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Cambodia: Partially reported outbreak in Roka Commune, but lots of other risks and unexplained infections


Roka Commune outbreak

Residents of Roka Commune in Cambodia began to suspect something was wrong in November 2014 when a 74-year old man tested HIV-positive. He sent his granddaughter and son-in-law for tests. They also tested positive. More residents went for tests; many were HIV-positive.

The next month, 24 December 2014, Cambodia’s Ministry of Health announced an investigation by the Ministry of Health with support from WHO, the US CDC, UNAIDS, UNICEF, and the Pasteur Institute in Cambodia.[1] In February 2016, the US CDC’s Morbidity and Mortality Weekly Report published a report from the investigation,[2] confirming 242 cases discovered through the end of February 2015. In early 2017, a newspaper article reported 292 infections in the outbreak.[3]

  • As a part of that investigation, a case-control study “identified medical injections and infusions as the most likely modes of transmission.”
  • A test that can identify how long people have been infected [preliminary incidence assay] “suggested that 30% of infections in this outbreak could be classified as having occurred within the 130 days preceding specimen collection.” This points not only to rapid spread but also to high risk to transmit – effectively demolishing WHO’s oft-repeated estimated risk of 0.3% to transmit through reused syringes and needles.
  • As in many other nosocomial HIV outbreaks, children were on the front lines: 22% of cases were in children <14 years old.
  • More than 70% of HIV-positive samples tested for hepatitis C antibodies were found to have antibodies – similar to what one would expect to find in injection drug users who routinely reuse syringes and needles to inject illegal drugs.

Risks continue

A December 2015 BBC article – one year after Roka broke into public view – reports continued and common unsafe practices.[4]

A Westerner who worked in Cambodia’s health sector for many years reports a general lack of knowledge about infection control throughout the country’s healthcare system. “I would say there are many more Rokas in Cambodia… The practices are so poor that it’s inevitable. I don’t think there’s a difference between licensed and unlicensed doctors… People blame this HIV outbreak [in Roka] on an unlicensed practitioner. But it could be many practitioners, licensed or unlicensed, working for the government or not, who have bad practices which can end up with Hepatitis B, or Hep C, or HIV…”

In mid-February 2016, an NGO reported 14 patients testing HIV-positive – 10 from Peam village in Kandal Province, a village of 1,000, and 4 from neighboring villages[5]. The article reported 32 previously known infections in Peam village, for a total of 42 or 4.2% of 1,000 villagers. In interviews, persons newly identified with HIV denied sexual risks and suspected infection from injections by a specified local doctor.

See also these dontgetstuck.org blogs posts

References

1. Eng Sarath. Ministry of Health, Cambodia. 24 December 2014. HIV cases in Sangke district, Battambang. Available at: http://www.cdcmoh.gov.kh/97-hiv-cases-in-sangke-district-battambang

2. Mean Chhi Vun et al. Cluster of HIV infections attributed to unsafe injections  – Cambodia December 1, 2014-February 28, 2015. Morbidity and Mortality Weekly Report 2016: 65:  142-145. Available at: http://www.cdc.gov/mmwr/volumes/65/wr/mm6506a2.htm (accessed 28 March 2016).

3. Millar P. How the residents of Cambodia’s “HIV village” are coping more than two years on. Southeast Asia Globe, 15 March 2017. Available at: http://sea-globe.com/how-the-residents-of-cambodias-hiv-village-are-coping-more-than-two-years-on/ (accessed 14 August 2017.

 

4. John Murphy. BBC, 17 December 2015. A country in love with injections and drips.
Available at: http://www.bbc.com/news/magazine-35111566

5. Aun Pheap, George Wright. Doctor denies spreading HIV in latest outbreak. Cambodia Daily News 22 February 2016. Available at: https://www.cambodiadaily.com/news/doctor-denies-spreading-hiv-in-latest-outbreak-108791/ (accessed 28 March 2016).

See also:

Kehumile Mazibuko. News Tonight Africa, 4 December 2015. Cambodia: unlicensed medical practitioner sentenced for infecting more than 100 people with HIV. Available at: http://newstonight.co.za/content/cambodia-unlicensed-medical-practitioner-sentenced-infecting-more-100-people-hiv

Khy Sovuthy, Anthony Jensen. Cambodia Daily, 8 December 2015. In HIV case, key evidence trails behind guilty verdict. Available at: https://www.cambodiadaily.com/news/in-hiv-case-key-evidence-trails-behind-guilty-verdict-102320/

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