Large HIV outbreak hits rural US county, 142 cases reported

A "large" outbreak of HIV linked to needle-sharing among intravenous drug users has hit a rural county in the US state of Indiana, with 142 people testing positive for the AIDS virus since late 2014, US health authorities said Friday.

"Urgent action is needed" to prevent further HIV transmission in Indiana's Scott County, where fewer than five infections have been identified annually in the past, the US Centers for Disease Control and Prevention (CDC) said.

"New cases of HIV are still being identified every day," Indiana State Health Commissioner Dr. Jerome Adams said in a statement. "We likely haven't reached the peak of this outbreak."

US health officials began investigating of the outbreak in January, after Indiana disease intervention specialists reported 11 confirmed HIV cases traced to Scott county, which has only a total of 4,200 people.

The majority of cases were in residents of the same country and were linked to syringe-sharing partners injecting the prescription opioid oxymorphone, a powerful oral semi-synthetic opioid analgesic, the CDC said.

A report released by the US health agency called injection drug use in this county "a multi-generational activity" because as many as three generations of a family and multiple community members injected together.

The report also found that syringes and drug preparation equipment are frequently shared.

"The reported daily numbers of injections ranged from four to 15, with the reported number of injection partners ranging from one to six per injection event," it said.

Poverty may play a role in the outbreak. "The county has substantial unemployment (8.9 percent), a high proportion of adults who have not completed high school (21.3 percent), a substantial proportion of the population living in poverty (19 percent), and limited access to health care," the report said.

"This county consistently ranks among the lowest in the state for health indicators and life expectancy."

On April 20, Indiana Governor Mike Pence signed an executive order, extending by 30 days the public health emergency declaration in Scott County and permitting the continued operation of a needle exchange program in that county.

A CDC emergency response team including disease intervention specialists and epidemiologists has also been sent to Scott County since March.