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Pakistan: HiV outbreak in Larkana District

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  • Pakistan: HiV outbreak in Larkana District


    ?Quack? infected 15 children with HIV in Larkana, minister tells PA
    Hasan MansoorUpdated May 03, 2019

    KARACHI: Health Minister Azra Pechuho informed the house on Thursday that a quack impersonating as a doctor had been arrested after a case was registered against him for using used syringes in Larkana district that caused the lethal Human Immunodeficiency Virus (HIV) infection in 15 children.

    The number of children in the same area then swelled to 67 when the government teams launched a community screening drive in the affected areas of Ratodero and Naudero. In addition to them, 26 adults were also found infected with HIV.

    Delivering her ministry?s policy statement during the Sindh Assembly?s session with Speaker Siraj Durrani in the chair, Dr Pechuho said after receiving reports of HIV affecting so many children in Larkana district, a team comprising specialists and officials had been sent to Ratodero and Naudero, where it was confirmed that at least 15 children fell prey to the deadly infection because of the use of used syringes by a local quack.

    ?All those children ? aged two months to eight years ? were being taken to a single doctor practising in the area. That doctor was using a single drip kit and a single injection on all those children,? said the minister...

  • #2

    25 more children, six adults tested positive: HIV outbreak spreads to other cities of Sindh
    M. Waqar Bhatti
    May 8, 2019

    KARACHI: An HIV positive outbreak initially reported from the Larkana district of Sindh seems to spreading to other cities of the province as five more persons were tested positive for HIV in the Hatri area of Larkana while 29 more persons, including 25 children, were tested positive for the viral infection in the Ratodero area of Larkana, health officials said on Tuesday.

    ?As many as 29 people, including 25 children ,were tested positive for HIV infection in Ratodero during an ongoing mass screening for the viral infection while five persons were tested positive for HIV in the Hatri area of Hyderabad also,? an official of the health department said and warned that hundreds of people could have also been tested positive in other areas of Sindh as no work was done to prevent the HIV transmission in high risk to low risk population in the province...


    • #3

      More HIV cases surface in Larkana
      Staff Report

      MAY 16, 2019

      More HIV cases surfaced in Sindh?s Larkana district on Wednesday. A total of 1,192 people of general population were screened in Ratodero. Out of them, 29 were found to be HIV positive. According to official figures of Sindh AIDS Control Programme (SACP), so far 13,876 people have been screened at various blood screening camps established in Ratodero taluka. Out of them, 507 have been found HIV positive. Out of the 507 cases, only 97 are adults, while 410 are children.
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela


      • #4
        10:29 AM, May 18, 2019 / LAST MODIFIED: 10:50 AM, May 18, 2019

        Pakistan doctor accused of infecting over 400 children with HIV

        AFP, Rato Dero
        Anger and fear continue to swell in the desperately poor village hit hard by the epidemic, which authorities say could be linked to either gross negligence or malicious intent by a local pediatrician.

        "They are coming by the dozens," says a doctor at the makeshift clinic, beset by a lack of equipment and personnel to treat the surging number of patients.
        "For the sake of saving money, these quacks will inject multiple patients with a single syringe. This could be the main cause of the spread of HIV cases," said Sikandar Memon, provincial programme manager of the Sindh Aids Control Programme.
        Authorities investigating the outbreak in Sindh say the accused doctor has also tested positive for HIV.
        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
        -Nelson Mandela


        • #5

          International rapid response team called over HIV/AIDS outbreak in Sindh: Dr Zafar Mirza
          Dawn.comUpdated May 26, 2019

          Assistant to the Prime Minister on National Health Services Dr Zafar Mirza on Sunday announced that after seeking the advice of the Sindh health minister, he had called an international rapid response team in the aftermath of the recent HIV/AIDS outbreak in the province.

          Pakistan is a considered a low-prevalence country for HIV but this month the news of hundreds of children and adults allegedly infected by an HIV-positive doctor in Sindh's Larkana district made the headlines. Following this, 56 more suspected cases of HIV were detected in Ratodero.

          Addressing a press conference today, Dr Mirza said that a joint team of the World Health Organisation (WHO) and the Centre for Disease Control (CDC) will reach Karachi in the next two to three days. The team of around 10 experts will go to the affected areas and conduct a "proper investigation" along with local doctors, he added.

          The SAPM said that he was hopeful that in the coming weeks, they will be able to determine the reasons behind the outbreak...


          • #6

            Pakistan Man Murders HIV Positive Wife As Outbreak Spreads Fear
            The police said the murder took place in a village near the epicentre of the outbreak on the outskirts of Larkana city in Pakistan's Sindh province, where thousands have been screened in the last month.
            World | Agence France-Presse | Updated: May 29, 2019 19:19 IST

            Health officials say nearly 700 people in Pakistan have tested positive in recent weeks. (File)


            A man killed his HIV positive wife on Wednesday in southern Pakistan, where hundreds of people have tested positive for the virus in recent weeks, stirring panic and casting a light on the country's dismal public health standards.

            The police said the murder took place in a village near the epicentre of the outbreak on the outskirts of Larkana city in Pakistan's Sindh province, where thousands have been screened in the last month.

            The victim -- a 32-year-old mother of four -- tested positive in recent days, according to a local police officer, with her husband accusing her of having an extramarital affair.

            "This morning the husband strangled (the victim) with a rope and then **** her from a tree outside his home," Roshan Ali -- a police officer in Shikarpur -- told AFP, adding that the suspect was now in custody.
            1m 4s

            HIV outbreak sparks panic in Southern Pakistan

            Hundreds of people in a village in southern Pakistan have allegedly been infected with HIV by a doctor using a contaminated syringe.

            Anger and fear continue to swell in the desperately poor villages and suburbs near Larkana affected by the epidemic, which authorities say could be linked to either gross negligence or malicious intent by a local doctor using tainted syringes...

            ************************************************** *******************************************


            Larkana HIV outbreak: Cases registered against 24 doctors, says DIG
            Naveed Larik
            8 hours ago

            Cases have been registered against 24 doctors, who are private practitioners, in Larkana district, DIG Irfan Baloch announced in press conference on Wednesday.

            He spoke about the recent outbreak of HIV in Larkana and the case of Dr Muzaffar Ghangro who was found guilty of medical negligence.

            Dr Ghanghro, who was arrested in Ratodero on April 30, has since tested positive for AIDS despite initially refusing to be tested. However, the JIT?s findings refute initial claims that he had deliberately injected his patients with HIV as a form of revenge. A Joint Investigation Team was set up by Larkana DIG Irfan Baloch in this regard. Larkana SSP Masood Bangash is part of the team.

            As of Tuesday, May 28, 700 people have been infected with HIV, out of whom around 550 are children, the DIG said...


            • #7

              Pakistan: HIV outbreak in Sindh province

              13 June 2019 - Authorities announced the current outbreak of Human Immunodeficiency Virus (HIV) in Larkana, Sindh Province in Pakistan on 25 April 2019.

              On 1 June 2019, 251 people were screened for HIV, of which 9 people were found to be HIV positive.

              In total, 26,041 people have been screened for HIV since the beginning of the outbreak and 751 people have tested positive for HIV.

              Of the 751 positive cases, only 324 (43%) are receiving Anti-Retroviral Treatment (ART) due to insufficient stocks in-country. Current stocks are enough to meet the needs of 240 children until 15 July 2019, of which 231 are already receiving treatment. This means that only 9 more children can be enrolled for treatment using available stocks, leaving many other children who have tested positive without treatment.

              Pakistan: HIV outbreak in Sindh province

              WHO guidelines on HIV treatment recommend a test-and-treat strategy. In this current outbreak, people with HIV stage III and IV are the targets for treatment. However, in some screening camps, WHO-recommended standards for testing are not being implemented due to unavailability of the recommended test kits.

              Possible drivers of the outbreak seem to indicate unsafe practices of blood transfusion and re-use of injection needles and syringes, although this is being further investigated.


              • #8

                HIV OUTBREAK: WHO awaits Sindh govt cooperation
                Jamal Dawoodpoto
                June 23, 2019

                462932_5289862_HIV1_akhbarThe WHO Representative/Head of Mission, Pakistan, Dr. Palitha Mahipala, has written a letter to Director General, Health Services, Sindh, in response to his letter dated 03rd June, about HIV outbreak in Larkana district and WHO support for outbreak response in Sindh.

                Dr. Palitha said in his letter they were waiting for suitable candidates to be identified by Sindh AIDS Control Program (SACP) for Human Resource Support for a physician, Counselor and Data Entry Operator. He said consignment of Pediatric ARVs, donated from MOH Ethiopia, will be available in the country by end June 2019 for HIV positive clients. He said WHO has placed orders for procurement of 50,000 HIV Rapid Diagnostics Kits (RDTs), and consignment will be available by 15th July, 2019. He said in his letter that WHO has negotiated with Common Management Unit (CMU) of Global Fund for provision of one CD4 Machine, which will be shifted shortly to Taluka Headquarter Hospital for proposed ART Clinics at Ratodero. Finally he said that WHO has already incorporated training of Department of Health staff on HIV treatment, Infection Control & Prevention and Hospital Waste Management.

                This shows that Sindh Government & Health Department has done nothing on their part for their own voters to control the dreaded viral disease but only relying on WHO and other international donor agencies which indeed is very astonishing and terrifying.

                Up to Friday, as many as 831 HIV positive cases were detected in Ratodero out of which 685 are children aged between 1 to 10 years and 146 are adults. So far 29,158 people among the general population have been screened since April 25, 2019 when SACP launched its screening camps in and around Ratodero taluka of Larkana district from where PPP Chairman Bilawal Bhutto Zardari has been elected as MNA and Faryal Talpur as MPA...


                • #9
                  HIV cases-Pakistan

                  Disease outbreak news
                  3 July 2019

                  On 25 April 2019, the local administration in Larkana district was alerted by media reports of a surge in human immunodeficiency virus (HIV) cases among children in Ratodero Taluka, Larkana district, Sindh province, Pakistan. A screening camp was initially established at Taluka?s main hospital. Later, screening was expanded to other health facilities including selected Rural Health Centers (RHCs) and Basic Health Units (BHUs). HIV rapid test kits that were initially used were replaced with pre-qualified WHO test kits.
                  From 25 April through 28 June 2019, a total of 30,192 people have been screened for HIV, of which 876 were found positive. Eighty-two per cent (719/876) of these were below the age of 15 years. During the screening, several risk factors were identified, including: unsafe intravenous injections during medical procedures; unsafe child delivery practices; unsafe practices at blood banks; poorly implemented infection control programs; and improper collection, storage, segregation and disposal of hospital waste.
                  This is the fourth reported outbreak of HIV in Larkana district since 2003. The first outbreak in 2003, was among people who inject drugs (PWID), the second was among 12 pediatric patients in a pediatric hospital in 2016, and the third, also in 2016, was among 206 patients in a dialysis unit.
                  Prior to this event, Larkana district had only one antiretroviral therapy (ART) clinic, which was for adults exclusively (2,568 registered cases by May 2019).
                  Public health response

                  The response to the event has been led by the provincial Department of Health (DOH) and the Sindh AIDS Control Program (SACP). The response has been supported by UN partners, the Pakistan Field Epidemiology & Laboratory Training Program (FELTP), Aga Khan University, and other partners.
                  A new HIV/AIDS ART Treatment Center for children has been established at Shaikh Zaid Children Hospital. Unauthorized laboratories, blood banks, and clinics have been closed.
                  A mission led by the Federal Ministry of Health (MOH) and WHO, supported by other UN partners and academia has been conducted through the first half of June. The objectives were to identify sources and chains of transmission of HIV, map the high-risk areas, and identify gaps in HIV diagnosis, care and treatment.
                  WHO risk assessment

                  Pakistan is one of the countries in the WHO Eastern Mediterranean Region where new HIV infections are increasing at an alarming level since 19871. The current HIV epidemic in Pakistan is defined as a concentrated epidemic. Although the overall prevalence is still less than 1% in the adult population, the latest estimate (2017) of people living with HIV (PLHIV) was 150,0002 . In 2018, 21,000 new PLHIV cases were recorded.
                  Regarding this event, the overall risk of disease spread within Larkana district is high due to:
                  • Non-availability of sufficient information to determine the complete extent and magnitude of the event;
                  • Number of cases among children (mostly under 5 years age group);
                  • Date / period of exposure of HIV to the cases is unknown;
                  • Lack of information regarding all possible sources of exposure;
                  • Insufficient treatment options due to lack of appropriate ARV drugs;
                  • History of repeated HIV outbreaks in the same geographical area;

                  Further epidemiological investigations will help determine the magnitude of the event, and whether this event is acute and isolated in nature, or a longer duration situation with these cases (accidentally diagnosed) representing the tip of the iceberg of a larger epidemic.
                  The risk at regional and global levels is considered very low because the mode of transmission of HIV is very specific and limited to mother to child transmission, contact with contaminated blood through contaminated syringes/other surgical instruments, blood transfusion or sexual contact with PLHIV. The situation is being closely monitored, and the risk will be re-assessed according to the results of the preliminary investigation.
                  WHO advice

                  This event highlights the importance of using high-impact interventions to reduce vulnerability and prevent transmission mainly in health care settings. It also takes into consideration the prevention of sexual transmission in high risk groups, transmission through injecting drug use and mother-to-child transmission.
                  WHO recommends that after 18 months of age, three different assays may be required to establish the diagnosis of HIV infection . However, infants less than 18 months of age who are born to HIV infected mother should be diagnosed through nucleic acid testing (NAT)3.
                  WHO stresses the importance of immediately linking all those diagnosed with HIV infection to antiretroviral treatment (ART), where the test should be repeated to rule out errors in diagnosis (in case second test is negative4) and, thereafter, ART should be started without any delay.
                  For more information,please see:

                  1Report on the global HIV/AIDS epidemic-June 1998
                  2UNAIDS Pakistan country profile
                  3WHO Consolidated guidelines on HIV testing services, July 2015
                  4WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, second edition 2016


                  • #10

                    Four more test HIV positive
                    By PPI
                    Published: August 18, 2019

                    Three children and an adult tested HIV positive on Friday, when the HIV screening camp in the Taluka Headquarter Hospital in Rato Dero resumed screenings after Eidul Azha holidays, according to Sindh AIDS Control Provincial Programme Manager Dr Sikandar Memon.

                    He said that out of the 21 people screened on Friday, four tested HIV positive bringing the total number of people who tested positive for the virus to 996. Of these, 816 are children and 180 are adults.

                    According to Dr Memon, 33,597 people have been screened so far at the five outreach sites in Rato Dero Taluka and one in Shikarpur District.

                    Larkana HIV/AIDS Treatment and Care Centre In-Charge Dr Hola Ram said that the number of HIV cases at the adult centre has been rising day by day.

                    He said that so far 2,780 cases have been registered out of which 2,028 are males, 677 females, 34 transpersons, and of the 41 children, 19 are male and 22 females. He added that two patients were registered on Friday.

                    According to Dr Ram, only 2,422 patients of 2,780 diagnosed with the virus are on ART treatment while the rest have either expired, abandoned treatment or have shifted to other centres...


                    • #11

                      Pakistan: 900 Children Among 1,100 Affected As HIV Outbreak Resurfaces
                      In Pakistan, HIV outbreak affects over 1100, mainly children in Sindh. Muzaffar Ghanghro, a pediatrician in Rato Dero injected used syringes which caused it.
                      Written By Tanima Ray | Mumbai | Updated On: October 28, 2019 17:42 IST

                      Over 1100 people in a small city near Larkana in Sindh province have been reportedly found to be HIV positive of which over 900 are children under 12 years old. Another 900 in Rato Dero and Larkana were tested positive earlier this year. The disease's outbreak resurfaced in April and now almost every household in the area has an HIV positive child. The source of the outbreak has been reportedly traced toa pediatrician who used the same syringe on several children. Pakistani Health officials claim that there are more who are affected as only a faction was examined by them of which 1100 have been found positive...


                      • #12

                        HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak
                        Fatima Mir, MSCR; Faisal Mahmood, MBBS; Prof Amna Rehana Siddiqui, PhD; Prof Shehla Baqi, MBBS; Syed Hani Abidi, PhD; Abdul Momin Kazi, MPH et al.
                        Publishedecember 19, 2019DOI:

                        In April 2019, an HIV screening camp for all ages was established in response to a report of an unusually large number of paediatric HIV diagnoses in Larkana, Pakistan. We aimed to understand the clinical profile of the children who registered for HIV care.

                        In this cross-sectional study, we review the outbreak response from the government, academia, and UN agencies in Larkana, Sindh, Pakistan. We report age-stratified and sex-stratified HIV prevalence estimated among individuals screened. For children who registered for HIV care, clinical history of previous injections and blood transfusions, HIV disease stage, hepatitis B and hepatitis C status, and CD4 count was abstracted from clinical records from Sindh AIDS Control Program HIV Clinic (Shaikh Zayed Childrens Hospital, Larkana, Pakistan) and analysed using percentages, χ 2 tests, and weight-for-age Z scores. We also analysed data for parents who were tested for HIV.

                        Between April 24, and July 15, 2019, 31 239 individuals underwent HIV testing, of whom 930 (3%) tested positive for HIV. Of these, 763 (82%) were younger than 16 years and 604 (79%) of these were aged 5 years and below. Estimated HIV prevalence was 3% overall; 7% (283 of 3803) in children aged 0–2 years, 6% (321 of 5412) in children aged 3–5 years, and 1% (148 of 11 251) in adults aged 16–49 years. Of the 591 children who registered for HIV care, 478 (81%) were 5 years or younger, 379 (64%) were boys, and 315 (53%) of 590 had a weight-for-age Z score of −3?2. Prevalence of hepatitis B surface antigen was 8% (48 of 574) and hepatitis C antibody positivity was 3% (15 of 574). Of children whose mothers tested for HIV, only 39 (11%) of 371 had HIV-positive mothers. Most children (404 [89%] of 453) reported multiple previous injections and 40 (9%) of 453 reported blood transfusions.

                        This HIV outbreak is unprecedented among children in Pakistan: a 54% increase in paediatric HIV diagnoses over the past 13 years. The outbreak was heavily skewed towards young children younger than 5 years, with a predominance of boys. Epidemiological and molecular studies are needed to understand the full extent of the outbreak and its drivers to guide HIV control strategies...


                        • #13

                          Pakistan study blames HIV outbreak in kids on bad healthcare
                          Kathy Gannon The Associated Press Published Thursday, December 19, 2019 6:53PM EST

                          ISLAMABAD -- A group of Pakistani doctors blames a recent outbreak of HIV among children in a southern city on poor healthcare practices such as using dirty needles and contaminated blood, according to a statement released Friday.

                          The doctors are also urging Pakistan's government to do more to understand how the virus went from high-risk groups such as drug users and sex workers to the general population. They also warned that there isn't enough medication in the city of Ratodero, in southern Sindh province, where 591 children need medical treatment.

                          The outbreak is extremely worrying, said the doctors, calling it "one of the worst" in Pakistan. They studied medical data of 31,239 people in Ratodero, where the HIV outbreak took place and who agreed to the study...