title: Risk factors for HIV infection among abandoned Romanian children.
abstract: OBJECTIVE
  To determine risk factors for HIV infection among abandoned Romanian infants and children living in a public institution.
  
  
  METHODS
  A cross-sectional study was conducted in June 1990 among 101 children between 0 and 4 years of age living in an orphanage. Orphanage and hospital records were reviewed and a blood specimen for hepatitis B and HIV serologic testing obtained from each child. A case-control study was conducted using data from the cross-sectional study. Cases were HIV-positive children; one HIV-negative control, matched by age, was selected for each case.
  
  
  RESULTS
  Overall, 20 (20%) children were HIV-positive, 88 (87%) tested positive for antibody to hepatitis B core antigen, and 32 (32%) were hepatitis B surface antigen-positive. In the case-control study, HIV-positive children had received more therapeutic injections [mean, 280; median, 231] than age-matched HIV-negative children [mean; 142, median, 155; P = 0.02]. Cases were more likely than controls to have received over 200 lifetime injections (odds ratio, 5.7; 95% confidence interval, 1.2-32.7). Blood transfusions and mother-to-child transmission were excluded as routes of HIV transmission. By reviewing sterilization records and interviewing local health-care workers, we determined that needles and syringes were often re-used without proper disinfection in the orphanage.
  
  
  CONCLUSIONS
  These data provide strong epidemiologic evidence that indiscriminate injections with contaminated needles and syringes were responsible for HIV transmission in this population.
authors.affiliation: Centers for Disease Control and Prevention, Division of HIV/AIDS, Atlanta, Georgia.
authors.forename: B S
authors.initials: BS
authors.lastname: Hersh
authors.forename: F
authors.initials: F
authors.lastname: Popovici
authors.forename: Z
authors.initials: Z
authors.lastname: Jezek
authors.forename: G A
authors.initials: GA
authors.lastname: Satten
authors.forename: R C
authors.initials: RC
authors.lastname: Apetrei
authors.forename: N
authors.initials: N
authors.lastname: Beldescu
authors.forename: J R
authors.initials: JR
authors.lastname: George
authors.forename: C N
authors.initials: CN
authors.lastname: Shapiro
authors.forename: H D
authors.initials: HD
authors.lastname: Gayle
authors.forename: D L
authors.initials: DL
authors.lastname: Heymann
mesh_terms: D001803:Blood Transfusion; D016022:Case-Control Studies; D002670:Child, Abandoned; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004866:Equipment Contamination; D005581:Foster Home Care; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission; D006512:Hepatitis B Core Antigens / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007267:Injections; D009339:Needles; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D013242:Sterilization; D013594:Syringes
chemical_list: D006512:Hepatitis B Core Antigens