Unis et
fera une mise ajour du sida en 1990.
AIDS, 1981-1990
Sida, 1981-1990
During the 1980s, the number ofreported AIDS cases increased
each year. Homosexual/bisexual men and intravenous (IV)-drug
users (i.e., persons who report a history of injecting drugs) have
accounted for the largest number of AIDS cases throughout the
epidemic. The total number of AIDS cases and of cases in these
categories increased most rapidly during the middle 1980s, with
more moderate increases in the late 1980s.
Au cours des annees 80, le nombre de cas de sida sign ales s 'est accru
chaque annee. C'est chez les hommes homosexuels OU bisexuels et les
personnes qui utilisent des drogues par voie endoveineuse qu 'on rencontre
le plus grand nombre de cas de sida pour I' ensemble de l'epidemie. Le
nombre total de cas de sida le nombre de ceux qui entrent dans ces
categories a augmente le plus rapidement au cours du milieu des annees 80,
pour suivre une courbe ascendante mains forte vers la fin de la decennie.
Reported AIDS cases associated with heterosexual transmission
of human immunodeficiency virus (HIV) have been increasing
steadily, with cases occuring more frequently among women than
Le nombre de cas de sida par transmission heterosexuelle du virus de
l'immunodeficience humaine (VlH) a augmente de farron soutenue, plus de
femmes etant touchees que d'hommes. De meme, la frequence du sida
(
among men. Similarly, cases in children associated with perinatal
(mother-to-infant) mv transmission have continued to increase.
The number of AIDS cases associated with blood or blood product
transfusions has stabilized.
transmis de la mere al'enfant a continue d'augmenter. Le nombre de cas de
sida attribuable ala transfusion de sang ou de produits sanguins s'est
stabilise.
AIDS, 1990
Sida, 1990
In 1990, 43,339 AIDS cases (17.2per100,000 population) were
reported, accounting for more than one fourth (161,073) of all cases
reported during 1981-1990. Homosexual/bisexual men and IV-drug
users represented more than three fourths of reported cases
(Table 1).
En 1990, 43 339 cas de sida (17,2 par 100 000 habitants) ont ete
signales, ce qui represente plus du quart des 161 073 cas repertories de 1981
a1990. Les hommes homosexuels OU bisexuels et Jes personnes utilisant
des drogues par voie endoveineuse representent plus des 3 quarts des cas
signales (tableau 1).
Table 1/Tableau 1
Characteristics of reported persons with AIDS and percent change in cases, by year of report and year of diagnosis· United States, 1989and1990
Caracteres demographiques des personnes declarees comme etant atteintes du sida, et taux de variation par annee de rapport et annee de diagnostic (Etats·Unis 1989 et
1990)
1990 Reported cases
Cas declares en 1990
Category
Categone
(
\
Sex/Sexe
Male/Hom mes
Female/Femmes
Age (yrs)/Age (annees)
0-4
5-9
10-19
20-29
30-39
40-49
50-59
<?:60
Race/Ethnicity***/Race/origineet!mique***
White/Personnes de race blanche
Black/Personnes de race noire
Hispanic/Hispanophones
,.
Asian/Pacific Islander
Asiatiques/habitants des iles du Pacifique
American Indian/Alaskan Native
Amerindiens/autochtones de I'Alaska
' ~·Region/Region
NortheasVNord-est
MidwesV'Midwest'
South/Sud
WesVOuest
U.S. territories/Territoires des Etats-Unis
HN exposure category/Categorie d'exposition au VIH
Male homosexual/bisexual contact
Hommes homosexuals ou bisexuals
Histol)' of intravenous-drug use
Utilisation de drogues par voie endoveineuse
Women and heterosexual men
Femmes et hommes heterosexuels
Male homosexual/bisexual contact
Hommes homosexuels ou bisexuels
Persons with hemophilia/Hemophiles
AdulVadolescenVAdultes/adolescents
Child/Enfants
Transfusion recipients/Receveurs de transfusions
AdulVadolescenVAdultes/adolescents
Child/Enfants
Heterosexual contacts/Contacts·heterosexuels
Born in pattern II countl)'*"*
Personnes nees dans un pays de "pattern II"*"'
Perinatal!Transmission prenatale ou perinatale
No identified risk!Nul facteur de risque reconnu
Total
...
**
'****
1989
% change 1989·1990
Taux de variation de 1989a1990
(%)
Rate*
Taux*
Reported
cases
Cas
declares
Reported
Declares
Diagnosed**
Reconnus**
38,082
5,257
(87.9)
(12.1)
30.9
4.1
31,282
3,948
21.7
33.2
5.9
17.4
622
120
208
8,338
19,722
10,026
3,013
1,290
(1.4)
(0.3)
(0.5)
(19.2)
(45.5)
(23.1)
(7.0)
(3.0)
3.3
0.6
0.6
19.7
46.8
33.5
13.4
3.1
533
89
149
6,992
16,260
7,640
2,518
1,049
16.7
34.8
39.6
19.3
21.3
31.2
19.7
23.0
2.3
33.0
17.0
5.9
4.7
13.6
4.1
13.5
22,342
13,186
7,322
(51.6)
(30.4)
(16.9)
11.8
42.5
31.9
18,661
10,336
5,829
19.7
27.6
25.6
2.5
12.0
13.3
260
(0.6)
3.8
239
8.8
-8.8
71
(0.2)
4.0
63
12.7
23.1
13,572
4,068
14,331
9,624
1,744
(31.3)
(9.4)
(33.1)
(22.2)
(4.0)
26.7
6.8
16.8
18.2
46.2
10,710
3,491
11,010
8,511
1,508
26.7
16.5
30.2
13.1
15.6
-2.2
12.7
14.9
3.3
31.0
23,738
(54.8)
19,891
19.3
5.2
10,018
(23.1)
8,089
23.8
2,295
(5.3)
2,214
3.7
-2.7
340
31
(0.8)
(0.1)
289
25
17.6
24.0
-2.9
16.7
866
39
2,289
(2.0)
(0.1)
(5.3)
777
40
1,631
11.5
-2.5
40.3
-1.0
-2.6
40.9
422
681
2,620
43,339
(1.0)
(1.6)
(6.0)
(100.0)
379
565
1,330
35,230
11.3
20.5
-10.1
7.8
23.0
7.2
Number
Nombre
!;
17.2
'
7.9
Per 100,000 population.!Par 100 000 habitants.
Diagnosed cases adjusted for estimated delays in reµorting./Nombre de cas reconnus rajuste en raison des retards dans la declaration.
Excludes persons with unspecified race/ethnicity.IA I' exclusion des personnes dont la race ou I' origine ethnique n' est pas precisee .
Persons born in countries where heterosexual transmission predaminates./Personnes nees dans un pays ou la transmission sefait surtout par contact heterosexuel.
(
.. 161
The number of cases reported per 100,000 population was
higher for men, blacks and Hispanics, persons 30-39 and 40-49
years of age, and persons in the U.S. territories (primarily reflecting
rates in Puerto Rico) and the Northeast region than for persons in
other demographic groups or geographic areas (Table 1). Rates for
reported cases among both women and men varied widely among
states.
Le nombre de cas declares par 100 000 habitants est plus e!eve chez les
hommes, les personnes de race noire et les hispanophones, !es personnes de
30 a 49 ans et les habitants des Territoires des Etats-Unis (refletant
principalement les taux rel eves a Puerto Rico) et de la region du Nord-est ·
que chez les personnes des autres groupes demographiques ou des autres
regions (tableau 1). Les nombre de cas declares tant chez les femmes que
chez les hommes varie grandement d'un :Etat al'autre.
Women accounted for 11.5% ofreported AIDS cases among
adolescents and adults. Of the 4,890 reported cases among
adolescent and adult women in 1990, 2,539 (51.9%) occurred
among black women, 1,236 (15.3%) among white women, and
1,069 (21.9%) among Hispanic women. A history of IV-drug use
was reported by 2,329 (47.6%) women with AIDS. Heterosexual
contact with a man infected with HIV or at high risk for HIV
infection accounted for 1,657 (33.9%) cases among women; 64.1 %
of these male sex partners were IV-drug users.
Comparison of AIDS Cases in 1989and1990
Les femmes representent 11,5 p. 100 des cas de sida signales chez les
adolescents et Jes adultes, soit 4 890. Parmi ces personnes, 2 539
(51,9 p. 100) sont de race noire, 1 236 (15,3 p. 100) de race blanche et 1 069
(21,9 p. 100) hispanophones. Le nombre de celles qui declarent avoir deja
utilise des drogues par voie endoveineuse est de 2 329 (47 .6 p. 100). Le
contact Mterosexuel avec un homme infecte par le VIH ou presentant un
risque eleve d'infection par ce virus serait a l'origine de 1 657 (33,9 p. 100)
des cas releves chez les femmes; 64,1 p. 100 de leurs partenaires sont des
utilisateurs de drogues par voie endoveineuse.
Comparaison entre Jes cas de sida de 1989 et ceux de 1990
The number of AIDS cases in 1990 was compared with the
number in 1989 by 2 approaches: 1) cases reported during theses 2
periods and 2) cases diagnosed during these 2 periods and adjusted
for reporting delays. Differences in the comparisons are due to the
effect of cases reported in 1990 but diagnosed in earlier years and
cases diagnosed in 1990 but not yet reported.
On I' a faite en considerant: 1) le nombre de cas signales pendant ces 2
annees, 2) le nombre de cas reconnus au cours de ces 2 annees et rajuste en
raison de retards dans la declaration des cas. Les differences constatees dans
ces comparaisons sorit amettre sur le compte des cas signales en 1990 qui
avaient ete reconnus au cours des annees anterieures et de ceux qui,
reconnus en 1990, n'ontpas encore ete declares.
Based on year of report, the number of AIDS cases increased by
35,230 to 43,339 (23%) from 1989 to 1990; based on year of
diagnosis, cases increased from 41,200 to 44,200 (7%) (Table 1). In
both comparisons, the largest proportionate increases occurred
among women, blacks and Hispanics, persons living in the South
(excluding the U.S. territories), and persons exposed to HIV
through heterosexual contact (Table 1). However, the largest
increases in the numbers of reported cases occurred among whites
and among homosexual/bisexual men (Table 1).
Si on se fonde sur l'annee de la declaration, le nombre de cas a augmente
de 23 p. 100, soit de 35 230 a43 339. Si !'on se fonde sur l'annee du
diagnostic, le nombre a augmente de 7 p. 100, soit de 41 200 a 44 200
(tableau 1). Dans les 2 comparaisons, on constate les augmentations
proportionnelles les plus irnportantes chez les femmes, les gens de race
noire et les hispanophones, chez les personnes vivant dans le Sud (a
!'exclusion des Territoires des Etats-Unis) et chez les personnes exposees au
VIH par contact heterosexuel (tableau 1). Neanmoins, c'est chez les
personnes de race blanche et !es hommes homosexuels ou bisexuels que
l' augmentation des nombres est la plus forte (tableau 1).
Source: Morbidity and Mortality Weedly Report. Vol 40. n° 22. 1991.
Source: Morbidity and Mortality Weekly Report, Vol 40, No 22,
1991.
(
\..
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