Top 5 Takeaways

1. Initial Detection: In April 2019, 14 children under 10 years old were diagnosed with HIV in Ratodero, Pakistan, prompting an investigation by the Sindh AIDS Control Program (SACP).
2. Widespread Testing: By May 18, 2019, 16,856 individuals were tested, revealing 571 new HIV cases, with 81% of these cases in children and adolescents aged ≤15 years.
3. International Support: The World Health Organization (WHO) and other international partners joined the investigation, identifying unsafe injection practices and poor infection control as key risk factors.
4. Ongoing Identification: From April 2019 to April 2020, 1,353 new HIV cases were identified, with 75% in children and adolescents aged <15 years.
5. Iatrogenic Transmission: The predominant mode of HIV transmission was iatrogenic, related to poor infection prevention and blood safety practices.

Original Article Author and Citation

Corresponding Author

Elizabeth M. Rabold, nqo6@cdc.gov, 404-498-5703

Suggested Citation

Rabold EM, Shaikh SA, Schenkel K, et al. Notes from the Field: Pediatric HIV Outbreak in Ratodero, Pakistan — April 2019–April 2020. MMWR Morb Mortal Wkly Rep 2021;70:1489–1490. DOI: http://dx.doi.org/10.15585/mmwr.mm7042a5

Summary

In April 2019, the Sindh AIDS Control Program (SACP) in Pakistan was alerted to 14 new pediatric HIV cases in Ratodero. Rapid testing identified 571 new HIV cases by mid-May, with a significant majority in children. The World Health Organization (WHO) and other international partners assisted in the investigation, identifying unsafe medical practices as major risk factors. Continued testing through April 2020 identified a total of 1,353 new HIV cases, predominantly in children. The investigation highlighted the need for improved infection control and blood safety practices to prevent future outbreaks.

Methods

The investigation involved setting up 18 health care and community testing sites in Larkana District. Testing was voluntary and did not include contact tracing or targeted testing at high-risk clinical entry points. Preliminary investigations included patient interviews, site visits, and review of surveillance data. A case-control study was conducted to identify the predominant mode of transmission.

Discussion

The findings indicated that iatrogenic transmission due to unsafe injection practices and poor infection control measures was the primary mode of HIV transmission. The high prevalence of hepatitis B and C among newly diagnosed HIV patients suggested a broader issue of bloodborne pathogen transmission. The response included recommendations for improving infection prevention, blood safety, and health care worker education.

Conclusion

The outbreak in Ratodero underscores the critical need for improved health care practices and infection control measures in Pakistan. Strengthening these areas at both local and national levels could help prevent future outbreaks of HIV and other bloodborne infections.

This has been your booster shot of MMWR Info! Please check back for more MMWR, Public Health, and Programming Tutorial content daily.