Influenza A(H1N1)pdm09 vaccination policies and coverage in Europe.

In August 2010 the Vaccine European New Integrated Collaboration Effort (VENICE) project conducted a survey to collect information on influenza A(H1N1)pdm09 vaccination policies and vaccination coverage in the European Union (EU), Norway and Iceland. Of 29 responding countries, 26 organised national pandemic influenza vaccination and one country had recommendations for vaccination but did not have a specific programme. Of the 27 countries with vaccine recommendations, all recommended it for healthcare workers and pregnant women. Twelve countries recommended vaccine for all ages. Six and three countries had recommendations for specific age groups in children and in adults, countries for specific adult age groups. Most countries recommended vaccine for those in new risk groups identified early in the pandemic such as morbid obese and people with neurologic diseases. Two thirds of countries started their vaccination campaigns within a four week period after week 40/2009. The reported vaccination coverage varied between countries from 0.4% to 59% for the entire population (22 countries); 3% to 68% for healthcare workers (13 countries); 0% to 58% for pregnant women (12 countries); 0.2% to 74% for children (12 countries). Most countries identified similar target groups for pandemic vaccine, but substantial variability in vaccination coverage was seen. The recommendations were in accordance with policy advice from the EU Health Security Committee and the World Health Organization.

Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008-2009.

In 2009 the second cross-sectional web-based survey was undertaken by the Vaccine European New Integrated Collaboration Effort (VENICE) project across 27 European Union (EU) member states (MS), Norway and Iceland (n=29) to determine changes in official national seasonal influenza vaccination policies since a survey undertaken in 2008 and to compare the estimates of vaccination coverage between countries using data obtained from both surveys. Of 27 responding countries, all recommended vaccination against seasonal influenza to the older adult population. Six countries recommended vaccination of children aged between six months and <18 years old. Most countries recommended influenza vaccination for those individuals with chronic medical conditions. Recommendations for vaccination of healthcare workers (HCW) in various settings existed in most, but not all countries. Staff in hospitals and long-term care facilities were recommended vaccination in 23 countries, and staff in out-patient clinics in 22 countries. In the 2009 survey, the reported national estimates on vaccine coverage varied by country and risk group, ranging from 1.1% - 82.6% for the older adult population; to between 32.9% -71.7% for clinical risk groups; and from 13.4% -89.4% for HCW. Many countries that recommend the influenza vaccination do not monitor the coverage in risk groups. In 2008 and 2009 most countries recommended influenza vaccination for the main risk groups. However, despite general consensus and recommendations for vaccination of high risk groups, many countries do not achieve high coverage in these groups. The reported vaccination coverage still needs to be improved in order to achieve EU and World Health Organization goals.

Antioxidants and free radical scavengers for the treatment of stroke, traumatic brain injury and aging.

The overproduction of reactive oxygen species (ROS) and reactive nitrogen species (RNS) is a common underlying mechanism of many neuropathologies, as they have been shown to damage various cellular components, including proteins, lipids and DNA. Free radicals, especially superoxide (O(2)*-), and non-radicals, such as hydrogen peroxide (H(2)O(2)), can be generated in quantities large enough to overwhelm endogenous protective enzyme systems, such as superoxide dismutase (SOD) and reduced glutathione (GSH). Here we review the mechanisms of ROS and RNS production, and their roles in ischemia, traumatic brain injury and aging. In particular, we discuss several acute and chronic pharmacological therapies that have been extensively studied in order to reduce ROS/RNS loads in cells and the subsequent oxidative stress, so-called "free-radical scavengers." Although the overall aim has been to counteract the detrimental effects of ROS/RNS in these pathologies, success has been limited, especially in human clinical studies. This review highlights some of the recent successes and failures in animal and human studies by attempting to link a compound's chemical structure with its efficacy as a free radical scavenger. In particular, we demonstrate how antioxidants derived from natural products, as well as long-term dietary alterations, may prove to be effective scavengers of ROS and RNS.

Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control.

BACKGROUND: Infections with carbapenem-resistant Enterobacteriaceae (CRE) are increasingly being reported from patients in healthcare settings. They are associated with high patient morbidity, attributable mortality and hospital costs. Patients who are "at-risk" may be carriers of these multidrug-resistant Enterobacteriaceae (MDR-E).The purpose of this guidance is to raise awareness and identify the "at-risk" patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE. METHODS: The guidance was created by a group of experts who were functioning independently of their organisations, during two meetings hosted by the European Centre for Disease Prevention and Control. A list of epidemiological risk factors placing patients "at-risk" for carriage with CRE was created by the experts. The conclusions of a systematic review on the prevention of spread of CRE, with the addition of expert opinion, were used to construct lists of core and supplemental infection prevention and control measures to be implemented for "at-risk" patients upon admission to healthcare settings. RESULTS: Individuals with the following profile are "at-risk" for carriage of CRE: a) a history of an overnight stay in a healthcare setting in the last 12 months, b) dialysis-dependent or cancer chemotherapy in the last 12 months, c) known previous carriage of CRE in the last 12 months and d) epidemiological linkage to a known carrier of a CRE.Core infection prevention and control measures that should be considered for all patients in healthcare settings were compiled. Preliminary supplemental measures to be implemented for "at-risk" patients on admission are: pre-emptive isolation, active screening for CRE, and contact precautions. Patients who are confirmed positive for CRE will need additional supplemental measures. CONCLUSIONS: Strengthening the microbiological capacity, surveillance and reporting of new cases of CRE in healthcare settings and countries is necessary to monitor the epidemiological situation so that, if necessary, the implemented CRE prevention strategies can be refined in a timely manner. Creating a large communication network to exchange this information would be helpful to understand the extent of the CRE reservoir and to prevent infections in healthcare settings, by applying the principles outlined here.This guidance document offers suggestions for best practices, but is in no way prescriptive for all healthcare settings and all countries. Successful implementation will result if there is local commitment and accountability. The options for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources.

Cholera in the United States, 1965-1991. Risks at home and abroad.

OBJECTIVE: To assess risks for cholera in the United States. DESIGN: Review of published reports of cholera outbreaks and sporadic cases and Centers for Disease Control and Prevention (CDC) memoranda and laboratory reports. PATIENTS: Persons with symptomatic laboratory-diagnosed cholera treated in the United States and territories. RESULTS: From 1965 through 1991, 136 cases of cholera were reported. Fifty-three percent of the patients were hospitalized and three persons died (case-fatality rate, 0.02). Ninety-three infections were acquired in the United States and 42 overseas; for one case the source was unknown. Domestically acquired cholera was largely related to the endemic Gulf Coast focus of Vibrio cholerae 01 (56 cases). The major domestic food vehicle was shellfish, particularly crabs harvested from the Gulf of Mexico or nearby estuaries. In 1991, 14 (54%) of 26 domestically acquired cases were caused by food from Ecuador (n = 11) and Thailand (n = 3). During 1991, the first cases of cholera in travelers returning from South America were reported. In 1991, the rate of cholera among air travelers returning from South America was estimated as 0.3 per 100,000; among air travelers returning from Ecuador, 2.6 per 100,000. CONCLUSIONS: Cholera remains a small but persistent risk in the United States and for travelers. An endemic focus on the Gulf Coast, the continuing global pandemic, and the epidemic in South America make this likely to continue for years to come. Physicians should know how to diagnose and treat cholera and should report all suspected cases to their state health departments.

Alterations in calcium-mediated signal transduction after traumatic injury of cortical neurons.

Calcium influx and elevation of intracellular free calcium ([Ca2+]i), with subsequent activation of degradative enzymes, is hypothesized to cause cell injury and death after traumatic brain injury. We examined the effects of mild-to-severe stretch-induced traumatic injury on [Ca2+]i dynamics in cortical neurons cultured on silastic membranes. [Ca2+]i was rapidly elevated after injury, however, the increase was transient with neuronal [Ca2+]i returning to basal levels by 3 h after injury, except in the most severely injured cells. Despite a return of [Ca2+]i to basal levels, there were persistent alterations in calcium-mediated signal transduction through 24 h after injury. [Ca2+]i elevation in response to glutamate or NMDA was enhanced after injury. We also found novel alterations in intracellular calcium store-mediated signaling. Neuronal calcium stores failed to respond to a stimulus 15 min after injury and exhibited potentiated responses to stimuli at 3 and 24 h post-injury. Thus, changes in calcium-mediated cellular signaling may contribute to the pathology that is observed after traumatic brain injury.

Tumor necrosis factor-alpha: a neuromodulator in the CNS.

In the central nervous system (CNS), the cytokine tumor necrosis factor-alpha (TNF alpha) is produced by both neurons and glial cells, participates in developmental modeling, and is involved in many pathophysiological conditions. There are activity-dependent expressions of TNF alpha as well as low levels of secretion in the resting state. In contrast to the conventional view of a cytotoxic effect of TNF alpha, accumulating evidence suggests a beneficial effect when TNF alpha is applied at optimal doses and at specific periods of time. The bimodal effect is related to subtypes of receptors, activation of different signal transduction pathways, and the presence of other molecules that alter the intracellular response elements such as immediate-early genes. TNF alpha may be an important neuromodulator in development of the CNS, diseases of demyelination and degeneration, and in the process of regeneration. It could induce growth-promoting cytokines and neurotrophins, or it could increase the production of antiproliferative cytokines, nitric oxide, and free radicals, thereby contributing to apoptosis.

The neurotrophins and their receptors: structure, function, and neuropathology.

The neurotrophins are a family of polypeptides that promote differentiation and survival of select peripheral and central neurons. Nerve growth factor, brain-derived neurotrophic factor, neurotrophin-3, neurotrophin-4, and neurotrophin-5 are included in this group. In recent years, tremendous advances have been made in the study of these factors. This has stimulated our review of the field, characterizing the neurotrophins from initial isolation to molecular analysis. The review also discusses their synthesis, localization, and responsive tissues, in both the periphery and CNS. The complex receptor interactions of the neurotrophins are also analyzed, as are putative signal transduction mechanisms. Discussion of the observed and postulated involvement in neuropathological disorders leads to the conclusion that the neurotrophins are involved in the function and dysfunction of the nervous system.

The projection of frontal cortical oculomotor areas to the superior colliculus in the domestic cat.

The projection of frontal cortical oculomotor areas to separate laminae of the superior colliculus was examined in adult domestic cats. Following the placement of WGA-HRP/HRP injections within the superficial, intermediate, and deep layers of the superior colliculus, several observations may be made regarding the frontal corticotectal projection in the cat. Large injections including all of the collicular layers result in the retrograde labeling of neurons in frontal cortical areas that have been suggested previously to be analogous to the frontal eye fields in monkeys. These areas are a portion of the ventral bank and lip of the cruciate sulcus, including a small portion of the medial wall of the hemisphere, and the medial and lateral banks and fundus of the presylvian sulcus. The same pattern of retrograde labeling in frontal cortical areas is seen when the injection sites are restricted to either the intermediate or deep collicular layers. That is, different frontal cortical areas of the cat project separately but not differentially upon different collicular laminae. The greatest numbers of labeled neurons within frontal cortical oculomotor areas are observed following injections placed laterally within the caudal portion of the superior colliculus, regardless of whether the injection sites are located within the intermediate or deep collicular layers. Injections restricted to the superficial gray layer do not result in retrograde labeling in any of the frontal cortical oculomotor areas of the cat. These results are discussed in terms of the patterns of visuomotor integration specific to the cat, as well as in relation to previous evidence showing similarities between frontal cortical areas in cats and monkeys.

The pretectal complex of the monkey: a reinvestigation of the morphology and retinal terminations.

The cytoarchitecture of the pretectal complex of the squirrel monkey was examined in Nissl- and myelin-stained sections in the coronal, horizontal, and sagittal plane. Five different pretectal subdivisions can be identified on the basis of their nuclear morphology. The general location and cytoarchitecture of these pretectal nuclei are similar to those described for non-primate mammals. Thus, the nomenclature used to designate the pretectal nuclei in other species can now be applied to the squirrel monkey. According to this standard terminology, the pretectal complex of the squirrel monkey consists of the nucleus of the optic tract; the pretectal olivary nucleus; and the medial, anterior, and posterior pretectal nuclei. The pattern of retinal innervation to the pretectum was also determined by placing intraocular injections of 3H-proline into one eye and processing the tissue according to standard autoradiographic techniques. The pattern of transported label is more dense over the contralateral nuclei than over the ipsilateral nuclei. In particular, dense transported label is observed bilaterally over the pretectal olivary nucleus and the nucleus of the optic tract with sparse label over the posterior and medial pretectal nuclei.

Subcortical projections of the inferior parietal cortex (area 7) in the stump-tailed monkey.

The efferent projections of the neocortex on the lateral convexity of the inferior parietal lobe (area 7 of Brodmann) were examined using the anterograde transport of tritiated amino acids. Multiple injections of 3H-leucine and 3H-proline were placed within the three cytoarchitecturally distinct zones that lie along the exposed surface of the inferior parietal lobe (IPL). The subcortical projections resulting from these injections were studied. Prominent projections were seen in the thalamus (medial and lateral pulvinar), brainstem (dorsolateral and ventral pontine nuclei), and basal ganglia (caudate and putamen) with less dense label over the thalamic intralaminar nuclei, pretectal complex, superior colliculus, reticular nucleus of the thalamus, suprageniculate nucleus, lateral posterior nucleus, oral pulvinar, and claustrum. In many of these cases there was a topographical relationship apparent with regard to the injections placed along the rostral-caudal dimension of the IPL. There is a striking reciprocal arrangement in the afferent and efferent projection systems of the IPL. The functional relevance of both the topography and the efferent projections of the IPL is discussed.

Interhemispheric connections in the visual cortex of the squirrel monkey (Saimiri sciureus).

The callosal connections within the posterior parietal and occipital cortices were studied in the squirrel monkey with horseradish peroxidase tracing techniques. The data were evaluated with particular emphasis on the relationship of major callosal connections along the 17-18 border. The overall pattern of callosal connections in the squirrel monkey also was compared with callosal patterns in other New World simians. Our results show that the dense band of callosal connections along the 17-18 border in the squirrel monkey differs from the connections observed in other New World monkeys in that it is virtually confined to area 18 and avoids area 17. In addition to a continuous band of callosal connections in area 18 that parallels the 17-18 border, rostral extensions of the band are oriented perpendicular to the 17-18 border and present an obvious periodicity. The remaining parieto-occipital cortex contains a complex pattern of callosal connections that is strikingly similar to patterns reported for other New World monkeys. Thus, it is likely that the dorsolateral extrastriate visual cortex in the squirrel monkey is organized in a manner similar to that found within other New World monkeys.

The parabigeminogeniculate projection: connectional studies in eight mammals.

Anterograde and retrograde tracing methods have been used to analyze the origin and distribution of parabigeminogeniculate axons in the gray squirrel, the gopher, the rat, the opossum, the cat, the greater bushbaby, the squirrel monkey and the macaque monkey. Our findings reveal that parabigeminogeniculate axons most heavily innervate regions of the lateral geniculate that are also targeted by axons arising from the superior colliculus (tectogeniculate). These geniculate layers and zones of parabigeminal and tectal overlap contain small cells, and in several species are associated with the small W cell retino-geniculocortical pathway. In addition to the dense input to small-celled layers and zones, parabigeminal axons in several species also innervate regions of the lateral geniculate nucleus that are relatively free of tectogeniculate axons and that are associated with the medium (X) and large (Y) cell streams. Finally, our data reveal that the laterality of parabigeminogeniculate pathways varies across mammals, being primarily crossed in the gray squirrel, the gopher, the rat, and the opossum, bilateral in the cat, and primarily ipsilateral in the three primates.

Neuroanatomical studies of the nigrotectal projection in the cat.

We have used retrograde and anterograde transport methods to analyze the nigrotectal projection in the cat. This projection arises from both pars reticulata (SNr) and pars lateralis (SNl) and distributes to all cellular laminae of the superior colliculus. This extensive nigrotectal innervation is not a simple, single circuit. Rather it appears to consist of several parallel channels, with each taking origin from a particular zone of the substantia nigra and terminating within specific collicular laminae and/or sublaminae. For instance, only neurons within the SNl project to the stratum griseum superficiale; such neurons also project diffusely to all other tectal laminae. Cells in the most lateral portion of the SNr project to a horizontal, patchy tier in the interface region between the stratum opticum and the stratum griseum intermediate (SGI). Finally, more medially placed neurons within the SNr project to a horizontal patchy tier within the middle of the SGI and to a wedge-shaped locus in the stratum griseum profundum. Our findings provide an anatomical substrate for electrophysiological data (Karabelas and Moschovakis: J. Comp. Neurol. 239: 309-329, '85) showing a widespread distribution of nigrorecipient tectal neurons in the cat.

Hypothalamic and ventral thalamic projections to the superior colliculus in the cat.

The present report describes the organization of collicular afferents that arise within either the hypothalamus or the ventral thalamus. Following the placement of large injections of WGA-HRP into the superior colliculus of the cat, retrogradely labeled neurons are located within the reticular nucleus of the thalamus, the zona incerta, the fields of Forel, and throughout the hypothalamus. Although the dorsal hypothalamic area contains the largest number of labeled hypothalamic neurons, labeled cells are also found within the periventricular, paraventricular, dorsomedial, ventromedial, posterior, lateral, and anterior hypothalamic nuclei. A strikingly similar pattern of distribution of labeled neurons is also observed following placement of small injections of WGA-HRP that are restricted within the stratum griseum intermedium (SGI). In contrast, hypothalamic and ventral thalamic labeling is not seen after placement of injections within the stratum griseum superficiale. Following the placement of injections of tritiated anterograde tracers within the dorsal hypothalamic area, transported label is organized in two bands of clusters over the SGI. When injections of tritiated tracers are placed within the zona incerta, terminal label is also located over the SGI; however, the distribution of silver grains does not appear as clusters or distinct puffs. On the basis of the comparison of the cellular types that give rise to these projections and the differences in terminal distribution, we suggest that the hypothalamic and ventral thalamic projections to the superior colliculus are totally separate and unrelated pathways. The functional implications of the hypothalamotectal pathway are also discussed.

Chemoarchitectonic subdivisions of the visual pulvinar in monkeys and their connectional relations with the middle temporal and rostral dorsolateral visual areas, MT and DLr.

The organization of the inferior pulvinar complex (PI) in squirrel monkeys was studied with histochemical localization of the calcium binding proteins calbindin-D28k and parvalbumin, and of cytochrome oxidase. With each of these markers, the inferior pulvinar complex can be subdivided into four distinct regions. Calbindin-D28k immunoreactivity is densely distributed in cells and neuropil within PI, except for a distinct centromedially located gap. This calbindin-poor zone, termed the medial division of the inferior pulvinar (PIM), corresponds precisely to a region that contains elevated cytochrome oxidase activity and parvalbumin immunostaining. The PIM extends slightly above and behind the classically defined limit of the inferior pulvinar, the corticotectal tract. Regions of inferior pulvinar with intense immunostaining for calbindin-D28k were the posterior division of the inferior pulvinar (PIP, medial to PIM) and the central division (PIC, lateral to PIM). A newly recognized lateral region, PIL, adjoins the lateral geniculate nucleus and stains more lightly for calbindin and parvalbumin immunoreactivity and for cytochrome oxidase. Staining patterns for calbindin, parvalbumin, and cytochrome oxidase in the pulvinar of rhesus monkeys closely resemble those shown in squirrel monkey inferior pulvinar, suggesting that a common organization exists in all primates. In order to examine cortical connection patterns of the histochemically defined compartments in the inferior pulvinar, injections of up to five neuroanatomical tracers (wheat germ agglutinin conjugated to horseradish peroxidase and fluorescent retrograde tracers) were placed in the same cerebral hemisphere. Single injection sites were in the middle temporal area (MT), and several separate injections were placed in a strip corresponding to the rostral subdivision of the dorsolateral area (DLr). Injections that involved only DLr and not MT labeled principally the PIC, and more sparsely PIP and PIL. DLr connections occupied a "shell" region dorsal to PIM that extended from PIC into the lateral and medial divisions of the pulvinar, PL and PM. Injection sites that included MT or were largely restricted to MT produced dense label in PIM and moderate label in PIC and PIL. The retinotopic organization within the inferior pulvinar was inferred from patterns of connections. Connections with cortex related most closely to central vision were found posteriorly in PIM and in adjacent portions of PIC as it wraps around the caudal pole of PIM. Cortex related to more peripheral locations in the lower visual field connected with more rostral PIM and PIC. Patterns of label within the portions of PL and PM that were immediately adjacent to PIM roughly paralleled those in PIM and PIC.(ABSTRACT TRUNCATED AT 400 WORDS)

The projections of the lateral geniculate nucleus of the squirrel monkey: studies of the interlaminar zones and the S layers.

Anterograde and retrograde tracing techniques were used to reveal that axons arising from neurons within the interlaminar zones and the S layers of the lateral geniculate nucleus of the squirrel monkey terminate within the supragranular layers of area 17. Specifically, our data indicate that the axons of the neurons housed within the S layers end in a patchlike fashion in cortical layers IIIa and IIIb, while neurons in the interlaminar zones project primarily to layer I. Both pathways may convey W-cell information from the retina and the superior colliculus to the striate cortex.

Patterns of retinal terminations and laminar organization of the lateral geniculate nucleus of primates.

Autoradiographic tracing procedures have been used to study the organization of retinogeniculate axons in seven primates, i.e., four species of New World monkeys, one species of Old World monkeys and two species of prosimians. These data suggest that the basic primate pattern of geniculate lamination consists of two parvocellular layers, two magnocellular layers, and two poorly developed and highly variable superficial (S) layers which are ventrally located. Ocular input to each member of each of the three pairs differs. In the macaque, the squirrel, and the saki monkey, the parvocellular layers subdivide and interdigitate into four leaflets so as to give the appearance of four parvocellular "layers." These leaflets are much less extensive in the owl and marmoset monkeys. In some individual macaque monkeys, there is further splitting of the parvocellular leaflets into subleaflets, giving the appearance of six parvocellular "layers." The prosimians (galago and slow loris) have two additional layers that are not found in pithecoid primates, and only one superficial layer is apparent. The two additional layers are termed "koniocellular" since they consist of very small cells. Finally, New and Old World monkeys have both ipsilateral and contralateral retinal input to the interlaminar zones. We conclude that the basic pattern of lateral geniculate organization is six layers, but not the traditional six. Prosimians have evolved two additional layers, the koniocellular layers, and have possibly lost one superficial layer. Both New World and Old World monkeys have elaborated the parvocellular layers by forming leaflets to varying extents. With the possible exception of the single S layer in prosimians, layers form pairs that are similar in cell types, but different in ocular input.

Synaptic morphology of substance P terminals on catecholamine neurons in the commissural subnucleus of the nucleus tractus solitarii in the rat.

The ultrastructure of substance P-containing nerve terminals synapsing on catecholamine neurons in the rat commissural subnucleus of the nucleus tractus solitarii (NTScom) was studied using a double immunocytochemical labeling technique. Although there were numerous tyrosine hydroxylase-immunoreactive (TH-I) somata present, substance P immunoreactive (SP-I) cell bodies were only occasionally found in the NTScom. At the light microscopic level, many SP-I terminals were seen closely associated with TH-I dendrites and somata. At the electron microscopic level, SP-I terminals synapsing on TH-I structures were also readily encountered. SP-I terminals contained small, clear, and predominantly spherical vesicles (32 +/- 4 nm diameter), as well as large dense-cored vesicles approximately 100 nm in diameter. Postsynaptic TH-I dendritic profiles of various calibers and somata were encountered. These postsynaptic TH-I structures often showed postsynaptic densities. The morphological features of the SP-TH synapses in the present study, that is, the size of synaptic vesicles and the presence of postsynaptic densities, are quite different from those of central carotid sinus afferent synapses reported in our previous study [Chen et al. (1992), J. Neurocytol., 21:137-147]. Therefore, most of the SP terminals of the SP-TH synapses in the NTScom appear not to originate from the carotid sinus afferents. SP-I second-order neurons of the carotid sinus afferent pathway [Chen et al. (1991), J. Auton. Nerv. Syst., 33:97-98] may be one of the possible sources of such terminals.

Invasive cervical cancer in human immunodeficiency virus-infected and uninfected hospital patients.

OBJECTIVE: To compare the prevalence of invasive cervical cancer in women with, and in women without, human immunodeficiency virus (HIV) infection, so as to evaluate the inclusion of invasive cervical cancer in the AIDS surveillance case definition. METHODS: The Sentinel Hospital Surveillance System for HIV Infection collected data and serum specimens that remained after clinical testing of persons who received inpatient or outpatient care at 14 hospitals with high HIV prevalence. We analyzed data on invasive cervical cancer obtained from medical record review and HIV serostatus from white, black, and Hispanic women in the age groups 20-34, 35-44, and 45-54 years. RESULTS: In 1994 and 1995, 2684 (6.6%) of the 40,524 women sampled were HIV infected. Of the HIV-positive women, 28 had invasive cervical cancer (10.4 per 1000 women) and of the HIV-negative women, 236 had invasive cervical cancer (6.2 per 1000 women, relative risk [RR] 1.7, 95% confidence interval [CI] 1.1, 2.5). The prevalence of invasive cervical cancer was higher for HIV-positive than for HIV-negative black women aged 20-34 (RR 3.8; CI 1.7, 8.5) and Hispanic women aged 20-34 (RR 7.3; CI 1.4, 37.1) and 35-44 (RR 3.9; CI 1.1, 14.7) years. Twenty-six of the 28 cases of invasive cervical cancer in HIV-positive women were in women known to be HIV-positive during admission. CONCLUSION: The prevalence of invasive cervical cancer was higher for women who were HIV positive than for women who were HIV negative. This lends support to the inclusion of invasive cervical cancer in the revision of the surveillance case definition for AIDS in 1993.