Surveillance of antenatal infections--HIV, hepatitis B, syphilis and rubella susceptibility in London

London has relatively high rates of HIV, hepatitis B and syphilis, and has the potential for undiagnosed infection in pregnancy. As part of a drive to improve HIV testing in pregnancy, surveillance of a number of antenatal infections has been carried out in London's 30 maternity units since 2000. Infection screening rates rose from 89% in 2000 to 94% in 2002, and HIV screening rates increased from 66% to 86%. During 2002, 115,230 women booked for antenatal care; 998 were HBsAg positive (about ten in 1000), 452 were HIV positive (five in 1,000), 412 tested positive for syphilis (four in 1000), and 3,929 were susceptible to rubella (36 in 1000). The main burden of infection was concentrated in a few geographic areas. Worryingly the majority of women found to be HIV positive were diagnosed by antenatal screening and not before.     

Detecting Mycobacterium tuberculosis Infection in Children Migrating to Australia

In 2015, Australia updated premigration screening for tuberculosis (TB) disease in children 2–10 years of age to include testing for infection with Mycobacterium tuberculosis and enable detection of latent TB infection (LTBI). We analyzed TB screening results in children <15 years of age during November 2015–June 2017. We found 45,060 child applicants were tested with interferon-gamma release assay (IGRA) (57.7% of tests) or tuberculin skin test (TST) (42.3% of tests). A total of 21 cases of TB were diagnosed: 4 without IGRA or TST, 10 with positive IGRA or TST, and 7 with negative results. LTBI was detected in 3.3% (1,473/44,709) of children, for 30 applicants screened per LTBI case detected. LTBI-associated factors included increasing age, TB contact, origin from a higher TB prevalence region, and testing by TST. Detection of TB and LTBI benefit children, but the updated screening program’s effect on TB in Australia is likely to be limited.     

Screening HIV in pregnancy: a survey of prenatal care patients

BACKGROUND: Women in Canada, as in the rest of the world, represent an increasing proportion of new HIV positive cases. In 2002, women accounted for 25% of all positive HIV tests reported in Canada; with the majority being in their childbearing years (15 to 39 years), perinatal transmission of HIV in Canada is cause for concern. Following the development of interventions that can effectively reduce vertical transmission rate, prenatal screening of HIV has become the first and most pivotal step in the prevention of mother-to-child HIV transmission. The purpose of this study was to assess how women's knowledge and attitudes regarding HIV and HIV screening in pregnancy influence screening rates. METHOD: A prospective anonymous survey of 231 women attending antenatal care clinics at a teaching university hospital or in a community clinic was conducted. RESULTS: In general, pregnant women supported universal HIV screening in the prenatal period. Women who previously had been tested for HIV and who did not perceive that they were at risk for contracting HIV were more likely to decline HIV testing in their current pregnancy. Overall knowledge regarding HIV and its transmission is less than optimal, particularly among those women who declined HIV testing. CONCLUSION: Knowledge gaps exist between women accepting and declining prenatal HIV screening, particularly relating to benefits of screening. These results suggest that efforts have to continue to be put into educating the public but also, importantly, into changing current attitudes.     

Safety of the Canadian blood supply in 1980-85: using a paediatric cohort for risk assessment of human immunodeficiency virus (HIV) infection

The risk of HIV from transfusions in Canada in the period 1980-85 was estimated, using the information from a transfused paediatric cohort. Children who were transfused between January 1980 and November 1985 at a tertiary care paediatric hospital were contacted by letter. With this notification, HIV testing for recipients was recommended. HIV testing histories were obtained. The number tested for HIV was estimated from the questionnaire responses and from data matching with the HIV-testing laboratory. Cases of HIV infection were identified through multiple sources. In this cohort, 11,028 children were transfused a mean of 21 units. Of the 10,220 living recipients, the estimated proportion tested for HIV was 86% to 91%. Thirty-one cases of HIV infection were identified, representing 0.28% of the cohort but 0.34% of those expected to have been tested. The estimated HIV incidence per 1,000 units transfused ranged from 0.028 [95% CI 0.0007, 0.155] in 1980 to 0.445 [95% CI 0.2592, 0.712] in 1985. This suggests that the risk of HIV from transfusions in Canada continued to rise until the implementation of HIV testing of donors in November 1985.     

Antenatal screening for HIV; are those who refuse testing at higher risk than those who accept testing?

BACKGROUND: The UK Department of Health recommends that all pregnant women are offered screening for infection with human immunodeficiency virus (HIV) and had encouraged maternity units to achieve uptake targets of 90 per cent by the end of 2002. Many maternity units fail to meet this target and there is concern that those women who are still refusing testing may include a higher proportion of women at high risk of infection. In consequence, those infected with HIV are not being identified and are not receiving the antiviral treatment, which would be of benefit to them and reduce the risk of transmission of HIV to their babies. METHODS: A retrospective audit of HIV screening uptake in women who were found to be infected with hepatitis B virus (HBV) and in those who were not infected with HBV was carried out in order to explore further the characteristics of 'acceptors' and 'refusers' of HIV screening. RESULTS: The overall uptake rate of HIV screening in the West Midlands population served by the National Blood Service was 60 per cent in 2001 and 74 per cent in 2002. The prevalence of HBV infection was found to be twice as high (0.39 per cent) in those who had refused an HIV test compared with those who had accepted a test (0.21 per cent) (p = 0.022). CONCLUSION: There is good evidence that women refusing HIV antenatal screening have a higher prevalence of another blood-borne virus, indicating clearly that further effort must be made to increase the screening uptake and fully integrate HIV screening with other antenatal tests.     

Syphilis in Immigrants and the Canadian Immigration Medical Examination

Background Immigrants to Canada must undergo screening for syphilis. This study presents the results of syphilis screening from 2000 to 2004 and describes its impact on Canadian syphilis reporting and epidemiology. The study identifies migrant groups at risk of syphilis disease. Methods All permanent resident applicants 15 years of age or older; younger individuals who have syphilis risk factors, and long-term temporary resident applicants are required to have non-treponemal syphilis screening done. Reactive results were confirmed. Immigration-related syphilis screening results were analyzed for year, migrant origin, migrant age and classification. Results A total of 2,209 individuals were found with positive syphilis serology from the screening of 2,001,417 applicants. The sex ratio of positive cases was M:F = 1.4. Rates per 100,000 applicants were: refugees 286, refugee claimants 267, family class187, temporary residents 85, and economic class 63. Age and geographic distribution reflected sexual transmission, known international prevalence, and the Canadian processes of immigration. Conclusions Certain immigration class applicants from syphilis high-prevalence source countries are a significant source of syphilis notifications in Canada. Identifiable populations and the immigration application medical processes represent global public health policy and program opportunities at the national level. Disclaimer: The paper was prepared in personal capacity; the analysis, and opinions expressed are those of the authors and are not to be attributed to the Department of Citizenship and Immigration or the Government of Canada, and do not necessarily reflect nor represent the position of any government department, agency, university or professional society to which the authors may belong.     

2010-2018年内蒙古自治区TB/HIV双重感染患者筛查与治疗情况分析

目的了解内蒙古自治区HIV/AIDS患者中TB筛查情况,为患者早期有效的治疗提供依据。方法对2010-2018年TB/HIV双重感染患者筛查资料进行分析。结果 2018年登记HIV/AIDS患者5 116例,其中4 959例接受过结核病筛查,筛查率为96.93%,检出结核患者27例,检出率为0.54%。2010-2018年共登记结核病患者132 229例,其中12 482例患者进行了HIV抗体阳性筛查,阳性筛查率为9.44%,检出HIV阳性患者11例,检出率为0.09%。2018年确诊28例TB/HIV双重感染患者,其中接受治疗28人,治疗率达100%。同时抗病毒和抗结核治疗、单纯抗病毒治疗、单纯抗结核治疗的治疗率分别占78.57%、3.57%、17.86%。TB/HIV双重感染者中,44例抗结核治疗,其中3例治愈,28例完成疗程,治疗成功率达70.45%。结论 2018年HIV/AIDS患者中TB的筛查率96.93%,达到"十三五规划"要求。艾滋病病毒感染者感染结核菌的危险性较高,在HIV/AIDS中开展TB监测将更有意义。     

Tuberculosis infection and disease among schoolchildren: the influence of the HIV epidemic and of other factors

BACKGROUND: The HIV/AIDS epidemic has caused an excess of tuberculosis cases in Spain and in other countries, but its impact on tuberculosis infection is less well understood. This study presents a massive screening undertaken to estimate the prevalence of tuberculous infection in a cohort of primary school entrants. The evolution of the risk of infection is studied by comparison with previous data in the same population. METHODS: Tuberculin skin test screening with 2TU of PPD RT 23 of first grade students in the primary schools of Barcelona, in the 1994-95 school year (cohort born in 1988). Information was also sought from families of unscreened children. Contacts of PPD+ children were traced to locate index cases. The results were also linked to the case registry of the tuberculosis control programme. RESULTS: The prevalence of tuberculin reactors free of BCG vaccination among the 11,080 schoolchildren screened belonging to the 1988 cohort was 0.76%. A 3% annual decline in the annual risk of infection is estimated by comparison with previous data. The identification of 24 cases with a previous history of tuberculosis disease and of 13 cases with active disease diagnosed after the screening was possible by the follow up of these tuberculin positive children and of the information provided by families of unscreened pupils. The screening detected 1.5 new cases of tuberculosis per 1000 tuberculin tests performed. Tuberculosis infection could be traced to HIV infected tuberculosis cases for at least 6% of the positive schoolchildren. CONCLUSIONS: The decline of the annual risk of infection continues in Barcelona, although at a slower pace than before the HIV/AIDS epidemic, probably attributable to the influence of injecting drug users with smear positive tuberculosis and HIV/AIDS.     

中国HIV抗体检测策略的应用评价

目的 评价中国HIV抗体检测策略在不同人群应用的效果和收益.方法 (1)收集103 133份一般人群(临床就诊病例、献血员、新兵)标本、1276份HIV感染高危人群(吸毒人群、HIV感染者的配偶)标本、2323份生化和免疫指标异常的标本,用现行HIV抗体检测策略进行检测.(2)对2002-2008年武警总医院90 289人次临床病例HIV抗体检测数据进行回顾性分析;对3个省级确认中心实验室过去3～5年确认检测的结果进行回顾性分析.结果 (1)筛查试验的收益在高危人群与一般人群显著不同,高危人群筛查阳性者中HIV抗体真阳性的比例约为50%,显著高于一般人群;主要针对一般人群的确认实验室筛查阳性标本中真阳性的比例为19.58%,显著低于主要针对高危人群的确认实验室.(2)2002-2008年临床HIV抗体检测,首次筛查阳性的真阳性率由3.7%上升到16.0%,同时,复检效率由92.6%下降为61.5%.(3)常见的生化和免疫异常未增加HIV抗体检测的非特异反应.结论 HIV抗体筛查阳性预示HIV感染的意义在不同人群有显著差别,高危人群显著高于一般人群.随着近年来HIV抗体检测试剂质量的改进和实验室质量控制水平的提高,HIV抗体首次筛查的准确性大幅度提高,而复检的效率显著下降.应考虑对不同人群采取不同的检测程序.     

Trends in the prevalence of HIV infection and risk behaviors in homo- and bisexual men

OBJECTIVES: To describe trends in the prevalence of HIV infection, in risk behaviors and in knowledge and attitudes related to antiretroviral therapy (ART) among men who have sex with men (MSM) recruited in Barcelona (Spain) between 1995 and 2002. METHODS: Cross-sectional surveys were conducted twice yearly from 1993. MSM were recruited in saunas, sex-shops, a cruising site in a public park and by a mailing sent to all members of a gay organization, using an anonymous self-administered questionnaire. From 1995 saliva samples were requested to determine the prevalence of HIV infection. RESULTS: The prevalence of HIV infection remained stable from 14.2% in 1995 to 18.3% in 2002 (p > 0.05). The proportion of men who had more than 10 sexual partners in the previous 12 months showed an increasing trend (from 45.2% in 1995 to 55.7% in 2002, p < 0.0001). Unprotected anal intercourse (UAI) with casual partners did not change significantly between 1995 and 2002 (25.8% en 2002). In 2002, 55.8% of steady couples in which one or both members did not know their serological status and 27.5% of serodiscordant couples reported UAI. The proportion of men who believed that "HIV-positive persons taking ART (7.7% in 2002) or with undetectable viral load (6.4% in 2002) cannot transmit the virus" remained steady since 1998 (p > 0.05). CONCLUSIONS: The prevalence of HIV and risk behaviors continues to be high among MSM in Barcelona. A strategic objective in the control of the HIV epidemic must be to continue the decrease in the number of occasions on which UAI takes place between men with discordant serological status.     

2～14岁赴美移民申请人结核病筛查结果分析

〔目的〕对2~14岁赴美移民申请人结核病筛查的结果进行分析,为早期发现潜伏结核感染、肺结核患者及结核病防控提供参考依据。〔方法〕对2009年7月—2010年3月期间在广东国际旅行卫生保健中心体检的2747名2~14岁赴美移民申请人进行结核病筛查,所有申请人均进行结核菌素皮试(TST);若TST≥10mm或申请人有疑似结核的体征或症状,应进行X线胸片检查;若胸片所见疑似结核或有疑似结核的体征或症状的,进行结核分枝杆菌实验室检测。〔结果〕TST皮试结果显示阳性率为47.40%,阴性率52.60%,其中中度阳性者624名,占总人数的22.72%,强阳性者25名,占总人数的0.91%。阴性率随年龄增长逐渐下降,阳性与中度阳性率随年龄增长逐渐上升(P0.001)。649名TST≥10 mm者胸片检查结果发现,疑似结核病患者8人,其中非领养儿童1例,领养儿童7例。结核分枝杆菌实验室检测结果发现,8例疑似肺结核患者中,1例为耐多药结核患者。〔结论〕加强儿童,特别是生活条件和营养条件差的儿童结核病的筛查,提高卡介苗覆盖率及接种质量对于儿童肺结核的防控具有重要意义。     

中国HIV抗体检测策略的应用评价

目的 评价中国HIV抗体检测策略在不同人群应用的效果和收益.方法 (1)收集103 133份一般人群(临床就诊病例、献血员、新兵)标本、1276份HIV感染高危人群(吸毒人群、HIV感染者的配偶)标本、2323份生化和免疫指标异常的标本,用现行HIV抗体检测策略进行检测.(2)对2002-2008年武警总医院90 289人次临床病例HIV抗体检测数据进行回顾性分析;对3个省级确认中心实验室过去3～5年确认检测的结果进行回顾性分析.结果 (1)筛查试验的收益在高危人群与一般人群显著不同,高危人群筛查阳性者中HIV抗体真阳性的比例约为50%,显著高于一般人群;主要针对一般人群的确认实验室筛查阳性标本中真阳性的比例为19.58%,显著低于主要针对高危人群的确认实验室.(2)2002-2008年临床HIV抗体检测,首次筛查阳性的真阳性率由3.7%上升到16.0%,同时,复检效率由92.6%下降为61.5%.(3)常见的生化和免疫异常未增加HIV抗体检测的非特异反应.结论 HIV抗体筛查阳性预示HIV感染的意义在不同人群有显著差别,高危人群显著高于一般人群.随着近年来HIV抗体检测试剂质量的改进和实验室质量控制水平的提高,HIV抗体首次筛查的准确性大幅度提高,而复检的效率显著下降.应考虑对不同人群采取不同的检测程序.     

中国HIV抗体检测策略的应用评价

目的 评价中国HIV抗体检测策略在不同人群应用的效果和收益.方法 (1)收集103 133份一般人群(临床就诊病例、献血员、新兵)标本、1276份HIV感染高危人群(吸毒人群、HIV感染者的配偶)标本、2323份生化和免疫指标异常的标本,用现行HIV抗体检测策略进行检测.(2)对2002-2008年武警总医院90 289人次临床病例HIV抗体检测数据进行回顾性分析;对3个省级确认中心实验室过去3～5年确认检测的结果进行回顾性分析.结果 (1)筛查试验的收益在高危人群与一般人群显著不同,高危人群筛查阳性者中HIV抗体真阳性的比例约为50%,显著高于一般人群;主要针对一般人群的确认实验室筛查阳性标本中真阳性的比例为19.58%,显著低于主要针对高危人群的确认实验室.(2)2002-2008年临床HIV抗体检测,首次筛查阳性的真阳性率由3.7%上升到16.0%,同时,复检效率由92.6%下降为61.5%.(3)常见的生化和免疫异常未增加HIV抗体检测的非特异反应.结论 HIV抗体筛查阳性预示HIV感染的意义在不同人群有显著差别,高危人群显著高于一般人群.随着近年来HIV抗体检测试剂质量的改进和实验室质量控制水平的提高,HIV抗体首次筛查的准确性大幅度提高,而复检的效率显著下降.应考虑对不同人群采取不同的检测程序.     

Less refusal to participate in HIV screening among pregnant women in the Amsterdam region since the introduction of standard HIV screening using the opting-out method

In 2003 the Municipal Health Service in Amsterdam started to screen pregnant women for HIV according to the opting-out method. In this method the HIV test is routinely included in the prenatal screening along with hepatitis B virus (HBV) and syphilis. If the woman does not want to be tested for HIV then she must actively opt out of this test. This screening method was chosen because in the universal screening method used in 2002, women had to give their explicit consent to test for HIV and this led to a high refusal rate (13.6%), especially among women from AIDS-endemic countries. After the introduction of the opting-out method, the refusal rate fell from 3% in the first quarter of 2003 to 1.4% in the last quarter of 2003. None of the women refused to be tested for HBV or syphilis. In 2003, the HIV prevalence among pregnant women was 0.3% (35/13.621). The experiences with this screening method in Amsterdam were used to implement the national opting-out method for HIV screening in pregnant women, which was introduced on 1 January 2004.     

43 310例孕产妇艾滋病监测结果分析

目的了解深圳市宝安区孕产妇艾滋病病毒(HIV)感染流行现状和趋势,对HIV阳性的孕产妇进行指导干预及治疗。方法对首次来院做产前检查的孕产妇进行HIV监测。HIV检测采用ELISA/硒法筛查和蛋白印迹(WB)法确诊。同时对4年中的孕产妇HIV监测情况作一比较。结果4年间,共对我院43310例孕产妇进行了HIV监测,检出5例阳性患者,孕产妇HIV阳性率为0.12‰。其中4例为经性途径感染,1例为经血途径感染。妊娠结局:1例自然流产,2例引产,2例行择期剖宫产。由于对HIV的监测及宣教,孕产妇的预防意识增强,监测率由2002年的86.3%上升到2006年的99.9%。结论对孕产妇HIV的监测,可有效地降低和阻止母婴垂直传播。近年深圳市宝安区孕产妇HIV感染主要经性途径感染,需进一步加强对此人群的行为教育干预,利用各种宣传渠道,提高孕产妇对母婴传播艾滋病的认识。     

AIDS and HIV infection in Poland in 2002

The cumulative number of AIDS cases diagnosed in Poland from 1986 up to the end of 2002 reached 1273, and 618 AIDS deaths were registered during this time. The yearly number of newly diagnosed cases remained stable (113 in 2002, incidence 0.3 per 100,000), but with 48 reported deaths the downward trend in AIDS mortality, experienced since 1996, was not sustained. Additionally, taking into account the official life statistics data, AIDS deaths might be underreported. In 2002, 574 newly detected HIV infections were reported (incidence 1.5 per 100,000), which is within the range observed in the past years. Injecting drug users constituted the most numerous risk group both among the AIDS cases (56.5%) and the HIV infection cases (31.1%). The proportion of reports of HIV infections with missing information regarding the risk group further increased in 2002, coming up to 55%. In order to monitor the epidemiological situation better quality of data will need to be assured.     

Results of the Expanded HIV Testing Initiative--25 jurisdictions, United States, 2007-2010

Approximately 20% of the estimated 1.2 million persons living with human immunodeficiency virus (HIV) infection in the United States at the end of 2008 were not aware of their infection. Testing, diagnosis, medical care, treatment with highly active antiretroviral therapy (HAART), and access to prevention services soon after HIV infection can prevent morbidity and mortality and reduce a person's risk for transmitting HIV. In 2006, CDC recommended screening patients aged 13--64 years for HIV infection in health-care settings that have a prevalence of undiagnosed HIV infection of ≥0.1%. In October 2007, CDC initiated the Expanded HIV Testing Initiative (ETI), through which it funded 25 health departments to facilitate HIV screening and increase diagnoses of HIV infections and linkage to care among populations disproportionately affected by HIV, especially non-Hispanic blacks. This report describes the results of that effort. Annual progress reports designed to provide data specific to ETI indicated that 2,786,739 HIV tests were conducted, of which 29,503 (1.1%) were positive and 18,432 (0.7%) resulted in new HIV diagnoses. Blacks accounted for 1,411,780 (60%) of tests and 11,638 (70%) of new HIV diagnoses. Clinical settings comprised at least 75% of the 1,331 testing venues and accounted for 90% of all tests and 81% of all new HIV diagnoses. Based on follow-up data available for 16,885 persons with new HIV diagnoses, 12,711 (75.3%) were linked successfully to HIV primary care. Through expanded HIV testing activities, substantial numbers of persons previously unaware of their HIV infection were identified and linked to care. Health departments should continue to partner with clinical-care providers to provide routine HIV screening, especially in populations disproportionately affected by HIV.     

Premarital screening for antibodies to human immunodeficiency virus type 1 in the United States. The Premarital Screening Study Group.

To evaluate premarital human immunodeficiency virus (HIV) screening as an approach to AIDS prevention in the United States, we determined the HIV antibody seroprevalence in marriage license applicants in eight areas by blinded testing of blood specimens routinely collected for syphilis serology. The seroprevalences were 0.0-0.4 percent in women and 0.0-1.1 percent in men. We also examined the impact of mandatory premarital HIV screening on marriage rates in Louisiana and Illinois. In 1988, after screening began, 9 percent and 16 percent fewer marriage licenses than in the previous two years were issued in Louisiana and Illinois, respectively. We estimated that mandatory premarital screening, if adopted nationally, would cost $167,230,000. We conclude that compared with other HIV prevention programs mandatory premarital screening would be expensive and would probably have a minor impact on the HIV epidemic.     

HIV screening of male inmates during prison intake medical evaluation--Washington, 2006-2010

Since 2006, CDC has recommended routine, opt-out human immunodeficiency virus (HIV) screening for patients in health-care settings with a prevalence of undiagnosed HIV infection of ≥0.1%. Before September 2007, the Washington State Department of Corrections (WADOC) only provided HIV testing to inmates on request. In September 2007, WADOC began routine HIV opt-in screening in which inmates were notified that HIV screening would be performed during the prison intake medical evaluation if they consented. In March 2010, WADOC switched to a routine opt-out HIV screening model in which inmates are notified that HIV screening will be performed unless they decline. To assess the proportion of inmates screened and the number of infections diagnosed during the use of the three HIV testing policies, WADOC reviewed HIV testing data for male inmates undergoing intake medical evaluation during January 2006--December 2010. From January 1, 2006, to August 31, 2007, 5% of 12,202 incoming inmates were tested for HIV at their request during the intake medical evaluation, and three (0.50%) of those tested had newly diagnosed HIV infection. From September 1, 2007, to March 15, 2010, 72% of 16,908 inmates agreed to opt-in HIV screening, and 13 (0.11%) tested positive for HIV. From March 16, 2010, to December 31, 2010, 90% of 5,168 inmates agreed to opt-out HIV screening, and six (0.13%) tested positive for HIV. Compared with routine opt-in HIV screening, opt-out HIV screening was associated with a greater proportion of inmates tested, without decreasing the rate of case detection.