CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN #3 - April 10, 1992
Centers for Disease Control and Prevention

1. What is this MMWR report about?

This article in the April 10, 1992, MMWR on an investigation of a child with hemophilia who recently became infected with HIV. The investigation was conducted by a state health department, the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Hemophilia Foundation.

2. How did the young boy described in the MMWR article become infected with HIV?

This investigation strongly suggested that the child was infected with HIV originating from his older brother, who also has hemophilia and HIV infection. The younger child most likely became infected after exposure to needles or syringes contaminated with blood from the older brother. Both children receive intravenous therapy for hemophilia, often at about the same time.

3. How do you know that the younger child was infected from his brother and not through some other way, like contaminated factor concentrate?

Laboratory studies of the viruses from the two brothers indicate that the viruses are very closely related. Because the older brother was known to be infected at least 4 years before the possible exposure of the younger brother, the younger brother was probably infected with HIV that came from the older brother. Also, the younger brother had no other exposures to HIV, and he received only a treated factor VIII product that has not been associated with HIV infection.

4. What kind of factor products did the younger child receive?

He received only heat-treated, donor-screened products.

5. Where does this family live?

To protect the confidentiality of the persons involved, the identity or location of this family cannot be released.

6. How do you know the younger child didn't become infected by being exposed to his brother's saliva, or something else besides his blood?

HIV transmission by casual household contact has not been documented. Furthermore, other than the younger brother, all of the people who lived with the older brother in this case had negative HIV tests. In addition, numerous studies of nonsexual household contacts of persons with HIV infection have found no cases of HIV transmission.

7. What is the risk of developing HIV infection after a needlestick injury? What should someone who has such an injury do?

The risk for infection after a needlestick exposure to HIV- contaminated blood is about 0.3%, or about 1 infection for each 340 needlestick exposures. If you are exposed to blood from a person with HIV infection, you should wash the site of exposure thoroughly with soap and water and contact your health care provider immediately for counseling and evaluation. To prevent needlestick injuries, you should not put caps back on needles, should not remove needles from syringes, and should dispose of needles in a puncture-proof container (e.g., a coffee can) that is kept out of the reach of children and others.

8. Can HIV be transmitted by getting blood from an infected person on one's skin?

The risk for infection after this type of exposure is very much lower than that for needlestick injuries. Simple precautions can virtually eliminate even this small risk. You should wear gloves when you are having contact with blood; cover any cuts, sores, or other breaks in your skin with a bandage; always wash your hands with soap and water even after removing gloves (especially after any hand contact with blood); and remove blood from surfaces with soap and water and disinfect the area with a chemical germicide. An easy solution can be made with bleach and water (1:100, or about 1/4 cup bleach to 1 gallon of water) prepared daily.

9. Can HIV be transmitted from child to child through regular play activities?

No. HIV is not known to be transmitted by the kind of casual contact as would ordinarily occur between children. Studies of nonsexual adult and child household contacts of persons with HIV infection found that none were infected. In the case just reported, the child most likely acquired HIV infection from contaminated injection equipment and not by just playing with his older brother.

10. When someone with HIV infection is receiving home infusions, what can be done to prevent other family members from becoming infected?

The best way to prevent HIV infection is to avoid exposures to blood. Guidelines for the prevention of HIV infection in health care settings have been published (MMWR 1987;36:1- 18S; MMWR 1988;37:377-82,387-8; MMWR 1989;38 [No. S-6]). These guidelines are also applicable to household settings in which home health care is provided. You should carefully dispose of needles and other injection equipment into a puncture-proof container immediately after use, use gloves, wash hands with soap and water after gloves are removed, and immediately and thoroughly wash skin surfaces if contamination with blood occurs. You also must be sure to have an adequate supply of gloves and needles, and have a puncture-resistant container for needle disposal easily accessible to the place where you are giving the infusions. Information about infection control for persons providing home health care is included in the brochure "Caring for Someone with AIDS: Information for friends, relatives, household members, and others who care for a person with AIDS at home." Single copies of this brochure are available from the CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20849-6003; telephone 1-800-458-5231.

11. Are special precautions needed when infusions are given to two people in the same setting?

Yes. In addition to preventing exposure to blood and blood- containing sharp objects, you need to take special care to avoid accidentally reusing needles or other injection equipment. You can do this by making a habit of disposing of your injection equipment immediately after each person is injected.

12. Should special precautions be taken when small children are with a person receiving injections?

You may need special precautions for young children whose natural curiosity may expose them to blood or sharp objects but who are too young to understand or comply with infection control measures. Young children should be kept away from situations where exposure to blood or sharp objects is likely, such as during injections. By immediately disposing of needles and other sharp objects into puncture-proof containers, the risk of needlesticks to children can also be decreased.

13. Does this case indicate a need to change recommendations regarding school attendance for children with HIV infection?

There are many studies of household contacts of persons with HIV infection that have not found transmission of HIV between household members despite close contact. This reassures us that the type of ordinary contact that would be expected at school or home does not transmit HIV. Based on these studies, CDC and others have recommended that children with HIV infection be allowed to attend school in most cases. This investigation does not indicate a need to alter this policy.

14. What can be done to use what was learned in this investigation to help families to prevent and better understand HIV transmission?

This case reinforces the importance of following infection control practices wherever health care is provided, including home and health-care facilities.

15. Whom can I contact for more information on HIV infection and AIDS?

The CDC National AIDS Hotline (1-800-342-2437) has trained information specialists to answer questions or provide referrals on HIV infection and AIDS. For single free copies of the brochure "Caring for Someone with AIDS" or other printed material on HIV infection and AIDS, please call or write the CDC National Prevention Information Network, P.O. Box 6003, Rockville MD 20849-6003; telephone 1-800-458-5231.

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