1
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Sauvage C, Laperche S, Corominas V, Stefic K, Le Cam S, Pouchol É, Morel P, Tiberghien P, Lot F. Impact of recent criteria changes for the deferral criteria specific to men who have sex with men in France. Vox Sang 2024. [PMID: 39218425 DOI: 10.1111/vox.13726] [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: 05/02/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVES In 2016, France allowed men who have sex with men (MSM) to donate blood if they had not had sex with men in the previous 12 months. In April 2020, this restriction was relaxed to 4 months due to the lack of negative impact observed on blood safety. This study assesses the impact of reducing this deferral period on epidemiological surveillance indicators. MATERIALS AND METHODS This study compares infection surveillance indicators between two 30-month periods before (P1) and after (P2) this second deferral change. RESULTS Overall, 79 donations tested positive for human immunodeficiency virus (HIV) (49 in P1 and 30 in P2), 322 for hepatitis C virus (HCV) (185 and 137), 622 for hepatitis B virus (HBV) (355 and 267) and 1684 for syphilis (799 and 885). Positive donation rates decreased between P1 and P2, except for syphilis: HIV (0.07/10,000 donations vs. 0.04; p > 0.5), HCV (0.25 vs. 0.20; p < 0.05), HBV (0.49 vs. 0.39; p < 0.01) and syphilis (1.10 vs. 1.29; p < 0.001). For all three viruses, residual risks of transmission by transfusion did not increase: HIV (1/7,800,000 donations vs. 1/10,500,000), HCV (1/25,200,000 vs. 1/47,300,000) and HBV (1/6,400,000 vs. 1/6,000,000). CONCLUSION Reducing the deferral period for MSM in April 2020 did not negatively impact residual risks, which remained very low, or the rate of positive donations, except for syphilis, which requires careful monitoring. To ensure equal access to blood donation, MSM have been allowed to donate blood under the same conditions as other donors since March 2022 (i.e., no more than one sexual partner in the last 4 months).
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Affiliation(s)
| | - S Laperche
- Établissement français du sang, Saint-Denis, France
| | - V Corominas
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | - K Stefic
- Centre National de Référence du VIH - Laboratoire associé, Inserm U1259, CHU Bretonneau & Université François Rabelais, Tours, France
| | - S Le Cam
- Établissement français du sang, Saint-Denis, France
| | - É Pouchol
- Établissement français du sang, Saint-Denis, France
| | - P Morel
- Établissement français du sang, Saint-Denis, France
| | - P Tiberghien
- Établissement français du sang, Saint-Denis, France
| | - F Lot
- Santé publique France, Saint-Maurice, France
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2
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Laperche S, Sauvage C, Gallian P, Jbilou S, Pouchol E, Py JY, Chabli L, Richard P, Morel P, Lot F, Tiberghien P. Human immunodeficiency virus, hepatitis C virus and hepatitis B virus incidence in blood donors from 2000 to 2020 in France: Trends and lessons from haemovigilance surveillance. Vox Sang 2023; 118:843-853. [PMID: 37694766 DOI: 10.1111/vox.13514] [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: 07/11/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Data from 21 years (2000-2020) of haemovigilance were used to assess human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) incidence rates in repeat blood donors and the occurrence of transfusion-transmitted (TT) viral infections. MATERIALS AND METHODS Blood donors who converted for HIV, HCV or HBV markers within serial three-year analysis periods were included. Epidemiological and virological data were retrieved from the national epidemiological donor database and were supplemented with information on blood components and the infection status of recipients of the previous negative donation (D.N-1) of donors who seroconverted. RESULTS Incidence rates declined from 1.27 to 0.35/100,000 person-years for HIV, from 0.59 to 0.19 for HCV and from 1.66 to 0.18 for HBV. Risk factors and lookback for 232 HIV, 90 HCV and 74 HBV seroconversions were investigated. The main risk factor identified at post-donation interview was having sex with men (47.8% of males) for HIV and a sexual risk for HCV (30.6%) and HBV (37.1%). The viral loads and sequences were retrospectively tested in 191 HIV, 74 HCV and 62 HBV D.N-1 archived samples. Six (five HBV and one HIV-1) were positive all low viral loads. Two recipients were infected by red blood cells from two HBV seroconverting donors before the introduction of HBV-nucleic acid testing. CONCLUSION HIV, HCV and HBV incidence rates in blood donors declined over the two past decades in France. There is a very small risk of a blood component that tests negative entering the blood supply resulting in TT infections, especially after introduction of molecular assays in donor screening.
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Affiliation(s)
- Syria Laperche
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- National Reference Centre for infectious risks in transfusion, Institut National de la Transfusion Sanguine, Paris, France
| | | | - Pierre Gallian
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Saadia Jbilou
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Elodie Pouchol
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Jean Yves Py
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Lila Chabli
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Pascale Richard
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Pascal Morel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- UMR RIGHT 1098, Université de Franche-Comté INSERM, Etablissement Français du Sang, Besançon, France
| | | | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- UMR RIGHT 1098, Université de Franche-Comté INSERM, Etablissement Français du Sang, Besançon, France
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3
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Butler-Foster T, Khandelwal A, Montemayor C, Miller YM, Yan MTS, Holmberg JA, Ipe TS, Accooe P, Cancelas JA. From MPOX to the next epidemic: Words matter when talking about equity-deserving groups. Transfusion 2023; 63:646-651. [PMID: 36756669 DOI: 10.1111/trf.17270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/18/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Terrie Butler-Foster
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Aditi Khandelwal
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Celina Montemayor
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Yvette Marie Miller
- Donor & Client Support Center, American Red Cross, Charlotte, North Carolina, USA
| | - Matthew T S Yan
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Tina S Ipe
- Our Blood Institute, Oklahoma City, Oklanoma, USA
| | - Philip Accooe
- U.S Department of Veterans Affairs, Long Beach, California, USA
| | - Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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4
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Lambert G, Cox J, Fourmigue A, Dvorakova M, Apelian H, Moodie EEM, Grace D, Skakoon-Sparling S, Moore DM, Lachowsky N, Jollimore J, Lal A, Parlette A, Hart TA. HIV incidence and related risks among gay, bisexual, and other men who have sex with men in Montreal, Toronto, and Vancouver: Informing blood donor selection criteria in Canada. Transfusion 2022; 62:2555-2567. [PMID: 36197064 PMCID: PMC10092181 DOI: 10.1111/trf.17127] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND An individualized behavior-based selection approach has potential to allow for a more equitable blood donor eligibility process. We collected biological and behavioral data from urban gay, bisexual, and other men who have sex with men (GBM) to inform the use of this approach in Canada. STUDY DESIGN AND METHODS Engage is a closed prospective cohort of sexually active GBM, aged 16+ years, recruited via respondent-driven-sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. Participants completed a questionnaire on behaviors (past 6 months) and tested for HIV and sexually transmitted and blood-borne infections at each visit. Rate ratios for HIV infection and predictive values for blood donation eligibility criteria were estimated by RDS-adjusted Poisson regression. RESULTS Data on 2008 (study visits 2017-02 to 2021-08) HIV-negative participants were used. The HIV incidence rate for the three cities was 0.4|100 person-years [95%CI:0.3, 0.6]. HIV seroconversion was associated with age <30 years: adjusted rate ratio (aRR) 9.1 [95%CI:3.2, 26.2], 6-10 and >10 anal sex partners versus 1-6 aRR: 5.3 [2.1,13.5] and 8.4 [3.4, 20.9], and use of crystal methamphetamine during sex: 4.2 [1.5, 11.6]. Applying the combined selection criteria: drug injection, ≥2 anal sex partners, and a new anal sex partner, detected all participants who seroconverted (100% sensitivity, 100% negative predictive value), and would defer 63% of study participants from donating. CONCLUSION Using three screening questions regarding drug injection and sexual behaviors in the past 6 months would correctly identify potential GBM donors at high risk of having recently contracted HIV. Doing so would reduce the proportion of deferred sexually active GBM by one-third.
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Affiliation(s)
- Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Joseph Cox
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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5
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Sriamporn KT, Saxton P, Consedine N, Hammoud M, Prestage G. Blood donation behaviour and attitudes towards the 12-month deferral policy among gay and bisexual men in New Zealand. Vox Sang 2022; 117:1145-1152. [PMID: 35919939 PMCID: PMC9804482 DOI: 10.1111/vox.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Gay and bisexual men (GBM) are deferred from donating blood in many countries. Perceptions by GBM that blood donor deferral policies are unjustifiably discriminatory, especially due to advances in HIV prevention, could contribute to non-compliance and need to be understood. We explore blood donation interest and history among GBM and attitudes towards donor deferral policies for the first time in New Zealand (NZ). MATERIALS AND METHODS Data from a cross-sectional online survey of GBM in NZ were examined. We constructed three groups: (1) never donated blood and not interested; (2) never donated but expressed interest; and (3) previously donated blood. We tested these for association with demographic and behavioural variables, as well as attitudes towards blood donation policy. RESULTS A total of 607 GBM were eligible for the study, of whom 32.9% reported having donated blood previously, 44.3% had never donated blood but expressed interest and 22.7% expressed no interest in donating. Among previous donors, a third (8.6% of the total sample) reported non-compliance with the deferral policy. Most participants found the 12-month deferral policy to be too strict (81.8%), unfair (75.4%) and homophobic (68.8%). CONCLUSION We estimate that, for the first time in NZ, almost 10% of the sample did not report compliance with the 12-month deferral policy for men who have sex with men (MSM). Negative attitudes towards the deferral policy were common and could potentially increase the risk to the blood supply if compliance reduces. Further work is needed to inform a deferral policy that is accepted by GBM while maintaining the safety of NZ's blood supply.
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Affiliation(s)
| | - Peter Saxton
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | | | - Mohamed Hammoud
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Garrett Prestage
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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6
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Caffrey N, Goldman M, Lewin A, Grégoire Y, Yi QL, O'Brien SF. Removing the men who have sex with men blood donation deferral: Informing risk models using Canadian public health surveillance data. Transfus Clin Biol 2022; 29:198-204. [PMID: 35987531 DOI: 10.1016/j.tracli.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Gay, bisexual and other men who have sex with men (gbMSM) were ineligible to donate blood in most countries since the 1980's. In Canada the deferral period has been incrementally decreased from lifetime to male-to-male sex in the last 3 months. Now a few countries have removed the deferral altogether. Risk models have been utilised to estimate the probability of an HIV positive donation being released into the blood supply and to inform incremental changes to the length of the deferral period. Here we use public health data to estimate the risk of HIV if the gbMSM deferral criteria were removed in Canada. MATERIAL AND METHODS We calculate the risk reduction among heterosexuals based on responses to standard risk questions routinely asked of donors. We assume gbMSM will donate at the same rate as heterosexual males. We apply the same risk reduction principle to HIV incidence and prevalence among gbMSM in the general population to evaluate the HIV risk without gbMSM time deferral. We model three scenarios where risk reduction is varied by assumptions about incidence and compliance with deferral criteria. RESULTS The estimates for all scenarios were not significantly different to the currently observed scenario which predicts a residual risk of 0.02 HIV positive per million donations (95% CI: 0.000006-0.09). CONCLUSION The models predict that removing the gbMSM deferral criteria would result in HIV residual risk similar to currently observed.
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Affiliation(s)
- N Caffrey
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada.
| | - M Goldman
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, K1H 8M5 Ottawa, Ontario, Canada.
| | - A Lewin
- Medical Affairs & Innovation, Héma-Québec 4045, boulevard de la Côte-Vertu, H4R 2W7 Saint-Laurent, QC, Canada.
| | - Y Grégoire
- Medical Affairs & Innovation, Héma-Québec 4045, boulevard de la Côte-Vertu, H4R 2W7 Saint-Laurent, QC, Canada.
| | - Q-L Yi
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada.
| | - S F O'Brien
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, K1G 5Z3 Ottawa, Ontario, Canada.
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7
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Lewin A, Grégoire Y, Delage G, Thibeault C, Viau C, Milot C, Parent É, Renaud C. Reported non-compliance with pre-donation screening among blood donors in Québec, Canada: A focus on the 3-month deferral for men who have sex with men. Vox Sang 2022; 117:966-970. [PMID: 35377497 DOI: 10.1111/vox.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES In Québec (Canada), the donation deferral for men who have sex with men (MSM) has recently been shortened to 3 months. Whether this change impacted compliance with pre-donation screening is unknown. We assessed compliance with the disclosure of male-to-male sex and other behavioural risk factors for HIV amid this change. MATERIALS AND METHODS Québec residents who donated from 14 July 2020 to 30 November 2020 were invited to participate in an online survey. Donors were informed that the survey was optional and anonymous. Survey questions were those used for routine pre-donation screening. Rates of reported non-compliance were weighted based on several characteristics. RESULTS Of 21,918 contacted donors, 7113 (32.45%) participated. Among male participants (N = 3347), six (0.27% [95% confidence interval (CI) = 0.09%-0.44%]) were not compliant with a 3-month MSM deferral. Among female participants (N = 3766), two (0.06% [95% CI = 0.00%-0.13%]) were not compliant with a 3-month deferral for sex with a man who had male-to-male sex ≤12 months. Other risk factors exhibited similar or lower rates of reported non-compliance. CONCLUSION Reported non-compliance with a 3-month MSM deferral and the disclosure of other HIV behavioural risk factors was low. These results warrant the investigation of behavioural donor risk assessment approaches to further improve the inclusiveness of blood donation.
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Affiliation(s)
- Antoine Lewin
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Yves Grégoire
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | - Gilles Delage
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
| | | | | | | | - Éric Parent
- Héma-Québec, Regulatory Affairs, Montréal, Québec, Canada
| | - Christian Renaud
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
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8
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Caffrey N, Goldman M, Osmond L, Yi QL, Fan W, O'Brien SF. HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada. Transfusion 2021; 62:125-134. [PMID: 34854092 DOI: 10.1111/trf.16753] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Canada, the deferral for men who have sex with men (MSM) has been progressively reduced from a permanent deferral for MSM since 1977, to 5 years, 1 year, and, most recently, 3 months. We estimated human immunodeficiency virus (HIV) residual risk and compliance with the MSM time deferral after each change. METHODS Four anonymous online compliance surveys were carried out before and after each change. HIV incidence and prevalence were monitored from 2010 to 2021. Residual risk was estimated using the incidence-window period model. RESULTS Human immunodeficiency virus prevalence, incidence, and residual risk did not change with incrementally shorter MSM deferrals. The residual risk per million donations post 3-month deferral was 0.05 (0.001-0.371). Men with temporally remote MSM history became eligible and, therefore, compliant as the deferral periods decreased (Cochran-Armitage p value = <.0001). However, the percentage of men with MSM history in the last 3 months with the indefinite deferral in place was similar to the percentage noncompliant, while the 3-month deferral was in place. MSM donors did not report high-risk behaviors for which they would otherwise be deferred in any survey. Following the change, an estimated 4467 MSM per year were eligible to donate, an increase from 2501 estimated eligible MSM donors following the change to the 1-year deferral. CONCLUSION With progressively shorter MSM deferral periods, HIV residual risk was unchanged. The proportion of male donors with deferrable MSM history remained low, while those with temporally remote MSM history became eligible, increasing the number of eligible MSM donors.
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Affiliation(s)
- Niamh Caffrey
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Mindy Goldman
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Osmond
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Qi-Long Yi
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Wenli Fan
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Sheila F O'Brien
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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9
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Delatorre MVV, Batalha KM, Santos LD, Bonet-Bub C, Avelino-Silva VI. Demographics and serological profile of blood donors who opt for the confidential unit exclusion in a blood bank in Sao Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e69. [PMID: 34495266 PMCID: PMC8428872 DOI: 10.1590/s1678-9946202163069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Blood transfusion is still an irreplaceable therapeutic modality, widely applied
to medical care. Clinical interviews and laboratory testing for
transfusion-transmitted infections (TTI) are routinely performed to prevent TTI
among the recipients. However, there is still a residual risk of TTI, and some
blood banks have adopted the confidential unit exclusion (CUE) as an additional
safety strategy. In this study, we investigated the demographic characteristics
and laboratory results of the screening of TTI among blood donors who opted for
the CUE, compared to blood donors who did not opt for the CUE. In this study, we
included 32,261 blood donations collected in a single blood bank in Sao Paulo,
Brazil. A very small proportion of donors (0.25%) opted for the CUE. They were
mainly single males and were more likely to have HBV, syphilis, and other
positive results in the combined screening for TTI, in comparison with those who
did not opt for the CUE. This difference was statistically significant in both
the univariable and the multivariable analysis adjusted for age, gender ,
marital status and years of schooling. Our findings highlight that CUE may be a
useful tool to improve the safety for blood recipients, but its efficiency is
context-dependent.
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Affiliation(s)
| | - Kalyne M Batalha
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil
| | - Leandro Dinalli Santos
- Hospital Israelita Albert Einstein, Departamento de Hemoterapia e Terapia Celular, São Paulo, São Paulo, Brazil
| | - Carolina Bonet-Bub
- Hospital Israelita Albert Einstein, Departamento de Hemoterapia e Terapia Celular, São Paulo, São Paulo, Brazil
| | - Vivian Iida Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
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10
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Aubé E, Lewin A, O'Brien SF, Grégoire Y, Pillonel J, Steele WR, Custer B, Davison KL, Germain M, Seed CR, Camirand Lemyre F. HIV residual risk in Canada for apheresis source plasma donation without deferral for men who have sex with men. Vox Sang 2021; 117:201-207. [PMID: 34268781 DOI: 10.1111/vox.13176] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES In Canada, men having sex with men (MSM) are deferred for 3 months from last sexual contact to reduce human immunodeficiency virus (HIV) risk to recipients. The aim of this paper was to model the Canadian residual risk of HIV-positive source plasma incorporating pathogen inactivation (PI) under no MSM deferral scenarios for apheresis plasma donations. MATERIALS AND METHODS A combined Bayesian network (BN) and Monte Carlo approach were implemented to estimate the HIV residual risk under 3-month deferral compared with no deferral without quarantine scenarios for MSM donors. Models involve the stochastic generation of donation and its infection status based on its corresponding simulated donor profile. Viral load reduction conferred by PI used by source plasma fractionators was simulated. Model parameters were derived from Héma-Québec and Canadian Blood Services data, viral loads in a large sample of HIV-positive US blood donors, CSL Behring documentation and from published data. RESULTS In the most likely scenario for the 3-month deferral model, there were 2.71 positive donations per 1,000,000 donations (95% confidence interval [CI] 2.63-2.78). For the no-deferral model, there were 3.01 positive donations per 1,000,000 donations (95% CI 2.94-3.09). For both scenarios, the risk of having an infectious pool was 0 in 300,000 pools (95% CI 0-0.0000123) after consideration of PI. CONCLUSION Based on simulation results, there would be a negligible HIV residual risk associated with the removal of a time-based MSM deferral without quarantine for source plasma incorporating PI.
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Affiliation(s)
- Eliana Aubé
- Department of Mathematics, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montreal, Quebec, Canada.,Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Yves Grégoire
- Medical Affairs and Innovation, Héma-Québec, Quebec City, Quebec, Canada
| | - Josiane Pillonel
- Direction des Maladies Infectieuses, Santé Publique France, St. Maurice, France
| | - Whitney R Steele
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Brian Custer
- Epidemiology and Health Policy Science, Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Katy L Davison
- Immunisation, Hepatitis & Blood Safety, Health Protection Agency, London, UK
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Quebec City, Quebec, Canada
| | - Clive R Seed
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Félix Camirand Lemyre
- Department of Mathematics, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Centre de recherche, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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11
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Smith I, Said B, Vaughan A, Haywood B, Ijaz S, Reynolds C, Brailsford S, Russell K, Morgan D. Case-Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018-2019. Emerg Infect Dis 2021; 27:1654-1661. [PMID: 34013866 PMCID: PMC8153866 DOI: 10.3201/eid2706.203964] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in England. Substantial yearly increases of autochthonous infections were observed during 2003–2016 and again during 2017–2019. Previous studies associated acute HEV cases with consumption of processed pork products, we investigated risk factors for autochthonous HEV infections in the blood donor population in England. Study participants were 117 HEV RNA–positive blood donors and 564 HEV RNA–negative blood donors. No persons with positive results were vegetarian; 97.4% of persons with positive results reported eating pork products. Consuming bacon (OR 3.0, 95% CI 1.7–5.5; p<0.0001), cured pork meats (OR 3.5, 95% CI 2.2–5.4; p<0.0001), and pigs’ liver (OR 2.9, 95% CI 1.0–8.3; p = 0.04) were significantly associated with HEV infection. Our findings confirm previous links to pork products and suggest that appropriate animal husbandry is essential to reduce the risk for HEV infection.
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12
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Germain M, Grégoire Y, Custer BS, Goldman M, Bravo M, Kamel H, Davison K, Field S, van den Hurk K, van de Laar TJW, Irving DO, Jones A, Liumbruno G, Morley S, O'Brien SF, Pillonel J, Steinsvåg CT, Takanashi M, Tsuno NH, Vesga Carasa MA, Wendel S, Vassallo RR, Tiberghien P. An international comparison of HIV prevalence and incidence in blood donors and general population: a BEST Collaborative study. Vox Sang 2021; 116:1084-1093. [PMID: 33835513 DOI: 10.1111/vox.13107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Efficiency in mitigating HIV transmission risk by transfusion may vary internationally. We compared HIV prevalence and incidence in blood donors across different jurisdictions in relation to those rates in the general population and differences in deferral practices. MATERIALS AND METHODS Data from 2007 to 2016 were collected in Australia, Brazil (São Paulo), Canada, England, France, Italy, Ireland, Japan, the Netherlands, New Zealand, Norway, Spain (Basque Country), USA (Vitalant) and Wales. For each country/region, the number of HIV antibody-positive donations and nucleic acid testing (NAT)-only-positive donations was broken down according to first-time or repeat donor status, along with the relevant denominators. RESULTS There is a modest correlation between HIV prevalence among first-time donors and HIV prevalence in the general population. However, rates of HIV-positive donations in repeat donors, a proxy for incidence, do not correlate with incidence rates in the general population. Rates in donors from Italy and Basque Country, where deferral criteria for men having sex with men are less stringent, are higher compared with most other jurisdictions. Rates of NAT-only-positive donations are extremely low and do not differ significantly after adjustment for multiple comparisons. CONCLUSION Donor HIV rates are only weakly associated with those observed in the general population. Countries with less stringent deferral criteria have higher HIV rates in their donor population, but the rates remain very low.
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Affiliation(s)
- Marc Germain
- Medical affairs and Innovation, Héma-Québec, Québec, Canada
| | - Yves Grégoire
- Medical affairs and Innovation, Héma-Québec, Québec, Canada
| | - Brian S Custer
- Vitalant Research Institute, Vitalant, San Francisco, CA, USA
| | - Mindy Goldman
- Donor and Clinical Services, Canadian Blood Services, Ottawa, Canada
| | | | - Hany Kamel
- Medical Affairs, Vitalant, Scottsdale, AZ, USA
| | | | | | | | | | - David O Irving
- Research and Development, Australian Red Cross Blood Service, Melbourne, Australia
| | | | | | - Sarah Morley
- New Zealand Blood Service, Auckland, New Zealand
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Canada
| | - Josiane Pillonel
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | | | | | | | | | | | | | - Pierre Tiberghien
- Établissement Français du Sang, La Plaine Saint-Denis, France.,Inserm UMR 1098 RIGHT, Université de Franche-Comté, Établissement Français du Sang, Besançon, France
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13
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Davison KL, Reynolds CA, Andrews N, Brailsford SR. Blood donation by men who have sex with men: using evidence to change policy. Vox Sang 2021; 116:260-272. [PMID: 33400285 DOI: 10.1111/vox.13033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2011 in the United Kingdom (UK), excluding Northern Ireland, the deferral of men who have sex with men (MSM) changed from lifetime to 12 months. We describe MSM who donated before and after this to inform further policy reviews. MATERIALS AND METHODS Characteristics and sexual behaviours of donors identifying as male from routine surveillance are described. Rates of infections are compared pre- and post-implementation of a 12-month deferral. Donors are compared with screen negative male donors responding to a large-scale survey during 2013/2014. RESULTS Comparing the five years pre- and post-change, the rate of confirmed positives for markers of HBV, HCV, HIV and syphilis decreased by 6·9% from 14·1 to 13·1/100 000 donations. The rate of recent infections was unchanged (1·72/100 000). Of 22 776 survey responses identifying as male, MSM disclosed sex between men over 12 months ago giving 99·35% compliance among male donors. Two-thirds of the 72 non-compliant MSM reported one to two partners and one-third had no new partners within 12 months. The most commonly reported reason for non-compliance from MSM both positive and negative for infection was 'not important to declare' (37·2% and 40·7%). Test seeking was rare (9·3% and 2·1%). CONCLUSION Compliance with the 12-month MSM deferral policy was very high. The very low rates of infections post-change demonstrated the effectiveness of the policy. These data were an important part of the 2017 review of all sexual behaviour deferrals.
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Affiliation(s)
- Katy L Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK
| | - Claire A Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK.,Microbiological Services, NHS Blood and Transplant, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK.,Microbiological Services, NHS Blood and Transplant, London, UK
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14
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Lau JYC, Lee CK, Chan CP, Leung JNS, Poon CM, Lee SS. Compliance and attitudes of blood donors following transitioning from permanent to 12-month deferral of men who have sex with men in Hong Kong. Vox Sang 2020; 116:504-512. [PMID: 33196117 DOI: 10.1111/vox.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Blood safety hinges not just on the scientific rationale for deferral period but potential donors' compliance with the prevailing policy. This study aimed to investigate donors' awareness, attitudes and compliance with the two-phased policy implementation of time-limited deferral for men who have sex with men (MSM) in Hong Kong. MATERIALS AND METHODS Three rounds of questionnaire survey were conducted between July 2017 and June 2019 covering the periods of pre-implementation (Round A), post-implementation without and with pre-donation questionnaire revision (Round B and C). Chi-square test and multivariable regression analysis were performed. RESULTS Of 3085 donors recruited, 968, 1036 and 1081 completed the surveys in Round A, B and C, respectively. The non-compliance rate of MSM remained stable at 0·6% (3/497), 0·4% (2/551) and 0·5% (3/587) among male donors in Round A, B and C, respectively. Two MSM donors from Round C complying with the prevailing policy were identified. About two-thirds (60·7%) of respondents from Round B and C were unaware of the policy change. Overall, over 80% were either neutral or positive about the change. CONCLUSION Our study showed a consistently low non-compliance rate of MSM over the three periods. The generally high level of acceptance of time-limited deferral among donors lends support to science-based policy development to protect blood safety. The identification of compliant MSM donors suggests that the 12-month deferral is effective and acceptable to MSM. With a deferral period far exceeding the window period, it is a step towards a more equitable policy.
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Affiliation(s)
- Janice Ying-Chui Lau
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, People's Republic of China
| | - Chin-Pok Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Jennifer Ngar-Sze Leung
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, People's Republic of China
| | - Chin-Man Poon
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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15
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Sauvage C, Charpentier F, Garrabé É, Pelat C, Spinardi R, Danic B, Lot F, Morel P, Laperche S, Pillonel J. Noncompliance to blood donor selection criteria by men who have sex with men - Complidon 2017, France. Vox Sang 2020; 115:628-636. [PMID: 32687631 DOI: 10.1111/vox.12975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In France, blood donation deferral for men who have sex with men (MSM) was reduced from permanent to 12 months in July 2016. Assessing noncompliance (rate and reasons) with this criterion is important to maintain a high level of viral safety in blood products. MATERIALS AND METHODS An anonymous online survey (Complidon) of a sample of blood donors was conducted in 2017. Data were post-stratified to be representative of all those who donated blood between July 2016 and December 2017. A multivariable analysis was performed to assess factors associated with noncompliance. RESULTS Among male donors, 0·73% [95% CI: 0·63-0·83] reported having sex with men in the 12 months preceding their donation. Factors associated with noncompliance were as follows: young age, a low educational level, concerns about privacy, and better knowledge of donor selection criteria and the window period than compliant men. More than half of noncompliant MSM donors (57·6% [95% CI: 50·6-64·3]) felt that sexual orientation should not be a criterion for donation, 47·2% [95% CI: 40·4-54·0] did not disclose their male-to-male sexual relations in order to avoid being excluded from donating, 40·5% [95% CI: 34·0-47·4] reported using condoms and 21·8% [95% CI: 16·7-27·9] had the same male partner for at least 12 months. CONCLUSION Complidon showed that compliance with blood donation criteria in MSM was high, but not optimal, especially among younger men. HIV residual risk did not increase after the implementation of 12-month deferral. Data from Complidon helped French policymakers to assess the additional HIV risk posed by increased access to blood donation for MSM.
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Affiliation(s)
| | | | - Éliane Garrabé
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | | | - Roxane Spinardi
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Bruno Danic
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | | | - Pascal Morel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Syria Laperche
- Centre national de référence Risque infectieux transfusionnel, Institut National de la Transfusion Sanguine, Paris, France
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16
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Lanteri MC, Santa-Maria F, Laughhunn A, Girard YA, Picard-Maureau M, Payrat JM, Irsch J, Stassinopoulos A, Bringmann P. Inactivation of a broad spectrum of viruses and parasites by photochemical treatment of plasma and platelets using amotosalen and ultraviolet A light. Transfusion 2020; 60:1319-1331. [PMID: 32333396 PMCID: PMC7317863 DOI: 10.1111/trf.15807] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The INTERCEPT Blood System pathogen reduction technology (PRT), which uses amotosalen and ultraviolet A light treatment (amotosalen/UV-PRT), inactivates pathogens in plasma and platelet components (PCs). This review summarizes data describing the inactivation efficacy of amotosalen/UVA-PRT for a broad spectrum of viruses and parasites. METHODS Twenty-five enveloped viruses, six nonenveloped viruses (NEVs), and four parasites species were evaluated for sensitivity to amotosalen/UVA-PRT. Pathogens were spiked into plasma and PC at high titers. Samples were collected before and after PRT and assessed for infectivity with cell cultures or animal models. Log reduction factors (LRFs) were defined as the difference in infectious titers before and after amotosalen/UV-PRT. RESULTS LRFs of ≥4.0 log were reported for 19 pathogens in plasma (range, ≥4.0 to ≥7.6), 28 pathogens in PC in platelet additive solution (PC-PAS; ≥4.1-≥7.8), and 14 pathogens in PC in 100% plasma (PC-100%; (≥4.3->8.4). Twenty-five enveloped viruses and two NEVs were sensitive to amotosalen/UV-PRT; LRF ranged from >2.9 to ≥7.6 in plasma, 2.4 or greater to greater than 6.9 in PC-PAS and >3.5 to >6.5 in PC-100%. Infectious titers for four parasites were reduced by >4.0 log in all PC and plasma (≥4.9 to >8.4). CONCLUSION Amotosalen/UVA-PRT demonstrated effective infectious titer reduction for a broad spectrum of viruses and parasites. This confirms the capacity of this system to reduce the risk of viral and parasitic transfusion-transmitted infections by plasma and PCs in various geographies.
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Affiliation(s)
- Marion C Lanteri
- Department of Scientific Affairs, Cerus Corporation, Concord, California, USA
| | | | - Andrew Laughhunn
- Department of Microbiology, Cerus Corporation, Concord, California, USA
| | - Yvette A Girard
- Department of Microbiology, Cerus Corporation, Concord, California, USA
| | | | - Jean-Marc Payrat
- Department of Scientific Affairs, Cerus Europe BV, Amersfoort, The Netherlands
| | - Johannes Irsch
- Department of Scientific Affairs, Cerus Europe BV, Amersfoort, The Netherlands
| | | | - Peter Bringmann
- Department of Microbiology, Cerus Corporation, Concord, California, USA
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17
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Pillonel J, Pelat C, Tiberghien P, Sauvage C, Danic B, Martinaud C, Barin F, Sainte-Marie I, Coignard B, Gross S, Laperche S, Lot F. The evolving blood donor deferral policy for men who have sex with men: impact on the risk of HIV transmission by transfusion in France. Transfusion 2020; 60:525-534. [PMID: 32027031 DOI: 10.1111/trf.15677] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Blood donation deferral for men who have sex with men (MSM) in France was reduced from permanent to 12 months in July 2016. To inform a further reduction of the deferral period, an HIV risk assessment was conducted with two scenarios: S1, 4-month deferral; S2, 4-month deferral only in the case of more than one sexual partner (i.e., similar to other blood donors). METHODS Baseline HIV residual risk (RR) was calculated from July 2016 to December 2017, using the Incidence Rate-Window Period method. The impact of both scenarios on RR was assessed using data from surveys on MSM and blood donors, to estimate 1) the number of additional MSM expected to donate in each scenario and 2) HIV incidence among these donors. RESULTS Baseline HIV RR was estimated at 1 in 6,380,000 donations. For S1, an additional 733 MSM donors, and an additional 0.09 HIV-positive donations were estimated, yielding an unchanged RR of 1 in 6,300,000. For S2, these numbers were estimated at 3102 and 3.92, respectively, yielding an RR of 1 in 4,300,000. Sensitivity analyses showed that, under worst-case assumptions, the RR would equal 1 in 6,225,000 donations for S1 and 1 in 3,000,000 for S2. CONCLUSION For both scenarios, the HIV RR remains very low. For S1, the risk is identical to the baseline RR. For S2, it is 1.5 times higher, and sensitivity analysis shows that this estimate is less robust than for S1. The French Minister of Health announced that S1 will be implemented in April 2020.
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Affiliation(s)
- Josiane Pillonel
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Camille Pelat
- Santé publique France, Direction Appui, Traitements et Analyses de données, Saint-Maurice, France
| | | | - Claire Sauvage
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Bruno Danic
- Etablissement Français du Sang de Bretagne, Rennes, France
| | | | - Francis Barin
- CHU Bretonneau & Université François Rabelais, Centre National de Référence du VIH-Laboratoire associé, Inserm U1259, Tours, France
| | - Isabelle Sainte-Marie
- Agence Nationale de Sécurité du Médicament et des produits de santé, Saint-Denis, France
| | - Bruno Coignard
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Sylvie Gross
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Syria Laperche
- Centre National de Référence Risques Infectieux Transfusionnels, Institut National de Transfusion Sanguine (INTS), Paris, France
| | - Florence Lot
- Santé publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
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