No 48 - 2011

World AIDS Day

1 December is World AIDS Day. The objective of the day is to raise awareness about global as well as local efforts to fight HIV and AIDS. This year, UNAIDS has chosen the theme "Getting to zero." The theme is concerned with the following three points: zero new HIV infections, zero discrimination and zero HIV deaths. In Denmark, the AIDS Foundation has chosen to focus on one point in particular: zero discrimination. Focus is therefore on combating any stigma surrounding HIV.

In Denmark, stigma contributes to the HIV epidemic as many fear the consequences of social exclusion, should it become known that they are HIV-positives. The affected persons may therefore hesitate to be HIV-tested.

Early diagnosis of HIV-positives equals early treatment which increases the chances of living a nearly normal life without complications to the infection. Furthermore, treatment will ensure that you do not transfer HIV to your sex partner. It is therefore essential that the diagnosis is made in time, for your own sake as well as to protect any partners.

Diagnosis is only possible on the basis of a test. In Denmark, more than half of all HIV positives are diagnosed so late that treatment should have been initiated at the time of diagnosis. And this applies not only to the very small group (about 10%), who is HIV-infected without knowing or suspecting that they are HIV-positives. It is thus not ignorance with regard to the infection risk which discourages people from having the test performed. Rather,it is fear of the outside world's condemnation and the social consequences an HIV diagnosis may have.

It seems that we have good reason to fear the stigma and social consequences associated with an HIV diagnosis. In a recent study from the AIDS Foundation, 63% of respondents were worried about saliva transfer of HIV infection, and many would avoid sharing a towel, toiled or cutlery, etc. with someone infected with HIV even though it has been known for more than 20 years that HIV infection will not spread as a result of such contact.

To overcome stigma and misinformation, everyone should know that:

• HIV only spreads via blood and sex.
• HIV does not spread via normal everyday contact between persons.
• HIV does not spread via saliva or tears.
• The risk of sexual infection is close to zero if the HIV positive person is taking his or her HIV medicine correctly and does not suffer from other sexually transmitted diseases.

There is no reason to be afraid of a person who is HIV-positive. And HIV positives should not feel stigmatized, nor fall victim to discrimination or social exclusion.
(S. Cowan, Department of Epidemiology) 

Postpartum fever with haemolytic group G streptococci

In the summer of 2011, beta-haemolytic group G streptococci (GGS) were reported in four patients at the maternity wards of two different hospitals.

The first woman gave birth vaginally shortly after arriving at the hospital and was running a high fever two hours later. Blood culture (BC) showed GGS growth. During its first day of life, the neonate developed clinical signs of sepsis and GGS growth was found in tracheal secretion, while BC was negative. The other women was discharged on the second day after delivery by Caesarean, but was readmitted three days later with fever and mastitis. There was growth of GGS in BC as well as in breast milk. The child was unaffected. During admission the two women had shared a bath and toilet for a period of two days. The two GGS isolates were of the same emm type (stG643.0) and PFGE profile.

A third woman delivered vaginally a month after the two cases described above. She was discharged a few hours after delivery, but was re-admitted a week later due to signs of endometritis and GGS growth in a vaginal swab.

In a fourth case at another hospital, GGS was found in BC from a child delivered by Caesarean. The GGS isolate was of emm type stG6.1. There was GGS (not typed) in the mother’s urine.

Commentary

It is well-known that group A streptococci may cause postpartum fever. The four cases show that there is good reason to pay attention to birth-related invasive GGS infections.

(H. Ingels, L. Lambertsen, S. Hoffmann, DBMP, M.L. Jöhnk, A.L. Sørensen, DCM Viborg, K. Klein, DCM Odense)

Malaria in Greece

Greece has witnessed a major local outbreak of malaria over the past six months. The period from 21 May to 15 November has brought a total of 63 malaria cases caused by Plasmodium Vivax. A total of 33 of the cases occurred among Greeks who had not travelled to a malaria-endemic country. These cases were observed at five distinct locations in Greece. The remaining 30 cases occurred among migrant workers in Evrotas in the Laconia district of Pelllopones in Southern Greece, see map at www.ssi.dk/rejser (Danish language).

The majority of the 30 migrant workers in Evrotas were from malaria-endemic countries: 21 from Pakistan and two from Afghanistan. The remaining seven migrant workers were from Romania (five), Morocco (one) and Poland (one).

A total of 27 of the Greek cases were also detected in Evrotas, but the last six were from Attiki (2), Evoia (2), Viotia (1) and Larissa (1).

Evrotas is an estuary area where locally acquired cases of vivax malaria were also repported in 2009 (eight cases) and 2010 (one case), primarily among migrant workers or Romas. None of the affected areas are dedicated tourist areas.

Commentary

Malaria was eliminated in Greece by 1974, but unites the necessary vectors (anopheles species) and climate conditions facilitating local malaria transmission if parasitaemic persons stay in the country during the summer half-year.

The Greek authorities have implemented a number of malaria control measures, information campaigns and intensive surveillance. The latest malaria case in a Greek occurred on 18 October, while the latest migrant worker case was seen in Week 44 in a Pakistani who had recently arrived to Greece. It is therefore estimated that the outbreak is receding, but until its termination is officially declared, travellers to the affected areas are recommended efficient mosquito bite protection. Danish physicians should also be aware of malaria among travellers from Greece.

(P.H. Andersen, Department of Epidemiology, L.S. Vestergaard, Malaria Reference Laboratory)

30 November 2011