MMWR Recommendations and Reports December 27, 1996 / 45(RR15);1-30
This report provides recommendations for use of the newly licensed hepatitis A vaccines (HAVRIX, manufactured by SmithKline Beecham Biologicals, and VAQTA, manufactured by Merck & Company, Inc.) in persons greater than or equal to 2 years of age and updates previous recommendations for use of immune globulin (IG) for protection against hepatitis A (superseding MMWR 1990;39{No. RR-2}:1-5). For preexposure protection, hepatitis A vaccine can now be used instead of IG in many circumstances; for postexposure prophylaxis, the recommendations for IG use are unchanged.
"One World, One Hope" is the theme designated by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for this year's World AIDS Day, December 1, 1996. Worldwide, 190 countries observe World AIDS Day to focus attention on the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic, which has resulted in an estimated 27.9 million HIV infections and 5.8 million deaths, including 1.3 million deaths in children.
In 1995 and 1996, the Food and Drug Administration (FDA) approved three products in the new protease inhibitor class of drugs--saquinavir (Invirase), ritonavir (Norvir), and indinavir (Crixivan). Another drug in this class of agents, nelfinavir (Viracept)(Agouron Pharmaceuticals), is expected to be available soon from the manufacturer through an expanded-access program. All four drugs, which inhibit HIV protease and thus interfere with viral maturation and replication, are the most potent antiretroviral agents available to treat patients with HIV disease.
A primary strategy for decreasing the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) is to increase the rate of condom use among at-risk persons, and an important approach for reducing unintended pregnancies is to increase the use of effective contraception.
Many adolescents in the United States engage in behaviors that increase their risk for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Because 95% of all youth aged 5-17 years are enrolled in school, school health programs can be an efficient method to help prevent these behaviors.
Human immunodeficiency virus (HIV) infection is a major cause of morbidity and mortality among women and children in the United States. In 1995, of the 73,380 acquired immunodeficiency syndrome (AIDS) cases reported, women accounted for 13,764 (19%). HIV infection is the third leading causes of death among all U.S. women aged 25-44 yers and the leading cause of death among black women in this age group. Moreover, an estimated 7000 infants are born to HIV-infected women in the United States each year; without intervention, approximately 15%-30% of these infants would be infected.
The Advisory Committee on Immunization Practices (ACIP) recommends measles-mumps-rubella vaccine (MMR) for all persons asymptomatically infected with human immunodeficiency virus (HIV) and recommends that MMR be considered for all symptomatic HIV-infected persons who would otherwise be eligible for measles vaccine, because measles virus infection can cause severe illness and death in such persons.
The Advisory Committee on Immunization Practices (ACIP) recommends measles-mumps-rubella vaccine (MMR) for all persons asymptomatically infected with human immunodeficiency virus (HIV) and recommends that MMR be considered for all symptomatic HIV-infected persons who would otherwise be eligible for measles vaccine, because measles virus infection can cause severe illness and death in such persons.
Although preventing blood exposures is the primary means of preventing occupationally acquired human immunodeficiency virus (HIV) infection, appropriate post-exposure management is an important element of workplace safety (1). Information suggesting that zidovudine (ZDV) postexposure prophylaxis (PEP) may reduce the risk for HIV transmission after occupational exposure to HIV-infected blood (2) prompted a Public Health Service (PHS) interagency working group *, with expert consultation **, to update a previous PHS statement on management of occupational exposure to HIV with the following findings and recommendations on PEP (1). ***
Injecting-drug use is the second most frequently reported risk behavior for infection with human immunodeficiency virus (HIV). As of December 31, 1995, of 513,486 cases of acquired immunodeficiency syndrome (AIDS) reported to CDC, 184,359 (36%) were directly or indirectly associated with injecting-drug use. Injecting-drug-user (IDU)-associated AIDS cases include persons who are IDU's (n=161,891), their heterosexual sex partners (n=18,710), and children (n=3,758) whose mothers were IDUs or sex partners of IDUs.
MMWR Recommendations and Reports, May 10, 1996/Vol. 45/No. RR-06
The AIDS Community Demonstration Projects (ACDPs were community-level human immunodeficiency virus-prevention programs targeting high-risk populations in five U.S. cities. For the intervention design, researchers developed a common study protocol based on behavior-change theories and models. This report describes the common study protocol used in the ACDPs, the preliminary findings, and the conclusions regarding the design, implementation, and evaluation of a community-level intervention; specific case studies from each project site are also described.
Beginning in 1990, outbreaks of multidrug-resistant tuberculosis (MDR-TB) have been reported in hospitals and prisons in the eastern United States. During June 1991-January 1995, MDR-TB was diagnosed in 47 patients and one health-care worker at a 120-bed, infectious disease referral hospital in urban Madrid; on April 19, 1995, the Spanish Field Epidemiology Training Program was asked to investigate this outbreak. This report summarizes the findings of this investigation, which suggested that nosocomial transmission of MDR-TB occurred on a hospital ward for patients with human immunodeficiency virus (HIV) infection.
The following map provides information about the reported number of acquired immunodeficiency syndrome (AIDS) cases per 100,000 population, by state of residence from January 1995 through December 1995. More detailed information about AIDS cases is provided in the HIV/AIDS Surveillance Report, single copies of which are available from the CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20849-6003.
By the end of 1994, at least 4588 adult inmates of U.S. prisons and jails had died as a result of acquired immunodeficiency syndrome (AIDS), and during 1994, at least 5279 adult inmates with AIDS were incarcerated in prisons and jails. Periodically conducted national surveys instituted in 1985 and sponsored by the U.S. Department of Justice's National Institute of Justice (NIJ) and CDC have documented the prevalence of human immunodeficiency virus (HIV)/AIDS and the incidence of sexually transmitted diseases (STDs) among adult inmates and confined juveniles.
Infection with human immunodeficiency virus (HIV) is diagnosed routinely by the enzyme immunoassay (EIA) for HIV-1 antibody; a nonreactive blood sample is designated as negative without further testing. However, one limitation of this screening algorithm is that a blood sample may be obtained from a patient with recent HIV infection before detectable HIV antibody is present ("window period"). This report describes a patient with confirmed HIV infection in whom EIAs for HIV antibody (HIV-EIAs) were persistently negative beyond the expected "window period."
MMWR Recommendations and Reports, March 1, 1996/Vol. 45/No. RR-2
The Public Health Service (PHS) has recommended a multifaceted approach to blood safety in the United States that includes stringent donor selection practices and the use of screening tests. Blood donations in the United States have been screened for antibody to human immunodeficiency virus type 1 (HIV-1) since March 1985 and type 2 (HIV-2) since June 1992. An estimated one in 450,000 to one in 660,000 donations per year (i.e. 18-27 donations) are infectious for HIV but not detected by currently available screening tests.
Behaviors associated with increased risk for sexual transmission of human immunodeficiency virus (HIV) by infected persons include unprotected intercouse, multiple sex partners, use of crack cocaine, failure to disclose serostatus to sex partners, and trading sex for money or drugs. Some sexually active, HIV-infected persons in the United States continue to practice risky behaviors.
During the 1980s, human immunodeficiency virus (HIV) infection, the cause of acquired immunodeficiency syndrome (AIDS), emerged as a leading cause of death in the United States. In 1993, HIV infection became the most common cause of death among persons aged 25-44 years. This report updates national trends in deaths caused by HIV infection in 1994, which continue to increase.
Because immunosuppression induced by human immunodeficiency virus (HIV) infection increases the likelihood that latent tuberculosis (TB) infection will become active in HIV-infected persons, in 1987, extrapulmonary or disseminated TB was added to the acquired immunodeficiency syndome (AIDS) surveillance case definition, and in 1993, pulmonary TB in HIV-infected persons was added to the case definition.
This information is designed to support, not replace, the relationship that exists between you and your doctor.