CDC Fact Sheet - December 4, 1993
Centers for Disease Control and Prevention

1. How did child 2 described in the NEW ENGLAND JOURNAL OF MEDICINE article become infected?

Child 2 is believed to have become infected by coming into contact with the infected blood of child 1. There were multiple opportunities for blood contact; for example, child 1 had frequent nosebleeds, bleeding from the mouth, and a laceration. The transmission most likely occurred through a blood contact during one of these episodes or a similar one that was never noticed or documented.

2. What is meant by "blood contact?"

When the blood of an HIV-infected person touches the skin or mucous membranes (e.g., eyes or mouth) of another person, it is possible for HIV to be transmitted. However, the vast majority of such contacts do not result in HIV transmission. Transmission through blood contact with skin is less likely than transmission through blood contact with mucous membranes and is probably facilitated when the skin is broken--for example, if there are cuts, scratches, rashes, or chapping.

3. How do you know that this child did not become infected through means other than blood contact?

Although child 2's mother was infected with HIV, child 2 did not acquire HIV from the mother. The child tested HIV negative on many different tests performed during the first 1½ years of life. This is not unusual--approximately 70%-85% of children born to HIV-infected mothers are not infected. In addition, special laboratory tests used to examine the genetic similarity of viral strains indicated that child 2 had a genetically different virus from the mother but a nearly identical virus to that of child 1.

Other possible transmission modes were eliminated. Child 2 did not receive any blood transfusions during the period when the transmission occurred, and there was no history or physical findings indicative of sexual abuse. In the one instance in which the children both received medicine by injection at a hospital, the injections were administered by different nurses in different locations.

4. How did the younger brother described in the MORBIDITY AND MORTALITY WEEKLY REPORT article become infected?

The laboratory findings of the investigation (same technique as described above) indicate that the young man was infected by HIV that originated from his older brother. On one occasion the two shaved with the same razor, and both cut themselves with it; HIV could have been transmitted during this incident. In addition, both brothers injected themselves with clotting factor concentrate (factor VIII) at home to treat their hemophilia. Although no such contact was noticed and documented, it is possible that the younger brother came in contact with his older brother's injection equipment.

5. How were other modes of transmission to the younger brother excluded?

HIV transmission to the younger brother through receipt of factor VIII was excluded because the younger brother had a nearly identical virus as his older brother who had been infected at least 4 years earlier. In addition, the younger brother had been receiving factor VIII that had been heat- treated to inactivate any possible HIV. Although the younger brother had received blood transfusions, all of the donors tested HIV negative. The two young men denied sexual contact with each other or with a common sex partner.

6. Have there been many other cases like these?

No. HIV transmission from one child to another in a household is very rare. There have been two previous reports of such transmission. In one, HIV was transmitted between two brothers with hemophilia. In this case, there were opportunities for exposures related to the use of needles for intravenous therapy for hemophilia. In the other, a brief report (from Germany), no mention was made of the possibility of blood contact.

However, in 17 studies of persons in the United States and Europe who had household contact with HIV-infected persons but did not have sex or share needles with them, there were no infections among more than 1,100 contacts, including more than 300 children.

7. How do you know that there aren't more cases like these?

Persons with AIDS are reported to state and local health departments in all U.S. states and territories. More than 4,900 cases of AIDS in children have been reported. Investigations are conducted whenever the source of the HIV infection is not initially reported. None of these investigations have uncovered cases of HIV transmission in households through any routes other than the recognized modes of transmission.

8. Are these cases examples of HIV transmission through "casual contact?"

No. The transmissions in these cases most likely occurred through skin or mucous membrane contact with infected blood, a recognized route of HIV transmission. HIV cannot be transmitted by being in the same room with an infected person, eating with an infected person, or sharing a bathroom with an infected person. It cannot be transmitted by working, studying, or living with an infected person, unless there is exposure through sex, needles, or direct contact with the infected person's blood.

9. What can be done to prevent similar occurrences from happening?

Contact should be avoided with the blood of persons with HIV infection, at risk for HIV infection, or whose HIV infection and risk status are unknown. This is true in all settings, even in the home. Hands and other parts of the body should be washed immediately after contact with blood. Blood spilled on environmental surfaces should be cleaned up with bleach diluted 1:10 to 1:100 in water. Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes, should be avoided. Needles and other sharp instruments should be used only when medically necessary and handled according to recommendations for health-care settings.

All persons providing health care in any setting should be trained in proper infection control techniques. Finally, patients with bloodborne infections should be informed that their blood may be infectious and should be counseled about the importance of preventing blood contact with others.

10. What precautions are necessary to protect children from contact with blood?

Persons caring for children with HIV infection or unknown HIV infection status in schools, day care settings, and homes should be trained in and adhere to proper infection control techniques. Special attention may be needed to protect young children who may be unable to prevent such exposures on their own. For example, extra attention may be necessary to ensure that open lesions are completely covered to prevent exposure to and from blood or other bloody body fluids, and to prevent sharing of toothbrushes or other items that may be contaminated by blood.

11. Will current recommendations regarding school or day care attendance for children with HIV infection need to be changed?

No. Because the risk of HIV transmission in settings such as schools and day care centers is extremely low and can be reduced by taking precautions to prevent exposures to blood, HIV-infected children should not be restricted from attendance based only on their HIV infection. Although it is important to investigate rare cases like these, it is equally important to view them in perspective. The vast majority of HIV infections are acquired through the well-recognized routes- -through sex or contaminated needles or from mother to child.

Therefore, it is important to avoid unwarranted and unnecessary discrimination against HIV-infected children. However, since children in schools or day care centers may have HIV or other bloodborne infections which may be unrecognized, precautions, as described in previously published guidelines, should be taken to prevent exposure to the blood of all children in these settings.

12. Where can I get more information about HIV infection and AIDS?

The CDC National AIDS Hotline (1-800-342-2437) has trained information specialists who can answer questions from callers 24 hours a day, 7 days a week. The CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20849-6003, telephone 1-800-458-5231 can provide written materials on HIV infection and AIDS.