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A tale of 2 HIV outbreaks caused by unsafe injections in Cambodia and the United States, 2014-2015

Published:November 23, 2016DOI:https://doi.org/10.1016/j.ajic.2016.10.014
      In 2014-2015, we saw 2 large outbreaks of HIV infection related to the unsafe use of injection equipment. In Cambodia, 242 persons in one rural commune (population: approximately 8,000) received a diagnosis of HIV infection over the course of 3 months. These infections were attributed to the reuse of injection equipment by an unlicensed health care provider in the informal health care sector.
      • Vun M.C.
      • Galang R.R.
      • Fujita M.
      • Killam W.
      • Gokhale R.
      • Pitman J.
      • et al.
      Cluster of HIV infections attributed to unsafe injection practices—Cambodia, December 1, 2014–February 28, 2015.
      In the U.S. State of Indiana, 181 persons in a rural southeastern town (population: approximately 4,200) received a diagnosis of HIV infection over the course of 6 months. These infections were attributed to the unsafe injection of prescription opioids
      • Conrad C.
      • Bradley H.M.
      • Broz D.
      • Buddha S.
      • Chapman E.L.
      • Galang R.R.
      • et al.
      Community outbreak of HIV infection linked to injection drug use of Oxymorphone–Indiana, 2015.
      by people who inject drugs (PWID) for recreational uses. In Cambodia and Indiana, a large percentage of the infections were determined to have occurred recently (ie, within 6-9 months of diagnosis) (Table 1).
      • Galang R.R.
      • Gentry J.
      • Peters P.J.
      • Brooks J.T.
      HIV-1 and HCV molecular epidemiology of a large community outbreak of HIV-1 infection linked to injection drug use of oxymorphone – Indiana, 2015 (Abstract MOAC0304LB).
      • Rouet F.
      • Leoz M.
      • Mom C.
      • Vun M.C.
      • Prak S.
      • Ken S.
      • et al.
      Investigation of bloodborne viruses from a nosocomial outbreak in rural Cambodia.
      Table 1Common characteristics: Cambodia and Indiana HIV outbreaks, 2014-2015
      Outbreak element Cambodia Indiana
      Setting Rural Rural
      Mode of HIV transmission Unsafe injection (medical) Unsafe injection (nonmedical)
      Timing of HIV spread Rapid (mo) Rapid (mo)
      Preoutbreak community HIV prevalence Low (0.6%) Low (<0.1%)
      Community access to HIV testing Minimal Minimal
      Outbreak HCV infection prevalence High (82%) High (92%)
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