Reports on HIV/AIDS: 1990

NOVEMBER 30, 1990, MMWR, Vol. 39, No. 47, pp. 850-853
comparison, the cumulative incidence rate in the United States was 515.7 per million
population (5). Countries in Eastern Europe reported few cases, and rates in those
countries were <6 per million (except in Romania, where the rate was 20 per million).
In northern European countries, including Denmark, the Federal Republic of Germany, the Netherlands, Norway, Sweden, and the United Kingdom, at least 70% of
reported cases occurred among homosexual/bisexual men; in two southern European countries-Italy and Spain-66% and 63% of cases, respectively, occurred
among IVDUs.
Countries in EURO reported 1199 pediatric AIDS cases, including 560 (46.7%) from
three countries-France, Italy, and Spain-and 428 (35.7%) from Romania. Vertical
transmission (i.e., from mother to infant) was the principal mode of transmission in
France (79%), Italy (89%), and Spain (70%); for these cases, 47% of mothers were
IVDUs. In Romania, 241 (56.3%) pediatric cases occurred in children with histories of
multiple hospitalizations and multiple injections, 169 (39.5%) in transfusion recipients, 13 (3.0%) in children born to HIV-infected mothers, and five (1.2%) in children
with coagulation disorders; many of the transfusion recipients also had histories of
multiple hospitalizations and multiple injections.
Adapted from WHO Wkly Epidemiol Rec 1990;65:239-43 as reported by: RA Ancelle-Park,
MD, JB Brunet, MD, E Couturier-Moren, MD, WHO Collaborating Centre on AIDS, Paris, France.
F Popovici, R Apetrei, N Beldescu, Romanian Ministry of Health. Surveillance Br, Div of HIV/AIDS,
Center for Infectious Diseases, CDC.
Editorial Note: In EURO, since March 1989, the countries reporting the largest
relative annual percent increases in AIDS cases have been in Eastern Europe
(Romania, 4680%; Poland, 338%; Union of Soviet Socialist Republics, 271%; and
Bulgaria, 133%). Factors that may account for these recent relative increases may
include the later introduction and recognition of HIV in these countries and/or
improved AIDS surveillance and reporting. In Romania, a large outbreak of nosocomially transmitted HIV infection accounted for most AIDS cases reported in that
country (6).
The outbreak in Romania represents the second report of a major nosocomial
outbreak of HIV transmission (6,7). Most AIDS patients in Romania appear to have
acquired HIV infection through transfusions of unscreened blood and through reuse
of inadequately sterilized needles and syringes, which resulted from shortages of
injection and sterilization equipment (6). This outbreak further demonstrates the
serious potential for HIV transmission in medical facilities that lack sufficient medical
supplies and have inadequate sterilization practices.
WHO, with technical assistance from CDC, has assisted the Romanian Ministry of
Health in establishing national AIDS surveillance and HIV sentinel surveillance
systems and in designing and conducting epidemiologic studies to further clarify the
magnitude and patterns of HIV transmission among Romanian children. Information
obtained from HIV/AIDS surveillance and from these studies is being used to help
target, enhance, and evaluate AIDS prevention activities in Romania.
References
1. WHO. Acquired immunodeficiency syndrome (AIDS). Wkly Epidemiol Rec 1990;65:329-31.
2. WHO. Acquired immunodeficiency syndrome (AIDS)-WHO/CDC case definition for AIDS.
Wkly Epidemiol Rec 1986;61:69-76.
3. WHO. Report on the meeting of the technical working group on HIV/AIDS in childhood.
Geneva: World Health Organization, February 27-March 1, 1989.
4. WHO. Acquired immunodeficiency syndrome (AIDS) report of the epidemiologic situation in
Europe as of 31 March 1989. Wkly Epidemiol Rec 1989;64:221-4.

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