KAZAKHSTAN: TWENTY FOUR YOUNG CHILDREN CONTRACT HIV

UNCLAS ALMATY 002888 SIPDIS TASHKENT FOR EPUTNAM SIPDIS E.O. 12958: N/A TAGS: AMED SOCI PGOV KHIV KZ SUBJECT: KAZAKHSTAN: TWENTY FOUR YOUNG CHILDREN CONTRACT HIV ¶1. Summary: In the last four months, twenty four children under the age of three have been identified as HIV-positive in the Southern Kazakhstan Oblast (SKO). A joint investigation by Kazakhstan's Ministry of Health and the CDC found that significant problems with infection control procedures and blood safety at several local children's hospitals were responsible. End summary. -------------- -------------- Twenty Four Children HIV-Positive in Southern Kazakhstan Oblast -------------- -------------- ¶2. Between March 21 and August 8, 2006, twenty four children ranging in age from two months to just over two years were identified as HIV-positive in the SKO. Eighteen of the children were tested after they exhibited signs and symptoms of HIV infection; two were tested because they had received blood transfusions; three were identified as a result of screening contacts; and one was self-referred. All these children had previously been hospitalized (from one to fourteen times) at four Shymkent hospitals. ¶3. Initially, most assumed that the children had caught the infection from their mothers. However, subsequent testing revealed that this was not the case. All mothers tested negative for HIV. -------------- -------------- Medical Experts Investigate Source and Extent of the Outbreak -------------- -------------- ¶4. Kazakhstan's Ministry of Health is currently leading two investigations, with technical assistance being provided by CDC's Central Asia Regional Office. These investigations are using different methodologies to try to positively identify the circumstances under which the children were infected, and to make recommendations on how to prevent further outbreaks. ¶5. The initial investigation began in May, after the Ministry of Health invited CDC to conduct a joint investigation into the matter. After intensive study, it was reported that multiple factors had contributed to the outbreak. Specifically, investigators found that unsafe injection techniques and blood safety violations were responsible for the infections. (Note: While these factors have been identified as the transmission pathways, the case-by-case particulars of how each child was infected are the subject of further study. End note.) ¶6. CDC investigators suggest that a lack of adequate training and improper medical practices, including the re-use of medical instruments, could be responsible for the spread of HIV infection. Several violations of safe blood transfusion practices were identified, including "direct" transfusion of untested blood and multiple fractions of the same blood unit transfused to different children. ¶7. The investigation also ruled out several previously-suggested explanations regarding the outbreak. The study showed that the infections were not the result of vertical transmission (from mother to child),that no single hospital was responsible for all the cases, and that no single medical procedure could have led to all of the infections at the various hospitals. -------------- Immediate Fall-out -------------- ¶8. Public trust in area hospitals has plummeted. According to Health Ministry officials, the number of patients in regional hospitals has fallen 50% in recent weeks. The directors of the Shymkent AIDS and Blood Centers and the director of the regional children's hospital have been relieved of their posts. Four blood transfusion centers in Shymkent have been closed, and the regional prosecutor- general has launched criminal cases of negligence against medical personnel in four area hospitals. ¶9. Health officials suspect that the number of infected children and donors is higher than is currently known, and have recommended HIV testing for all children under the age of 5 who have undergone treatment at Shymkent hospitals. In an additional precaution, regional authorities have ordered wide-scale HIV testing of medical personnel in area hospitals and blood centers. ORDWAY