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Date: Sun, 02 Jan 94 08:48:38 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR 24 Dec 93] Improper Infection Control During Employee
Vaccination
Message-ID: <RF9iFc1w165w@stat.com>

                        Epidemiologic Notes and Reports
                     Improper Infection-Control Practices
                    During Employee Vaccination Programs --
                  District of Columbia and Pennsylvania, 1993

     The improper use of needles and syringes and contamination of multidose
medication vials can result in transmission of bloodborne pathogens (e.g.,
hepatitis B virus [HBV] and human immunodeficiency virus [HIV]) and other
infectious agents from patient to patient (1-6). Since September 1993, CDC has
received reports from health-care providers and public health departments in
two U.S. cities regarding improper infection-control practices during
vaccination of employees at worksite vaccination programs. These practices
could potentially have exposed vaccine recipients to infectious agents. This
report summarizes the preliminary findings of an ongoing investigation of
these reports.*

    District of Columbia. A company occupational health officer reported that
a physician retained to administer influenza vaccine to employees had been
observed reusing needles to subsequently vaccinate other employees.
Investigation by the local health department confirmed that the physician
vaccinated a series of employees by using the following routine: the physician
first aspirated several doses of vaccine from a multidose vial into a syringe,
inoculated an employee, and then, after wiping the needle with an alcohol
swab, used the same needle and syringe to subsequently inoculate another
employee.

     Pennsylvania. A supervisor at a worksite reported that a physician
retained to administer influenza and pneumococcal vaccines to employees had
been observed puncturing multidose vials of vaccine with needles that had been
used previously to inoculate patients. Investigation by the local health
department confirmed that the physician first aspirated a dose of influenza
vaccine into a syringe and inoculated an employee; then, using the same
syringe and needle, aspirated pneumococcal vaccine from a multidose vial of
that vaccine and inoculated the same person. Although a new syringe and needle
were used for each employee, the physician repeatedly punctured the multidose
vials containing pneumococcal vaccine with used needles.

     Follow-up. Persons who received vaccinations at these worksites have been
counseled and offered serotesting for bloodborne pathogens (e.g., HBV and
HIV). Further investigation and follow-up of the vaccine recipients are
ongoing.

Reported by: M Levy, MD, District of Columbia Commission of Public Health. M
Moll, MD, BR Jones, DVM, Pennsylvania Dept of Health. HIV Infections Br,
Hospital Infections Program, and Hepatitis Br, Div of Viral and Rickettsial
Diseases, National Center for Infectious Diseases; National Immunization
Program; National Institute for Occupational Safety and Health, CDC.

Editorial Note: This report describes examples of improper use of needles,
syringes, and multidose vials that could potentially result in patient-to-
patient transmission of infectious agents. For example, bacteria can survive
in and have been transmitted to patients through contaminated multidose vials
and syringes (1,2,7). HBV has been transmitted by contaminated multidose
medication vials and reuse of contaminated needles and syringes (3,4). In
addition, nosocomial patient-to-patient transmission of HIV has occurred when
needles and syringes were reused without being properly sterilized (5) or were
inadvertently reused between patients (6). Finally, in a laboratory simulation
of improper clinical use, syringes and multidose vials became contaminated
with viruses (8).
     Reports of transmission of infectious agents by a single injection with a
contaminated needle and syringe or from a multidose vial have been limited.
However, the frequency with which injections are administered in health-care
settings increases the likelihood of infection transmission if proper
infection-control practices are not followed when medications, vaccines, and
other parenteral substances are injected. The following infection-control
principles are consistent with previous CDC recommendations and should be
adhered to by health-care providers and all other persons who administer
parenteral substances by injection (9,10):

o  A needle or syringe that previously has been used to inoculate a patient
   is considered contaminated and should not be used to aspirate medication
   or vaccine from a multidose vial if any of the contents of the vial will
   subsequently be administered to another patient.

o  All hypodermic needles, as well as the lumens of syringes used to
   administer parenteral substances, should be sterile. Needles and
   syringes manufactured for single use only should be discarded and should
   not be reprocessed or reused on a different patient because the
   reprocessing method may not sterilize the internal surfaces and/or may
   alter the integrity of the device.

o  Reusable needles and syringes should be cleaned and then sterilized by
   standard heat-based sterilization methods (e.g., steam autoclave or
   dry-air oven) between uses. Reprocessing of reusable needles and
   syringes by use of liquid chemical germicides cannot guarantee sterility
   and is not recommended.

o  Used needles should never be recapped or otherwise manipulated using
   both hands or any other technique that involves directing the point of
   a needle toward any part of the body. Either a one-handed "scoop"
   technique or a mechanical device designed for holding the needle sheath
   should be used if recapping is necessary. Used needles and syringes
   should be disposed of in puncture-resistant containers located as close
   as practical to where the needles and syringes are used.

References

1. Stetler HC, Garbe PL, Dwyer DM. Outbreaks of group A streptococcal
abscesses following diphtheria-tetanus toxoid-pertussis vaccination.
Pediatrics 1985;75:299-303.

2. CDC. Postsurgical infections associated with an extrinsically contaminated
intravenous anesthetic agent--California, Illinois, Maine, and Michigan, 1990.
MMWR 1990;39:426-7,433.

3. Alter MJ, Ahtone J, Maynard JE. Hepatitis B transmission associated with a
multiple-dose vial in a hemodialysis unit. Ann Intern Med 1983;99:330-3.

4. Oren I, Hershow RC, Ben-Porath E, et al. A common-source outbreak of
fulminant hepatitis B in a hospital. Ann Intern Med 1989;110:691-8.

5. Hersh BS, Popovici F, Apetrei RC, et al. Acquired immunodeficiency syndrome
in Romania. Lancet 1991;338:645-9.

6. CDC. Patient exposures to HIV during nuclear medicine procedures. MMWR
1992;41:575-8.

7. Highsmith AK, Greenhood GP, Allen JR. Growth of nosocomial pathogens in
multidose parenteral medication vials. J Clin Microbiol 1982;15:1024-8.

8. Plott RT, Wagner RF, Tyring SK. Iatrogenic contamination of multidose vials
in simulated use: a reassessment of current patient injection technique. Arch
Dermatol 1990;126:1441-4.

9. Garner JS, Favero MS. Guidelines for handwashing and hospital environmental
control. Am J Infect Control 1986;14:110-26.

10. CDC. Recommendations for prevention of HIV transmission in health-care
settings. MMWR 1987;36(no. 2S).

*Single copies of this report will be available free until December 17, 1994,
from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-
6003; telephone (800) 458-5231.




------------------------------

Date: Sun, 02 Jan 94 08:49:31 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Respiratory Syncytial Virus Activity
Message-ID: <9g9iFc2w165w@stat.com>

                                Current Trends
                Update: Respiratory Syncytial Virus Activity --
                              United States, 1993

     Respiratory syncytial virus (RSV), a common cause of communitywide
outbreaks of acute respiratory disease, is associated with an estimated 90,000
hospitalizations and 4500 deaths from lower respiratory tract disease in both
infants and young children in the United States (1). Outbreaks usually occur
from late fall or early winter through spring. Since 1989, RSV activity in the
United States has been monitored by the National Respiratory and Enteric Virus
Surveillance System (NREVSS), a voluntary, laboratory-based system. This
report summarizes surveillance results from NREVSS for RSV detections from
July 1, 1993, through December 11, 1993, and assesses trends in RSV from July
1, 1990, through December 11, 1993.
     A total of 69 laboratories (hospital-based, public health, and free-
standing) that participate in NREVSS in 39 states report weekly to CDC the
number of specimens tested for RSV by the antigen-detection and virus-
isolation methods and the number of positive results. Onset of RSV activity is
defined by NREVSS as the first of 2 consecutive weeks when at least half of
participating laboratories reported any RSV detections or isolations.
     As of November 30, 1993, 36 (59%) of the 61 laboratories reporting
detections noted an increase in RSV-positive results, indicating the onset of
outbreak activity for the 1993-94 winter season. By December 11, the median
percentage positive had increased to 16.7%.
     During the three preceding seasons (i.e., 1990-91, 1991-92, and 1992-93),
nationwide onset of RSV outbreak activity began during the last week of
October through mid-December; activity peaked during January-February (Figure
1). Although the timing of the peak in the percentage of specimens positive
for individual laboratories varied, these peaks usually occurred within 1
month of the national peak.

Reported by: Emory Univ School of Public Health, Atlanta. National Respiratory
and Enteric Virus Surveillance System laboratories. Respiratory and Enteric
Virus Br, Div of Viral and Rickettsial Diseases, National Center for
Infectious Diseases, CDC.

Editorial Note: With the onset of the 1993-94 RSV season, health-care
providers should consider the role of RSV as a cause of acute respiratory
disease in both children and adults. Most severe manifestations of infection
with RSV (e.g., pneumonia and bronchiolitis) occur in infants aged 2-6 months;
however, children of any age with underlying cardiac or pulmonary disease or
who are immunocompromised are at risk for serious complications from this
infection. Because natural infection with RSV provides limited protective
immunity, RSV may cause repeated symptomatic infections throughout life. In
adults, RSV usually causes upper respiratory tract manifestations but may
cause lower respiratory tract disease--especially in the elderly and in
persons with compromised immune systems.
     RSV is a common, but preventable, cause of nosocomially acquired
infection; the risk for nosocomial transmission is increased during community
outbreaks. Sources for nosocomially acquired infection include infected
patients, staff, visitors, or contaminated fomites. Nosocomial outbreaks or
transmission of RSV can be controlled with strict attention to contact-
isolation procedures (2). In addition, chemotherapy with ribavirin is
indicated for some patients (e.g., those at high risk for severe complications
or who are seriously ill with this infection) (3); prophylaxis with
intravenous RSV immunoglobulin for high-risk patients may become available
during future RSV seasons (4).

References

1. Institute of Medicine. Appendix N. In: Institute of Medicine. New vaccine
development: establishing priorities. Vol 1. Diseases of importance in the
United States. Washington, DC: National Academy Press, 1985:397-409.

2. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals.
Infect Control 1983;4(suppl):245-325.

3. Committee on Infectious Diseases, American Academy of Pediatrics. Ribavirin
therapy of respiratory syncytial virus. In: American Academy of Pediatrics.
Report of the Committee on Infectious Diseases. 22nd ed. Elk Grove Village,
Illinois: American Academy of Pediatrics, 1991:581-7.

4. Groothuis JR, Simoes EAF, Levin MJ, et al. Prophylactic administration of
respiratory syncytial virus immune globulin to high-risk infants and young
children. N Engl J Med 1993;329:1524-30.




------------------------------

Date: Sun, 02 Jan 94 08:51:14 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Status of Public Health in Bosnia & Herzegovina
Message-ID: <4J9iFc3w165w@stat.com>

                              International Notes
              Status of Public Health -- Bosnia and Herzegovina,
                             August-September 1993

     Since 1991, civil strife in the former Yugoslav republics (Figure 1) has
resulted in more than 150,000 war-related casualties (1), approximately 3.5
million displaced persons (2), widespread destruction of the health
infrastructure, disruption of food production and distribution, and other
increased risks to public health. The impact of the war has been especially
severe in Bosnia and Herzegovina (1991 population: 4.3 million) (1). To assist
in targeting humanitarian aid to the region, in August 1993, the U.S. Agency
for International Development's Office of Foreign Disaster Assistance asked
CDC to assess the public health status and needs of Bosnia and Herzegovina.
This report summarizes the results of that assessment and focuses on three
central Bosnian regions.
     This assessment was based on interviews with local public health
officials and international humanitarian aid workers; reviews of data
collected by local public health institutions and results of surveys conducted
by United Nations (UN) agencies and nongovernment organizations (NGOs); and
observations in central Bosnia (regions of Sarajevo, Zenica, and Tuzla) and
Herzegovina. Because of security and time constraints, primary data could not
be collected.
     The principal public health impact of the war has been injuries resulting
from war-related trauma. In Sarajevo, the war accounted for more than 6800
deaths from trauma (57% of all reported mortality) and 16,000 wounded persons
during April 1992-March 1993 (3). In addition, the increase in the crude
mortality rate reported in Sarajevo (2.9 deaths per 1000 population in April
1993 compared with 0.8 per month in 1991) was attributed to these casualties
(3). In the Zenica Provincial Hospital, the proportion of surgical cases
associated with trauma increased from 22% in April 1992 (the month the war
began) to a peak of 78% in December 1992 and declined to 40% in August 1993.
Overall, 60% of surgical cases from July 1992 through August 1993 were war-
related injuries.
     Based on estimates of the Office of the United Nations High Commissioner
for Refugees (UNHCR), the number of persons displaced from their homes in
Bosnia and Herzegovina from January 1993 through August 1993 increased from
810,000 to approximately 2 million (2). In August 1993, approximately 90% of
displaced persons were living in private homes, and 10% were housed in
collective centers maintained by local and international humanitarian aid
agencies.
     Although increased numbers of displaced persons and the disruption of
local agricultural production have intensified needs for international food
aid, military forces representing different factions have intermittently
blocked access by UN food convoys to central Bosnia. In August 1993, UNHCR was
able to transport only 57% of basic food requirements for beneficiaries in the
Zenica region and only 39% of requirements for the Tuzla region. Despite these
limited rations, nutrition surveys conducted by the World Health Organization
(WHO) in central Bosnia in July 1993 did not detect an increased prevalence of
protein-energy malnutrition--even though the mean weight loss for adults in
Sarajevo since April 1992 has been 10-12 kg per person (4,5).
     The incidence of diagnosed cases of hepatitis A and other enteric
diseases has increased in all areas of central Bosnia since the beginning of
the war (Republic Institute for Public Health of Bosnia and Herzegovina,
unpublished data, 1993; 6) (Table 1). The increased occurrence of enteric
diseases reflects deterioration in the quantity and quality of water supplies
that has resulted from diverted water sources, cracked water pipes, lack of
diesel to run water pumps, and frequent losses of water pressure that, in
turn, permit cross-contamination by sewage. In August 1993, for example, piped
water supplies in Sarajevo were restricted to an average of 5 liters per
person per day (WHO recommends daily provision of 20 liters per person to
maintain health).
     Although some elements of the public health system continue to function,
in most areas, routine prevention programs have been curtailed. For example,
in central Bosnia from June 1991 through July 1993, 33% of children aged 13-25
months had been vaccinated against measles compared with coverage rates of
90%-95% in 1990 (4). However, since April 1992, no outbreaks of measles had
been reported (6). In Sarajevo, during April 1992-July 1993, inadequate
prenatal-care services contributed to increases in spontaneous abortions (64%)
and perinatal mortality (70%) and a 19% decrease in average birthweight (S.
Simic, MD, Kosevo Hospital, Sarajevo, personal communication, 1993).
     These prevention and other primary-care programs have been limited
because of decreased access to the population, damaged health-care facilities,
and inadequate supplies and resources. An especially critical supply hindered
by the military blockade has been diesel, which cost $36 U.S. per gallon on
the illegal market in Sarajevo in August 1993. Because of this fuel shortage,
water pumps cannot function, health-care workers cannot travel to rural
clinics, and some public health programs (e.g., garbage collection and
vaccination campaigns) have been curtailed.

Reported by: Republic Institute for Public Health of Bosnia and Herzegovina,
Sarajevo, Zenica, and Tuzla. Office of the World Health Organization, Regional
Office for Europe, Special Representative of the Regional Director, Zagreb,
Croatia. US Office of Foreign Disaster Assistance, Washington, DC. Technical
Support Div, International Health Program Office, CDC.

Editorial Note: During war-related emergencies in developing countries,
infectious diseases consistently have been reported as the leading cause of
morbidity and mortality in the affected civilian populations (7). However, the
proportion of deaths in the civilian population attributed to war-related
injuries in Bosnia is among the highest documented in recent humanitarian
emergencies related to civil war (7). By comparison, population surveys in
central and southern Somalia determined that trauma deaths accounted for 4%-
11% of mortality during April 1992-January 1993 (CDC, unpublished data, 1993).
     Although increases in enteric disease-related mortality have not been
reported, the fivefold to 16-fold increases in the incidence rates of
diarrheal disease and hepatitis A from 1990 through 1993 in three central
Bosnian regions underscore the urgent need for improvements in water and
sanitation. Rates of infectious diseases in Bosnia are lower than those
reported in civil wars in developing countries and may reflect at least five
factors: 1) disease reporting has been incomplete; 2) most displaced persons
are residing in private homes rather than in mass camps; 3) elements of a
previously well functioning local public health system are still operating; 4)
public health efforts of UN agencies and NGOs have supplemented local
programs; and 5) a well educated, resourceful population has maintained
relatively high standards of personal hygiene (S. Sahadzic, United Nations
Children's Fund, Sarajevo, personal communication, 1993).
     The limited occurrence of vaccine-preventable diseases in Bosnia and
Herzegovina may reflect high prewar vaccination rates and the relative absence
of crowded camps that have characterized other refugee emergencies. However,
measles epidemics have occurred in countries with measles vaccine coverage
levels of 70% or higher (8) and the potential for such outbreaks remains high
in central Bosnia.
     Even though the availability and distribution of food rations have been
limited in Bosnia, WHO surveys suggest low prevalences of acute malnutrition.
This finding may reflect a combination of four factors: 1) the presence of
substantial household food reserves in 1992 (3); 2) a baseline (i.e. prewar)
prevalence of elevated body mass index (9); 3) effective food distribution
efforts by UNHCR from 1992 until July 1993 (2); and 4) food deliveries by
commercial trucks through regular trade routes from Croatia and Serbia until
April 1993 (3).
     This assessment was limited by the degree of underreporting and
diminished sensitivity of currently operating surveillance systems. Because
reports of health status provided by government sources under such
circumstances may be subject to bias, independent public health surveillance
and assessments should be conducted to ensure the accuracy of such reports.
     Priorities for relief efforts in Bosnia and Herzegovina may differ from
those usually recommended for complex disasters in developing countries (7).
Moreover, during 1994, the public health of residents of this region may be
further threatened by lack of access by international relief agencies, limited
food and fuel reserves, a likely increase in the nutritionally vulnerable
population (especially children, the elderly, and pregnant women), and the
severity of the winter. In addition to the identification of secure routes of
access and transportation of diesel into central Bosnia, recommendations for
immediate action by appropriate UN agencies and NGOs have included
strengthening of programs for water and sanitation, childhood vaccination, and
prenatal care and expansion of the WHO health monitoring and nutritional
surveillance system.

References

1. Toole MJ, Galson S, Brady W. Are war and public health compatible? Lancet
1993;341:1193-6.

2. Office of the United Nations High Commissioner for Refugees. Information
notes on former Yugoslavia, August 1993. Split, Croatia: Office of the United
Nations High Commissioner for Refugees, 1993.

3. Medecins Sans Frontieres/Holland. Report of a household survey in Sarajevo,
Bosnia-Herzegovina, April 1993. Amsterdam: Medecins Sans Frontieres, 1993.

4. World Health Organization Nutrition Unit, Zagreb. Summary report of
nutritional health surveys carried out in Bosnia-Herzegovina during June/July
1993. Zagreb, Croatia: World Health Organization, 1993.

5. Black ME, Healing TD. Communicable diseases in former Yugoslavia and in
refugees arriving in the United Kingdom. Communicable Disease Report
1993;3:R87-R90.

6. Healing TD. End of mission report on the health monitoring program in the
war affected areas of former Yugoslavia. London: Communicable Disease
Surveillance Center, 1993.

7. Toole MJ, Waldman RJ. Refugees and displaced persons. JAMA 1993;270:600-5.

8. Cutts FT, Henderson RH, Clements CJ, Chen RT, Patriarca PA. Principles of
measles control. Bull World Health Organ 1991;69:1-7.

9. World Health Organization Nutrition Unit, Zagreb. Eighteenth report:
nutrition report from 1st-31st July. Zagreb, Croatia: World Health
Organization, 1993.




------------------------------

Date: Sun, 02 Jan 94 08:52:02 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Acyclovir Resistant Genital Herpes Found Person Healthy Immune System
Message-ID: <FL9iFc4w165w@stat.com>

                  Acyclovir-Resistant Genital Herpes Found in
                       Person with Healthy Immune System

             National Institute of Allergy and Infectious Diseases
                         NATIONAL INSTITUTES OF HEALTH
                               December 8, 1993



     Researchers at the National Institute of Allergy and Infectious Diseases
(NIAID) report the first documented case of recurrent genital herpes in a
person with a healthy immune system whose repeated outbreaks were not
suppressed by oral acyclovir, the standard therapy for preventing
recurrences.
     The study revealed the patient's virus to be resistant to the drug, which
suggests that acyclovir-resistant strains of the herpes virus may pose
problems for healthy patients as well as for people with compromised immune
systems.
     The research report appears in the Dec. 9 issue of The New England
Journal of Medicine. Genital herpes, a contagious viral infection caused by
the herpes simplex virus (HSV), affects an estimated 30 million Americans.
Each year, as many as 500,000 new cases may occur.  Once a person is infected,
the virus remains in the body and causes new outbreaks.  While some people
recognize only one or two recurrences in a lifetime, others may experience
several outbreaks a year.
     "Acyclovir has safely and effectively suppressed frequent genital herpes
recurrences in people with healthy immune systems for more than a decade,"
says Anthony S. Fauci, M.D., NIAID director. "This study, however, signals a
limitation in the current treatment of this disease and underscores the need
for new preventative and therapeutic strategies."
     "The possibility that resistance to acyclovir could occur in people with
healthy immune systems has long been a concern," says Stephen E. Straus, M.D.,
chief of the Laboratory of Clinical Investigation (LCI) for NIAID and lead
researcher on the study. "Viral resistance has been documented in animal
models and already is a problem in people with compromised immune systems such
as individuals with HIV infection."
     "While acyclovir-resistant genital herpes may be rare in people with
healthy immune systems, the current study suggests that resistance to the drug
may be emerging," Dr. Straus adds.
     In an earlier NIAID study of long-term treatment to suppress outbreaks of
genital herpes in people with healthy immune systems, investigators found
evidence of acyclovir resistance, but could not link these findings to
patients' outbreaks.
     The current report describes a 24-year-old man who since November of 1990
has had frequent, symptomatic outbreaks of genital herpes despite increasing
doses of oral acyclovir of up to 4.8 grams per day, which is six times the
amount usually required to suppress recurrences.  The patient's immune system
has prevented the outbreaks from becoming severe or longlasting, the authors
note.
     "Intravenous acyclovir or other antiviral therapies might suppress this
patient's recurring disease, but the potential cost, side effects and probable
temporary benefit that they would provide preclude consideration of these
treatments," says Dr. Straus.
     Study investigators acknowledge that this patient may have acquired an
acyclovir-resistant virus through sexual contact with an HIV-infected partner
known to be taking acyclovir.  They suggest, however, that resistance also may
have developed during the course of his therapy.
     Dr. Straus' co-authors include Rhonda G. Kost, M.D., also of LCI, Edgar
L. Hill, M.S., of the Division of Virology at Burroughs Wellcome Company,
Research Triangle Park, N.C., and Michael Tigges, Ph.D., of Chiron
Corporation, Emeryville, Calif.
     NIAID, a component of the National Institutes of Health, supports
research on AIDS, tuberculosis and other infectious diseases as well as
allergies and immunologic diseases.  NIH is an agency of the U.S. Public
Health Service, part of the U.S. Department of Health and Human Services.




------------------------------

Date: Sun, 02 Jan 94 08:52:33 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Seeking Help and Information Regarding Chronic ITP
Message-ID: <am9iFc5w165w@stat.com>

                 "Seeking Help and Info Regarding Chronic ITP"

                Please address your responses to mjw@texaco.com

I'm writing on behalf of my 4-year old son who has Chronic ITP. This is a
relatively rare disorder, and treatment is extremely limited for patients that
don't spontaneously recover on their own.  I'm looking for other families with
Chronic ITP children to correspond with, concerning how to deal with
developmental problems that may occur in future years.  I'm also seeking
information regarding any success with experimental treatments for this
disorder.  We've tried steroids and high-dose IVIGG, and most recently,
immunizations for pneumococcal, meningococcal and hemophilus B, hoping to
trigger an auto-immune response that might also have a positive effect on the
ITP.  The've talked about trying Interferon, but haven't yet.  Splenectomy
seems to be considered as a last-resort for Chronic ITP patients, but we keep
hearing how dangerous this is for children.  I would very much appreciate
hearing from anyone having additional information about any of this.  Thanks
in advance!

Please e-mail your reply to mjw@texaco.com (using subject *Matt*).




------------------------------

Date: Sun, 02 Jan 94 08:53:01 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Neurosciences Internet Resource Guide
Message-ID: <3m9iFc6w165w@stat.com>

              ===================================================
                     NEUROSCIENCES INTERNET RESOURCE GUIDE
              ===================================================
                          December 1993,  version 1.0

                                  Compiled by
                       Steve Bonario and Sheryl Cormicle
                                nirg@umich.edu

                  School of Information and Library Studies,
                            University of Michigan
              ---------------------------------------------------

After considerable effort and plenty of invaluable input and advice from the
Internet's neuroscience community, we are happy to announce the availability
of The Neurosciences Internet Resource Guide, version 1.0.  This document aims
to be a guide to existing, free, Internet-accessible resources helpful to
neuroscientists of all stripes.  We are pleased and proud to present the first
fruits of our labor, a snapshot of what we found on the Internet between
September and December of 1993.  This is not a static document -- we expect it
to change and you can help change it.  Let us know what we missed
<nirg@umich.edu>.

HOW TO GET IT
-------------

An **ASCII text version** (86K) is available in the
Clearinghouse of Subject-Oriented Internet Resource Guides as
follows:

anonymous FTP:
        host:   una.hh.lib.umich.edu
        path:   /inetdirsstacks
        file:   neurosci:cormbonario

gopher:
        via U. Minnesota list of gophers
        menu:   North America/USA/Michigan/Clearinghouse.../
                        All Guides/Neurosciences

WWW:
        gopher://una.hh.lib.umich.edu/00/inetdirsstacks/
                neurosci:cormbonario


We are also creating a **hypertext version** of the guide intended for viewing
using Mosaic, the World Wide Web browser from NCSA.  This version is under
construction, but accessible.  Check it out and give us feedback!  The URL is:

http://http2.sils.umich.edu/Public/nirg/nirg1.html


QUESTIONS OR COMMENTS?   nirg@umich.edu




------------------------------

Date: Sun, 02 Jan 94 08:53:28 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: CancerNet Update
Message-ID: <sN9iFc7w165w@stat.com>

            +----------------------------------------------+
            |       NATIONAL           INSTITUTE           |
            |               C A N C E R                    |
            |  INTERNATIONAL           INFORMATION         |
            |               C E N T E R                    |
            +----------------------------------------------+
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CancerNet has been updated for January. The following statements
were modified.

Changed Cancer Information Statements:

Adult acute myeloid leukemia                        cn-101029
Adult Hodgkin's disease                             cn-100003
Brain metastases                                    cn-103854
Breast cancer                                       cn-100013
Cervical cancer                                     cn-100103
Childhood acute myeloid leukemia                    cn-101081
Childhood brain tumor                               cn-100047
Colon cancer                                        cn-100008
Laryngeal cancer                                    cn-101519
Lip and oral cavity cancer                          cn-102840
Malignant mesothelioma                              cn-101071
Malignant thymoma                                   cn-101248
Melanoma                                            cn-101302
Nonsmall cell lung cancer                           cn-100039
Ovarian germ cell tumor                             cn-103125
Plasma cell neoplasm                                cn-100281
Prostate cancer                                     cn-101229
Skin cancer                                         cn-101228
Small cell lung cancer                              cn-100040
Testicular cancer                                   cn-101121


Changed Patient statements:


Adult acute myeloid leukemia                        cn-201029
Adult Hodgkin's disease                             cn-200003
Laryngeal cancer                                    cn-201519
Malignant thymoma                                   cn-201248
Melanoma                                            cn-201302
Nonsmall cell lung cancer                           cn-200039
Ovarian germ cell tumor                             cn-203125
Skin cancer                                         cn-201228


Changed screening statements:

Breast cancer                                       cn-304723


Changed supportive care statements:

Constipation, impaction, and bowel obstruction       cn-303510
Fever, chills, and sweats                            cn-302327
Nausea and vomiting                                  cn-304466
Nutrition                                            cn-304467
Superior vena cava syndrome                          cn-304708





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Changes to PDQ database information:

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New NCI Fact Sheets:

Breast Cancer Screening                                   cn-600513
Questions and Answers on Tamoxifen (in Spanish)           cn-600721


Fact Sheets which have been changed:

The National Cancer Institute Cancer Centers Program      cn-600012
Referral Information for Breast Cancer Prevention Trial   cn-400020
                                                          cn-400021
                                                          cn-400022
                                                          cn-400023
                                                          cn-400024
                                                          cn-400025

Referral Information for the Prostate Cancer Prevention
Trial                                                     cn-400090
                                                          cn-400091
                                                          cn-400092
                                                          cn-400093
                                                          cn-400094
                                                          cn-400095

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------------------------------

Date: Sun, 02 Jan 94 08:54:09 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Institute of Tropical Medicine Epidemiological Bulletin 12/11/93
Message-ID: <yo9iFc8w165w@stat.com>

IPK - EPIDEMIOLOGICAL BULLETIN               Vol 3e / No.49
                                             Date: 12/11/93


Institute of Tropical Medicine "Pedro Kouri"
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------------

Cuba. Cases and Cumulative of selected notifiable diseases. Week
ending 12/11/93. (49th week)
-------------------------------------------------------------------
DISEASES            IN THIS WEEK   CUMULATIVE          RATES+
                    1992 1993      1992      1993      1992 1993
------------------------------------------------------------------
 TYPHOID FEVER      2    *         48        207       0.4  2.0
 TUBERCULOSIS       14   16        549       608       5.3  5.9
 HANSEN DISEASE     5    2         279       167       2.7  1.9
 PERTUSSIS          *    *         1         11        0.0  0.1
 SCARLET FEVER      *    4         582       340       5.7  3.3
 TETANUS            *    *         3         2         0.0  0.0
 ASEPTIC MEN.       59   38        3945      3250     38.7  31.5
 BACTERIAL MEN.     24   38        1653      1116     16.2  10.8
 VARICELLA          263  205       103290    40123  1015.8  389.9
 VIRAL HEPATITIS    349  187       30380     14200   298.7  138.0
 MALARIA            *    8         11        8         0.1  0.0
 LEPTOSPIROSIS      34   80        602       824       5.9  8.0
 MENINGOCOCCAL D.   5    2         144       68        1.4  0.6
 SYPHILIS           234  234       10400     8710    102.2  84.6
 GONORRHEA          377  359       24660     17924   242.5  174.2
 ACUMINATA COND.    42   35        2311      1786     22.7  17.3
 MEASLES            *    *         11        *         0.1  *
 RUBELLA            *    *         6         *         0.0  *
 MUMPS              *    1         3         1         0.0  0.0
 ACUTE AMEB. D.     25   6         793       1452      7.8  14.2
------------------------------------------------------------------
 Source:  1992, MND (Written Report) EIG-IPK.
          1993, MND (Phone Report) EIG-IPK.

          * Means 0 reported case.
          + Period adjusted rate.


Medical Consultations of Acute Diarrhoeal Diseases by age groups.
Cases and Cumulative. Week ending 12/11/93 (49th week).
------------------------------------------------------------------
               IN THIS WEEK                       CUMULATIVE
 AGE           CASES               MEDIAN         1992      1993
 GROUPS        1992      1993      (1986-1992)
------------------------------------------------------------------
 <1            2969      3502      3892           183719   154403
 1 - 4         3467      4298      3685           207641   191350
 5 - 14        2148      3130      2336           133278   139000
 15 - 64       6840      7989      6405           467508   473263
 > 65          764       907       637            48135    49058
------------------------------------------------------------------
 Source:  MND (Phone Report).


Acute Respiratory Infections. Cuba, Weekly Index by age groups.
Week ending 12/11/93 (49th week)
-------------------------------------------------------
 AGE           WEEKLY         EPIDEMIC       EPIDEMIC
 GROUPS        INDEX          INDEX          THRESHOLD
-------------------------------------------------------
 < 1           412            613            728
 1 - 4         250            337            420
 5 - 14        88             95             120
 15 - 64       26             36             46
 > 65          22             29             36
 ALL AGES      56             72             84
-------------------------------------------------------
 Source:  MND (Phone Report). Index x 10000 inhabitants.


Notified Outbreaks. Week 12/09/93 - 12/15/93.
-----------------------------------------------------------------
DISEASES       NUMBER OF OUTBREAKS      CASES    PROVINCES
-----------------------------------------------------------------
 F.T.D.                        6        154      CIENFUEGOS 5/56
                                                 VILLA CLARA 1/98
------------------------------------------------------------------
 A.R.I.                        1        15       HOLGUIN
------------------------------------------------------------------
 A.D.D.                        1        18       HOLGUIN
-----------------------------------------------------------------
 Source:  DIS.


Meningococcal Disease. Cuba. More important indexes. Week ending
12/15/93.
-------------------------------------------------------------------
AGE       MORBIDITY                MORTALITY           LETHALITY
 GROUPS   CASES     RATES          DEATHS    RATES     RATES
          1992 1993 1992 1993      1992 1993 1992 1993 1992 1993
------------------------------------------------------------------
 0-5      95   39   9.0  3.6       18   8    1.7  0.7  18.6 20.5
 6-14     14   8    1.3  0.6       2    1    0.1  0.0  14.2 12.5
 >15      35   21   0.4  0.2       13   9    0.1  0.1  37.1 42.8
 ALL AGES 144  68   1.4  0.6       33   18   0.3  0.1  22.9 26.4
------------------------------------------------------------------
 Source:  DIS, EIG-IPK
          Cumulative and period adjusted rate x 100000 inhabitants.
          Lethality expressed as percentage.


_________________________________________________________________
This bulletin was prepared with the 53% of provinces-days-
information. The provinces: Villa Clara, Cienfuegos and Holguin
have contributed with the 100% provinces-days-information.

The offered indexes are provisionals and were taken from the daily
report of the Direct Information System (DIS) remitted by
Provincial Centers of Hygiene and Epidemiology, from the weekly
phone report of Mandatory Notifiable Diseases (MND) remitted by
National Statistics Division of the Ministry of Public Health, and
from the Reference Laboratories of the Institute of Tropical
Medicine "Pedro Kouri".
_________________________________________________________________

This is the weekly IPK-Epidemiological Bulletin emitted via
Electronic Mail. The numbering plan agree with the IPK-
Epidemiological Bulletin edited by Institute of Tropical Medicine
"Pedro Kouri" and it is an abbreviated version.

If you are interested in receiving this bulletin, please send your
electronic address to:

Lic. Andres M. Alonso
Institute of Tropical Medicine "Pedro Kouri"
ipk-b@infomed.cu




------------------------------

Date: Sun, 02 Jan 94 08:54:54 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: HIV/AIDS Quarterly Surveillance Report Nov 1993
Message-ID: <8P9iFc9w165w@stat.com>

HIV/AIDS Surveillance Report
Monday    November 1, 1993

Suggested Citation:
Centers for Disease Control and Prevention.  HIV/AIDS Surveillance
Report, November 1993

Report Description
The U.S. AIDS case data presented below are extracted from the
"HIV/AIDS/ Survillance Report", published each quarter by the
Division of HIV/AIDS, Center for Infectious Diseases, Centers for
Disease Control and Prevention, Atlanta, GA  30333.  In addition to
the data presented here, the printed report contains maps, figures,
and technical notes.  Single copies of the printed report are
available from:

                        CDC National AIDS Clearinghouse
                        P.O. Box 6003
                        Rockville, MD  20849-6003


Table 1. AIDS cases and annual rates per 100,000 population, by
state, reported October 1991 through September 1992, October 1992
through September 1993;(1) and cumulative totals, by state and age
group, through September 1993,(2) United States
                                     Oct. 1991-         Oct. 1992-
                                     Sept. 1992         Sep. 1993
State of residence                  No.    Rate        No.    Rate

Alabama                             465    11.4        705    17.0
Alaska                               18     3.2         60    10.2
Arizona                             408    10.9      1,202    31.3
Arkansas                            237    10.0        420    17.5
California                        8,641    28.4     17,474    56.4
Colorado                            415    12.3      1,193    34.5
Connecticut                         538    16.3      1,693    51.4
Delaware                            126    18.5        346    49.9
District of Columbia                724   121.0      1,370   232.3
Florida                           5,007    37.7      9,613    70.6
Georgia                           1,348    20.4      2,597    38.4
Hawaii                              175    15.4        324    27.9
Idaho                                36     3.5         71     6.6
Illinois                          1,842    16.0      3,005    25.8
Indiana                             370     6.6        831    14.6
Iowa                                 86     3.1        196     7.0
Kansas                              188     7.5        335    13.3
Kentucky                            207     5.6        316     8.4
Louisiana                           829    19.5      1,172    27.4
Maine                                50     4.0        126    10.2
Maryland                          1,096    22.6      2,353    47.6
Massachusetts                       767    12.8      2,532    42.4
Michigan                            784     8.4      1,752    18.6
Minnesota                           237     5.3        624    13.9
Mississippi                         231     8.9        468    17.9
Missouri                            650    12.6      1,679    32.3
Montana                              22     2.7         35     4.3
Nebraska                             68     4.3        179    11.1
Nevada                              235    18.3        601    44.0
New Hampshire                        48     4.3         99     9.0
New Jersey                        2,051    26.4      4,390    56.3
New Mexico                           90     5.8        307    19.4
New York                          8,232    45.6     16,031    88.4
North Carolina                      648     9.6      1,059    15.5
North Dakota                          4     0.6          4     0.6
Ohio                                696     6.4      1,490    13.5
Oklahoma                            228     7.2        716    22.3
Oregon                              283     9.7        732    24.4
Pennsylvania                      1,338    11.2      2,556    21.2
Rhode Island                        102    10.2        305    30.3
South Carolina                      347     9.7      1,395    38.4
South Dakota                          8     1.1         23     3.2
Tennessee                           442     8.9        967    19.2
Texas                             2,944    17.0      7,164    40.4
Utah                                145     8.2        270    14.9
Vermont                              26     4.6         60    10.5
Virginia                            606     9.6      1,590    24.9
Washington                          573    11.4      1,459    28.2
West Virginia                        61     3.4         78     4.3
Wisconsin                           224     4.5        700    13.9
Wyoming                               4     0.9         36     7.7

Subtotal                         44,900    17.8     94,703    37.0

Guam                                  1     0.7          2     1.5
Pacific Islands, U.S.                 -       -          -       -
Puerto Rico                       1,796    50.5      2,621    73.1
Virgin Islands, U.S.                 19    18.6         42    40.8


Total                            46,716    18.2     97,368    37.5


                                 Cumulative totals
                             Adults/         Children
                           adolescents    < 13 years old     Total

Alabama                        2,275             43           2,318
Alaska                           154              2             156
Arizona                        3,059             14           3,073
Arkansas                       1,239             21           1,260
California                    62,201            356          62,557
Colorado                       3,516             18           3,534
Connecticu                     4,415             98           4,513
Delaware                         830              7             837
District of Columbia           5,231             78           5,309
Florida                       32,008            751          32,759
Georgia                        9,255             87           9,342
Hawaii                         1,250             10           1,260
Idaho                            203              2             205
Illinois                      10,522            140          10,662
Indiana                        2,443             17           2,460
Iowa                             577              6             583
Kansas                         1,031              5           1,036
Kentucky                       1,148             13           1,161
Louisiana                      4,811             67           4,878
Maine                            427              4             431
Maryland                       7,187            152           7,339
Massachusetts                  7,238            132           7,370
Michigan                       4,904             62           4,966
Minnesota                      1,829             13           1,842
Mississippi                    1,483             20           1,503
Missouri                       4,626             33           4,659
Montana                          134              2             136
Nebraska                         469              4             473
Nevada                         1,641             15           1,656
New Hampshire                    368              6             374
New Jersey                    18,106            423          18,529
New Mexico                       831              2             833
New York                      63,660          1,321          64,981
North Carolina                 3,735             75           3,810
North Dakota                      32              -              32
Ohio                           4,944             68           5,012
Oklahoma                       1,795             15           1,810
Oregon                         2,233              9           2,242
Pennsylvania                   9,086            120           9,206
Rhode Island                     842              9             851
South Carolina                 3,022             38           3,060
South Dakota                      57              2              59
Tennessee                      2,734             26           2,760
Texas                         23,572            213          23,785
Utah                             818             20             838
Vermont                          176              2             178
Virginia                       4,710             82           4,792
Washington                     4,765             18           4,783
West Virginia                    359              5             364
Wisconsin                      1,705             19           1,724
Wyoming                           91              -              91

Subtotal                     323,747          4,645         328,392

Guam                              12              -              12
Pacific Islands, U.S               2              -              2
Puerto Rico                   10,436            256          10,692
Virgin Islands, U.S.             147              5             152


Total                        334,344          4,906         339,250

(1)  Includes 9  months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
(2)  During the third quarter of 1993, CDC received reports of
23,664 cases and  9,951 deaths among adults/adolescents and 196
cases and 105 deaths among children.




Table 2. AIDS cases and annual rates per 100,000 population, by
metropolitan area with 500,000 or more population, reported October
1991 through September 1992, October 1992 through September 1993;1)
and cumulative totals, by area and age group, through September
1993, United States
                                     Oct. 1991-        Oct. 1992-
                                     Sept. 1992        Sept. 1993
Metropolitan
area of residence(2)                 No.    Rate        No.    Rate

Akron, Ohio                           36     5.4         46     6.9
Albany-Schenectady, N.Y.             106    12.2        217    24.7
Albuquerque, N.M.                     58     9.6        186    30.2
Allentown, Pa.                        32     5.3        122    20.0
Ann Arbor, Mich.                      29     5.8         63    12.4
Atlanta, Ga.                         956    31.3      1,773    56.4
Austin, Tex.                         241    27.6        586    65.0
Bakersfield, Calif.                   50     8.8        161    27.3
Baltimore, Md.                       669    27.7      1,628    66.6
Baton Rouge, La.                      92    17.1        135    24.7
Bergen-Passaic, N.J.                 267    20.9        677    52.8
Birmingham, Ala.                     116    13.7        259    30.2
Boston, Mass.                        659    11.6      2,268    40.2
Buffalo, N.Y.                         69     5.8        198    16.5
Charleston, S.C.                      70    13.4        259    47.9
Charlotte, N.C.                      118     9.9        245    20.1
Chicago, Ill.                      1,614    21.5      2,619    34.5
Cincinnati, Ohio                     112     7.3        230    14.7
Cleveland, Ohio                      199     9.0        458    20.6
Columbus, Ohio                       158    11.5        336    24.1
Dallas, Tex.                         759    27.7      1,805    64.4
Dayton, Ohio                          67     7.0        132    13.7
Denver, Colo.                        335    20.1      1,010    58.9
Detroit, Mich.                       606    14.1      1,233    28.7
El Paso, Tex.                         46     7.5        116    18.3
Fort Lauderdale, Fla.                848    65.9      1,165    88.4
Fort Worth, Tex.                     160    11.5        404    28.2
Fresno, Calif.                        99    12.7        173    21.5
Gary, Ind.                            47     7.7         78    12.6
Grand Rapids, Mich.                   37     3.9        126    13.0
Greensboro, N.C.                     128    12.0        151    14.0
Greenville, S.C.                      62     7.4        255    29.8
Harrisburg, Pa.                       46     7.7         78    12.9
Hartford, Conn.                      167    14.8        565    50.2
Honolulu, Hawaii                     124    14.6        256    29.6
Houston, Tex.                      1,023    29.8      2,587    72.8
Indianapolis, Ind.                   170    12.1        397    27.7
Jacksonville, Fla.                   327    35.0        910    94.7
Jersey City, N.J.                    313    56.6        619   111.8
Kansas City, Mo.                     314    19.6        736    45.4
Knoxville, Tenn.                      35     5.8         78    12.7
Las Vegas, Nev.                      180    19.5        468    46.9
Little Rock, Ark.                     82    15.8        171    32.6
Los Angeles, Calif.                3,327    37.1      5,557    61.1
Louisville, Ky.                       90     9.4        166    17.2
Memphis, Tenn.                       174    17.1        414    40.1
Miami, Fla.                        1,324    67.0      2,423   120.1
Middlesex, N.J.                      217    21.1        354    34.2
Milwaukee, Wis.                      127     8.8        361    24.8
Minneapolis-Saint Paul, Min.         204     7.9        550    20.9
Monmouth-Ocean City, N.J.            111    11.1        366    36.4
Nashville, Tenn.                     125    12.5        269    26.3
Nassau-Suffolk, N.Y.                 370    14.1      1,010    38.4
New Haven, Conn.                     318    19.5        987    60.4
New Orleans, La.                     476    36.8        612    46.9
New York, N.Y.                     7,163    83.8     13,288   155.3
Newark, N.J.                         838    43.8      1,540    80.6
Norfolk, Va.                         105     7.2        325    21.9
Oakland, Calif.                      563    26.7      1,225    57.2
Oklahoma City, Okla.                 113    11.6        310    31.5
Omaha, Neb.                           49     7.5        136    20.6
Orange County, Calif.                553    22.6        717    29.0
Orlando, Fla.                        331    26.1        870    66.3
Philadelphia, Pa.                  1,005    20.3      2,110    42.5
Phoenix, Ariz.                       292    12.8        863    36.9
Pittsburgh, Pa.                      148     6.2        214     8.9
Portland, Oreg.                      249    15.9        655    40.3
Providence, R.I.                      96    10.5        285    31.1
Raleigh-Durham, N.C.                 128    14.5        189    20.8
Richmond, Va.                        140    15.9        385    42.9
Riverside-San Bernardino, Calif.     435    16.0      1,045    36.6
Rochester, N.Y.                       76     7.1        243    22.4
Sacramento, Calif.                   287    20.7        453    31.5
Saint Louis, Mo.                     290    11.6        841    33.3
Salt Lake City, Utah                 129    11.7        241    21.3
San Antonio, Tex.                    217    16.1        426    31.1
San Diego, Calif.                    631    24.8      1,474    56.7
San Francisco, Calif.              1,896   116.9      4,592   279.8
San Jose, Calif.                     183    12.2        502    33.2
San Juan, P.R.                     1,075    57.9      1,638    87.3
Sarasota, Fla.                        90    18.0        148    28.9
Scranton, Pa.                         26     4.1         54     8.4
Seattle, Wash.                       424    20.4      1,043    49.1
Springfield, Mass.                    92    15.3        210    35.0
Stockton, Calif.                      34     6.9        109    21.6
Syracuse, N.Y.                        71     9.5        168    22.2
Tacoma, Wash.                         38     6.3        137    21.9
Tampa-Saint Petersburg, Fla.         535    25.5      1,421    66.6
Toledo, Ohio                          33     5.4         90    14.6
Tucson, Ariz.                         93    13.7        258    37.6
Tulsa, Okla.                          70     9.7        236    32.1
Ventura, Calif.                       73    10.8        130    19.0
Washington, D.C.                   1,345    31.3      2,560    58.7
West Palm Beach, Fla.                529    59.7        787    86.5
Wichita, Kansas                       62    12.6         96    19.2
Wilmington, Del.                      93    17.8        261    49.1
Youngstown, Ohio                      23     3.8         29     4.8

Metropolitan areas with
  500,000 or more population      39,112    24.8     81,352    50.9

Metropolitan areas with
  50,000 to 500,000 population     4,821    10.5     10,306    22.0

Non-metropolitan areas             2,587     4.9      5,288    10.0

Total (3)                         46,716    18.2     97,368    37.5


                                   Cumulative totals
                         Adults/           Children
Area of residence(2)  adolescents    < 13 years old      Total

Akron, Ohio                  214             -            214
Albany-Schenectady, N.Y.     672             14           686
Albuquerque, N.M.            490              1           491
Allentown, Pa.               314              4           318
Ann Arbor, Mich.             194              4           198
Atlanta, Ga.               6,836             43         6,879
Austin, Tex.               1,705             14         1,719
Bakersfield, Calif.          357              3           360
Baltimore, Md.             4,548            113         4,661
Baton Rouge, La.             469              7           476
Bergen-Passaic, N.J.       2,425             51         2,476
Birmingham, Ala.             716             11           727
Boston, Mass.              6,510            117         6,627
Buffalo, N.Y.                653              8           661
Charleston, S.C.             611              5           616
Charlotte, N.C.              747             10           757
Chicago, Ill.              9,251            125         9,376
Cincinnati, Ohio             768             11           779
Cleveland, Ohio            1,414             27         1,441
Columbus, Ohio             1,085              6         1,091
Dallas, Tex.               5,867             24         5,891
Dayton, Ohio                 481              8           489
Denver, Colo.              2,918             13         2,931
Detroit, Mich.             3,484             45         3,529
El Paso, Tex.                303              1           304
Fort Lauderdale, Fla.      5,114            109         5,223
Fort Worth, Tex.           1,350             15         1,365
Fresno, Calif.               519              4           523
Gary, Ind.                   240              2           242
Grand Rapids, Mich.          326              3           329
Greensboro, N.C.             631             11           642
Greenville, S.C.             521              2           523
Harrisburg, Pa.              313              6           319
Hartford, Conn.            1,397             17         1,414
Honolulu, Hawaii             946              6           952
Houston, Tex.              9,225             87         9,312
Indianapolis, Ind.         1,178              5         1,183
Jacksonville, Fla.         2,140             49         2,189
Jersey City, N.J.          2,933             68         3,001
Kansas City, Mo.           2,197              9         2,206
Knoxville, Tenn.             238              2           240
Las Vegas, Nev.            1,260             14         1,274
Little Rock, Ark.            485              9           494
Los Angeles, Calif.       21,704            146        21,850
Louisville, Ky.              509              8           517
Memphis, Tenn.             1,007              9         1,016
Miami, Fla.                9,303            260         9,563
Middlesex, N.J.            1,515             33         1,548
Milwaukee, Wis.              914             12           926
Minneapolis-Saint Paul,
                 Minn.     1,619             10         1,629
Monmouth-Ocean City, N.J.  1,253             35         1,288
Nashville, Tenn.             844             10           854
Nassau-Suffolk, N.Y.       3,200             66         3,266
New Haven, Conn.           2,654             77         2,731
New Orleans, La.           2,868             37         2,905
New York, N.Y.            54,716          1,183        55,899
Newark, N.J.               7,229            184         7,413
Norfolk, Va.               1,006             22         1,028
Oakland, Calif.            4,138             26         4,164
Oklahoma City, Okla.         825              1           826
Omaha, Neb.                  343              1           344
Orange County, Calif.      2,811             21         2,832
Orlando, Fla.              2,249             42         2,291
Philadelphia, Pa.          7,082             87         7,169
Phoenix, Ariz.             2,236              9         2,245
Pittsburgh, Pa.            1,026              6         1,032
Portland, Oreg.              943              6         1,949
Providence, R.I.             791              8           799
 Raleigh-Durham, N.C.        787             18           805
Richmond, Va.              1,006             13         1,019
Riverside-San Bernardino,
                  Calif.   2,727             27         2,754
Rochester, N.Y.              742              8           750
Sacramento, Calif.         1,490             14         1,504
Saint Louis, Mo.           2,224             21         2,245
Salt Lake City, Utah         726             14           740
San Antonio, Tex.          1,591             14         1,605
San Diego, Calif.          4,877             32         4,909
San Francisco, Calif.     17,397             27        17,424
San Jose, Calif.           1,514             11         1,525
San Juan, P.R.             6,577            168         6,745
Sarasota, Fla.               570             12           582
Scranton, Pa.                188              3           191
Seattle, Wash.             3,536             10         3,546
Springfield, Mass.           574             15           589
Stockton, Calif.             307              8           315
Syracuse, N.Y.               497              6           503
Tacoma, Wash.                360              7           367
Tampa-Saint Petersburg,
                  Fla.     3,781             53         3,834
Toledo, Ohio                 271              4           275
Tucson, Ariz.                619              5           624
Tulsa, Okla.                 549              5           554
Ventura, Calif.              378              1           379
Washington, D.C.           9,366            138         9,504
West Palm Beach, Fla.      2,916            107         3,023
Wichita, Kansas              276              2           278
Wilmington, Del.             617              6           623
Youngstown, Ohio             148              -           148

Metropolitan areas with 500,000
   or more population    284,441          4,131       288,572

Metropolitan areas with 50,000
   500,000 population     31,977            485        32,462

Non-metropolitan areas    16,621            268        16,889


Total (3)                334,344          4,906       339,250


1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 Based on Metropolitan Statistical Areas (MSA) revised June 1993.
3 Totals include 1,327 persons whose area of residence is unknown.







Table 3. AIDS cases by age group, exposure category, and sex,
reported October 1991 through September 1992, October 1992 through
September 1993;(1) and cumulative totals, by age group and exposure
category, through September 1993, United States

                                                           Males

                                          Oct. 1991-     Oct. 1992-
                                          Sept. 1992    Sept. 1993

Adult/adolescent
exposure category                          No.  (%)      No. (%)
Men who have sex with men                 24,334 (61)   46,025 (56)
Injecting drug use                         8,621 (22)   19,142 (23)
Men who have sex with men and inject drugs 2,638 ( 7)    5,353 ( 7)
Hemophilia/coagulation disorder              317 ( 1)      990 ( 1)
Heterosexual contact:                      1,613 ( 4)    3,328 ( 4)
  Sex with injecting drug user               703          1,102

  Sex with bisexual male                       -              -

  Sex with person with hemophilia              3             10

  Born in Pattern-II(3) country              271            607

  Sex with person born
    in Pattern-II country                     14             43

  Sex with transfusion recipient
    with HIV infection                        18             59

  Sex with HIV-infected person,
    risk not specified                       604          1,507

Receipt of blood transfusion,
 blood components, or tissue(4)              385 ( 1)      695 ( 1)
Other/risk not identified(5)               1,925 ( 5)    6,174 ( 8)

Adult/adolescent subtotal                 39,833 (100) 81,707 (100)


Pediatric (< 13 years old)
exposure category

Hemophilia/coagulation disorder               23  ( 6)     18 ( 4)
Mother with/at risk for HIV
   infection:                                329  (89)    397 (91)
    Injecting drug use                       114          126
    Sex with injecting drug user              54           68
    Sex with bisexual male                     7            5
    Sex with person with hemophilia            5            1
    Born in Pattern-II country                19           22
    Sex with person born
      in Pattern-II country                    3            3
    Sex with transfusion recipient
      with HIV infection                       1            1
    Sex with HIV-infected person,
      risk not specified                      31           45
    Receipt of blood transfusion,
      blood components, or tissue             12           16
    Has HIV infection,
      risk not specified                      83          110
Receipt of blood transfusion,
  blood components, or tissue                 12  ( 3)     15 ( 3)
Risk not identified                            5  ( 1)      7 ( 2)

Pediatric subtotal                           369 (100)    437 (100)

Total                                     40,202       82,144


                                                  Females

                                        Oct. 1991-     Oct. 1992-

                                        Sept. 1992    Sept. 1993

Adult/adolescent
exposure category                         No.  (%)      No. (%)

Men who have sex with men                    -           -

Injecting drug use                       2,815  (46)  6,891 (47)
Men who have sex with men and inject drugs   -           -

Hemophilia/coagulation disorder            6  ( 0)     27 ( 0)
Heterosexual contact:                  2,588  (42)  5,545 (37)
  Sex with injecting drug user         1,474        2,474

  Sex with bisexual male                 177          423

  Sex with person with hemophilia         20           61

  Born in Pattern-II(3) country          165          324
  Sex with person born
    in Pattern-II country                 15           31
  Sex with transfusion recipient
    with HIV infection                    49          101
  Sex with HIV-infected person,
    risk not specified                   688        2,131
Receipt of blood transfusion,
 blood components, or tissue(4)          278  ( 5)    496 ( 3)
Other/risk not identified(5)             466  ( 8)  1,833 (12)

Adult/adolescent subtotal              6,153 (100) 14,792 (100)

Pediatric (< 13 years old)
exposure category
Hemophilia/coagulation disorder            -            -

Mother with/at risk for HIV
   infection:                            347  (96)    417 (97)
    Injecting drug use                   144          138
    Sex with injecting drug user          62           65
    Sex with bisexual male                 8            4
    Sex with person with hemophilia        2            2
    Born in Pattern-II country            12           15
    Sex with person born
      in Pattern-II country                2            2
    Sex with transfusion recipient
      with HIV infection                   3            2
    Sex with HIV-infected person,
      risk not specified                  21           51
    Receipt of blood transfusion,
      blood components, or tissue         10            7
    Has HIV infection,
      risk not specified                  83          131
Receipt of blood transfusion,
  blood components, or tissue              6  ( 2)      9  (2)
Risk not identified                        8  ( 2)      6  (1)

Pediatric subtotal                       361 (100)    432 (100)

Total                                  6,514       15,224


                                           Totals
                             Oct. 1991-   Oct. 1992-    Cumulative
                             Sept. 1992   Sept. 1993    total2
Adult/adolescent
exposure category                No.    (%)   No.    (%)    No. (%)


Men who have sex with men   24,334  (53) 46,025  (48) 183,344  (55)

Injecting drug use          11,436  (25) 26,033  (27)  80,713  (24)

Men who have sex with men
  and inject drugs           2,638  ( 6)  5,353  ( 6)  21,142  (6)
Hemophilia/coagulation disor   323  ( 1)  1,017  ( 1)   2,963  (1)
Heterosexual contact:        4,201  ( 9)  8,873  ( 9)  24,358  (7)
    Sex with injecting
               drug user     2,177        3,576        11,750
    Sex with bisexual male     177          423         1,250
    Sex with person
            with hemophilia     23           71           193
    Born in Pattern-II(3)
                  country      436          931         3,758
    Sex with person born
      in Pattern-II country     29           74           279
    Sex with transfusion recipient
      with HIV infection        67          160           456
    Sex with HIV-infected person,
      risk not specified     1,292        3,638         6,672

Receipt of blood transfusion,
  blood components,
              or tissue(4)     663  ( 1)  1,191  ( 1)   5,984  (2)

Other/risk not
                identified(5) 2,391  ( 5)  8,007  ( 8)  15,840  (5)

Adult/adolescent subtotal   45,986 (100) 96,499 (100) 334,344 (100)


Pediatric (< 13 years old)
exposure category

Hemophilia/coagulation
                        disorder 23  ( 3)     18  ( 2)     202  (4)
Mother with/at risk for HIV
      infection:                676  (93)    814  (94)   4,328 (88)
   Injecting drug use           258          264         1,920
   Sex with injecting drug user 116          133           846
   Sex with bisexual male        15            9            88
   Sex with person with
                hemophilia        7            3            21
   Born in Pattern-II country    31           37           305
   Sex with person born
     in Pattern-II country        5            5            23
   Sex with transfusion recipient
     with HIV infection           4            3            19
   Sex with HIV-infected person,
     risk not specified          52           96           275
   Receipt of blood transfusion,
     blood components, or tissue 22           23            98
   Has HIV infection,
      risk not specified        166          241           733
Receipt of blood transfusion,
  blood components, or tissue    18  ( 2)     24  ( 3)     327  (7)
Risk not identified              13  ( 2)     13  ( 1)      49  (1)

Pediatric subtotal              730 (100)    869 (100)   4,906
(100)

Total                        46,716       97,368       339,250

1 Includes 9  months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 Includes 7 persons known to be infected with human
immunodeficiency virus type 2 (HIV-2). See JAMA 1992;267:2775-9.
3 See technical notes.
4 Twenty-seven adults/adolescents and 2 children developed AIDS
after receiving blood screened negative for HIV antibody.  Six
additional adults developed AIDS after receiving tissue or organs
from HIV-infected donors.  Three of the 6 received tissues or
organs from a donor who was negative for HIV antibody at the time
of donation.  See N Engl J Med 1992;326:726-32.
5 "Other" refers to 11 health-care workers who developed AIDS after
  occupational exposure to HIV-infected blood, as documented by
evidence of seroconversion; to 4 patients who developed AIDS after
exposure to HIV within the health-care setting, as documented by
laboratory studies; to 1 person who acquired HIV infection
perinatally and was diagnosed with AIDS after age 13; and to 1
person with intentional self-inoculation of blood from an
HIV-infected person.  "Risk not identified" refers to persons whose
mode of exposure to HIV is unknown.  This includes persons under
investigation; persons who died, were lost to follow-up, or
declined interview; and persons whose mode of exposure to HIV
remains unidentified after investigation.

Table 4. Male adult/adolescent AIDS cases by exposure category and
race/ethnicity, reported October 1992 through September 1993,(1)
and cumulative totals, through September 1993, United States
                                           White, not
                                            Hispanic
                                    Oct. 1992-  Cumulative
                                    Sept. 1993    total

Exposure category                    No.   (%)     No.   (%)

Men who have sex with men         30,094  (73) 125,392  (78)
Injecting drug use                 4,285  (10)  12,670  ( 8)
Men who have sex with men
  and inject drugs                 3,001  ( 7)  11,959  ( 7)
Hemophilia/coagulation disorder      794  ( 2)   2,349  ( 1)
Heterosexual contact:                607  ( 1)   1,654  ( 1)
    Sex with injecting drug user       227           804
    Sex with person with hemophilia      6            13
    Born in Pattern-II(2) country        1             8
    Sex with person born
      in Pattern-II country             10            52
    Sex with transfusion recipient
      with HIV infection                25            72
    Sex with HIV-infected person,
      risk not specified               338           705
Receipt of blood transfusion,
  blood components, or tissue        431  ( 1)   2,519  ( 2)

Risk not identified(3)             2,032  ( 5)   4,380  ( 3)

Total                             41,244 (100) 160,923 (100)


                                           Black, not
                                            Hispanic
                                    Oct. 1992-  Cumulative
                                    Sept. 1993    total

Exposure category                    No.   (%)     No.   (%)

Men who have sex with men         9,614  (37)  34,166  (42)
Injecting drug use                9,667  (37)  29,762  (36)
Men who have sex with men
  and inject drugs                1,568  ( 6)   5,974  ( 7)
Hemophilia/coagulation disorder     110  ( 0)     260  ( 0)
Heterosexual contact:             2,125  ( 8)   6,279  ( 8)
    Sex with injecting drug user       682         2,118
    Sex with person with hemophilia      1             4
    Born in Pattern-II(2) country      605         2,571
    Sex with person born
      in Pattern-II country             31            86
    Sex with transfusion recipient
      with HIV infection                26            51
    Sex with HIV-infected person,
      risk not specified               780         1,449
Receipt of blood transfusion,
  blood components, or tissue        157  ( 1)     606  ( 1)
Risk not identified(3)             2,807  (11)   5,127  ( 6)

Total                             26,048 (100)  82,174 (100)


                                           Hispanic
                                    Oct. 1992-  Cumulative
                                    Sept. 1993    total

Exposure category                    No.   (%)     No.   (%)

Men who have sex with men           5,638  (42)  21,475  (45)
Injecting drug use                  5,094  (38)  18,143  (38)
Men who have sex with men
  and inject drugs                    712  ( 5)   3,021  ( 6)
Hemophilia/coagulation disorder        68  ( 1)     224  ( 0)
Heterosexual contact:                 570  ( 4)   1,375  ( 3)
    Sex with injecting drug user        185           599
    Sex with person with hemophilia       2             4
    Born in Pattern-II(2) country         -            10
    Sex with person born
      in Pattern-II country               2            11
    Sex with transfusion recipient
      with HIV infection                  6            28
    Sex with HIV-infected person,
      risk not specified                375           723
Receipt of blood transfusion,
  blood components, or tissue           91  ( 1)     385  ( 1)
Risk not identified(3)               1,234  ( 9)   2,728  ( 6)

Total                               13,407 (100)  47,351 (100)


                                          Asian/Pacific
                                             Islander
                                    Oct. 1992-  Cumulative
                                    Sept. 1993    total

Exposure category                    No.   (%)     No.   (%)

Men who have sex with men            445  (74)   1,583  (79)
Injecting drug use                    28  ( 5)      79  ( 4)
Men who have sex with men
  and inject drugs                    22  ( 4)      57  ( 3)
Hemophilia/coagulation disorder       12  ( 2)      35  ( 2)
Heterosexual contact:                 15  ( 2)      29  ( 1)
    Sex with injecting drug user         6            12
    Sex with person with hemophilia      -             -
    Born in Pattern-II country           -             3
    Sex with person born
      in Pattern-II country              -             1
    Sex with transfusion recipient
      with HIV infection                 2             2
    Sex with HIV-infected person,
      risk not specified                 7            11
Receipt of blood transfusion,
  blood components, or tissue         12  ( 2)      72  ( 4)
Risk not identified                   69  (11)     152  ( 8)

Total                                603 (100)   2,007 (100)


                                        American Indian/
                                          Alaska Native
                                    Oct. 1992-  Cumulative
                                    Sept. 1993    total

Exposure category                    No.   (%)     No.   (%)

Men who have sex with men            158  (63)     388  (63)
Injecting drug use                    23  ( 9)      62  (10)
Men who have sex with men
  and inject drugs                    42  (17)     107  (17)
Hemophilia/coagulation disorder        6  ( 2)      16  ( 3)
Heterosexual contact:                  4  ( 2)      10  ( 2)
    Sex with injecting drug user         1             5
    Sex with person with hemophilia      -             -
    Born in Pattern-II country           -             -
    Sex with person born
      in Pattern-II country              -             -
    Sex with transfusion recipient
      with HIV infection                 -             -
    Sex with HIV-infected person,
      risk not specified                 3             5
Receipt of blood transfusion,
  blood components, or tissue          1  ( 0)       5  ( 1)
Risk not identified                   15  ( 6)      26  ( 4)

Total                                 249 (100)     614 (100)


                                            Cumulative
                                            totals(4)

                                    Oct. 1992-  Cumulative
                                    Sept. 1993    total

Exposure category                    No.   (%)     No.   (%)

Men who have sex with men         46,025  (56) 183,344  (62)
Injecting drug use                19,142  (23)  60,835  (21)
Men who have sex with men
  and inject drugs                 5,353  ( 7)  21,142  ( 7)
Hemophilia/coagulation disorder      990  ( 1)   2,890  ( 1)
Heterosexual contact:              3,328  ( 4)   9,361  ( 3)
    Sex with injecting drug user      1,102         3,539
    Sex with person with hemophilia      10            22
    Born in Pattern-II country          607         2,597
    Sex with person born
      in Pattern-II country              43           150
    Sex with transfusion recipient
      with HIV infection                 59           154
    Sex with HIV-infected person,
      risk not specified              1,507         2,899
Receipt of blood transfusion,
  blood components, or tissue        695  ( 1)   3,596  ( 1)
Risk not identified                6,174  ( 8)  12,474  ( 4)


Total                             81,707 (100) 293,642 (100)

1 Includes 9  months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 See technical notes.
3 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown.  This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
4  Includes 573 men whose race/ethnicity is unknown.





Table 5. Female adult/adolescent AIDS cases by exposure category
and race/ethnicity, reported October 1992 through September
1993,(1) and cumulative totals, through September 1993, United
States
                                                White, not
                                                 Hispanic

                                           Oct. 1992-  Cumulative
                                          Sept. 1993    total

Exposure category                          No.   (%)     No.   (%)

Injecting drug use                        1,718  (46)   4,459  (43)

Hemophilia/coagulation disorder              14  ( 0)      48  ( 0)

Heterosexual contact:                     1,387  (37)   3,595  (35)

    Sex with injecting drug user              586         1,703
    Sex with bisexual male                    199           627
    Sex with person with hemophilia            50           140
    Born in Pattern-II(2) country               3             5
    Sex with person born
      in Pattern-II country                     4            15
    Sex with transfusion recipient
      with HIV infection                       49           176
    Sex with HIV-infected person,
      risk not specified                      496           929
Receipt of blood transfusion,
  blood components, or tissue               223  ( 6)   1,398  (14)

Risk not identified(3)                      398  (11)     793  ( 8)


Total                                     3,740 (100)  10,293 (100)



                                                Black, not
                                                  Hispanic

                                           Oct. 1992-  Cumulative
                                          Sept. 1993     total

Exposure category                          No.   (%)     No.   (%)

Injecting drug use                        3,861  (48)  11,386  (52)

Hemophilia/coagulation disorder               7  ( 0)      15  ( 0)

Heterosexual contact:                     2,884  (36)   7,864  (36)
    Sex with injecting drug user              1,191         4,101
    Sex with bisexual male                      150           428
    Sex with person with hemophilia               9            21
    Born in Pattern-II(2) country               316         1,143
    Sex with person born
      in Pattern-II country                      26           110
    Sex with transfusion recipient
      with HIV infection                         27            63
    Sex with HIV-infected person,
      risk not specified                      1,165         1,998
Receipt of blood transfusion,
  blood components, or tissue               167  ( 2)     571  ( 3)

Risk not identified(3)                    1,089  (14)   1,892  ( 9)


Total                                     8,008 (100)  21,728 (100)



                                                Hispanic

                                           Oct. 1992-  Cumulative
                                          Sept. 1993    total
Exposure category                          No.   (%)     No.   (%)

Injecting drug use                        1,265  (44)   3,907  (47)

Hemophilia/coagulation disorder               5  ( 0)       9  ( 0)

Heterosexual contact:                     1,192  (41)   3,377  (41)

    Sex with injecting drug user               667         2,337
    Sex with bisexual male                      60           162
    Sex with person with hemophilia              1             7
    Born in Pattern-II(2) country                4            11
    Sex with person born
      in Pattern-II country                      1             4
    Sex with transfusion recipient
      with HIV infection                        17            51
    Sex with HIV-infected person,
      risk not specified                       442           805
Receipt of blood transfusion,
  blood components, or tissue                88  ( 3)     349  ( 4)

Risk not identified(3)                      327  (11)     631  ( 8)


Total                                     2,877 (100)   8,273 (100)



                                                Asian/Pacific
                                                  Islander

                                           Oct. 1992-  Cumulative
                                          Sept. 1993    total

Exposure category                          No.   (%)     No.   (%)

Injecting drug use                          15  (15)      34  (15)
Hemophilia/coagulation disorder              1  ( 1)       1  ( 0)
Heterosexual contact:                       57  (58)     104  (45)
    Sex with injecting drug user              15            31
    Sex with bisexual male                    13            28
    Sex with person with hemophilia            -             2
    Born in Pattern-II country                 1             1
    Sex with person born
      in Pattern-II country                    -             -
    Sex with transfusion recipient
      with HIV infection                       8            11
    Sex with HIV-infected person,
      risk not specified                      20            31
Receipt of blood transfusion,
  blood components, or tissue               16  (16)      59  (26)
Risk not identified                         10  (10)      32  (14)

Total                                       99 (100)     230 (100)

                                            American Indian/
                                             Alaska Native

                                           Oct. 1992-    Cumulative

                                          Sept. 1993      total

Exposure category                          No.   (%)     No.   (%)

Injecting drug use                           17  (37)      52  (50)

Hemophilia/coagulation disorder               -             -
Heterosexual contact:                        20  (43)      32  (31)

    Sex with injecting drug user               12            21
    Sex with bisexual male                      1             3
    Sex with person with hemophilia             1             1
    Born in Pattern-II country                  -             -
    Sex with person born
      in Pattern-II country                     -             -
    Sex with transfusion recipient
      with HIV infection                        -             -
    Sex with HIV-infected person,
      risk not specified                        6             7
Receipt of blood transfusion,
  blood components, or tissue                 2  ( 4)       8  ( 8)

Risk not identified                           7  (15)      11  (11)


Total                                        46 (100)     103 (100)


                                                  Cumulative
                                                   totals(4)

                                           Oct. 1992-    Cumulative

                                          Sept. 1993      total

Exposure category                          No.   (%)     No.   (%)


Injecting drug use                        6,891  (47)  19,878  (49)

Hemophilia/coagulation disorder              27  ( 0)      73  ( 0)

Heterosexual contact:                     5,545  (37)  14,997  (37)

    Sex with injecting drug user               2,474         8,211
    Sex with bisexual male                       423         1,250
    Sex with person with hemophilia               61           171
    Born in Pattern-II country                   324         1,161
    Sex with person born
      in Pattern-II country                       31           129
    Sex with transfusion recipient
      with HIV infection                         101           302
    Sex with HIV-infected person,
      risk not specified                       2,131         3,773
Receipt of blood transfusion,
  blood components, or tissue               496  ( 3)   2,388  ( 6)

Risk not identified                       1,833  (12)   3,366  ( 8)


Total                                    14,792 (100)  40,702 (100)


1 Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2 See technical notes.
3 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown.  This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
4  Includes 75 women whose race/ethnicity is unknown.





Table 6. Pediatric AIDS cases by exposure category and
race/ethnicity, reported October 1992 through September 1993, and
cumulative totals, through September 1993, United States
                                                White, not
                                                 Hispanic

                                           Oct. 1992-    Cumulative

                                          Sept. 1993      total

Exposure category                          No.   (%)     No.   (%)

Hemophilia/coagulation disorder              13  ( 9)     141  (14)

Mother with/at risk for HIV
        infection:                          118  (84)     663  (68)
    Injecting drug use                         38           290
    Sex with injecting drug user               22           132
    Sex with bisexual male                      4            39
    Sex with person with hemophilia             2            13
    Born in Pattern-II1 country                 -             3
    Sex with person born
      in Pattern-II country                     -             -
    Sex with transfusion recipient
      with HIV infection                        1             6
    Sex with HIV-infected person,
      risk not specified                       10            45
    Receipt of blood transfusion,
      blood components, or tissue               6            29
    Has HIV infection,
      risk not specified                       35           106
Receipt of blood transfusion,
  blood components, or tissue                 9  ( 6)     167  (17)

Risk not identified(2)                        1  ( 1)       9  ( 1)


Total                                       141 (100)     980 (100)



                                                  Black, not
                                                   Hispanic

                                            Oct. 1992-
Cumulative
                                           Sept. 1993        total

Exposure category                           No.   (%)       No. (%)


Hemophilia/coagulation disorder                1  ( 0)      24  (1)
Mother with/at risk for HIV
      infection:                             489  (97)   2,556 (95)
   Injecting drug use                          153         1,133
   Sex with injecting drug user                 70           390
   Sex with bisexual male                        2            28
   Sex with person with hemophilia               -             5
   Born in Pattern-II1 country                  37           300
   Sex with person born
     in Pattern-II country                       5            22
   Sex with transfusion recipient
     with HIV infection                          1             5
   Sex with HIV-infected person,
     risk not specified                         57           148
   Receipt of blood transfusion,
     blood components, or tissue                12            43
   Has HIV infection,
     risk not specified                        152           482
Receipt of blood transfusion,
  blood components, or tissue                  6  ( 1)      74  (3)
Risk not identified(2)                         8  ( 2)      29  (1)

Total                                        504 (100)   2,683(100)


                                                  Hispanic

                                           Oct. 1992-    Cumulative

                                          Sept. 1993      total

Exposure category                          No.   (%)     No.   (%)

Hemophilia/coagulation disorder              4  ( 2)      33  ( 3)
Mother with/at risk for HIV
       infection:                          197  (93)   1,074  (90)
    Injecting drug use                        69           483
    Sex with injecting drug user              40           318
    Sex with bisexual male                     3            20
    Sex with person with hemophilia            1             3
    Born in Pattern-II(1) country              -             2
    Sex with person born
      in Pattern-II country                    -             1
    Sex with transfusion recipient
      with HIV infection                       1             8
    Sex with HIV-infected person,
      risk not specified                      27            77
    Receipt of blood transfusion,
      blood components, or tissue              5            25
    Has HIV infection,
      risk not specified                      51           137
Receipt of blood transfusion,
  blood components, or tissue                7  ( 3)      76  ( 6)
Risk not identified(2)                       4  ( 2)      11  ( 1)

Total                                      212 (100)   1,194 (100)


                                                  Asian/Pacific
                                                     Islander

                                            Oct. 1992-  Cumulative
                                           Sept. 1993    total

Exposure category                           No.   (%)     No.   (%)


Hemophilia/coagulation disorder               -             3  (14)

Mother with/at risk for HIV
       infection:                             2  (50)      10  (45)

    Injecting drug use                          1             3
    Sex with injecting drug user                -             2
    Sex with bisexual male                      -             1
    Sex with person with hemophilia             -             -
    Born in Pattern-II country                  -             -
    Sex with person born
      in Pattern-II country                     -             -
    Sex with transfusion recipient
      with HIV infection                        -             -
    Sex with HIV-infected person,
      risk not specified                        1             1
    Receipt of blood transfusion,
      blood components, or tissue               -             1
    Has HIV infection,
      risk not specified                        -             2
Receipt of blood transfusion,
  blood components, or tissue                 2  (50)       9  (41)

Risk not identified                           -             -

Total                                         4 (100)      22 (100)



                                                American Indian/
                                                  Alaska Native

                                           Oct. 1992-    Cumulative

                                          Sept. 1993      total

Exposure category                          No.   (%)     No.   (%)
Hemophilia/coagulation disorder              -             1  ( 7)
Mother with/at risk for HIV
       infection:                            2 (100)      13  (93)
    Injecting drug use                          1             6
    Sex with injecting drug user                1             2
    Sex with bisexual male                      -             -
    Sex with person with hemophilia             -             -
    Born in Pattern-II country                  -             -
    Sex with person born
      in Pattern-II country                     -             -
    Sex with transfusion recipient
      with HIV infection                        -             -
    Sex with HIV-infected person,
      risk not specified                        -             2
    Receipt of blood transfusion,
      blood components, or tissue               -             -
    Has HIV infection,
      risk not specified                        -             3
Receipt of blood transfusion,
  blood components, or tissue                   -             -
Risk not identified                             -             -

Total                                       2 (100)      14 (100)


                                                  Cumulative
                                                   totals(3)

                                           Oct. 1992-    Cumulative

                                          Sept. 1993      total
Exposure category                          No.   (%)     No.   (%)

Hemophilia/coagulation disorder              18  ( 2)     202  ( 4)

Mother with/at risk for HIV
  infection:                                814  (94)   4,328  (88)

    Injecting drug use                         264         1,920
    Sex with injecting drug user               133           846
    Sex with bisexual male                       9            88
    Sex with person with hemophilia              3            21
    Born in Pattern-II country                  37           305
    Sex with person born
      in Pattern-II country                      5            23
    Sex with transfusion recipient
      with HIV infection                         3            19
    Sex with HIV-infected person,
      risk not specified                        96           275
    Receipt of blood transfusion,
      blood components, or tissue               23            98
    Has HIV infection,
      risk not specified                       241           733
Receipt of blood transfusion,
  blood components, or tissue                24  ( 3)     327  ( 7)

Risk not identified                          13  ( 1)      49  ( 1)


Total                                       869 (100)   4,906 (100)


1 See technical notes.
2 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown.  This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.
3  Includes 13 children whose race/ethnicity is unknown.




Table 7. AIDS cases in adolescents and adults under age 25, by sex
and exposure category, reported October 1991 through September
1992, October 1992 through September 1993,(1) and cumulative totals
through September 1993, United States

                                        13-19 years old

                              Oct. 1991-   Oct. 1992-   Cumulative
                              Sept. 1992   Sept. 1993     total

Male
exposure category              No.   (%)    No.   (%)    No.   (%)

Men who have sex with men       36  (35)     91  (28)    319  (33)

Injecting drug use               4  ( 4)     14  ( 4)     62  ( 6)

Men who have sex with men
  and inject drugs               5  ( 5)      8  ( 2)     45  ( 5)

Hemophilia/coagulation disorder 47  (46)    172  (52)    440  (45)

Heterosexual contact:            3  ( 3)     13  ( 4)     29  ( 3)

   Sex with injecting drug user  1            6           11

   Sex with person with
     hemophilia                  -            1            1

   Born in Pattern-II(2)
    country                      -            1            8

   Sex with person born
     in Pattern-II country       -            -            1

   Sex with transfusion recipient
     with HIV infection          -            -            -

   Sex with HIV-infected person,
     risk not specified          2            5            8

Receipt of blood transfusion,
  blood components, or tissue    5  ( 5)     12  ( 4)     42  ( 4)

Risk not identified(3)           2  ( 2)     19  ( 6)     40  ( 4)


Male subtotal                  102  (100)   329  (100)   977  (100)



Female
exposure category


Injecting drug use               12  (20)     14  ( 8)     86 (20)
Hemophilia/coagulation
 disorder                         1  ( 2)      1  ( 1)      5
( 1)
Heterosexual contact:            34  (58)    105  (62)    236 (54)
   Sex with injecting drug user  20           37          127

   Sex with bisexual male         1            7           11

   Sex with person with
     hemophilia                   2            1             6
   Born in Pattern-II country     1            4            11

   Sex with person born
      in Pattern-II country       -            1             2
   Sex with transfusion recipient
     with HIV infection           -            2             3
   Sex with HIV-infected person,
      risk not specified         10           53           76

Receipt of blood transfusion,
   blood components, or tissue    1  ( 2)     14  ( 8)     41( 9)
Risk not identified              11  (19)     36  (21)     67(15)

Female subtotal                  59 (100)    170 (100)    435 (100)


Total                           161          499          1,412



                                      20-24 years old
                            Oct. 1991-   Oct. 1992-   Cumulative
                           Sept. 1992   Sept. 1993     total
Male
exposure category            No.   (%)    No.   (%)    No.   (%)

Men who have sex with men    694  (63)  1,489  (60)  6,485  (64)
Injecting drug use           146  (13)    282  (11)  1,245  (12)
Men who have sex with men
  and inject drugs           110  (10)    204  ( 8)  1,063  (11)
Hemophilia/coagulation
 disorder                     42  ( 4)    154  ( 6)    385  ( 4)
Heterosexual contact:         55  ( 5)    118  ( 5)    363  ( 4)
   Sex with injecting
 drug user                    24           40          135
   Sex with person with
 hemophilia                    -            -            1
   Born in Pattern-II(2)
 country                       8           17           98
   Sex with person born
     in Pattern-II country     -            2            2
   Sex with transfusion recipient
     with HIV infection        1            4            9
   Sex with HIV-infected person,
     risk not specified       22           55          118
Receipt of blood transfusion,
  blood components, or tissue  6  ( 1)     22  ( 1)     85  ( 1)
Risk not identified(3)        53  ( 5)    220  ( 9)    445  ( 4)

Male subtotal              1,106 (100)  2,489 (100) 10,071 (100)

Female
exposure category

Injecting drug use           123  (32)    283  (30)    931  (35)
Hemophilia/coagulation
 disorder                      1  ( 0)      4  ( 0)      9  ( 0)
Heterosexual contact:        206  (54)    483  (51)  1,329  (50)
   Sex with injecting drug
 user                        118          233          754
   Sex with bisexual male     14           32          108
   Sex with person with
 hemophilia                    2            7           27
   Born in Pattern-II country  5           11           64
   Sex with person born
     in Pattern-II country     -            1           12
   Sex with transfusion recipient
     with HIV infection        -            2            7
   Sex with HIV-infected person,
     risk not specified       67          197          357
Receipt of blood transfusion,
  blood components, or tissue,12  ( 3)     19  ( 2)     81  (3)
Risk not identified           40  (10)    167  (17)    291  (11)

Female subtotal              382 (100)    956 (100)  2,641 (100)

Total                      1,488        3,445       12,712

1  Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2  See technical notes.
3  "Risk not identified" refers to persons whose mode of exposure
to HIV is unknown.  This includes persons under investigation;
persons who died, were lost to follow-up, or declined interview;
and persons whose mode of exposure to HIV remains unidentified
after investigation.



Table 8. AIDS cases by sex, age at diagnosis, and race/ethnicity,
reported through September 1993,(1) United States
                        White, not      Black, not

                       Hispanic        Hispanic         Hispanic

Male
Age at diagnosis (years) No.   (%)       No.   (%)       No. (%)

Under 5                   329  ( 0)     1,167  ( 1)       478 ( 1)
5-12                      248  ( 0)       183  ( 0)       155 ( 0)
13-19                     473  ( 0)       299  ( 0)       186 ( 0)
20-24                   4,735  ( 3)     3,282  ( 4)     1,938 ( 4)
25-29                  23,298  (14)    12,067  (14)     7,742 (16)
30-34                  37,653  (23)    19,017  (23)    11,723 (24)
35-39                  35,879  (22)    19,483  (23)    10,671 (22)
40-44                  25,717  (16)    13,213  (16)     7,088 (15)
45-49                  15,223  ( 9)     6,869  ( 8)     3,793 ( 8)
50-54                   8,173  ( 5)     3,800  ( 5)     2,012 ( 4)
55-59                   4,671  ( 3)     2,121  ( 3)     1,174 ( 2)
60-64                   2,775  ( 2)     1,155  ( 1)       587 ( 1)
65 or older             2,328  ( 1)       869  ( 1)       437 ( 1)

Male subtotal         161,502 (100)    83,525 (100)    47,984 (100)



Female
Age at diagnosis (years)

Under 5                   320  ( 3)     1,143  ( 5)       455 ( 5)
5-12                       81  ( 1)       189  ( 1)       106 ( 1)
13-19                     102  ( 1)       262  ( 1)        68 ( 1)
20-24                     672  ( 6)     1,347  ( 6)       594 ( 7)
25-29                   1,875  (18)     3,801  (16)     1,699 (19)
30-34                   2,455  (23)     5,618  (24)     2,126 (24)
35-39                   1,918  (18)     5,094  (22)     1,707 (19)
40-44                   1,093  (10)     2,826  (12)       988 (11)
45-49                     594  ( 6)     1,187  ( 5)       472 ( 5)
50-54                     359  ( 3)       706  ( 3)       273 ( 3)
55-59                     344  ( 3)       381  ( 2)       168 ( 2)
60-64                     249  ( 2)       248  ( 1)        87 ( 1)
65 or older               632  ( 6)       258  ( 1)        91 ( 1)

Female subtotal        10,694 (100)    23,060 (100)     8,834 (100)


Total (2)             172,196         106,585          56,818


                       Asian/Pacific   American Indian/
                        Islander       Alaska Native       Total(2)

Male
Age at diagnosis (years)  No.   (%)         No.   (%)       No. (%)

Under5                     8  ( 0)           8  ( 1)     1,992 (1)
5-12                       7  ( 0)           1  ( 0)       594 (0)
13-19                     11  ( 1)          11  ( 2)       980 (0)
20-24                     75  ( 4)          23  ( 4)    10,071 (3)
25-29                    267  (13)         123  (20)    43,576 (15)
30-34                    420  (21)         173  (28)    69,100 (23)
35-39                    443  (22)         126  (20)    66,742 (23)
40-44                    346  (17)          85  (14)    46,548 (16)
45-49                    218  (11)          34  ( 5)    26,191 ( 9)
50-54                    108  ( 5)          17  ( 3)    14,140 ( 5)
55-59                     62  ( 3)           9  ( 1)     8,066 ( 3)
60-64                     20  ( 1)          10  ( 2)     4,551 ( 2)
65 or older               37  ( 2)           3  ( 0)     3,680 ( 1)

Male subtotal          2,022 (100)         623 (100)   296,231(100)


Female
Age at diagnosis (years)

Under 5                    1  ( 0)           5  ( 5)     1,933 (4)
5-12                       6  ( 3)           -             384 (1)
13-19                      1  ( 0)           1  ( 1)       435 (1)
20-24                     12  ( 5)          10  ( 9)     2,641 (6)
25-29                     23  (10)          23  (21)     7,430 (17)
30-34                     48  (20)          34  (31)    10,300 (24)
35-39                     38  (16)          14  (13)     8,792 (20)
40-44                     37  (16)           9  ( 8)     4,961 (12)
45-49                     21  ( 9)           5  ( 5)     2,286 (5)
50-54                     14  ( 6)           2  ( 2)     1,356 (3)
55-59                      8  ( 3)           1  ( 1)       903 ( 2)
60-64                     12  ( 5)           3  ( 3)       599 ( 1)
65 or older               16  ( 7)           1  ( 1)       999 ( 2)

Female subtotal          237 (100)         108 (100)    43,019(100)


Total (2)              2,259               731         339,250

1  Includes 9 months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2  Includes 575 males and 86 females whose race/ethnicity is
unknown.



Table 9. AIDS cases, case-fatality rates,(1) and deaths, by
half-year and age group, through September 1993,(2) United States
                            Adults/adolescents


            Cases diagnosed    Case-fatality    Deaths occurring

Half-year   during interval         rate        during interval


Before 1981               92              81.5                30

1981 Jan. - June          98              89.8                37

     July - Dec.         208              91.3                87

1982 Jan. - June         407              92.6               155

     July - Dec.         707              91.1               290

1983 Jan. - June       1,312              93.2               526

     July - Dec.       1,654              93.2               939
1984 Jan. - June       2,581              92.8             1,406

     July - Dec.       3,408              92.8             1,981

1985 Jan. - June       4,970              92.0             2,825

     July - Dec.       6,379              91.6             3,904

1986 Jan. - June       8,413              90.4             5,109

     July - Dec.      10,026              88.3             6,568

1987 Jan. - June      13,115              88.6             7,613

     July - Dec.      14,574              85.7             8,013

1988 Jan. - June      16,836              83.4             9,397

     July - Dec.      17,425              83.1            10,764

1989 Jan. - June      20,096              78.7            12,379

     July - Dec.      20,434              76.5            14,231

1990 Jan. - June      22,629              70.8            14,404

     July - Dec.      22,128              66.3            15,265

1991 Jan. - June      25,769              58.7            15,902

     July - Dec.      27,410              49.4            17,497

1992 Jan. - June      30,925              36.1            17,431

     July - Dec.      31,177              23.4            17,555

1993 Jan. - June      27,847              11.4            14,787

     July - Sept.      3,724               5.5             2,410


Total (3)            334,344              60.3           201,775



                                   Children < 13 years old
               Cases diagnosed    Case-fatality    Deaths occurring

Half-year      during interval         rate        during interval

Before 1981               6              66.7                 1
1981 Jan. - June         11              81.8                 2
     July - Dec.          5             100.0                 6
1982 Jan. - June         13              84.6                 9
     July - Dec.         16              81.3                 5
1983 Jan. - June         32             100.0                13
     July - Dec.         42              90.5                16
1984 Jan. - June         51              84.3                26
     July - Dec.         62              87.1                22
1985 Jan. - June         99              76.8                45
     July - Dec.        128              82.8                69
1986 Jan. - June        138              81.9                65
     July - Dec.        189              70.9                91
1987 Jan. - June        218              72.0               117
     July - Dec.        257              67.7               168
1988 Jan. - June        258              64.7               134
     July - Dec.        338              61.2               174
1989 Jan. - June        352              60.2               171
     July - Dec.        333              57.4               184
1990 Jan. - June        357              52.9               191
     July - Dec.        377              43.0               190
1991 Jan. - June        357              42.3               163
     July - Dec.        325              35.7               199
1992 Jan. - June        384              32.3               168
     July - Dec.        318              27.0               197
1993 Jan. - June        213              18.3               161
     July - Sep.         27               7.4                26

Total (3)             4,906              53.3             2,615

1  Case-fatality rates are calculated for each half-year by date of
  diagnosis.  Each 6-month case-fatality rate is the number of
deaths ever reported among cases diagnosed in that period
(regardless of the year of death), divided by the number of total
cases diagnosed in that period, multiplied by 100.  For example,
during the interval January through June 1982, AIDS was diagnosed
in 407 adults/adolescents.  Through September 1993, 377 of these
407 were reported as dead.  Therefore, the case fatality rate is
92.6 (377 divided by 407, multiplied by 100).
 The case-fatality rates shown here may be underestimates because
of incomplete reporting of deaths.  Reported deaths are not
necessarily caused by HIV-related disease.
2  Includes 9  months of data collected under the 1993 AIDS
surveillance case defintions for adults and adolescents.
3  Death totals include 270 adults/adolescents and 2 children known
to have died, but whose dates of death are unknown.




Table 10. AIDS cases by year of diagnosis and definition category,
diagnosed through September 1993,(1) United States
                                     Period of diagnosis
                            Before      Oct. 1989-    Oct. 1990-

                          Sept. 1989    Sept. 1990    Sept. 1991

Definition category         No.  (%)      No.  (%)      No.  (%)

Pre-1987 definition     106,479  (79)  28,634  (64)  29,523  (58)

1987 definition          26,788  (20)  13,559  (30)  16,078  (31)

1993 definition(2)        1,610  ( 1)   2,402  ( 5)   5,467  (11)

    Severe HIV-related
    immunosuppression(3)  1,181        2,021         4,669

    Pulmonary tuberculosis  362          333           706

    Recurrent pneumonia      55           44            85

    Invasive cervical cancer 16            8            13


Total                   134,877 (100)  44,595 (100)  51,068 (100)


                                      Period of diagnosis
                          Oct. 1991-    Oct. 1992-     Cumulative
                          Sept. 1992    Sept. 1993        total
Definition category         No.  (%)      No.  (%)       No.  (%)

Pre-1987 definition      28,340  (47)  13,876  (29)  206,852  (61)
1987 definition          17,521  (29)   9,537  (20)   83,483  (25)
1993 definition(2)       15,032  (25)  24,404  (51)   48,915  (14)
    Severe HIV-related
   immunosuppression(3)  13,587        22,718         44,176
  Pulmonary tuberculosis  1,195         1,115          3,711
    Recurrent pneumonia     223           541            948
  Invasive cervical cancer   38            48            123

Total                    60,893 (100)  47,817 (100)  339,250 (100)

1  Includes 9  months of data collected under the 1993 AIDS
surveillance case definition for adults and adolescents.
2  Persons who meet only the 1993 AIDS case definition and whose
date of diagnosis is before January 1993 were diagnosed
retrospectively.  The sum of diagnoses listed for the four
conditions under the 1993 definition do not equal the 1993
definition total because some persons have more than one diagnosis
from the added conditions of pulmonary tuberculosis, recurrent
pneumonia, and invasive cervical cancer.
3  Defined as CD4+ T-lymphocyte count of less than 200 cells/uL or
a CD4+ percentage less than 14 in persons with laboratory
confirmation of HIV infection.




Table 11.  Health-care workers with documented and possible
occupationally acquired AIDS/HIV infection, by occupation, reported
through September 1993, United States(1)

                           Documented               Possible
                           occupational             occupational
                           transmission(2)        transmission(3)
occupation                       No.                      No.

Dental worker, including dentist   -                        6
Embalmer/morgue technician         -                        3
Emergency medical technician
 /paramedic                        -                        8
Health aide/attendant              1                        9
Housekeeper/maintenace worker      1                        6
Laboratory technician, clinical   15                       14
Laboratory technician,nonclinical  1                        1
Nurse                             13                       15
Physician, nonsurgical             5                        8
Physician, surgical                -                        2
Respiratory therapist              1                        2
Technician, dialysis               1                        1
Technician, surgical               1                        1
Technician/therapist,
other than those listed above      -                        3
Other health-care occupations      -                        2

Total                             39                       81

1  Health-care workers are defined as those persons, including
students and trainees, who have worked in a health-care, clinical,
or HIV laboratory setting at any time since 1978.  See MMWR
1992;41:823-5.
2  Health-care workers who had documented HIV seroconversion after
occupational exposure: 34 had percutaneous exposure, 4 had
mucocutaneous exposure, 1 had both percutaneous and mucocutaneous
exposures. Thirty-six exposures were to blood from an HIV-infected
person, 1 to visibly bloody fluid, 1 to an unspecified fluid, and
1 to a concentrated virus in a laboratory.  Eleven of these
health-care workers have developed  AIDS.
3  These health-care workers have been investigated and are without
identifiable behavioral or transfusion risks; each reported
percutaneous or mucocutaneous occupational exposures to blood or
body fluids, or lab oratory solutions containing HIV, but HIV
seroconversion specifically resulting from an occupational exposure
was not documented.



Table 12. Adult/adolescent AIDS cases by single and multiple
exposure categories, reported through September 1993, United States

                                                     AIDS cases
Exposure category                                    No.    (%)
Single mode of exposure
  Men who have sex with men                        176,793    (53)
  Injecting drug use                                68,029    (20)
  Hemophilia/coagulation disorder                    2,212    ( 1)
  Heterosexual contact                              23,536    ( 7)
  Receipt of transfusion(1)                          5,978    ( 2)
  Receipt of transplant of tissues/organs(2)             6    ( 0)
  Other(3)                                              16    ( 0)

  Single mode of exposure subtotal                 276,567    (83)

Multiple modes of exposure

  Men who have sex with men;injecting drug use      18,885    ( 6)
  Men who have sex with men;
   hemophilia/coagulation disorder                      82    ( 0)
  Men who have sex with men;heterosexual contact     3,718    ( 1)
  Men who have sex with men;receipt of
   transfusion/transplant                            2,554    ( 1)
  Injecting drug use;hemophilia/
   coagulation disorder                                 88    ( 0)
  Injecting drug use;heterosexual contact           11,003    ( 3)
  Injecting drug use;receipt of
   transfusion/transplant                            1,114    ( 0)
  Hemophilia/coagulation disorder;
   heterosexual contact                                 29    ( 0)
  Hemophilia/coagulation disorder;
   receipt of transfusion/transplant                   704    ( 0)
  Heterosexual contact;receipt of
   transfusion/transplant                              822    ( 0)
  Men who have sex with men;
   injecting drug use;hemophilia/
   coagulation disorder                                 20    ( 0)
  Men who have sex with men;injecting drug use;
   heterosexual contact                              1,764    ( 1)
  Men who have sex with men;injecting drug use;
   receipt of transfusion/transplant                   392    ( 0)
  Men who have sex with men;hemophilia/coagulation
   disorder;heterosexual contact                         4    ( 0)
  Men who have sex with men;hemophilia/coagulation
   disorder;receipt of transfusion/transplant           27    ( 0)
  Men who have sex with men;heterosexual contact;
   receipt of transfusion/transplant                   163    ( 0)
  Injecting drug use;hemophilia/coagulation
   disorder;heterosexual contact                        20    ( 0)
  Injecting drug use;hemophilia/coagulation
   disorder;receipt of transfusion/transplant           28    ( 0)
  Injecting drug use;heterosexual contact;
   receipt of transfusion/transplant                   421    ( 0)
  Hemophilia/coagulation disorder;heterosexual
   contact;receipt of transfusion/transplant            18    ( 0)
  Men who have sex with men;injecting drug use;
   hemophilia/coagulation disorder;heterosexual contact  4    ( 0)
  Men who have sex with men;injecting drug use;
   hemophilia/coagulation disorder;
   receipt of transfusion/transplant                      5   ( 0)
  Men who have sex with men;
   injecting drug use;heterosexual contact; receipt of
   transfusion/transplant                                71   ( 0)
  Men who have sex with men;
   hemophilia/coagulation disorder;heterosexual contact;
   receipt of transfusion/transplant                      3   ( 0)
  Injecting drug use;hemophilia/
   coagulation disorder;heterosexual contact;
   receipt of transfusion/transplant                     10   ( 0)
  Men who have sex with men;injecting drug use;
   hemophilia/coagulation disorder;heterosexual contact;
   receipt of transfusion/transplant                      1   ( 0)

Multiple modes of exposure subtotal                  41,950   (13)

Risk not identified(4)                               15,823   ( 5)

Total                                               334,344  (100)

1 Includes 27 adult/adolescents and 2 children who developed AIDS
after receiving blood screened negative for HIV antibody.
2 Six adults developed AIDS after receiving tissue from
HIV-infected donors. Three of the 6 received tissue or organs from
a donor who was negative for HIV antibody at the time of donation.
See N Engl J Med 1992;326:726-32.
3 "Other" refers to 11 health-care workers who developed AIDS after
occupational exposure to HIV-infected blood as documented by
evidence of seroconversion; to 4 patients who developed AIDS after
exposure to HIV within the health-care setting, as documented by
laboratory studies; to 1 person who acquired HIV infection
perinatally and was diagnosed with AIDS after age 13; and to 1
person with intentional self-inoculation of blood from an HIV-infected person.
4 "Risk not identified" refers to persons whose mode of exposure to
HIV is unknown.  This includes persons under investigation; persons
who died, were lost to follow-up, or declined interview; and
persons whose mode of exposure to HIV remains unidentified after
investigation.


TECHNICAL NOTES:  HIV/AIDS SURVEILLANCE REPORT


Surveillance and Reporting of AIDS

All 50 states, the District of Columbia, U.S dependencies and possessions,
and independent nations in free association with the U.S. (1) report AIDS
cases to CDC using a uniform case definition and case report form.  The
original  definition was modified in 1985 (MMWR 1985;34:373-5) and
again in 1987 (MMWR 1987;36 [suppl. no. 1S]:1S-15S).  The revisions
incorporated a broader range of AIDS indicator diseases and conditions and
used human immunodeficiency virus (HIV) diagnostic tests to improve the
sensitivity and specificity of the definition.  For persons with laboratory-
confirmed HIV infection, the 1987 revision incorporated HIV
encephalopathy, wasting syndrome, and other indicator diseases that are
diagnosed presumptively (i.e., without confirmatory laboratory evidence of
the opportunistic disease).  AIDS cases that meet the criteria of both the pre-
1987 and 1987 definitions are classified in the pre-1987 definition category.
Compared with patients who meet the pre-1987 case definition, a higher
proportion of patients who meet only the 1987 case definition were female,
black, or Hispanic, or were intravenous drug users (MMWR 1989;38:229-
36).

Each issue of this update includes information received and tabulated by
CDC through the last day of the previous month.  Data are tabulated by date
of report to CDC unless otherwise noted.  Data for U.S. dependencies and
possessions and for associated independent nations are included in the totals.

Age group tabulations are based on the person's age at diagnosis of AIDS:
adult/adolescent cases include persons 13 years of age and older; pediatric
cases include children under 13 years of age.  Age group tabulations in
Table 13 (only included in the year-end edition) are based on age at death.

Metropolitan areas are defined as the Metropolitan Statistical Areas (MSA)
for all areas except the 6 New England states.  For these states, the New
England County Metropolitan Areas (NECMA) are used.  Metropolitan areas
are named for a central city in the MSA or NECMA, may include several
cities and counties, and may cross state boundaries.  For example, AIDS
cases and annual rates presented for the District of Columbia in Table 1
include only persons residing within the geographic boundaries of the
District.  AIDS cases and annual rates for Washington, D.C., in Table 2
include persons residing within several counties in the metropolitan area.
State or metropolitan data tabulations are based on the person's residence at
diagnosis of the first AIDS-indicator disease(s).  The cities and counties
which comprise each metropolitan area in Table 2 are listed in the Bureau of
Census publication, "State and Metropolitan Area Data Book, 1986."

Data in this report are provisional.  Fifty percent of patients are reported to
CDC within 3 months of diagnosis.  However, reporting delays vary widely
and have been as long as several years for some cases.  The median delay in
reporting appears to have increased, from about 2 months in 1982 to about 3
months in 1988; however, recent analyses suggests that reporting delay may
be decreasing.

Completeness of reporting of diagnosed cases to state and local health
departments varies by geographic region and patient population; however,
mortality studies suggest that 70 to 90 percent of HIV-related deaths in men
25-44 years old are identified through national surveillance of AIDS
(MMWR 1989;38:561-3).  In addition, multiple routes of exposure,
opportunistic diseases diagnosed after the initial case report was submitted
to CDC, and vital status may not be determined or reported for all cases.
Caution should be used in interpreting case-fatality rates because reporting
of deaths is known to be incomplete.

Exposure Categories

For surveillance purposes, AIDS cases are counted only once in a hierarchy
of exposure categories.  Persons with more than one reported mode of
exposure to HIV are classified in the exposure category listed first in the
hierarchy, except for persons with a history of both homosexual/bisexual
contact and intravenous drug use.  They make up a separate exposure
category.

"Homosexual/bisexual contact" cases include men who report sexual contact
with other men.  "Heterosexual contact" cases include persons who report
either specific heterosexual contact with a person with, or at increased risk
for, HIV infection (e.g., an intravenous drug user), or persons presumed to
have acquired HIV infection through heterosexual contact because they were
born in countries with a distinctive pattern of transmission termed "Pattern
II" by the World Health Organization (MMWR 1988;37:286-8, 293-5).
Pattern II transmission is observed in areas of sub-Saharan Africa and in
some Caribbean countries.  In these countries, most of the reported cases
occur in heterosexuals and the male-to-female ratio is approximately 1:1.
Intravenous drug use and homosexual transmission either do not occur or
occur at a low level.

"Undetermined" cases are persons with no reported history of exposure to
HIV through any of the routes listed in the hierarchy of exposure categories.
Undetermined cases include persons who are currently under investigation
by local health department officials; persons whose exposure history is
incomplete because of death, refusal to be interviewed, or loss to follow-up;
and persons who were interviewed or for whom follow-up information was
available and no exposure mode was identified.  Persons who have an
exposure mode identified at the time of follow-up are reclassified into the
appropriate exposure category.

Rates

Rates are on an annual basis per 100,000 population.  The denominator for
computing rates in Table 1 and Table 2 are extrapolations based on U.S.
Bureau of Census data from the 1980 census and from 1988 post-census
estimates.  Each 12-month rate is the number of cases for a 12 month period
divided by the 1989 or 1990 extrapolation, multiplied by 100,000.

The denominators for computing race-specific rates (Table 9, included only
in the year-end edition) are based on 1990 census projections published in
U.S. Bureau of Census publications, "Projections of the Population of the
United States, by Age, Sex, and Race, 1988 to 2080," and "Projections of
the Hispanic Population, 1983 to 2080."  Race-specific rates are the number
of cases reported for a particular race/ethnicity during the preceding 12-
month period divided by the 1990 census projection for that race/ethnicity,
multiplied by 100,000.

Case-fatality rates are on a semiannual basis by date of diagnosis.  Each 6-
month case-fatality rate is the number of fatal cases reported, divided by the
number of total cases, diagnosed in that period, multiplied by 100.

Trends in AIDS Incidence

Tabulations of AIDS cases by date of report give a general description of
AIDS cases, but analyses by date of diagnosis give a more accurate
description of trends.  Delays in reporting, however, can have a substantial
impact on tabulated numbers of cases diagnosed in recent time periods.
About half of all cases are reported within 3 months of diagnosis, but about
15% are reported more than 1 year after diagnosis.  Delays are substantially
longer for pediatric cases and for transfusion-associated cases in adults.

Figure 5 (included only in the year-end edition report) shows trends in AIDS
incidence by month of diagnosis.  The points on the plot show the estimated
numbers of cases diagnosed, after adjusting for estimated reporting delays.
The smooth curve is computed using the Lowess procedure (J.M. Chaber,
W.S. Cleveland, B. Kleiner, and P.A. Tukey.  "Graphical Methods for Data
Analysis."  Duxbury Press, Boston, 1983, Chapter 4).

Reporting delays were estimated by a maximum likelihood statistical
procedure for each HIV exposure category (J.M. Karon, O.J. Devine, and
W.M. Morgan "Predicting AIDS incidence by extrapolating from recent
trends."  In:  C. Castillo-Chavex, ed. "Mathematical and Statistical
Approaches to AIDS Epidemiology.  Lecture Notes in Biomathematics," vol.
83, Springer Verlag, Berlin, 1989).  The adjusted incidence used in Figure 5
is the sum of the adjusted incidences for each HIV exposure group.

The Lowess procedure makes no assumption about the overall trends in the
data.  A fitted value is computed for each month by weighted least squares
regression using only the adjusted number of cases diagnosed during an
interval about the month (in Figure 5, the 30% of months closest to the
chosen month); the weights decrease for times further from the chosen
month.  The procedure assumes that incidence during the interval about each
month is approximately a linear function of time.  Lowess tends to produce
a curve that is linear at each end, as observed in the figure; predictions of
future numbers of cases should not be made by extrapolating the Lowest
curve.

The Lowess curve should be considered a description of the overall trend in
AIDS cases.  This curve emphasizes that the rate of increase in incidence
slowed during the middle of 1987.  See MMWR 1990:39:81-86.

(1) Included among the dependencies, possessions, and independent nations
are Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the
Republic of Palau, the Republic of the Marshall Islands, the Commonwealth
of the Northern Mariana Islands, and the Federated States of Micronesia.
The latter 5 comprise the category "Pacific Islands, U.S." listed in Table 1.
------------------------------

End of HICNet Medical News Digest V06 Issue #58
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: david@stat.com                 FAX: +1 (602) 451-6135
Bitnet  : ATW1H@ASUACAD



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