In Indiana, where a public health emergency was declared on March 26 and has been extended until May 24, the only local health care provider in the county where all the cases occurred, along with local health officials, law enforcement, community partners, regional health care providers, and the CDC, provided a comprehensive response, including a public education campaign, establishment of an incident command center and community outreach center, short-term authorization of syringe exchange, and support for comprehensive medical care. The care includes HIV and HCV treatment, as well as substance abuse counseling and treatment, according to a “Notes From the Field Report” in the Morbidity and Mortality Weekly Report (MMWR 2015 April 24;64 [early release]:1-2).
“State and local health departments and academic partners, with the assistance of CDC, are working to implement and improve the community outreach programs supported by the executive order and to interrupt injection drug use-related HIV and hepatitis C virus transmission. Contact tracing by state and CDC disease intervention specialists continues to identify those potentially exposed,” the report states.
During the teleconference, Dr. Duwve described the response in detail, noting that the HIV treatment clinic is staffed by Indiana University infectious disease physicians and is supported by the Indiana State Department of Health and local partners.
Testing and treatment services are also provided at the county jail, she said.
“The outbreak highlights the vulnerability of many rural, resource poor populations to drug use, misuse, and addiction. This outbreak also demonstrates the importance of timely HIV surveillance activity and rapid response to interrupt disease transmission,” she said, noting that it also points to the need for expanded mental health and substance use treatment programs in medically under-served rural areas.
Dr. Mermin of the CDC added that “the situation in Indiana should serve as a warning that we cannot let down our guard against these deadly infections.”