AIDS surveillance: a direct assessment of under-reporting.

OBJECTIVE: To assess directly the extent of under-reporting of AIDS cases to the National AIDS surveillance system. DESIGN: All AIDS cases diagnosed from 1 January 1982 to 1 August 1989 in Riverside Health Authority were identified from a local register of HIV infection and cross-checked against records of AIDS cases reported to the national AIDS surveillance system. SETTING: Riverside Health Authority, London, UK. MAIN OUTCOME MEASURES: An estimate of under-reporting was made by identifying both the number of AIDS cases that had not been reported and the number of AIDS cases reported after August 1989 (allowing for reporting delay). Changes in the timeliness, 1982-1989, of AIDS reporting by Riverside physicians were measured by comparing reporting delay (time between diagnosis and report) and the proportion of AIDS cases reported more than a year after diagnosis (non-reports). RESULTS: A total of 807 AIDS cases were identified. Under-reporting of AIDS cases was found to be 10%; less than 3% (20 cases) of the AIDS identified had not been reported by September 1991. The timeliness of AIDS reporting from Riverside improved significantly from 1987, when the median reporting delay fell from 7 to 4 months, and the proportion of non-reports fell from 36 to 17% (Mann-Whitney U test P < 0.001, chi 2 test P < 0.001, respectively). CONCLUSIONS: Our estimate of 10% AIDS under-reporting is half that used to adjust the previous forecasts of the AIDS epidemic in the UK, confirms current thinking that under-reporting lies between 5 and 15%, and supports the view that AIDS reporting is more complete than the reporting of most other infectious diseases.

Prevention of neural tube defects in an urban health district.

An evaluation of voluntary prenatal screening for neural tube defects with serum alphafetoprotein (s-AFP) is presented. During a three year period, there were 52 fetuses with neural lesions. Of 46 mothers who bore a fetus with an open neural lesion, 25 were detected, of whom 23 agreed to the termination of their pregnancies. An unscreened group of 2331 mothers (17% of all deliveries) produced 14 fetuses with neural tube defects, an incidence of 6.0 per 1000, 1.8 times the incidence (3.3 per 1000) in the screened group. Pitfalls occurring in the assessment of hyper-alphafetoproteinemia included inaccurate gestational dating and allowance for excessive body weight. The results of a robust AFP-NTD screening programme supported in selected cases by ultrasonar visualisation of the spine argue for its continuance in this district.

Impact of HIV infection on mortality in young men in a London health authority.

OBJECTIVE: To determine the number of deaths attributable to HIV infection among men aged 15-64 in a geographically defined population in the United Kingdom. DESIGN: Retrospective review of death certificates and linkage with local and national HIV and AIDS surveillance data. SETTING: Riverside District Health Authority, London. MAIN OUTCOME MEASURES: Numbers of deaths attributed to HIV infection in male residents of Riverside aged 15-64 and 15-44 over a six month period. Proportion of attributed deaths were (i) identified from death certificates by the Office of Population Censuses and Surveys as being due to HIV infection and (ii) reported as cases of AIDS or HIV related deaths to the Public Health Laboratory Service Communicable Disease Surveillance Centre. RESULTS: 34 of 213 (16%) deaths in men aged 15-64 and 27 of 69 (39%) deaths in men aged 15-44 were attributed to HIV infection. Six of 33 (18%) attributed deaths were identified by the Office of Population Censuses and Surveys and 32/34 (94%) were reported to the Communicable Disease Surveillance Centre. CONCLUSIONS: HIV infection was the leading cause of death in male residents of Riverside aged 15-44 and the third commonest cause of death in those aged 15-64. Most individuals dying of known HIV infection were reported to the Communicable Disease Surveillance Centre but identification of the true cause of death from the process of death certification was poor. Measures to improve the certification of HIV and AIDS or the use of AIDS surveillance information correctly to code the cause of death needs to be considered to ensure that the true impact of HIV infection is reflected in routine mortality statistics.