Current Trends World Health Organization Workshop:
Conclusions and Recommendations on Acquired Immunodeficiency
Syndrome
An international conference on acquired immunodeficiency
syndrome
(AIDS), sponsored by the U.S. Department of Health and Human
Services
and the World Health Organization (WHO), was held in Atlanta,
Georgia,
April 15-17, 1985. It was attended by over 3,000 participants from
50
countries and was followed on April 18-19 by a WHO consultation to
review the information presented at the conference and to assess
its
international implications.
The group of WHO consultants concluded that information is now
sufficient to permit health authorities to take actions that may
decrease the incidence of AIDS among certain risk groups. The
group
submitted the following conclusions and recommendations:
WHO should:
Establish a network of collaborating centers with
special expertise in the field. The centers should
assist in training staff members and providing
reference
panels of sera, evaluation of diagnostic tests, and
provision of advice on the production of working
reagents. They should also assist in preparing
educational material and organizing studies to
determine
the natural history of the disease and the extent of
infection in different parts of the world.
Coordinate global surveillance of AIDS using a
compatible reporting format and the currently
accepted
case definition. WHO should disseminate these data
and
other important developments on the disease as widely
and as rapidly as possible.
Assist in developing an effective vaccine, and when
appropriate, developing international requirements
for
the vaccines. WHO should take an active role in
facilitating the evaluation of candidate vaccines.
Encourage and assist in periodic serologic studies in
countries where AIDS has yet to be recognized and
should
ensure the collection of comparable data and
representative selections of sera, since
lymphadenopathy-associated virus/human T-lymphotropic
virus type III (LAV/HTLV-III) infection precedes AIDS
in
an individual or a community, early recognition will
require serologic studies in groups with potential
risk
of infections.
Member countries should:
Inform the public that LAV/HTLV-III infection is
acquired through heterosexual and homosexual
intercourse, needle-sharing by intravenous drug
abusers,
transfusion of contaminated blood and blood products,
transmission by infected mothers to their babies, and
probably repeated use of needles and other unsterile
instruments used for piercing skin/mucous membranes.
Information should be provided about the risk of
LAV/HTLV-III infection and AIDS, especially to those
men
and women who may be at increased risk because of
multiple sexual partners. There is currently no
evidence of spread of LAV/HTLV-III by casual social
contact even within households. Provision of timely
and
accurate information on these points is recommended
to
allay inappropriate public concern.
Ensure that health-care workers are informed about
AIDS
and LAV/HTLV-III infection, modes of transmission,
clinical spectrum, available programs of management
(including psychosocial support), and methods for
prevention and control.
Assess the risk that AIDS poses to each country's
population and establish methods of diagnosis,
surveillance, and laboratory testing, including
specific
tests for LAV/HTLV-III.
Screen, where feasible, potential donors of blood and
plasma for antibody to LAV/HTLV-III, and not use
positive units for transfusion or for the manufacture
of
products where there is a risk of transmitting
infectious agents. Potential donors should be
informed
about the testing in advance of the donation.
Reduce the risk of transmission of LAV/HTLV-III by
factor VIII and IX concentrates by treating them by
heat
or other proven methods of inactivation. The use of
such products is recommended.
Inform potential donors of organs, sperm, or other
human
material about AIDS, and encourage groups at
increased
risk of infection to exclude themselves from
donating.
Whenever possible, serologic testing should be
performed
before these materials are used. This is
particularly
important when donor material is collected from an
unconscious or deceased patient on whom relevant
information may be absent.
Refer individuals with positive tests for antibody to
LAV/HTLV-III for medical evaluation and counseling.
Such people should be encouraged to inform their
health-care attendants of their status.
Develop guidelines for the total care of patients and
for handling their specimens in hospital and other
settings. These guidelines should be similar to
those
that have been effective for care of patients with
hepatitis B.
Develop codes of good laboratory practice to protect
staff against risk of infection. Such
recommendations
may be based on those found in the Laboratory
Biosafety
Manual published by WHO (1). The level of care
required
for work with specimens from patients infected with
LAV/HTLV-III is similar to that required with
hepatitis
B. The use of class II biologic safety cabinets is
recommended. These cabinets are adequate for
containment of other agents, such as herpes and
hepatitis viruses, mycobacteria, and protozoa, that
may
be present in the specimens. For work involving
production and purification of LAV/HTLV-III, P3
biosafety containment levels must be employed.
j. Collect and store serum samples from representative
laboratory workers at the time of employment and at
regular intervals thereafter, to be able to assess
the
risk of laboratory acquired infection and
effectiveness
of biosafety guidelines. Countries should provide
this
information to WHO for collation and dissemination.
Provision of samples and testing should be carried
out
with the informed consent of the subjects.
k. Be aware of the importance of keeping confidential
information about the results of serologic testing
and
the identity of AIDS patients. Serologic testing
should
be undertaken with the informed consent of the
subject.
Abstracted from WHO Weekly Epidemiological Record 1985;60:129-39.
Reference
WHO. Biological safety. Weekly Epidemiological Record
1983;58:289-90.
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