Comprehensive investigations of unexplained HIV infections to protect children Myburgh et al. (2020) report 32 children seen at Tygerberg Hospital and nearby pediatric clinics in Cape Town, 2004Town, -2019 HIV infections that are not contracted from their mothers. The authors speculate on possible risks, including health care procedures and risks in the community. Importantly, they ask for "Greater effort . . . to . . . investigate each horizontally HIV-infected child to establish possible routes of transmission and inform future prevention strategies."As demonstrated outside sub-Saharan Africa, investigations "to inform future prevention strategies" first aim to determine what medical procedures someone has had and where, and then visit suspected facilities to identify possible lapses in standard precautions, and if lapses are suspected test others attending those facilities.From such investigations, the number of children found with HIV infections from unsafe health care settings have been far larger than what Myburgh et al. report. An investigation beginning from two unexplained HIV infections in Russia in 1988 found that health care had infected 265 children (Pokrovsky, 1992). Another investigation beginning from one HIV-positive child in Romania in 1989 found about 10,000 children were infected from health care (Buzducea et al., 2010). One study in Libya in 1998-1999 found 402 children infected from health care settings (Visco-Comandini et al., 2005). Beginning in 2006-2008, investigations in three Asian countries: Kazakhstan, Kyrgyzstan, and Uzbekistan found more than 100 children in each country with HIV contracted from health care settings (Thorne et al., 2010). Myburgh et al. report 371 children with HIV from health care settings in Ratodero, Pakistan; a later account reports 975 HIV-positive children (Ahmed, 2020). Ratodero's investigation began on one HIV-positive 2-year-old child with an HIV-negative mother (Farmer, 2020). In all six countries with investigations at least 10 years ago, HIV infections remain concentrated in injection drug users and men who have sex with men, showing that HIV transmission through health care was stopped.Many other studies not cited by Myburgh et al. have reported HIV-infected children with HIV-negative mothers in Africa (Gisselquist et al., 2004;Reid, 2009), showing that many studies missed many opportunities for investigations to protect children.Myburgh et al. attribution of infections in 10-15 children to community-associated risks, although most such children blood exposures as well, should be viewed sceptically in the absence of investigations (visiting identified facilities to observe procedures, and if there are any questions, testing other children). All cases with blood exposures represent opportunities to protect children by finding and preventing errors in providing health care.
