The Proportion of Cases of AIDS Diagnosed in Outpatients

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Abstract
To the Editor.— In San Francisco, 98% of all cases of acquired immunodeficiency syndrome (AIDS) are reported to the Department of Public Health through a combination of active and passive surveillance of hospitals, clinics, and physicians, and 2% are reported through searches of death certificates. The passive surveillance system, which accounts for about 45% of reported cases, depends primarily on hospital-based infection control practitioners to report patients whose illness is diagnosed in hospitals. Since infection control practitioners are, typically, most familiar with inpatients, AIDS patients diagnosed in hospital outpatient departments may not be known to them and consequently may not be reported. In areas where there is less complete reporting of AIDS than in San Francisco, these cases may be a source of potential underreporting. To determine what proportion of AIDS cases is initially diagnosed in outpatients, we reviewed 200 consecutive AIDS cases reported to the Department of Public Health

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