Outbreak of HIV infection linked to nosocomial transmission, China, 2016–2017

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Abstract

On January 25, 2017, a physician from ZC Hospital in Hangzhou, China, reported to the Zhejiang Provincial Center for Disease Control and Prevention that a potential HIV outbreak might have occurred during lymphocyte immunotherapy (LIT) performed at the hospital on December 30, 2016. We immediately began investigating and identified the index case-patient as an LIT patient’s husband who donated lymphocytes for his wife’s LIT and later screened HIV-reactive. Subsequent contamination by a technician resulted in the potential exposure of 34 LIT patients. Acute HIV infection was diagnosed in 5 persons. Phylogenetic analysis confirmed that the HIV-1 gag, pol, and env gene sequences from the index and outbreak-related cases had ≥99.5% similarity. Rapid investigation and implementation of effective control measures successfully controlled the outbreak. This incident provides evidence of a lapse in infection control causing HIV transmission, highlighting the need for stronger measures to protect patients from infectious disease exposure.

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Pan, X., Jiang, J., Ma, Q., Zhang, J., Yang, J., Chen, W., … Wu, Z. (2018). Outbreak of HIV infection linked to nosocomial transmission, China, 2016–2017. Emerging Infectious Diseases, 24(12), 2141–2149. https://doi.org/10.3201/eid2412.180117

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