VZCZCXRO8813
RR RUEHDBU RUEHLN RUEHVK RUEHYG
DE RUEHTA #2888 2240309
ZNR UUUUU ZZH
R 120309Z AUG 06
FM AMEMBASSY ALMATY
TO RUEHC/SECSTATE WASHDC 6556
INFO RUCNCIS/CIS COLLECTIVE
RUEHAK/AMEMBASSY ANKARA 1956

UNCLAS ALMATY 002888 
 
SIPDIS 
 
TASHKENT FOR EPUTNAM 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: AMED SOCI PGOV KHIV KZ
SUBJECT: KAZAKHSTAN: TWENTY FOUR YOUNG CHILDREN CONTRACT HIV 
 
 
¶1. Summary: In the last four months, twenty four children under 
the age of three have been identified as HIV-positive in the 
Southern Kazakhstan Oblast (SKO).  A joint investigation by 
Kazakhstan's Ministry of Health and the CDC found that 
significant problems with infection control procedures and 
blood safety at several local children's hospitals were 
responsible.  End summary. 
 
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Twenty Four Children HIV-Positive in Southern Kazakhstan Oblast 
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¶2. Between March 21 and August 8, 2006, twenty four children 
ranging in age from two months to just over two years were 
identified as HIV-positive in the SKO.  Eighteen of the 
children were tested after they exhibited signs and symptoms 
of HIV infection; two were tested because they had received 
blood transfusions; three were identified as a result of 
screening contacts; and one was self-referred.  All these 
children had previously been hospitalized (from one to 
fourteen times) at four Shymkent hospitals. 
 
¶3. Initially, most assumed that the children had caught the 
infection from their mothers.  However, subsequent testing 
revealed that this was not the case.  All mothers tested 
negative for HIV. 
 
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Medical Experts Investigate Source and Extent of the Outbreak 
--------------------------------------------- ---------------- 
 
¶4. Kazakhstan's Ministry of Health is currently leading two 
investigations, with technical assistance being provided by 
CDC's Central Asia Regional Office.  These investigations 
are using different methodologies to try to positively 
identify the circumstances under which the children were 
infected, and to make recommendations on how to prevent 
further outbreaks. 
 
¶5. The initial investigation began in May, after the Ministry of 
Health invited CDC to conduct a joint investigation into the 
matter.  After intensive study, it was reported that 
multiple factors had contributed to the outbreak. 
Specifically, investigators found that unsafe injection 
techniques and blood safety violations were responsible for 
the infections. (Note: While these factors have been 
identified as the transmission pathways, the case-by-case 
particulars of how each child was infected are the subject 
of further study. End note.) 
 
¶6. CDC investigators suggest that a lack of adequate training and 
improper medical practices, including the re-use of medical 
instruments, could be responsible for the spread of HIV 
infection.  Several violations of safe blood transfusion 
practices were identified, including "direct" transfusion of 
untested blood and multiple fractions of the same blood unit 
transfused to different children. 
 
¶7. The investigation also ruled out several previously-suggested 
explanations regarding the outbreak.  The study showed that 
the infections were not the result of vertical transmission 
(from mother to child), that no single hospital was 
responsible for all the cases, and that no single medical 
procedure could have led to all of the infections at the 
various hospitals. 
 
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Immediate Fall-out 
------------------ 
 
¶8. Public trust in area hospitals has plummeted.  According to 
Health Ministry officials, the number of patients in 
regional hospitals has fallen 50% in recent weeks.  The 
directors of the Shymkent AIDS and Blood Centers and the 
director of the regional children's hospital have been 
relieved of their posts.  Four blood transfusion centers in 
Shymkent have been closed, and the regional prosecutor- 
general has launched criminal cases of negligence against 
medical personnel in four area hospitals. 
 
¶9. Health officials suspect that the number of infected children 
and donors is higher than is currently known, and have 
recommended HIV testing for all children under the age of 5 
who have undergone treatment at Shymkent hospitals.  In an 
additional precaution, regional authorities have ordered 
wide-scale HIV testing of medical personnel in area 
hospitals and blood centers. 
 
ORDWAY