Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)
I. IDENTIFICATION
A. CLINICAL DESCRIPTION:
Acquired immunodeficiency syndrome (AIDS) is a severe, life-threatening condition that was first recognized as a distinct syndrome in 1981. AIDS represents the late stage of infection with the human immunodeficiency virus (HIV) most often resulting in progressive deterioration of the immune system and development of opportunistic diseases and/or malignancies. Most people infected with HIV develop detectable antibodies within 1-3 months after infection but may remain free of signs or symptoms for several months to years. The severity of HIV-related illness is, in general, directly related to the degree of immune dysfunction.
The case definition for AIDS was substantially revised in 1993 to add pulmonary tuberculosis, recurrent pneumonia and invasive cervical cancer to the list of opportunistic diseases that are AIDS defining in HIV-infected persons. In addition, the 1993 case definition added immunologic criteria to include all HIV-infected persons with a CD4+ T-lymphocyte cell count of <200/ m L or a CD4+ T-lymphocyte percentage of <14, regardless of clinical status, as AIDS cases .
On January 1, 2000 CDC implemented a surveillance case definition for HIV infection in adults and children which integrates reporting criteria for HIV infection and AIDS in a single case definition and incorporates new laboratory tests in the laboratory criteria for HIV case reporting. The 2000 case definition for HIV infection includes HIV nucleic acid (DNA or RNA) detection tests that were not previously commercially available. Hence, diagnostic criteria for HIV infection is now based on the result of any test licensed for diagnosing HIV infection in the US .
No vaccine exists for HIV infection, but considerable progress has been made in the development of antiretroviral therapies that slow viral progression and substantially reduce the amount of virus in an infected person resulting in decreased morbidity and mortality.
B. REPORTING CRITERIA:
AIDS: Clinical diagnosis.
HIV: Western blot confirmed (positive/reactive) antibody test, HIV p24 antigen test, polymerase chain reaction (PCR) – DNA (detectable HIV virus) or RNA (detectable HIV viral load).CD4+ T Lymphocyte count: a CD4+ T-lymphocyte count of <200/ m L or <14 percent
C. CASE DEFINITION: See CDC Case Definition for HIV infection and AIDS.
- AIDS: CDC. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(No. RR-17).
- HIV: CDC. CDC guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999:48(No. RR-13).
D. LABORATORY CRITERIA FOR DIAGNOSIS:
Reporting Positive HIV Test Results
Wisconsin Statute 252.15(7) requires all positive, validated HIV test results be reported to the state epidemiologist. (DPH Form 4338 - Wisconsin HIV Confidential Case Report). This includes any test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV. Reports should be sent directly to the state epidemiologist.Reporting Confirmed and Suspect AIDS Cases
Confirmed or suspect cases of AIDS are reportable to the state epidemiologist under Wisconsin Statute 252.05 (DPH Form 4264 - AIDS Case Report). AIDS case reports should be sent directly to the state epidemiologist and not to the local health department. DPH will forward the AIDS and/or HIV reports to the appropriate local health agency for Partner Counseling and Referral Services and will send non-identifying case information to CDC.Reporting of a CD4+ T-lymphocyte count <200/ m L or <14 percent
Under Wisconsin Administrative Rule Chapter HFS 145, Control of Communicable Diseases, Category III a CD4+ T-lymphocyte count of <200/ m L or <14 percent is reportable to the state epidemiologist.Confidentiality
Wisconsin Statute 252.15(5) and 252.15(5m) specifies who may know an individual’s HIV test result and under what circumstances. Negligent or willful disclosure of an HIV test result to a person not authorized under Wisconsin Statute 252.15 may result in civil and/or criminal penalties. Persons to whom identifying HIV information is disclosed are bound by the same confidentiality restrictions as the source person or agency.Information in the surveillance system that would permit identification of an individual on whom a record is maintained, is collected with a guarantee that it will be held in confidence, will be used only for the purposes stated in the assurance on file at the local health department, and will not otherwise be disclosed or released without the consent of the individual in accordance with Section 308(d) of the Public Health Service Act (42 USC 242m).
II. ACTIONS REQUIRED / PREVENTION MEASURES
A. WISCONSIN DISEASE SURVEILLANCE CATEGORY III: Report to the state epidemiologist by individual case report form or other means within 72 hours of the identification of a case or suspected case.
B. EPIDEMIOLOGY REPORTS REQUESTED:
III. CONTACTS FOR CONSULTATION
A. BCDP / COMMUNICABLE DISEASE / AIDS PROGRAM: 608-267-5287.
B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.
C. WISCONSIN STATE LABORATORY OF HYGIENE: 608-262-2302.
D. OTHER CONTACTS:
- Wisconsin HIV/STD/Hepatitis C Information and Referral Center :
- outside Milwaukee area: 800-334-2437
- Milwaukee area: 273-2437
- Local Health Departments
- Local Chapter of American Red Cross
- Local hospital infection control practitioner
|
Wisconsin AIDS Service Organization Offices |
||
|
Northern Region
|
1105 Grand Ave Suite 3 Schofield WI 54476 |
715-355-6867 800-551-3311 715-355-0640 (FAX) |
|
Northeastern Region
AIDS Resource Center of Wisconsin |
824 S Broadway
Green Bay WI 54304 |
920-437-7400
|
Western Region
|
505 Dewey St South Suite 107
Eau Claire WI 54701 |
715-836-7710 |
|
2519 South Ave La Crosse WI 54601 |
608-785-9866 |
|
Board of Trade Building 1507 Tower Ave Suite 230 Superior WI 54880 |
715-394-4009 |
Southern Region
|
600 Williamson St Madison WI 53703
|
608-252-6540 |
|
101 Milwaukee St. #96
|
608-756-2550 |
|
136 West Grand Ave Suite 202
|
608-364-4027 |
|
Southeastern
Region
AIDS Resource Center of Wisconsin |
820 N Plankinton Ave Milwaukee WI 53203
|
414-273-1991 |
| AIDS Resource Center of Wisconsin |
1212 57th St Kenosha WI 53140 |
262-657-6644 |
C. PUBLIC HEALTH INTERVENTION
• Health education programs should reach individuals at high risk for HIV infection and the general population with information on ways to lower the risk of transmitting HIV through sexual intercourse and injection drug use. Health education programs must be developmentally and culturally appropriate and tailored to the needs of target populations.
• The only sure way to avoid HIV infection through sex is to abstain from sexual intercourse or to engage in mutually monogamous sexual intercourse where both partners are known to be uninfected. In other situations, latex condoms must be used correctly every time a person has vaginal, anal, or oral sex. Correct and consistent use of latex condoms with water based lubricants can reduce the risk of sexual transmission.
• Injection drug users should have access to drug treatment and needle exchange programs as well as risk reduction education on safer needle use.
• HIV counseling and voluntary testing and referrals to needed medical services should be offered routinely in sexually transmitted disease, tuberculosis and drug treatment clinics; in clinics offering prenatal care or family planning services; in facilities offering services to gay men; and in communities where HIV seroprevalence is high.
• All pregnant women should be encouraged to undergo voluntary HIV testing as a routine part of prenatal care. All pregnant women found to be infected with HIV should be offered antiretroviral therapy consistent with current CDC recommendations.
• Care should be taken in handling, using and disposing of needles and other sharp instruments. (The Bloodborne Pathogen Standard of the Occupational Health and Safety Administration and the federal Needlestick Safety and Prevention Act mandate the use of safe needle devices in public and private settings.)
• Persons sustaining occupational significant exposures to blood, body fluids visibly contaminated with blood, and body fluids considered potentially infectious for HIV (semen and vaginal secretions) should receive immediate medical attention and receive follow-up care consistent with current CDC recommendations for managing occupational exposures. While the CDC has not established recommendations regarding nonoccupational significant exposures (e.g., sexual or needle-sharing), persons sustaining such exposures should receive prompt medical evaluation consistent with CDC recommendations for occupational exposures.
• All persons identified with HIV infection should be offered partner counseling and referral services (PCRS) that include targeted risk reduction education, referral for medical care and support services, and assistance with notifying and referring sexual and needle-sharing partners for additional services. For additional information regarding HIV PCRS in Wisconsin, contact the Wisconsin PCRS Coordinator at 608-267-5288.
IV. RELATED REFERENCES
1. Heymann DL, ed. ACQUIRED IMMUNODEFICIENCY SYNDROME. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004: 1-9.
2. AIDS/HIV PROGRAM PUBLICATIONS: The following are available from the AIDS/HIV Program, 1 West Wilson Street, Room 318, PO Box 2659, Madison, WI 53701 608/267-5287:
NUMBER
TITLE
TYPE
DESCRIPTION
QUANTITY REQUESTED
DPH 4264
(Rev. 2/00)
AIDS Case Report
Form
Form health care providers use to report a diagnosis of AIDS in an individual.
PPH 42118
Are you at risk for Hepatitis C?
Poster
Full color poster (18” x 24”) highlighting risk factors for HIV infection and contact information.
PPH 42118S
Are you at risk for Hepatitis C? (Spanish)
Corre usted el riesgo Hepatitis C?
Poster
Spanish language version of full color poster PPH 42118 (described above).
PPH 42118A
Are you at risk for Hepatitis C?
Postcard
Consumer postcard summarizing risk factors for hepatitis C infection and contact information.
PPH 42118AS
Are you at risk for Hepatitis C? (Spanish)
Corre usted el riesgo Hepatitis C?
Postcard
Spanish language version of postcard PPH 42118A (described above).
DPH 42016 (10/03)
Authorization for Release of Confidential HIV Test Results
Form
Sample consent form to authorize release of confidential HIV test results.
DPH 42016S
(10/03)
Authorization for Release of Confidential HIV Test Results (Spanish)
Form
Spanish language version of sample consent form DPH 42016 (described above).
(9/00 Edition)
Behavioral Risk Assessment Tool
1 page
Tool to assess client HIV risk behaviors.
DPH 4544
(10/03)
Consent for Confidential HIV Testing
Form
Sample form for obtaining consent when testing for HIV infection.
DPH 4544S
(10/03)
Consent for Confidential HIV Testing (Spanish)
Form
Spanish language version of sample consent form DPH 4544 (described above).
PPH 4407
Counseling and Testing Sites
List
Listing of DPH-funded HIV antibody counseling and testing sites.
PPH 4533
(10/92)
DHSS Recommendations for Preventing transmission of HIV & HBV from Health Care workers to Patients & from Patients to Health Care Workers through Medical/Dental Procedures
Report
These recommendations address issues of infection control, testing, immunization, significant exposures, confidentiality, reporting, assessment and monitoring of infected health care workers, retrospective patient notification, policy development and enforcement.
PPH 42113
Find out about Hepatitis C and your risk
Brochure
Consumer brochure describing hepatitis C infection, risk factors, and prevention.
PPH 42113S
Find out about Hepatitis C and your risk (Spanish)
Infórmase acerca de la Hepatitis C y del Riesgo
Brochure
Spanish language version of brochure PPH 42113 (described above).
PPH 4770
(11/95)
For You and Your Baby
Brochure
Consumer brochure for pregnant women regarding the importance of HIV testing during pregnancy.
PPH 4770S
For You and Your Baby (Spanish)
- Para usted y su bebe’
Brochure
Spanish language version of brochure POH 4770 (described above).
PPH 4770H
For You and Your Baby (Hmong)
-Muab Rau Koj Thiab Koj Tus Menyuam Mos
Brochure
Hmong language version of brochure POH 4770 (described above).
PPH 42116
HIV testing: an important step
Brochure
Consumer brochure describing HIV testing and risk factors associated with HIV infection.
PPH 42116S
HIV testing: an important step (Spanish)
La Prueba de HIV: Un Paso Importante
Brochure
Spanish language version of brochure PPH 42116 (described above).
PPH 42114
(1/03)
Information for Health Professionals
HIV Partner Counseling and Referral Services
Brochure
Brochure for health professionals describing HIV Partner Counseling and Referral Services
PPH 42006
Live. And let live. African American Family Poster
Poster
Color poster of three-member family.
Message: Live. And let live. – HIV. Get tested.
PPH 42007
Live. And let live. Hispanic Family Poster (English)
Poster
Color poster of four-member family.
Message: Live. And let live. – HIV. Get tested.
PPH 42007S
Live. And let live. Hispanic Family Poster (Spanish)
Poster
Color poster of four-member family.
Message: Vive. Y deja vivir. – HIV. Hazte la prueba.
PPH 42008
Live. And let live. African American Couple Poster
Poster
Color poster of couple (male and female).
Message: Live. And let live. – HIV. Get tested.
PPH 42009
Live. And let live. Hispanic Couple Poster (English)
Poster
Color poster of couple (male and female).
Message: Live. And let live. – HIV. Get tested.
PPH 42009S
Live. And let live. Hispanic Couple Poster (Spanish)
Poster
Color poster of couple (male and female).
Message: Vive. Y deja vivir. – HIV. Hazte la prueba.
PPH 42010
Live. And let live. African American Male Poster
Poster
Color poster of individual male.
Message: Live. And let live. – HIV. Get tested.
PPH 42011
Live. And let live. Brochure (English)
Brochure
HIV prevention brochure emphasizing the importance of HIV testing.
PPH 42011S
Live. And let live. Brochure
(Spanish)
Brochure
HIV prevention brochure in Spanish emphasizing the importance of HIV testing.
PPH 42012
Live. And let live. African American Male Postcard
Postcard
Color postcard of individual male.
Message: Live. And let live. – HIV. Get tested.
PPH 42013
Live. And let live. African American Couple Postcard
Postcard
Color postcard of couple (male and female).
Message: Live. And let live. – HIV. Get tested.
PPH 42014
Live. And let live. Hispanic Family Postcard (English)
Postcard
Color postcard of four-member family.
Message: Live. And let live. – HIV. Get tested.
PPH 42014S
Live. And let live. Hispanic Family Postcard (Spanish)
Postcard
Color postcard of four-member family.
Message: Vive. Y deja vivir. – HIV. Hazte la prueba.
PPH 42018
Live. And let live. Community Education Kit
Education Guide
HIV prevention community education guide focused on African American and Hispanic communities.
Limit to 1
PPH 42112
(1/03)
Programs for persons with HIV
Brochure
Brochure describing the Wisconsin AIDS/HIV Drug Assistance Program and the Health Insurance Premium Subsidy Program.
PPH 42112S
(1/03)
Programs for persons with HIV
(Spanish)
Programas para personas infectadas con el VIH
Brochure
Spanish language version of brochure PPH 42112 (described above).
(5/99 Edition)
Multicultural Competency Assessment for HIV Prevention in Wisconsin
4 pages
Tools to assist agencies and individuals in assessing and developing their cultural competency.
PPH 42002
MMWR Reprint –
Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for prophylaxis
Report
Morbidity and Mortality Weekly Report (MMWR) [RR-7 5/98] updating and consolidating PHS recommendations for the management of health-care workers (HCWs) who have occupational exposure to blood and other body fluids that may contain HIV, including recommendations for postexposure prophylaxis (PEP).
PPH 42004
MMWR Reprint -
Recommendations for prevention of HIV transmission in health-care settings
Report
Morbidity and Mortality Weekly Report (MMWR) [2S
8/87] containing specific recommendations for preventing the transmission of HIV in health care settings.
PPH 4565
(1/93)
Practice Standards and Administrative Guidelines for HIV-Related Case Management
3-hole punched guide
This guide defines case management and identifies administrative guidelines, practice standards for case management, and case management forms.
RAY LIST
Rainbow Alliance for Youth (RAY)
Single sheet
Listing of Wisconsin groups serving gay, lesbian, bisexual, and transgender youth.
PPH 4868
(Rev. 1/03)
Talking with partners: an act of caring and concern
Brochure
Client brochure for HIV positive persons to assist in understanding partner counseling and referral services.
PPH 4868SP
(1/03)
Talking with partners: an act of caring and concern
(Spanish)
Brochure
Spanish language version of brochure PPH 4868 (described above).
PPH 4297
(01/03)
Why take Chances? Protect Yourself
Brochure
Two-color brochure providing basic information about HIV infection and AIDS.
PPH 4297S
(01/03)
Why take Chances? Protect Yourself (Spanish)
¡No Se Arriesque! ¡Protéjase!
Brochure
Spanish translation of brochure PPH 4297 listed above.
PPH 42115
(Rev. 07/04)
Wisconsin AIDS/HIV Health Insurance Premium Subsidy Program and AIDS?HIV Drug Assistance Program Fact Sheet
One-page fact sheet
Fact sheet providing overviews of and eligibility requirements for the Wisconsin AIDS/HIV Health Insurance Premium Subsidy and the Wisconsin AIDS/HIV Drug Assistance Programs
DPH 4614 A & 4614B (Rev. 07/04)
Application materials for Wisconsin AIDS/HIV Health Insurance Premium Subsidy Program and Wisconsin AIDS/HIV Drug Assistance Program
Multiple page application form
This is a combined application for the Wisconsin Aids/HIV Health Insurance Premium Subsidy Program and the Wisconsin AIDS/HIV Drug Assistance Program. Part A is completed by the applicant and Part B is completed by the applicant’s physician
PPH 4538
(Rev. 12/04)
Wisconsin AIDS/HIV Program Resource Materials
List
Listing of publications and forms available through the AIDS/HIV Program with descriptions and ordering information.
PPH 4597
Wisconsin AIDS/HIV Update
Quarterly journal
50 page quarterly journal with current information on surveillance, counseling & testing, patient care, transmission, education and news items.
Limit to 1
DPH 4338
(Rev. 1/00)
Wisconsin Human Immunodeficiency Virus (HIV) Confidential Case Report
Form
Form health care providers use to report the diagnosis of HIV infection.
PPH 42001
Wisconsin HIV Partner Counseling and Referral Services Provider List
5 pages
Listing by county of staff providing HIV partner counseling and referral (partner notification) services in Wisconsin .
PPH 4295
(Rev. 12/02)
Wisconsin Statues & Administrative Code Pertaining to AIDS and HIV Infection
Book
Compilation of statutes and codes related to HIV and AIDS.
Limit to 5
2005-2008 Wisconsin Comprehensive HIV Prevention Plan
Book
This document outlines HIV prevention priorities and strategies developed by the HIV Prevention Community Planning Council.
PPH 42148
2005-2008 Comprehensive HIV Prevention Guide
Book
This document serves as a handbook for the provision of HIV prevention services in Wisconsin and includes epidemiologic data, challenges, successes, and suggested approaches for reaching HIV prevention target populations.
V. DISEASE TRENDS
Cumulative cases of AIDS and HIV in Wisconsin reported through 12/31/2003
AIDS (Cases meeting the 1993 CDC Case Definition 5,424
HIV infection (AIDS and Western blot confirmed HIV cases) 8,328
AIDS cases / year
HIV infection / year
Year
AIDS cases/
year of diagnosis
AIDS cases /
year of report
Year
HIV infection /
year of diagnosis
HIV infection /
year of report
1982
4
0
1982
9
0
1983
14
6
1983
24
6
1984
30
22
1984
52
24
1985
48
33
1985
241
39
1986
109
72
1986
346
152
1987
165
120
1987
518
323
1988
231
148
1988
594
417
1989
274
176
1989
593
524
1990
387
259
1990
755
672
1991
382
252
1991
634
656
1992
524
304
1992
629
683
1993
511
809
1993
533
650
1994
464
483
1994
440
514
1995
458
453
1995
507
562
1996
371
347
1996
407
426
1997
271
340
1997
357
447
1998
234
273
1998
323
382
1999
181
227
1999
263
372
2000
216
336
2000
313
389
2001
203
259
2001
277
336
2002
184
268
2002
292
389
2003
163
237
2003
221
365
TOTAL
5,424
5,424
TOTAL
8,328
8,328
A complete analysis of HIV case reporting in Wisconsin can be found on the DHFS website at: http://dhfs.wisconsin.gov/aids-hiv