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A total of 1,069 newly discovered cases of kala-azar (a few recurrent cases included) is recorded in China during the four year period from 1985 to 1988. The kala-azar patients were found in the Provinces and Autonomous Regions of Gansu, Sichuan, Xinjiang, Shaanxi, Shanxi, Inner-Mongolia and Shandong. Comparing with the 443 cases recorded during the previous 4 years period 1981-1984, significant uprise of the disease is evident, especially in the Provinces of Gansu and Sichuan. In southern Gansu and northern Sichuan, the incidence of visceral leishmaniasis in dogs is consistently high and these places are considered as areas endemic to leishmaniasis of canine source. Phlebotomus chinensis naturally infected with promastigotes are found in the mountainous regions 2,200 m and 1,500 m above the sea level respectively, and the promastigotes are identified as Leishmania donovani. As kala-azar patients and dogs infected with visceral leishmaniasis are mostly in the area below 1,600 m sea level and the area above 2,000 m sea level is unpopulated, the natural infection of sandflies was thought, therefore, to come from wild animal hosts and the natural nidus of kala-azar there warrants further investigation. It is suggested that consolidation and surveillance should be emphasized in endemic areas where leishmaniasis control has been very successful and research projects encouraged to meet the technical need for further achievement.
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The surveillance programme described in an earlier report was used to monitor outbreaks of influenza in three successive winters. Influenza virus A was active in all of them, but the only major outbreak of influenza B was in 1973--4. The highest incidence of influenza A was in the 0--4 age group in all three winters, but schoolchildren bore the brunt of infections by influenza virus B.
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The International Bone Marrow Transplant Registry (IBMTR) receives and analyses detailed information contributed by transplant teams at more than 175 institutions worldwide. This collaborative research effort has grown rapidly; there are now more than 8000 cases in the database. This is a summary of the current status of bone marrow transplantation in leukemia and severe aplastic anemia, a brief summary of key findings reported by the IBMTR during the past year, as well as studies planned for the coming year.
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In 1988, the number of malaria cases reported was 134.2 thousand (Taiwan Province not included). Comparing with 210.6 thousand cases reported in 1987, a decrease of 36.3% was noted. Based on data reported by each county in the country, about 950.7 million people in 2,541 counties/cities were living in areas where malaria incidence was less than 0.1 per 1,000 (including originally malaria-free areas as well as areas free from the disease); 96.6 million people in 207 counties/cities with an incidence of 0.1-1.0 per 1,000; 30.4 million in 79 counties/cities with an incidence of 1.1-10.0 per 1000, and 0.4 million in 4 counties with an incidence of above 10.0 per 1,000. While the incidence decreased markedly in most endemic areas, it fluctuated in the southern part of China due to the increase in the floating population, shortage of insecticides, and natural calamities in some areas. In Hainan province the incidence increased by 21.1% over 1987; increase in incidence and focal outbreaks also occurred in some areas of Yunnan, Guangdong, Guangxi, Guizhou provinces/autonomous region. In the provinces of Anhui, Jiangsu, Henan and Jiangxi, the major endemic areas in central China, the incidence decreased by 43.6-71.4% over last year, there were 57 thousand cases, accounting for 42.6% of the total cases recorded in the country. Downward trends of incidence continued in other provinces, autonomous regions and municipalities. The distribution of falciparum malaria was confined to 63 counties of 6 provinces/autonomous region, while non-indigenous falciparum malaria cases were found in 88 counties of 8 provinces due to the population movements.(ABSTRACT TRUNCATED AT 250 WORDS)
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A total of 328 cases of infection with human immunodeficiency virus (HIV) in Western Australia in 1983-1987 was studied with respect to demographic factors, the risk profile, the clinical progression of disease, the utilization of inpatient services and trends in incidence over time. The crude incidence rates were 8.8 cases/100,000 person-years in men and 0.4 cases/100,000 person-years in women. Age-specific rates peaked at 25 to 29 years of age in men. The risk of HIV infection was associated with metropolitan residence, low socioeconomic level, and two specific occupational groups. Homosexual and bisexual men constituted 86% of all cases; the incidence rate of HIV infection in such men was approximately 1000-times higher than was the incidence rate by apparent sexual transmission in heterosexual persons. However, the proportion of cases that occurred in women or that apparently was caused by heterosexual sexual transmission increased from zero in 1983-1984 to 7.5% and 5.4%, respectively, in 1987. After two years of follow-up, 71% of preclinical (category-C) patients had developed signs, symptoms or evidence of immune dysfunction, and 12% of those patients with lymphadenopathy or with other early clinical features of disease (category-B) had progressed to the acquired immunodeficiency syndrome (AIDS). At 21 months of follow-up, the survival rate with AIDS was 9%. Patients with AIDS utilized an average of 68.9 short-stay hospital bed-days per person-year, while category-B patients used 11.5 hospital bed-days per person-year. Notifications of HIV infection increased each year from 1983 to 1986, but fell by 22% in 1987. The latter may have been as a result of chance, a screening artefact or a real reduction in the incidence rate.
While agreeing that the periodic evaluation of physicians is in the public interest, HANYS believes that the January 1988 Report contains numerous legal and practical problems, contradictions, and invalid assumptions that all call for a re-evaluation of this particular approach. As written, the proposal raises serious concerns regarding the conduct of peer review activities. Further, it may jeopardize the concerted efforts hospitals and their medical staffs are making to improve quality through peer review. Without a more in-depth, thorough, and thoughtful review of these issues, the implementation of this Report's recommendations would not be in the best interests of the people of New York who are served by its physicians and hospitals.
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