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61St YEAR-61E ANNÉE Wkly kpidem Rcc - Helete eputem. hebd. lÿM , 61, oü-76 No. 10 WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ GENEVA GENÈVE WEEKLY EPIDEMIOLOGICAL RECORD RELEVÉ ÉPIDÉMIOLOGIQUE HEBDOMADAIRE Telegraphic Address, EP1DNATIONS GENEVA Telex m i l Adresse télégraphique: EP1DNAT10NS GENÈVE Télex 27S2I Automatic Telex Reply Service Service automatique de réponse par teks Telex 281SQ Geneva with ZC2SC u d ENGL for a reply ui English Télex 28150 Genève suivi de ZC2C et FRAN pour une réponse en français 7 MARCH 1986 61st YEAR-6 1 e ANNÉE 7 MARS 1986 ACQUIRED IMMUNODEFICIENCY SYNDROME SYNDROME DTMMUNODÉFICIT ACQUIS (AIDS) (SIDA) WHO/CDC case definition for AIDS Définition OMS/CDC du cas de SIDA For surveillance purposes, a relatively precise case definition is Aux fins de la surveillance, il est nécessaire de disposer d’une définition required that includes the most characteristic manifestations of relativement précise du cas de SIDA qui englobe les manifestations les LAV/HTLV-III infections. WHO recently adopted the case defi­ plus caractéristiques des infections par le LAV/HTLV-III. L’OMS a nition of AIDS in adults amd children developed by the Centers récemment adopté une définition du cas de SIDA chez l’adulte et l’enfant for Disease Control (CDC) and endorsed by the participants at the élaborée par les Centers for Disease Control (CDC) et entérinée par les Second Meeting of the WHO Collaborating Centres on AIDS held participants à la Deuxième réunion des Centres collaborateurs pour le in Geneva 16-18 December 1985. The WHO/CDC definition, to SIDA qui s’est tenue à Genève du 16au 18décembre 1985. La définition be applied in countries where appropriate diagnostic techniques OMS/CDC est à utiliser dans les pays qui possèdent les moyens de dia­ are available, specifies that a case of acquired immunodeficiency gnostic appropriés; elle précise qu’un cas de syndrome d’immunodéficit syndrome (AIDS) is an illness characterized by: acquis (SIDA) se caractérise comme suit: I. one or more of the opportunistic diseases listed below (diag­ I. présence d’une ou plusieurs affections opportunistes figurant sur la nosed by methods considered reliable) that are at least mod­ liste ci-après, (diagnostiquées par des méthodes jugées fiables) et qui erately mdicauve of underlying cellular immunodeficiency; soient au moms modérément indicatives d’une immunodépression and cellulaire sous-jacente, et II. absence of all known underlying causes of cellular immunode­ II. immunodépression cellulaire de cause initiale inconnue (autre que ficiency (other than LAV/HTLV-III infection) and absence of l’infection par le LAV/HTLV-III) et absence de toute autre cause de all other causes of reduced resistance reported to be associated moindre résistance qui sou liée à au moins une de ces maladies with at least one of those opportunistic diseases. opportunistes. Despite having the above, patients are excluded as AIDS cases if Même s’il satisfait aux entères ci-dessus, un malade ne sera pas con­ they have negative result(s) on testing for serum antibody to sidéré comme sidatique si la recherche des anticorps sénques anti- LAV/HTLV-III,* do not have a positive culture for LAV/HTLV- LAV/HTLV-III ou la culture du virus LAV/HTLV-III sont négatives* et III. and ha ve both a normal or high number of T-helper (OKT4 or si le nombre de lymphocytes T-auxiliaires (OKT4 ou LEU3) et le rapport LEU3) lymphocytes and a normal or high rauo of T-helper to T-auxiliaires/T-suppresseurs (OK.T8 ou LEU2) sont normaux ou élevés. T-suppressor (OK.T8 or LEU 2) lymphocytes. In the absence of test En l’absence de ces données, on considérera comme sidatiques les results, patients satisfying all other criteria m this definition are malades qui satisfont à l’ensemble des autres critères. included as cases. This general case definition may be made more explicit by Cette définition générale peut être rendue plus explicite en spéci­ specifying: fiant: I. the particular diseases considered at least moderately indica­ I. les maladies qui sont considérées comme au moins modérément tive of cellular i mm unodeficiency, which are used as indicators indicatives d’une immunodépression cellulaire et que l’on considère of AIDS; and comme des indicateurs du SIDA; et II. the known causes of cellular immunodeficiency, or other II. les causes admises d'immunodépression cellulaire ou autres causes de causes of reduced resistance reported to be associated with moindre résistance liées à telle ou telle maladie dont la présence particular diseases, which would disqualify a patient as an permet d’exclure un SIDA. AIDS case. I. Diseases at least moderately indicative of underlying cellular I. Maladies au moins modérément indicatives de la présence d’une immunodeficiency : immunodépression cellulaire In the following list of diseases, the required diagnostic methods Dans la liste ci-après, les examens qui doivent être positifs sont indi­ with positive results are shown in parentheses. “Microscopy” may qués entre parenthèses. «L’examen microscopique» peut impliquer éga­ include cytology. lement un examen cytologique. * A single ncg&uve test for LAV/HTLV-Ui may be applied here ifn is an antibody test * Une seule épreuve négative de recherche du LAV/HTLY-1U est suffisante ici s’il s’agit d’un by El .ISA, imraunofluorescent, or Western blot methods, because such tests are very examen sérologique immuno-enzymatique, par immunofluorescence ou Western blot, car ces sensitive. Viral cultures are less sensitive but more speofic, and so may be relied on if techniques sont très sensibles. Les cultures devirus sont moins sensibles mais {dus spécifiques ; en posiu ve but no t if negatrvc. If multiple antibody tests have inconsistent results, the result revanche, elles ne sont fiables que si elles sont positives. Si une sene d’epreuves sérologiques applied to the case delimtion should be that of the majority, A positive culture, however, donne des résultats incohérents, on prendra en considération le résultat donne parla muante des would overrule negative antibody lests. epreuves. Cependant une culture positive remporte air un examen sérologique negauf Epidemiological notes contained m this issue inforrTMMQns frmjfm'fiinfluyifK contenues dans ce numéro : Acquired immunodeficiency syndrome (AIDS)» Expanded Formation à la planification et au financement de la santé, grippe, Programme on Immunization» influenza, training in health programme élargi de vaccination, syndrome d'immunodéficit planning and financing. acquis (SIDA). List of newly infected areas, p. 76. Liste des zones nouvellement infectées, p. 76. M dy Eputem R tc No 10 - 7 March 1986 - 70 - Relevé epidérn. hebd. N° 10 - 7 mars 1986 A. Praiozoal and helminthic infections: A. Parc&uoses dues à des protozoaires ou à des helminthes. 1. crypiosporidiosis, intestinal, causing diarrhoea for over 1 1. cryptosporidiose intestinale avec diarrhée persistant plus d’un mois month (on histology or stool microscopy); (examen histologique ou microcoprologique); 2. Pneumocystis carinii pneumonia (on histology, or microscopy 2. pneumonie à Pneumocystis carimi (examen histologique, ou examen of a “touch" preparation, bronchial washings, or sputum); microscopique d’une empreinte, d’un lavage bronchique ou d’un cra­ chat); 3. strongyloidosis, causing pneumonia, central nervous system 3. strongyloïdose, entraînant une pneumonie, une infection du SNC ou infection, or infection disseminated beyond the gastrointestinal une infection débordant le tractus gastro-intestinal (diagnostic histo­ tract (on histology); logique); 4. toxoplasmosis, causing infection in internal organs other than 4. toxoplasmose entraînant l’infection d’organes internes à l’exception liver, spleen, or lymph nodes (on histology or microscopy of a toutefois de la rate ou des ganglions lymphatiques (diagnostic histo­ “touch” preparation). logique ou examen microscopique d’une empreinte). B. Fungal infections: B. Infections fongiques. 1. candidiasis, causing oesophagitis (on histology, or microscopy 1. candidose entraînant une œsopbagite (examen histologique ou of a “wet” preparation from the oesophagus, or endoscopic or examen microscopique d'une préparation «fraîche» provenant d’une autopsy findings of white plaques on an erythematous mucosal biopsie œsophagienne, ou examen endoscopique ou encore observa­ base, but not by culture alone), tion à l’autopsie de plaques blanchâtres sur une muqueuse érythéma­ teuse, à l'exclusion d’une simple culture); 2. cryptococcosis, causing central nervous system or other infec­ 2. cryptococcose déterminant une infection du SNC ou autre infection tion disseminated beyond lungs and lymph nodes (on culture, généralisée débordant les poumons et les ganglions lymphatiques (par antigen detection, histology, or Indian ink preparation of culture, déteenon de l'antigène correspondant, examen histologique CSF). ou préparation de LCR à l’encre de Chine). C. Bacterial infections: C. Infections bactériennes: 1. Mycobacterium avium or mtracellulare (M. avium complex), or 1. Mycobacterium avium ou mtracellulare (complexe M. avium), ou M. M. kansasti, causing infection disseminated beyond lungs and kansasu, entraînant une infection généralisée débordant les poumons lymph nodes (on culture). et les ganglions lymphatiques (par culture). D. Viral infections. D. Infections virales: 1. cytomegalovirus causing infection in internal organs other than 1. cytomégalovirus : infection des organes internes à l’exception du foie, liver, spleen, or lymph nodes (on histology or cytology, but not de la rate ou des
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