Impact of antenatal HIV screening to prevent HIV infection in children in Norway 1987-99.

OBJECTIVE: To assess the impact of the antenatal HIV screening programme in Norway in preventing HIV infection in children. SETTING: Norway, 1987-99. METHODS: In a simulated retrospective cohort design data were used from the mandatory HIV surveillance system to compare the observed number of children born infected with HIV in Norway 1987-99 to the expected number without the antenatal screening programme. The main measures were relative and absolute performance of the screening programme. Other measures were uptake and false positive rate of screening, and number and exposure category of screen positive women. RESULTS: 96% of 961 000 eligible pregnant women were tested. 0.1% had an indeterminate test result and 46 women (5.0/100 000) were confirmed screen positive. 27 were African or south east Asian women infected before immigration to Norway. Nine out of 739 000 live born children (1.2/100 000) were infected compared with the expected 18 with no screening. The absolute impact of the screening programme was 1.3 (95% confidence interval (95% CI) -0.1 to 2.7) prevented infections in 100 000 women screened. The relative preventive impact was 51% (-15% to 81%). CONCLUSIONS: The limited absolute impact is because of the very low prevalence of undetected HIV infection among pregnant women in Norway.

Anonymous reporting of HIV infection: an evaluation of the HIV/AIDS surveillance system in Norway 1983-2000.

Several European countries are considering implementing surveillance systems for HIV infection, but questions remain regarding patient confidentiality. The population-based HIV/AIDS surveillance system in Norway integrates anonymous HIV case reports from laboratories and clinicians and named AIDS case reports. This evaluation includes a description of the system, evidence of system attributes, estimation of resources for system operations, and documentation of the system's usefulness. HIV case reports provide a far better picture of the epidemic than AIDS reports. The median delay between positive HIV test and reporting was 30 days (interquartile range 18-49 days). Completeness of demographic and epidemiologic information in the surveillance database ranges from 60 to 100%. Information on pre-AIDS mortality and emigration is incomplete. The system cost euro 25,200 in 1999. Results are published every week and used for planning of health care and prevention. We conclude that the Norwegian surveillance system with anonymous reporting of HIV cases is simple, inexpensive and flexible, and capable of providing a representative and timely overview that guides prevention. The system fulfils its objectives while respecting confidentiality and adhering to ethical principles. A similar system may be considered in other countries.

[Attitude of pregnant women to routine voluntary antenatal HIV testing]. / Gravides holdninger til rutinemessig tilbud om HIV-testing.

INTRODUCTION: Since 1987, more than 95% of pregnant Norwegian women have accepted the offer of an antenatal HIV test. We investigated women's opinion regarding antenatal HIV testing. MATERIAL AND METHODS: In an anonymous questionnaire survey in 1997, we asked 500 randomly selected women who had recently given birth about their knowledge about HIV, perception of the information given, and their attitudes towards HIV testing. RESULTS: The response rate was 74%. Half the women knew that testing was voluntary. 30% were satisfied with the information. This was associated with having been told that the test was voluntary (odds ratio 13). 61% of those who were tested, were told so. 75% of the women would opt for HIV testing in a future pregnancy and most women wanted the offer of a test to be routine procedure. INTERPRETATION: Women do not receive information that meets their needs. The programme does not accord with its objectives and is hardly ethically justifiable. There is a need for more information, especially concerning the voluntary character of antenatal HIV testing.

[Communicable disease control in connection with international air traffic to Norway]. / Smittevern ved internasjonal flytrafikk til Norge.

International air traffic has increased the risk of importation of infectious diseases to Norway. We have used notification data and a theoretical framework to assess the risk of importation and subsequent disemination of serious infectious diseases in Norway. Every year, a few cases of these diseases are imported to Norway, especially malaria, shigellosis and typhoid fever. A few secondary cases of enteric diseases may occur, but epidemics are unlikely. Counselling and immunisation of Norwegians going abroad is the first step in prevention. Secondly, health services all over the country should be able to diagnose imported diseases early and institute infection control measures. However, there is no need for concentrating resources for disease control at international airports in Norway.

[Surveillance of the HIV-epidemic in Norway]. / Overåking av HIV-epidemien i Norge.

Surveillance of HIV infection and AIDS is still a cornerstone in the efforts to prevent spread of HIV in Norway. The surveillance system aims at measuring the incidence and prevalence of HIV infection in the country. We describe the development of the surveillance from 1983 until 1996 based on the National Notification System for Infectious Diseases. New cases of HIV infection are reported anonymously but cases of AIDS are reported with name. Key information on each case includes age, gender, residence and the most likely time, place and route of transmission. The notification system is supplemented by screening of pregnant women, military recruits and blood donors, and by surveys of the number of tests performed, and other information. The information is analysed regularly, interpreted and communicated to the health services and the public.

[The HIV-epidemic in Norway 1996--mainly heterosexual transmission]. / HIV-epidemien i Norge inntil 1996--hovedvekt på heteroseksuell smitte.

Up to 1996, a total of 1,537 individuals had been reported as having HIV infection in Norway (population 4.3 million). 511 of these had developed AIDS and 410 had died from AIDS. 223 persons had acquired HIV heterosexually. Less than a fifth of these had acquired the infection from persons who themselves had been infected with HIV heterosexually in Norway. Named testing of pregnant women, recruits and blood donors confirms the limited spread of HIV. We estimate that the annual incidence of heterosexually acquired HIV infection has remained at 20-30 for the last ten years. Earlier prognoses for the epidemic in Norway were grossly erroneous, mainly owing to lack of knowledge about the factors determining the spread of HIV. Given the low rate of transmission of the virus and the sexual behaviour of Norwegians, there was never any real danger of a large heterosexual HIV epidemic in this country. The future efforts to combat the epidemic should focus on maintaining features that make Norwegian society less vulnerable to HIV.

[The HIV-epidemic among homosexual men in Norway]. / HIV-epidemien blant homoseksuelle menn i Norge.

Up to 1996, 592 men had been reported as having homosexually acquired HIV infection in Norway (population 4.3 million). 295 of these had developed AIDS and 242 had died from AIDS. Although HIV testing is common practice among homosexual men in Norway, we estimate that 100-200 HIV infected homosexual men have not been diagnosed as yet. HIV spread rapidly among homosexuals in Norway in the early 1980s. The annual incidence peaked in 1985, at 70-100 cases, and has since remained at 40-50. In our opinion the initial decrease in incidence was due mainly to dissemination of information by the gay community itself, led by pioneering gay health workers. The stable incidence during the last decade is disappointing, however, considering the vast resources used for prevention. A major challenge in HIV prevention in Norway towards the year 2000 is to bring down the incidence among homosexual men.

[The HIV-epidemic among drug addicts in Norway]. / HIV-epidemien blant stoffmisbrukere i Norge.

Up to 1996, 368 persons in Norway (population 4.3 million) had been reported as being HIV-infected because of intravenous drug use. 72 of these had developed AIDS and 59 had died from AIDS. HIV-testing is very common among drug users in Norway and new cases are rarely detected at treatment centres or at autopsy. Some 15-30 cases may still be undiagnosed. HIV spread very rapidly among drug users in Norway in 1984 and 1985, by around 100 new cases per year. Since then, the annual incidence has decreased from 30-40 cases in 1986 to 10-15 in 1995. Although the drug users seldom shared syringes even before the advent of the HIV epidemic, we believe that the public rehabilitation programmes, needle exchange programmes and health information have contributed to control HIV in this group. We expect an annual incidence of 10-15 cases the next five years.

[Infections during the 1995 flood in Ostlandet. Prevention and incidence]. / Infeksjonssykdommer under flommen på Ostlandet 1995. Forebygging og forekomst.

During the 1995 river floods in eastern Norway, 7,000 people were forced to abandon their houses and the public water supplies of some 150,000 people were threatened. The National Institute of Public Health feared outbreaks of waterborne diseases. We supplemented the local preventive efforts with expert advice and public information. We emphasised measures to maintain safe water supplies and to provide information on safe management of flood water during evacuation and clean-up. We observed no increase in the incidence of acute gastroenteritis or other possibly flood-related communicable diseases among the 329,000 people living in the municipalities affected by the floods. We conclude that the floods did not cause a measurable increase in the incidence of communicable diseases. This was probably due to some extent to the measures taken to protect the water supplies.

Systemic group B streptococcal disease in neonates and young infants in Norway 1985-94.

In the period 1985-94, 237 out of 575,248 (0.41 per 1000) live born infants in Norway were reported to suffer culture-confirmed systemic group B streptococcal disease before their 90th day of life. The annual incidence increased from 0.20 per 1000 live births in 1985 to 0.64 in 1994, due solely to an increase in cases with an onset before the seventh day of life. Future studies should address the possible causes of this increase.

[Indications for testing for sexually transmitted Chlamydia trachomatis infections]. / Indikasjoner for testing for seksuelt overførte infeksjoner med Chlamydia trachomatis.

Laboratory testing for sexually transmitted Chlamydia trachomatis infection is widely used in Norwegian general practice. The yield of this testing is declining, since the prevalence of infection in the community has decreased. Thus, the cost-effectiveness of testing is reduced, and the risk of false positive results using non-culture methods has increased. In cooperation with a panel of medical microbiologists, gynaecologists, venerologists, general practitioners and public health specialists, we have reviewed the literature and drawn up a set of recommendations for the use of laboratory testing for genital C. trachomatis infection. We emphasize clinical testing of men and women, notification of partners in order to reach males, and screening of women under the age of 25 after each change of sexual partner.

[Communicable diseases in Norway. Epidemiological status and future challenge for prevention of the most important diseases]. / Smittsomme sykdommer i Norge. Epidemiologisk status og fremtidige smittevernmessige utfordringer overfor de viktigste sykdommene.

The authors briefly review the incidence of some of the more important communicable diseases in Norway today. Thanks to extensive use of vaccines, effective preventive measures and useful antibiotics, many of these diseases are no longer a threat to public health, as was the rule up to the latter half of this century. However, constant vigilance is needed to sustain this positive situation.

[Evaluation of the National Notification System for infectious diseases during an outbreak of Shigella epidemic in Norway 1994]. / Evaluering av Meldesystem for infeksjonssykdommer under shigellaepidemien i Norge 1994.

The National Notification System for Infectious Diseases, in Norwegian abbreviated to MSIS, registered 110 cases of Shigella sonnei-infection in persons with debut of symptoms during weeks 21 to 25, 1994, and where we did not receive information that the patients had been abroad. We evaluated the notification system during this outbreak of infectious disease by looking at delays in the notification process and estimating the proportion of patients who received an etiological diagnosis. It took a median time of seven days from onset of illness until a faecal specimen was obtained and a further ten days (maximum 15 days) until the result was registered in MSIS. The time lapse between receiving the specimen until MSIS had registered the result varied from six to 15 days among the laboratories which sent more than four notifications. In the summarical notification system we registered an increase of 712 cases (86%) of acute gastroenteritis compared with the same week the previous two years.