A system for surveillance of voluntary HIV testing: results of the first 2 years, 1989-1990.

OBJECTIVE: In 1988, in order to improve the already established surveillance of AIDS and HIV-infected cases in Scotland, UK, the Communicable Diseases (Scotland) Unit [CD(S)U], in collaboration with microbiologists responsible for HIV testing, instituted a routine system for the epidemiological surveillance of all voluntary HIV tests. METHODS: To facilitate information capture, a standardized HIV request form was introduced for use throughout the country by clinicians requesting an HIV test. In addition, a network of laboratory computers, operated by clerical personnel, was established for the collection and collation of data. RESULTS: In 1989, of 9483 individuals tested for HIV, 129 (1.4%) were HIV-antibody-positive compared with 130 (1.2%) of 11,111 tested in 1990. A comparison of 1989 with 1990 rates of HIV among specific population groups, including injecting drug users (4.1%, 1989; 2.7%, 1990), homosexual men (5.2%, 1989; 4.5%, 1990), heterosexual men and women with high-risk partners (1.6%, 1989; 1.8%, 1990) and heterosexual men and women with lesser risk (0.3%, 1989; 0.5%, 1990), revealed no statistically significance differences at a 95% level of confidence. CONCLUSION: We believe that this surveillance system is the first of its kind to be implemented on a nationwide basis. The first 2 years' findings suggest a degree of stability in new transmissions of HIV occurring in Scotland. However, the increasing numbers of those known to be HIV-infected continue to cause considerable concern: 1943 individuals were reported to CD(S)U as HIV-antibody-positive by December 1991.

Prevalence of HIV among childbearing women and women having termination of pregnancy: multidisciplinary steering group study.

OBJECTIVE: To determine the prevalence of HIV among pregnant women, in particular those whose behaviour or that of their partners put them at "low risk" of infection. DESIGN: Voluntary named or anonymous HIV testing of pregnant women during 21 months (November 1988 to July 1990). SUBJECTS AND SETTING: All women who planned to continue their pregnancy and attended clinics serving the antenatal populations of Edinburgh and Dundee. All women admitted for termination of pregnancy to gynaecology wards serving the pregnant populations of Dundee and outlying rural areas. MAIN OUTCOME MEASURES: Period prevalence of HIV antibody positivity. RESULTS: 91% of antenatal clinic attenders and 97% of women having termination of pregnancy agreed to HIV testing on a named or anonymous basis. HIV period prevalences for antenatal clinic attenders and women having termination of pregnancy tested in Dundee were 0.13% and 0.85% respectively, and for antenatal clinic attenders tested in Edinburgh 0.26%. For those at "low risk" rates for antenatal clinic attenders and women having termination of pregnancy in Dundee were 0.11% and 0.13%, and for antenatal clinic attenders in Edinburgh 0.02%. In Dundee HIV prevalence among women having a termination of pregnancy (0.85%) was significantly greater than that among antenatal clinic attenders (0.13%). CONCLUSIONS: HIV infection is undoubtedly occurring among women at "low risk," and it is clear that a policy of selective testing of those at only "high risk" is inadequate for pregnant women living in areas of high prevalence such as Edinburgh and Dundee. Moreover, when studying pregnant populations in such areas there is the need to include those having a termination of pregnancy.

PIP: This study sought to determine the prevalence of HIV among pregnant women, in particular those whose behavior or that of their partners put them at low-risk for infection. This was a voluntary named or anonymous HIV testing of pregnant women between November 1988-July 1990 among all women who planned to continue their pregnancies and attended clinics serving antenatal populations in Edinburgh and Dundee and those women admitted for termination of pregnancy to gynecology wards serving the pregnant populations of Dundee and outlying rural areas. 91% of the antenatal clinic attenders and 97% of women having pregnancy termination agreed to HIV testing on either a named or anonymous basis. HIV period prevalences for antenatal clinic attenders and women having pregnancy termination tested in Dundee were 0.13% and 0.85% respectively, and for antenatal clinic attenders tested in Edinburgh 0.26%. For those at low-risk, the rates for antenatal clinic attenders and women having pregnancy termination in Dundee were 0.11% and 0.13%, and for antenatal clinic attenders in Edinburgh 0.02%. In Dundee, HIV prevalence among women having a termination of pregnancy (0.95%) was significantly greater than that among antenatal clinic attenders (0.13%). HIV infection is undoubtedly occurring among low-risk women and it is clear that a policy of selective testing of those only at high-risk is inadequate for pregnant women living in areas of high prevalence such as Edinburgh and Dundee. Moreover, when studying pregnant populations in such areas, there is a need to include those undergoing pregnancy termination.

Infections in British clinical laboratories, 1988-1989.

During 1988-89 this continuing survey showed 18 infections in the staff of laboratories reporting from 166 centres, representing 21,756 person-years of exposure. Shigella and other bowel infections (one caused by S typhi) predominated, affecting 11 microbiology medical laboratory scientific officers. Three shigella infections originated from quality control samples. Pulmonary tuberculosis affected four workers, including two mortuary technicians, but without detected occupational exposure to Mycobacterium tuberculosis. Other infections included one caused by Brucella melitensis. Hepatitis was not reported. The sustained low level of hepatitis is encouraging and suggests a low risk to staff of bloodborne infections such as human immunodeficiency virus.

Infections in British clinical laboratories, 1986-87.

During 1986-87 this continuing survey showed 15 specific infections in the staff of 235 laboratories, representing 28,524 person years of exposure. The community was the probable source of four of the five cases of tuberculosis and one of the five cases of salmonellosis. Occupational exposure was the probable cause of four infections by Shigella flexneri, three by Salmonella typhimurium, and one by S typhi, all affecting medical laboratory scientific officers (MLSOs) in microbiology. Occupational exposure was also the probable cause of one case of tuberculosis in a mortuary technician and one of probable non-A, non-B hepatitis in a medical laboratory scientific officer haematology worker. The overall incidence of reported infections was 52.6/100,000 person years (35/100,000 for infections of probable occupational origin). The highest rates of laboratory acquired infections related to MLSO microbiology workers and mortuary technicians. No additional infections were seen as a result of extending the survey to forensic laboratories.

Lochgoilhead fever: outbreak of non-pneumonic legionellosis due to Legionella micdadei.

Analysis of case histories from 187 people who had visited a hotel and leisure complex in Lochgoilhead, a village on the west coast of Scotland, indicated that 170 had had an acute illness characterised by headache, fatigue, arthralgia, myalgia, cough, and breathlessness. These symptoms were consistent with Pontiac fever-like illness. Legionella micdadei was isolated from the leisure complex whirlpool spa at the time that 60 of 72 individuals with symptoms seroconverted to L micdadei antigen. This outbreak is thought to be the first of a Pontiac fever-like illness ascribed to L micdadei and the first large-scale outbreak of its kind to have occurred outside North America. Whirlpool spas can be a major reservoir of legionella organisms; they must therefore be properly maintained and operated to prevent outbreaks of infection.

Infections in British clinical laboratories, 1984-5.

During 1984-5 this continuing survey showed that 41 infections occurred in the staff of 193 laboratories, representing 23,043.5 person years of exposure. The community was the probable source of two cases each of hepatitis A and B, one of tuberculosis, two of campylobacter enteritis, and 12 of Norwalk viral diarrhoea. Occupational exposure was the probable cause of six hepatitis B infections (affecting haematology, biochemistry, and microbiology staff), three of tuberculosis (affecting mortuary and morbid anatomy workers), seven shigella, three salmonella (including one typhoid) and one pseudocholera infection (all in microbiology medical laboratory scientific officers), and a streptococcal infection in a mortuary technician. An episode of hepatitis of uncertain cause affected a carrier of hepatitis B. The incidence of reported infections of all types was 178 per 100,000 person years (91 for infections of suspected occupational origin). The highest incidence was in morbid anatomy and mortuary workers, followed by microbiology medical laboratory scientific officers.