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Whitaker BI, Huang Y, Gubernot D, Eder AF, Herbenick D, Fu TC, Forshee RA, Anderson SA. Modeling US blood donor deferrals under a policy of individual risk assessment for HIV risk sexual behavior. Transfusion 2024. [PMID: 38864291 DOI: 10.1111/trf.17916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND In May 2023, the Food and Drug Administration (FDA) released final guidance for blood donor eligibility that recommended the elimination of 3-month deferral for men who have sex with men (MSM) and the related deferral for women who have sex with MSM. In its place, FDA introduced an individual risk assessment policy of asking all presenting blood donors, regardless of sex or gender, if they have had a new partner or more than one sexual partner in the last 3 months and deferring those who also report anal sex (penile-anal intercourse) during this period. We modeled the possible impact of this policy on the US blood donor base. STUDY DESIGN AND METHODS We developed a computational model to estimate the percentage of blood donors who would be deferred under a policy of individual HIV risk assessment. The model incorporated demographic information about donors and national survey data on HIV risk behaviors and included age and sex distributions and dependencies. RESULTS Our model estimates that approximately 1.2% of US blood donors would be deferred under the individual HIV risk assessment paradigm. DISCUSSION The model predicts a relatively minor effect of replacing the time-based deferral for MSM with individual risk-based deferral for sexual behavior. As US blood centers implement this new policy, the effect may be mitigated by donor gains, which warrant further study. The new policy is unlikely to adversely affect the availability of blood and blood components.
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Affiliation(s)
- Barbee I Whitaker
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, Silver Spring, Maryland, USA
| | - Yin Huang
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, Silver Spring, Maryland, USA
| | - Diane Gubernot
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, Silver Spring, Maryland, USA
| | - Anne F Eder
- FDA Center for Biologics Evaluation and Research, Office of Blood Research and Review, Silver Spring, Maryland, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
| | - Tsung-Chieh Fu
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
| | - Richard A Forshee
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, Silver Spring, Maryland, USA
| | - Steven A Anderson
- FDA Center for Biologics Evaluation and Research, Office of Biostatistics and Pharmacovigilance, Silver Spring, Maryland, USA
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Custer B, Whitaker BI, Pollack LM, Buccheri R, Bruhn RL, Crowder LA, Stramer SL, Reik RA, Pandey S, Stone M, Di Germanio C, Buchacz K, Eder AF, Lu Y, Forshee RA, Anderson SA, Marks PW. HIV risk behavior profiles among men who have sex with men interested in donating blood: Findings from the Assessing Donor Variability and New Concepts in Eligibility study. Transfusion 2023; 63:1872-1884. [PMID: 37642154 DOI: 10.1111/trf.17515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Individual risk assessment allows donors to be evaluated based on their own behaviors. Study objectives were to assess human immunodeficiency virus (HIV) risk behaviors in men who have sex with men (MSM) and estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors. STUDY DESIGN AND METHODS Cross-sectional survey and biomarker assessment were conducted in eight U.S. cities. Participants were sexually active MSM interested in blood donation aged 18-39 years, assigned male sex at birth. Participants completed surveys during two study visits to define eligibility, and self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, one of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Associations were assessed between HIV infection status or HIV PrEP use and behaviors, including sex partners, new partners, and anal sex. RESULTS A total of 1566 MSM completed the visit 1 questionnaire and blood draw and 1197 completed the visit 2 questionnaire. Among 1562 persons without HIV, 789 (50.4%) were not taking PrEP. Of those not taking PrEP, 66.2% reported one sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. CONCLUSION The study found that questions were able to identify sexually active, HIV-negative MSM who report lower risk sexual behaviors. About a quarter of enrolled study participants would be potentially eligible blood donors using individual risk assessment questions.
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Affiliation(s)
- Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbee I Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Lance M Pollack
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Renata Buccheri
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Roberta L Bruhn
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lauren A Crowder
- American Red Cross, Scientific Affairs, Rockville, Maryland, USA
| | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, Maryland, USA
| | | | - Suchitra Pandey
- Stanford Blood Center & Stanford University, Palo Alto, California, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kate Buchacz
- U.S. Centers for Disease Control and Prevention, HIV Research Branch, Division of HIV Prevention, Atlanta, Georgia, USA
| | - Anne F Eder
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Yun Lu
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Richard A Forshee
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Steven A Anderson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Peter W Marks
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
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Crowder LA, Haynes JM, Notari EP, Dodd RY, Stramer SL. Low risk of human T-lymphotropic virus infection in U.S. blood donors; Is it time to consider a one-time selective testing approach? Transfusion 2023; 63:764-773. [PMID: 36794656 DOI: 10.1111/trf.17279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND U.S. blood donors are tested at each donation for human T-lymphotropic virus (HTLV) antibodies. Depending on donor incidence and other mitigation/removal technologies, a strategy of one-time selective donor testing should be considered. METHODS Antibody seroprevalence was calculated for HTLV-confirmed-positive American Red Cross allogeneic blood donors from 2008 to 2021. Incidence was estimated for seven 2-year time periods using confirmed-positive repeat donors having seroconverted in 730 days. Leukoreduction failure rates were obtained from internal data from July 1, 2008-June 30, 2021. Residual risks were calculated using a 51-day window period. RESULTS Between 2008 and 2021, >75 million donations (>18 million donors) yielded 1550 HTLV seropositives. HTLV seroprevalence was 2.05 antibody-positives per 100,000 donations (0.77 HTLV-1, 1.03 HTLV-2, 0.24 HTLV-1/2), and 10.32 per 100,000 among >13.9 million first-time donors. Seroprevalence differed significantly by virus type, sex, age, race/ethnicity, donor status, and U.S. census region. Over 14 years and 24.8 million person-years of observation, 57 incident donors were identified (25 HTLV-1, 23 HTLV-2, and 9 HTLV-1/2). Incidence decreased from 0.30 (13 cases) in 2008-2009 to 0.25 (7 cases) in 2020-2021. Female donors accounted for most incident cases (47 vs. 10 males). In the last 2-year reporting period, the residual risk was 1 per 2.8 million donations and 1 per 3.3 billion donations when coupled with successful leukoreduction (0.085% failure rate). CONCLUSIONS HTLV donation seroprevalence for the years 2008-2021 varied by virus type and donor characteristics. Low HTLV residual risk and use of leukoreduction processes support the conclusion that a selective one-time donor testing strategy should be considered.
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Affiliation(s)
- Lauren A Crowder
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - James M Haynes
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Edward P Notari
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Roger Y Dodd
- Medical and Scientific Office, American Red Cross, Rockville, Maryland, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
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Retrospective Study of the Seroprevalence of HIV, HCV, and HBV in Blood Donors at a Blood Bank of Western Mexico. Pathogens 2021; 10:pathogens10070878. [PMID: 34358028 PMCID: PMC8308904 DOI: 10.3390/pathogens10070878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Obtaining blood which is safe for transfusions is one of the principal challenges in the health systems of developing countries. Supply of contaminated blood increases morbidity, mortality, and the costs of patient care. In Mexico, serological screening is mandatory, but only a few of the main blood banks routinely perform a nucleic acid test (NAT). Data from 80,391 blood donations processed between August 2018 and December 2019 at the Central Blood Bank of the Western National Medical Center of the Mexican Social Security Institute (IMSS) were analyzed. All donors were screened for serological markers and NAT was performed. Reactive donors were followed-up to confirm their results. The number of reactive donors and seroprevalence rates for HIV, HCV, and HBV were 152 (18.91/10,000), 385 (47.89/10,000), and 181 (22.51/10,000), respectively; however, these rates decreased when NAT-confirmed reactive results were considered. Male donors were found to have a higher seroprevalence than females, and younger donors higher than older donors. The present study shows that HIV, HCV, and HBV seroprevalence in blood donors in Western Mexico is low. We propose that Mexico should establish future strategies, including pathogen reduction technologies (PRTs), in order to improve blood safety and reduce transfusion-transmissible infections (TTIs).
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Cardona Arias JA, Palacios Mena VO, Dizu Calambas KF, Flórez Duque J, Higuita Gutiérrez LF. SEROPREVALENCIA DE VIH Y FACTORES ASOCIADOS EN DONANTES DE UN BANCO DE SANGRE DE LA CIUDAD DE MEDELLÍN - COLOMBIA, 2005 – 2018. ACTA BIOLÓGICA COLOMBIANA 2020. [DOI: 10.15446/abc.v25n3.79489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El objetivo de esta investigación fue estimar la seropositividad de VIH y factores asociados en donantes de un banco de sangre de la ciudad de Medellín - Colombia, 2005 - 2018. Se realizó un estudio transversal en 166 603 donantes del banco de Sangre de la Escuela de Microbiología de la Universidad de Antioquia. Las estimaciones se basaron en proporciones y razones de odds con sus intervalos de confianza del 95 %. La mayoría de donantes fueron del Valle de Aburrá, 50,2 % hombres, 65,4 % altruistas, 59,3 % de primera vez y 81,2 % captados fuera de las instalaciones del Banco. La seropositividad general de VIH fue 0,275 % (IC 95 %=0,25-0,30), en las frecuencias específicas fue del 0,324 % en hombres y 0,224 % en mujeres; 0,299 % en donantes con edad entre 18 - 40 años, 0,212% en los de 41 - 65 años, y del 0,333 % en los de primera vez; 0,213 % en lo no repetitivos y 0,149 % en los donantes repetitivos. Se concluye que la seropositividad de la infección fue similar en comparación con investigaciones previas, con un descenso importante desde el 2013. El riesgo de infección fue estadísticamente mayor en los hombres, los menores de 40 años y donantes de primera vez. Esto es importante para conocer la línea base y evaluar acciones de prevención en la población de estudio, orientar estudios etiológicos y mejorar políticas de hemovigilancia.
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Steele WR, Dodd RY, Notari EP, Xu M, Nelson D, Kessler DA, Reik R, Williams AE, Custer B, Stramer SL. Prevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in United States blood donations, 2015 to 2019: The Transfusion-Transmissible Infections Monitoring System (TTIMS). Transfusion 2020; 60:2327-2339. [PMID: 32869326 DOI: 10.1111/trf.16005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Transfusion-Transmissible Infections Monitoring System (TTIMS) combines data from four US blood collection organizations including approximately 60% of all donations to monitor demographic and temporal trends in infectious disease markers and policy impacts. STUDY DESIGN AND METHODS Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) consensus-positive definitions combined serology and nucleic acid testing results. These along with donor and donation characteristics were assembled into a single data set. Overall donation prevalence and demographic subsets were compared pre- and post-implementation of the 2015 change in men who have sex with men (MSM) deferral policy, among other prevalence comparisons. RESULTS From October 2015 to September 2019, there were 712 HIV-, 1735 HBV-, and 5217 HCV-positive samples identified from approximately 27.5 million donations (>9.4 million donors). Prevalences per 100 000 donations were 2.6 (HIV), 6.3 (HBV), and 19.0 (HCV), and the highest for all three agents were in donations from first-time male donors. Two slight but significant increases in HIV prevalence were observed, both for comparisons of Year 1 (pre-MSM policy change) versus Year 4 (post-MSM policy change) for first-time males and first-time females; in contrast, similar comparisons demonstrated decreases in HCV prevalence (all donors and general trends for males and females). Except for HIV, prevalence increased with age; for all agents, prevalence was markedly higher in the south. CONCLUSIONS No major trends were observed over 4 years covering the MSM policy change from indefinite to a 12-month deferral, but ongoing monitoring is warranted. Demographic trends are consistent with those observed in other donor studies and community trends.
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Affiliation(s)
| | | | | | - Meng Xu
- American Red Cross, Gaithersburg, Maryland, USA
| | | | | | - Rita Reik
- OneBlood, St. Petersburg, Florida, USA
| | - Alan E Williams
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
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Bloch EM, Goel R, Wendel S, Burnouf T, Al-Riyami AZ, Ang AL, DeAngelis V, Dumont LJ, Land K, Lee CK, Oreh A, Patidar G, Spitalnik SL, Vermeulen M, Hindawi S, Van den Berg K, Tiberghien P, Vrielink H, Young P, Devine D, So-Osman C. Guidance for the procurement of COVID-19 convalescent plasma: differences between high- and low-middle-income countries. Vox Sang 2020; 116:18-35. [PMID: 32533868 PMCID: PMC7323328 DOI: 10.1111/vox.12970] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Background and objectives COVID‐19 convalescent plasma (CCP) has been used, predominantly in high‐income countries (HICs) to treat COVID‐19; available data suggest the safety and efficacy of use. We sought to develop guidance for procurement and use of CCP, particularly in low‐ and middle‐income countries (LMICs) for which data are lacking. Materials and methods A multidisciplinary, geographically representative group of individuals with expertise spanning transfusion medicine, infectious diseases and haematology was tasked with the development of a guidance document for CCP, drawing on expert opinion, survey of group members and review of available evidence. Three subgroups (i.e. donor, product and patient) were established based on self‐identified expertise and interest. Here, the donor and product‐related challenges are summarized and contrasted between HICs and LMICs with a view to guide related practices. Results The challenges to advance CCP therapy are different between HICs and LMICs. Early challenges in HICs related to recruitment and qualification of sufficient donors to meet the growing demand. Antibody testing also posed a specific obstacle given lack of standardization, variable performance of the assays in use and uncertain interpretation of results. In LMICs, an extant transfusion deficit, suboptimal models of donor recruitment (e.g. reliance on replacement and paid donors), limited laboratory capacity for pre‐donation qualification and operational considerations could impede wide adoption. Conclusion There has been wide‐scale adoption of CCP in many HICs, which could increase if clinical trials show efficacy of use. By contrast, LMICs, having received little attention, require locally applicable strategies for adoption of CCP.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | | | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Ai Leen Ang
- Blood Services Group, Health Sciences Authority, Singapore, Singapore
| | | | - Larry J Dumont
- Vitalant Research Institute, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA.,Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Kevin Land
- Vice President Clinical Services, Vitalant, Scottsdale, AZ, USA.,Department of Pathology, UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China, China.,King's Park Rise, Kowloon, China
| | - Adaeze Oreh
- National Blood Transfusion Service, Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Marion Vermeulen
- The South African National Blood Service, Johannesbur, South Africa
| | - Salwa Hindawi
- Haematology & Transfusion Medicine, King Abdalaziz University, Jeddah, Saudi Arabia
| | | | | | - Hans Vrielink
- Department Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, NL, Netherlands
| | | | - Dana Devine
- Canadian Blood Services, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia So-Osman
- Department Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, NL, Netherlands.,Department of Haematology, Erasmus Medical Center, Rotterdam, NL, Netherlands
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Keil SD, Ragan I, Yonemura S, Hartson L, Dart NK, Bowen R. Inactivation of severe acute respiratory syndrome coronavirus 2 in plasma and platelet products using a riboflavin and ultraviolet light-based photochemical treatment. Vox Sang 2020; 115:495-501. [PMID: 32311760 PMCID: PMC7264728 DOI: 10.1111/vox.12937] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
Background and Objective Severe acute respiratory distress syndrome coronavirus‐2 (SARS‐CoV‐2), the causative agent of coronavirus disease 2019 (COVID‐19), is a member of the coronavirus family. Coronavirus infections in humans are typically associated with respiratory illnesses; however, viral RNA has been isolated in serum from infected patients. Coronaviruses have been identified as a potential low‐risk threat to blood safety. The Mirasol Pathogen Reduction Technology (PRT) System utilizes riboflavin and ultraviolet (UV) light to render blood‐borne pathogens noninfectious, while maintaining blood product quality. Here, we report on the efficacy of riboflavin and UV light against the pandemic virus SARS‐CoV‐2 when tested in both plasma and platelets units. Materials and Methods Stock SARS‐CoV‐2 was grown in Vero cells and inoculated into either plasma or platelet units. Those units were then treated with riboflavin and UV light. The infectious titres of SARS‐CoV‐2 were determined by plaque assay using Vero cells. A total of five (n = 5) plasma and three (n = 3) platelet products were evaluated in this study. Results In both experiments, the measured titre of SARS‐CoV‐2 was below the limit of detection following treatment with riboflavin and UV light. The mean log reductions in the viral titres were ≥3·40 and ≥4·53 for the plasma units and platelet units, respectively. Conclusion Riboflavin and UV light effectively reduced the titre of SARS‐CoV‐2 in both plasma and platelet products to below the limit of detection in tissue culture. The data suggest that the process would be effective in reducing the theoretical risk of transfusion transmitted SARS‐CoV‐2.
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Affiliation(s)
| | - Izabela Ragan
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Lindsay Hartson
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, USA
| | | | - Richard Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Dodd RY, Crowder LA, Haynes JM, Notari EP, Stramer SL, Steele WR. Screening Blood Donors for HIV, HCV, and HBV at the American Red Cross: 10-Year Trends in Prevalence, Incidence, and Residual Risk, 2007 to 2016. Transfus Med Rev 2020; 34:81-93. [PMID: 32178888 DOI: 10.1016/j.tmrv.2020.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
Prevalence, incidence and residual risk of HIV, HCV and HBV are critical indicators of the safety of the blood supply. The American Red Cross routinely monitors these markers. Herein the results of testing over 58 million donations from 2007 to 2016 are reported. The prevalence and incidence of these infections has declined or remained essentially stable over the 7.5 to 10-year period. In 2015 to 2016, the prevalence of HIV, HCV and HBV were respectively: 1.65, 11.47 and 5.85 per hundred thousand (pht) donations with a significant decrease over the 10-year study only for HCV. Weighted incidence rates for all positives were 1.98 pht person years (py) for HIV, 2.20 pht py for HCV and 1.25 pht py for HBV. Estimates of residual risk using these incidence rates were: HIV, 1:2.3 million; HCV, 1:2.6 million; and HBV, 1:1.5 million donations, reflecting very low risk to recipients. There have been increases in the safety of the blood supply compared to prior published estimates. Demographic factors were shown to be associated with variations in infection prevalence and incidence. Continuing changes in the structure of the donor population or changes in policy could impact these measures of safety.
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Affiliation(s)
- Roger Y Dodd
- American Red Cross, Scientific Affairs, Rockville, MD, USA.
| | | | - James M Haynes
- American Red Cross, Scientific Affairs, Rockville, MD, USA.
| | | | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA.
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10
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Fong IW. Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges. CURRENT TRENDS AND CONCERNS IN INFECTIOUS DISEASES 2020. [PMCID: PMC7120358 DOI: 10.1007/978-3-030-36966-8_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Blood transfusions are vital components of modern medical treatment to which there is no viable alternative despite efforts to create artificial blood. Each year thousands of lives are saved by blood transfusions in every country of the world. However, blood and blood products can result in significant adverse events including immunologic reactions, infections, inefficacy, and others which can sometimes result in death and severe disability. Thus, the sustainability of safe blood systems and costs are considered to be at crisis level. In industrialized countries, the risk of transfusion-transmitted infections such as HIV, syphilis, hepatitis viruses B and C are very low [generally [<1 in a million units], but in developing countries [especially in Africa] blood safety is still not assured. Compounding the problem of blood/product safety with respect to infectious agents are new emerging infectious microbes that are not being routinely tested for in blood that are donated. This chapter reviews the infectious risk of blood transfusions, types, mode and geographic variation, and the methods being used by blood services to attenuate and prevent these risks.
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Godbey EA, Thibodeaux SR. Ensuring safety of the blood supply in the United States: Donor screening, testing, emerging pathogens, and pathogen inactivation. Semin Hematol 2019; 56:229-235. [PMID: 31836028 DOI: 10.1053/j.seminhematol.2019.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Safety of the blood supply has been a critical aspect of the transfusion medicine field since its inception, including infections that can be passed to a blood product recipient. Reactive efforts to identify potentially infected blood products are used throughout the blood donation process and afterward. Before donation, potential donors are provided educational materials about infection risks, examined and then screened through a series of questions that help temporarily, permanently, or indefinitely defer donors who could harbor acute and/or chronic infections. During donation, aseptic technique and diversion pouches reduce the potential to introduce bacteria into the blood product. Before transfusion, the blood products are tested for several infectious diseases by serology, nucleic acid testing, or a combination. During transfusion, the patient is monitored closely, and suspected transfusion reactions should be reported and investigated. The FDA regularly publishes guidance documents to incorporate knowledge gained regarding transfusion-transmitted infections, so that information can be shared and practices updated so that transfusion-related patient care can be optimized over time. Pathogen reduction processes are being developed and deployed that provide a proactive approach to both recognized and emerging pathogens.
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Affiliation(s)
| | - Suzanne R Thibodeaux
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
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12
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Pessoni LL, Aquino ÉCD, Alcântara KCD. Prevalence and trends in transfusion-transmissible infections among blood donors in Brazil from 2010 to 2016. Hematol Transfus Cell Ther 2019; 41:310-315. [PMID: 31409582 PMCID: PMC6978541 DOI: 10.1016/j.htct.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 02/12/2019] [Accepted: 03/22/2019] [Indexed: 01/27/2023] Open
Abstract
Background Assessing trends in the rate of transfusion-transmissible infections (TTIs) in blood donors is critical to the monitoring of the blood supply safety and the donor screening effectiveness. The objective of this study was to conduct a trend analysis of TTIs and associated demographic factors of donors at a public blood bank in the central Brazil. Methods A retrospective analysis (2010–2016) of blood donation data was performed to determine the prevalence of markers for TTIs. Multinomial and multivariate logistic regression were used to verify the association between the explanatory variables and TTIs. The trend was evaluated with the Prais Winsten’s regression analysis. Results The prevalence of TTIs was 4.04% (5,553 donors) among 137,209 donors, with a steady trend in the analyzed period. The seroprevalence for the hepatitis B virus (HBV), syphilis, hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease, and human T-lymphotropic virus (HTLV) were 1.63%, 0.87%, 0.46%, 0.21%, 0.21% and 0.09%, respectively. The prevalence of HBV decreased (b = −0.021, p < 0.001), while syphilis increased (b = 0.112; p = 0.001), during the period investigated. The probability for a positive test for TTI was higher among donors with a low level of education, aged ≥30 years old, without stable marital status, and first-time donors. Conclusions Even with the reduction in HBV, the increased rate of syphilis may have contributed to the fact that the overall rate of TTIs did not decrease in the evaluated period.
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13
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Chen X, Liu F, Fu X, Feng Y, Zhang D, Liu H, Xi G, Hu J. Prevalence of human T-cell lymphotropic virus type-1 infection among blood donors in mainland China: a systematic review and meta-analysis of the last 20 years. Expert Rev Hematol 2019; 12:579-587. [PMID: 31220418 DOI: 10.1080/17474086.2019.1632703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The southeastern coastal area of China has a high prevalence of HTLV-1 infection among blood donors. However, the estimation of HTLV-1 prevalence on a national and regional level is little known. The aim of this study is to understand and explore the estimation of HTLV-1 infection prevalence among blood donors on a national and regional level in mainland China by using a systematic review and meta-analysis. Study design and methods: All relevant publications of the past two decades (1998-2017), which were reported in both English and Chinese languages, were adopted and systematically assessed. The estimation of prevalence and its 95% confidence interval (CI) at the level of provinces/municipalities and overall were estimated using meta-analysis method. Results: From the 327 studies searched, 60 met the inclusion criteria. These were from 18 provinces and four municipalities and included 1,420,079 blood donors. The overall estimation of the HTLV-1 prevalence in blood donors was 0.169‰, and its 95% CI was 0.121‰-0.240‰. Conclusion: A disproportionate distribution of HTLV-1 infection among blood donors in different provinces/municipalities regarding its prevalence has been reported. This study recommends developing appropriate HTLV-1 screening strategies of blood donors in various regions of China considering regional prevalence, and cost-effectiveness.
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Affiliation(s)
- Xue Chen
- a Chengdu Blood Center , Chengdu , China
| | - Fang Liu
- b Department of Medical Laboratory, West China Second University Hospital, Sichuan University , Chengdu , China.,c Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University , Chengdu , China
| | - Xuemei Fu
- a Chengdu Blood Center , Chengdu , China
| | - Yi Feng
- d Institute of Health Policy & Hospital Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital , Chengdu , China.,e School of Psychology and Public Health, La Trobe University , Bundoora , VIC , Australia
| | - Dingding Zhang
- f Institute of Health Policy & Hospital Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China , Chengdu , China
| | - Humin Liu
- a Chengdu Blood Center , Chengdu , China
| | | | - Jinliang Hu
- d Institute of Health Policy & Hospital Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital , Chengdu , China
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14
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Li L, Ou S, Huang C, Zhou X, Ge H, Li J, Zeng J, Zhou A, He L, Xu Q, Wu J, Li L, Wang C, Zang L, Huang L, Niu L, Han H, Zhang G, Wan J, Wang F, Xu T, Zhao B, Qian L, Wu Y, Liu Z. The prevalence of human T-cell leukemia virus in blood donors in China. Transfusion 2019; 59:2361-2367. [PMID: 30985961 DOI: 10.1111/trf.15309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND China has not yet incorporated routine human T-lymphotropic virus (HTLV)-1/2 blood donor screening, even though HTLV has been reported in the southeastern coastal region. This study was conducted to investigate the prevalence of HTLV in five major regions across of China. METHODS From January 2016 to December 2017, blood samples were collected in 20 blood centers located in different regions of China. These samples were screened for HTLV-1/2 antibodies using enzyme-linked immunosorbent assay (ELISA). If the test samples were reactive, the samples were confirmed with a western blot (WB) assay. If the results of WB were indeterminate, the donor was interviewed after a minimum lapse of 8 weeks. All follow-up samples from donors were tested for anti-HTLV-1/2 with ELISA and WB. RESULTS There were 875,453 donor samples tested for anti-HTLV-1/2 by ELISA. In all, 365 samples tested negative, 22 samples tested positive by WB, and 14 samples with HTLV status undetermined due to being lost to follow-up. The prevalences were 11.09, 5.96, 3.16, 2.88 and 0.98 per 100,000 in Xiamen, Changsha, Beijing, Shenzhen, and Nanjing blood center, respectively. The prevalences were 0 per 100,000 for all 15 other blood centers. There was significant differences in the prevalence of HTLV in different regions of China (p = 0.0011). CONCLUSION In China, HTLV-1 confirmed positive donors are mainly from southeastern coastal areas. It may be necessary to conduct HTLV screening in these areas to reduce the risk of transfusion-transmitted HTLV.
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Affiliation(s)
- Ling Li
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Shanhai Ou
- Xiamen Blood Center, Xiamen, Fujian, China
| | | | | | | | - Jianping Li
- Liaoning Blood Center, Shenyang, Liaoning, China
| | - Jinfeng Zeng
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Alyssa Zhou
- University of California, Berkeley, Berkeley, California
| | - Liu He
- Hefei Tian Yi Biotech Institute Co., Ltd., Hefei, Anhui, China
| | - Quming Xu
- Maanshan Blood Center, Maanshan, Anhui, China
| | - Jie Wu
- Wuhu Blood Center, Wuhu, Anhui, China
| | - Longhuo Li
- Anqing Blood Center, Anqing, Anhui, China
| | | | - Liang Zang
- Dalian Blood Center, Dalian, Liaoning, China
| | | | - Libin Niu
- Changzhi Blood Center, Changzhi, Shanxi, China
| | - Hui Han
- Hainan Blood Center, Haikou, Hainan, China
| | - Gang Zhang
- Changsha Blood Center, Changsha, Hunan, China
| | - Jianhua Wan
- Urumchi Blood Center, Urumchi, Xinjiang, China
| | - Fang Wang
- Liaoning Blood Center, Shenyang, Liaoning, China
| | - Ting Xu
- Yili Blood Center, Yili, Xinjiang, China
| | | | | | - Yanyun Wu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan, China.,Bloodworks Northwest, Seattle, Washington
| | - Zhong Liu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
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15
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Prevention of transfusion-transmitted infections. Blood 2019; 133:1854-1864. [PMID: 30808637 DOI: 10.1182/blood-2018-11-833996] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/03/2019] [Indexed: 01/10/2023] Open
Abstract
Since the 1970s, introduction of serological assays targeting virus-specific antibodies and antigens has been effective in identifying blood donations infected with the classic transfusion-transmitted infectious agents (TTIs; hepatitis B virus [HBV], HIV, human T-cell lymphotropic virus types I and II, hepatitis C virus [HCV]). Subsequently, progressive implementation of nucleic acid-amplification technology (NAT) screening for HIV, HCV, and HBV has reduced the residual risk of infectious-window-period donations, such that per unit risks are <1 in 1 000 000 in the United States, other high-income countries, and in high-incidence regions performing NAT. NAT screening has emerged as the preferred option for detection of newer TTIs including West Nile virus, Zika virus (ZIKV), and Babesia microti Although there is continual need to monitor current risks due to established TTI, ongoing challenges in blood safety relate primarily to surveillance for emerging agents coupled with development of rapid response mechanisms when such agents are identified. Recent progress in development and implementation of pathogen-reduction technologies (PRTs) provide the opportunity for proactive rather than reactive response to blood-safety threats. Risk-based decision-making tools and cost-effectiveness models have proved useful to quantify infectious risks and place new interventions in context. However, as evidenced by the 2015 to 2017 ZIKV pandemic, a level of tolerable risk has yet to be defined in such a way that conflicting factors (eg, theoretical recipient risk, blood availability, cost, and commercial interests) can be reconciled. A unified approach to TTIs is needed, whereby novel tests and PRTs replace, rather than add to, existing interventions, thereby ameliorating cost and logistical burden to blood centers and hospitals.
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16
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Ramachandran S, Groves JA, Xia GL, Saá P, Notari EP, Drobeniuc J, Poe A, Khudyakov N, Schillie SF, Murphy TV, Kamili S, Teo CG, Dodd RY, Khudyakov YE, Stramer SL. Recent and occult hepatitis B virus infections among blood donors in the United States. Transfusion 2019; 59:601-611. [PMID: 30499591 PMCID: PMC8190636 DOI: 10.1111/trf.15057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Characteristics of US blood donors with recent (RBI) or occult (OBI) hepatitis B virus (HBV) infection are not well defined. METHODS Donors with RBI and OBI were identified by nucleic acid and serologic testing among 34.4 million donations during 2009-2015. Consenting donors were interviewed and their HBV S-gene sequenced. RESULTS The overall rate of HBV-infected donors was 7.95 per 100,000; of these, 0.35 per 100,000 and 1.70 per 100,000 were RBI and OBI, respectively. RBI (n = 120) and OBI (n = 583) donors constituted 26% of all HBV-infected (n = 2735) donors. Detection of HBV DNA in 92% of OBI donors required individual donation nucleic acid testing. Donors with OBI compared to RBI were older (mean age, 48 vs 39 years; p < 0.0001) with lower median viral loads (9 vs. 529 IU/mL; p < 0.0001). A higher proportion of OBI than RBI donors were born or resided in an endemic country (39% vs. 5%; p = 0.0078). Seventy-seven percent of all RBI and OBI donors had multiple sex partners, an HBV-risk factor. Of 40 RBI and 10 OBI donors whose S gene was sequenced, 33 (83%) and 6 (60%), respectively, carried HBV subgenotype A2; 18 (55%) and 2 (33%), respectively, shared an identical sequence. Infection with 1 or more putative HBV-immune-escape mutants was identified in 5 (50%) of OBI but no RBI donors. CONCLUSION RBI and OBI continue to be identified at low rates, confirming the importance of comprehensive HBV DNA screening of US blood donations. HBV-infected donors require referral for care and evaluation and contact tracing; their HBV strains may provide important information on emergent genotypes.
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Affiliation(s)
- Sumathi Ramachandran
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jamel A. Groves
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | - Guo-liang Xia
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paula Saá
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | | | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Poe
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah F. Schillie
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trudy V. Murphy
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chong-Gee Teo
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roger Y. Dodd
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | - Yury E. Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Ticehurst JR, Pisanic N, Forman MS, Ordak C, Heaney CD, Ong E, Linnen JM, Ness PM, Guo N, Shan H, Nelson KE. Probable transmission of hepatitis E virus (HEV) via transfusion in the United States. Transfusion 2019; 59:1024-1034. [PMID: 30702157 DOI: 10.1111/trf.15140] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) can inapparently infect blood donors. To assess transfusion transmission of HEV in the United States, which has not been documented, a donor-recipient repository was evaluated. STUDY DESIGN AND METHODS To identify donations that contained HEV RNA and were linked to patient-recipients with antibody evidence of HEV exposure, we assayed samples from the Retrovirus Epidemiology Donor Study (REDS) Allogeneic Donor and Recipient repository that represents 13,201 linked donations and 3384 transfused patients. Posttransfusion samples, determined to contain IgG anti-HEV by enzyme-linked immunosorbent assay, were reassayed along with corresponding pretransfusion samples for seroconversion (incident exposure) or at least fourfold IgG anti-HEV increase (reexposure). HEV-exposed patients were linked to donations in which HEV RNA was then detected by reverse-transcription quantitative polymerase chain reaction, confirmed by transcription-mediated amplification, and phylogenetically analyzed as subgenomic cDNA sequences. RESULTS Among all patients, 19 of 1036 (1.8%) who had IgG anti-HEV before transfusion were reexposed; 40 of 2348 (1.7%) without pretransfusion IgG anti-HEV seroconverted. These 59 patients were linked to 257 donations, 1 of which was positive by reverse-transcription quantitative polymerase chain reaction and transcription-mediated amplification. Plasma from this donation contained 5.5 log IU/mL of HEV RNA that grouped with HEV genotype 3, clade 3abchij. The patient-recipient of RBCs from this donation had a greater than eightfold IgG increase; however, clinical data are unavailable. CONCLUSIONS This is the first report of probable HEV transmission via transfusion in the United States, although it has been frequently observed in Europe and Japan. Additional data on the magnitude of the risk in the United States are needed.
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Affiliation(s)
- John R Ticehurst
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Medical Microbiology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael S Forman
- Division of Medical Microbiology, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Carly Ordak
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Christopher D Heaney
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Paul M Ness
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Oncology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nan Guo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Hua Shan
- Department of Transfusion Medicine, Stanford University, Palo Alto, California
| | - Kenrad E Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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18
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Haass KA, Sapiano MRP, Savinkina A, Kuehnert MJ, Basavaraju SV. Transfusion-Transmitted Infections Reported to the National Healthcare Safety Network Hemovigilance Module. Transfus Med Rev 2019; 33:84-91. [PMID: 30930009 DOI: 10.1016/j.tmrv.2019.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
Transfusion-transmitted infections (TTIs) can be severe and result in death. Transfusion-transmitted viral pathogen transmission has been substantially reduced, whereas sepsis due to bacterial contamination of platelets and transfusion-transmitted babesiosis may occur more frequently. Quantifying the burden of TTI is important to develop targeted interventions. From January 1, 2010, to December 31, 2016, health care facilities participating in the National Healthcare Safety Network Hemovigilance Module monitored transfusion recipients for evidence of TTI and recorded the total number of units transfused. Facilities use standard criteria to report TTIs. Incidence rates of TTIs, including for bacterial contamination of platelets and transfusion-transmitted babesiosis, are presented. One hundred ninety-five facilities reported 111 TTIs and 7.9 million transfused components to the National Healthcare Safety Network Hemovigilance Module. Of these 111 reports, 54 met inclusion criteria. The most frequently reported pathogens were Babesia spp in RBCs (16/23, 70%) and Staphylococcus aureus in platelets (12/30, 40%). There were 1.95 (26 apheresis, 4 whole blood derived) TTIs per 100 000 transfused platelet units and 0.53 TTI per 100 000 transfused RBC components, compared to 0.68 TTI per 100 000 all transfused components. Bacterial contamination of platelets and transfusion-transmitted babesiosis were the most frequently reported TTIs. Interventions that reduce the burden of bacterial contamination of platelets, particularly collected by apheresis, and Babesia transmission through RBC transfusion would reduce transfusion recipient morbidity and mortality. These analyses demonstrate the value and importance of facility participation in national recipient hemovigilance using standard reporting criteria.
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Affiliation(s)
- Kathryn A Haass
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention.
| | - Mathew R P Sapiano
- Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention
| | - Alexandra Savinkina
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention; Oak Ridge Institute for Science and Education
| | - Matthew J Kuehnert
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Sridhar V Basavaraju
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
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19
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Revisiting human T-cell lymphotropic virus types 1 and 2 infections among rural population in Gabon, central Africa thirty years after the first analysis. PLoS Negl Trop Dis 2018; 12:e0006833. [PMID: 30359373 PMCID: PMC6201875 DOI: 10.1371/journal.pntd.0006833] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/11/2018] [Indexed: 01/03/2023] Open
Abstract
HTLV-1 infection is considered as highly endemic in central Africa. Thirty years ago, a first epidemiological study was performed in Gabon, central Africa, and revealed that the prevalence varied from 5.0 to 10.5%. To evaluate current distribution of HTLVs in Gabon, 4.381 samples were collected from rural population living in 220 villages distributed within the 9 provinces of country. HTLVs prevalence was determined using two ELISA tests and positive results were confirmed by Western Blot. The overall HTLV-1 seroprevalence was of 7.3% among the rural Gabonese population; with 5.4% for men and 9.0% for women. Prevalence of HTLV-1 differed by province, ranging from 2.3% to 12.5% into the rain forest. Being a woman older than 51 years represented a high risk for HTLV-1 acquisition. Hospitalization, operation/surgery, transfusion and medical abortion or fever, arthritis and abdominal pain are also significant risk factors. In addition, 0.1% of samples were found as HTLV-2 positive, while 12.0% had an indeterminate HTLV serological pattern. HTLV-3 and HTLV-4 were not found. Phylogenetic analysis was performed on 87 samples and demonstrated that HTLV-1 present in Gabon belongs mostly to subtype B, however the rare subtype D was also found. Altogether, our results demonstrate that almost thirty years after the first epidemiological study prevention of HTLVs infection is still an issue in Gabon.
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20
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Bloch EM, Ness PM, Tobian AAR, Sugarman J. Revisiting Blood Safety Practices Given Emerging Data about Zika Virus. N Engl J Med 2018; 378:1837-1841. [PMID: 29742377 DOI: 10.1056/nejmsb1704752] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Evan M Bloch
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
| | - Paul M Ness
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
| | - Aaron A R Tobian
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
| | - Jeremy Sugarman
- From the Johns Hopkins University School of Medicine (E.M.B., P.M.N., A.A.R.T., J.S.) and the Berman Institute of Bioethics, Johns Hopkins University (J.S.), Baltimore
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21
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Estimated hepatitis C prevalence and key population sizes in San Francisco: A foundation for elimination. PLoS One 2018; 13:e0195575. [PMID: 29641546 PMCID: PMC5895024 DOI: 10.1371/journal.pone.0195575] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Initiated in 2016, End Hep C SF is a comprehensive initiative to eliminate hepatitis C (HCV) infection in San Francisco. The introduction of direct-acting antivirals to treat and cure HCV provides an opportunity for elimination. To properly measure progress, an estimate of baseline HCV prevalence, and of the number of people in various subpopulations with active HCV infection, is required to target and measure the impact of interventions. Our analysis was designed to incorporate multiple relevant data sources and estimate HCV burden for the San Francisco population as a whole, including specific key populations at higher risk of infection. METHODS Our estimates are based on triangulation of data found in case registries, medical records, observational studies, and published literature from 2010 through 2017. We examined subpopulations based on sex, age and/or HCV risk group. When multiple sources of data were available for subpopulation estimates, we calculated a weighted average using inverse variance weighting. Credible ranges (CRs) were derived from 95% confidence intervals of population size and prevalence estimates. RESULTS We estimate that 21,758 residents of San Francisco are HCV seropositive (CR: 10,274-42,067), representing an overall seroprevalence of 2.5% (CR: 1.2%- 4.9%). Of these, 16,408 are estimated to be viremic (CR: 6,505-37,407), though this estimate includes treated cases; up to 12,257 of these (CR: 2,354-33,256) are people who are untreated and infectious. People who injected drugs in the last year represent 67.9% of viremic HCV infections. CONCLUSIONS We estimated approximately 7,400 (51%) more HCV seropositive cases than are included in San Francisco's HCV surveillance case registry. Our estimate provides a useful baseline against which the impact of End Hep C SF can be measured.
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22
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Stramer SL, Townsend RL, Foster GA, Johnson R, Weixlmann B, Dodd RY. Discordant human T-lymphotropic virus screening with Western blot confirmation: evaluation of the dual-test algorithm for US blood donations. Transfusion 2018; 58:638-640. [PMID: 29322517 DOI: 10.1111/trf.14471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human T-lymphotropic virus (HTLV) blood donation screening has used a dual-testing algorithm beginning with either a chemiluminescent immunoassay or enzyme-linked immunosorbent screening assay (ELISA). Before the availability of a licensed HTLV supplemental assay, repeat-reactive (RR) samples on a first assay (Assay 1) were retested with a second screening assay (Assay 2). Donors with RR results by Assay 2 were deferred from blood donation and further tested using an unlicensed supplemental test to confirm reactivity while nonreactive (NR) donors remained eligible for donation until RR on a subsequent donation. This "dual-test" algorithm was replaced in May 2016 with the requirement that all RRs by Assay 1 be further tested by a licensed HTLV supplemental test (Western blot [WB]). In this study, we have requalified the dual-test algorithm using the available licensed HTLV WB. STUDY DESIGN AND METHODS We tested 100 randomly selected HTLV RRs on screening Assay 1 (Abbott PRISM chemiluminescent immunoassay) but NR on screening Assay 2 (Avioq ELISA) by a Food and Drug Administration-licensed WB (MP Biomedicals) to ensure that no confirmed positives were among those that were RR by Assay 1 but NR by Assay 2. RESULTS Of the 100 samples evaluated, 79 of 100 were WB seronegative, 21 of 100 indeterminate, and 0 of 100 seropositive. Of the 79 of 100 seronegative specimens, 73 of 79 did not express any bands on WB. CONCLUSIONS We demonstrated that none of the 100 samples RR on Assay 1 but NR on Assay 2 were confirmed positive. This algorithm prevents such donors from requiring further testing and from being deferred.
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Affiliation(s)
- Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | | | | | - Ramona Johnson
- National Testing Laboratory, American Red Cross, Charlotte, North Carolina
| | - Barbara Weixlmann
- National Testing Laboratory, American Red Cross, Charlotte, North Carolina
| | - Roger Y Dodd
- Holland Laboratory, American Red Cross, Rockville, Maryland
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Galel SA, Simon TL, Williamson PC, AuBuchon JP, Waxman DA, Erickson Y, Bertuzis R, Duncan JR, Malhotra K, Vaks J, Huynh N, Pate LL. Sensitivity and specificity of a new automated system for the detection of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus nucleic acid in blood and plasma donations. Transfusion 2017; 58:649-659. [PMID: 29250788 DOI: 10.1111/trf.14457] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Use of nucleic acid testing (NAT) in donor infectious disease screening improves transfusion safety. Advances in NAT technology include improvements in assay sensitivity and system automation, and real-time viral target discrimination in multiplex assays. This article describes the sensitivity and specificity of cobas MPX, a multiplex assay for detection of human immunodeficiency virus (HIV)-1 Group M, HIV-2 and HIV-1 Group O RNA, HCV RNA, and HBV DNA, for use on the cobas 6800/8800 Systems. STUDY DESIGN AND METHODS The specificity of cobas MPX was evaluated in samples from donors of blood and source plasma in the United States. Analytic sensitivity was determined with reference standards. Infectious window periods (WPs) before NAT detectability were calculated for current donor screening assays. RESULTS The specificity of cobas MPX was 99.946% (99.883%-99.980%) in 11,203 blood donor samples tested individually (IDT), 100% (99.994%-100%) in 63,012 donor samples tested in pools of 6, and 99.994% (99.988%-99.998%) in 108,306 source plasma donations tested in pools of 96. Seven HCV NAT-yield donations and one seronegative occult HBV infection were detected. Ninety-five percent and 50% detection limits in plasma (IU/mL) were 25.7 and 3.8 for HIV-1M, 7.0 and 1.3 for HCV, and 1.4 and 0.3 for HBV. The HBV WP was 1 to 4 days shorter than other donor screening assays by IDT. CONCLUSION cobas MPX demonstrated high specificity in blood and source plasma donations tested individually and in pools. High sensitivity, in particular for HBV, shortens the WP and may enhance detection of occult HBV.
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Affiliation(s)
- Susan A Galel
- Roche Molecular Systems, Inc., Pleasanton, California
| | | | | | - James P AuBuchon
- Bloodworks Northwest.,Departments of Medicine and Laboratory Medicine, University of Washington, Seattle, Washington
| | | | - Yasuko Erickson
- Mississippi Valley Regional Blood Center, Davenport, Iowa.,Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Rasa Bertuzis
- Roche Molecular Systems, Inc., Pleasanton, California
| | - John R Duncan
- Roche Molecular Systems, Inc., Pleasanton, California
| | | | - Jeffrey Vaks
- Roche Molecular Systems, Inc., Pleasanton, California
| | - Nancy Huynh
- Roche Molecular Systems, Inc., Pleasanton, California
| | - Lisa Lee Pate
- Roche Molecular Systems, Inc., Pleasanton, California
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24
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Goldman M, W-Y Shih A, O'Brien SF, Devine D. Donor deferral policies for men who have sex with men: past, present and future. Vox Sang 2017; 113:95-103. [DOI: 10.1111/vox.12623] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Goldman
- Canadian Blood Services; Ottawa ON Canada
| | - A. W-Y Shih
- Vancouver General Hospital; Vancouver BC Canada
| | | | - D. Devine
- Canadian Blood Services; Vancouver BC Canada
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25
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Frazier SK, Higgins J, Bugajski A, Jones AR, Brown MR. Adverse Reactions to Transfusion of Blood Products and Best Practices for Prevention. Crit Care Nurs Clin North Am 2017; 29:271-290. [PMID: 28778288 DOI: 10.1016/j.cnc.2017.04.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transfusion, a common practice in critical care, is not without complication. Acute adverse reactions to transfusion occur within 24 hours and include acute hemolytic transfusion reaction, febrile nonhemolytic transfusion reaction, allergic and anaphylactic reactions, and transfusion-related acute lung injury, transfusion-related infection or sepsis, and transfusion-associated circulatory overload. Delayed transfusion adverse reactions develop 48 hours or more after transfusion and include erythrocyte and platelet alloimmunization, delayed hemolytic transfusion reactions, posttransfusion purpura, transfusion-related immunomodulation, transfusion-associated graft versus host disease, and, with long-term transfusion, iron overload. Clinical strategies may reduce the likelihood of reactions and improve patient outcomes.
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Affiliation(s)
- Susan K Frazier
- PhD Program, RICH Heart Program, College of Nursing, University of Kentucky, CON Building, Office 523, 751 Rose Street, Lexington, KY 40536-0232, USA.
| | - Jacob Higgins
- College of Nursing, University of Kentucky, CON Building, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Andrew Bugajski
- College of Nursing, University of Kentucky, CON Building, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Allison R Jones
- Department of Acute, Chronic & Continuing Care, School of Nursing, University of Alabama at Birmingham, NB 543, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Michelle R Brown
- Clinical Laboratory Science, University of Alabama at Birmingham, SHPB 474, 1705 University Boulevard, Birmingham, AL 35294, USA
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26
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Attitudes, perceptions and knowledge among men who have sex with men towards the blood donation deferral policy in Israel. PLoS One 2017; 12:e0170364. [PMID: 28152072 PMCID: PMC5289429 DOI: 10.1371/journal.pone.0170364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/04/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are permanently deferred from donating blood in Israel. Pressure to change this policy exists, despite data showing higher prevalence and incidence of HIV in MSM. A survey was conducted to evaluate current knowledge, attitudes, perceptions and compliance if deferral was changed. STUDY DESIGN AND METHODS Anonymous survey was published in a gay-oriented website, collecting demographic information, history of blood donation, attitudes, knowledge and compliance with permanent versus temporary deferral. Responses were analyzed given 1 point for every "yes" response (0-7 points). Student's t-test was applied to compare differences between continuous variables. Correlations were described with the Pearson correlation coefficient. RESULTS Responses from 492 MSM were analyzed. Average age was 31±9 years. 76% donated blood at least once, mostly for social solidarity (score of 3.2 on 1-5 scale). Tests seeking or protest scores were 1.7 and 1.6, respectively. 66% were unaware of the higher risk of HIV transmission by MSM, or the potential to infect 3 recipients. Knowledge regarding HIV transmission by blood positively correlated with knowledge regarding other routes of HIV transmission (r = 0.11; p = 0.03), age (r = 0.10; p = 0.04), and higher rate of non-compliance with the current deferral policy (OR = 1.9; p = 0.02). Activism for LGBT rights was associated with lower risk for non-adherence (OR = 0.5; p = 0.03). If temporary deferral is introduced 66% will comply with the new policy, but 23% will continue to donate as long as MSM deferral policy is in place. CONCLUSION A high proportion of MSM do not comply with the current lifetime deferral. This may partially change if temporary deferral is introduced.
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27
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Crowder LA, Steele WR, Notari EP, Hopkins CK, Lima JLO, Foster GA, Townsend RL, Krysztof DE, Dodd RY, Stramer SL. Prevalence, incidence, and risk factors of human immunodeficiency virus infection in blood donors in the Southeastern United States. Transfusion 2016; 57:404-411. [PMID: 27807863 DOI: 10.1111/trf.13891] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/25/2016] [Accepted: 09/13/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive blood donors pose a risk to blood safety. The Southeastern United States has the highest reported HIV infection rates. Here we calculate HIV prevalence, incidence, and residual risk in Southeastern US blood donors and report risk factors disclosed by incident donors in counseling sessions. STUDY DESIGN AND METHODS American Red Cross donation and testing data from 2009 to 2014 for three Southeastern collection regions were used to calculate HIV prevalence, incidence, and residual risk. Incident donors had a previous HIV-negative donation within 730 days of their positive donation. Residual risk was defined as the window period multiplied by incidence. RESULTS From 2009 to 2014, a total of 236 HIV-positive donors occurred in these regions for an overall prevalence of 8.3 per 100,000 donations. There were 56 incident donors over the 6-year period with incidence decreasing from 7.1 per 100,000 person-years (PYs) in the first two years (2009-2010) to 3.5 in the last two years (2013-2014). Residual risk decreased from 1 in 562,000 to 1 in 1,100,000. The most commonly reported risk factor behavior in male incident donors was men who have sex with men; females expressed no predominant risk factor. CONCLUSION HIV prevalence and incidence among blood donors in the southeast are higher than other US regions, consistent with general public health surveillance. However, the overall residual risk estimates are low at less than 1 per million. Ongoing monitoring of the blood supply along with educational efforts to provide infected individuals with alternatives to donation remain important initiatives.
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Affiliation(s)
- Lauren A Crowder
- Scientific Affairs, American Red Cross, Columbia, South Carolina
| | - Whitney R Steele
- Scientific Affairs, American Red Cross, Columbia, South Carolina
| | - Edward P Notari
- Scientific Affairs, American Red Cross, Columbia, South Carolina
| | - Courtney K Hopkins
- East Division, Biomedical Services, American Red Cross, Columbia, South Carolina
| | - Jose L O Lima
- Southern Region, American Red Cross, Douglasville, Georgia
| | - Gregory A Foster
- Scientific Affairs, American Red Cross, Columbia, South Carolina
| | | | - David E Krysztof
- Scientific Affairs, American Red Cross, Columbia, South Carolina
| | - Roger Y Dodd
- Medical Office, Biomedical Services, American Red Cross, Rockville, Maryland
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Columbia, South Carolina
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