title: Cluster of HIV Infections Attributed to Unsafe Injection Practices--Cambodia, December 1, 2014-February 28, 2015.
abstract: In December 2014, local health authorities in Battambang province in northwest Cambodia reported 30 cases of human immunodeficiency virus (HIV) infection in a rural commune (district subdivision) where only four cases had been reported during the preceding year. The majority of cases occurred in residents of Roka commune. The Cambodian National Center for HIV/AIDS (acquired immunodeficiency syndrome), Dermatology and Sexually Transmitted Diseases (NCHADS) investigated the outbreak in collaboration with the University of Health Sciences in Phnom Penh and members of the Roka Cluster Investigation Team. By February 28, 2015, NCHADS had confirmed 242 cases of HIV infection among the 8,893 commune residents, an infection rate of 2.7%. Molecular investigation of the HIV strains present in this outbreak indicated that the majority of cases were linked to a single HIV strain that spread quickly within this community. An NCHADS case-control study identified medical injections and infusions as the most likely modes of transmission. In response to this outbreak, the Government of Cambodia has taken measures to encourage safe injection practices by licensed medical professionals, ban unlicensed medical practitioners, increase local capacity for HIV testing and counseling, and expand access to HIV treatment in Battambang province. Measures to reduce the demand for unnecessary medical injections and the provision of unsafe injections are needed. Estimates of national HIV incidence and prevalence might need to be adjusted to account for unsafe injection as a risk exposure.
authors.forename: Mean Chhi
authors.initials: MC
authors.lastname: Vun
authors.forename: Romeo R
authors.initials: RR
authors.lastname: Galang
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.forename: William
authors.initials: W
authors.lastname: Killam
authors.forename: Runa
authors.initials: R
authors.lastname: Gokhale
authors.forename: John
authors.initials: J
authors.lastname: Pitman
authors.forename: Dejana
authors.initials: D
authors.lastname: Selenic
authors.forename: Sovatha
authors.initials: S
authors.lastname: Mam
authors.forename: Chandara
authors.initials: C
authors.lastname: Mom
authors.forename: Didier
authors.initials: D
authors.lastname: Fontenille
authors.forename: Francois
authors.initials: F
authors.lastname: Rouet
authors.forename: Saphonn
authors.initials: S
authors.lastname: Vonthanak
mesh_terms: D000368:Aged; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D016000:Cluster Analysis; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged