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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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2
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Williams P, O'Flaherty N, Field S, Waters A. Human T-lymphotropic virus in Irish blood donors: Impact on future testing strategy. Transfusion 2022; 62:1799-1807. [PMID: 35829653 PMCID: PMC9539962 DOI: 10.1111/trf.17017] [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: 12/07/2021] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
Aim A risk‐based approach to the testing of blood donations for Human T‐Lymphotropic Virus (HTLV) should include an assessment of blood donation seroepidemiology. The objectives of the present study were to determine the proportion of HTLV positive units in Irish blood donations, and subsequently, to estimate the current risk of transfusion transmitted HTLV (TT‐HTLV). Methods Over 3 million donations screened between 1996 and 2020, were included in the study (n = 3,666,253). Factors considered in the assessment of TT‐HTLV risk included: (I) HTLV seropositivity, (ii) probability of a leucodepletion failure, and (iii) the HTLV testing strategy. Results Six HTLV positive donations were detected throughout the study period, all of them in previously unscreened blood donors (0.000164%; n = 6/3,666,253), 3 of whom had donated prior to the introduction of HLTV antibody testing. On average 0.11% of manufactured blood components assessed, failed to satisfy the leucodepletion quality assurance criteria of less than 1 × 106 cells/unit. In using these values to model the risk of TT‐HTLV, it was shown that the combination of leucodepletion with either universal screening of all = donors, or selective testing of first‐time donors, a possible HTLV transfusion transmitted infection would be prevented every 468–3776 years. Conclusions This is the first report on the proportion of HTLV positive in Irish blood donations (1996–2020) and will be used to inform blood donation screening policy in Ireland. Evidence is provided for recommending a selective HTLV donor screening algorithm in Ireland that is accompanied by a robust framework for continued surveillance of leucodepletion failure rate.
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Affiliation(s)
- Pádraig Williams
- Irish Blood Transfusion Service, National Blood Centre, Dublin, Ireland
| | - Niamh O'Flaherty
- Irish Blood Transfusion Service, National Blood Centre, Dublin, Ireland.,UCD National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Stephen Field
- Irish Blood Transfusion Service, National Blood Centre, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Allison Waters
- Irish Blood Transfusion Service, National Blood Centre, Dublin, Ireland.,UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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3
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Fowler F, Einsiedel L. A Qualitative Study Exploring Perceptions to the Human T Cell Leukaemia Virus Type 1 in Central Australia: Barriers to Preventing Transmission in a Remote Aboriginal Population. Front Med (Lausanne) 2022; 9:845594. [PMID: 35572972 PMCID: PMC9100826 DOI: 10.3389/fmed.2022.845594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/28/2022] [Indexed: 01/24/2023] Open
Abstract
Background Central Australia has the highest recorded prevalence of infection with the human T cell leukaemia virus type 1 (HTLV-1) worldwide. Each of the clinical diseases associated with HTLV-1 have been reported in this region, including deaths due to adult T cell leukaemia, which is causally linked to HTLV-1. Nevertheless, no public health response has been implemented to reduce HTLV-1 transmission among the affected Aboriginal population. In the first study to explore the perceptions of healthcare professionals along with those of Aboriginal people whose communities are actually impacted by HTLV-1, we sought to understand the barriers to preventing HTLV-1 transmission in this remote area. Methodology/Principal Findings Semi and un-structured interviews were conducted with 30 Australian Aboriginal people, 26 non-Aboriginal healthcare professionals and 3 non-Aboriginal community workers. The purpose of the interviews was to explore perceptions towards HTLV-1 in a health context with a focus on sexual and reproductive rights. Deductive and inductive analyses were applied to the data and a decolonizing lens brought peripheral stories to the fore. A major finding was the contrast between views expressed by Aboriginal participants and healthcare professionals regarding the provision of knowledge to those affected. Aboriginal participants consistently articulated that they and their communities should be informed of, and can hold, knowledges pertaining to HTLV-1. This finding controverted the perceptions of healthcare professionals that the complexities of the virus would not be well-understood by their Aboriginal patients and that sharing HTLV-1 knowledges might overwhelm Aboriginal people. Further analyses revealed a spectrum of understanding and clinical practice, while also delineating signs of an imagined public health response. Conclusions/Significance HTLV-1 remains a neglected infection in Australia. Knowledge of HTLV-1 is held by a privileged medical elite and does not flow to marginalised Aboriginal people living in affected communities. We demonstrate that differences in the perspectives of stakeholders presents a significant barrier to the development of cohesive, culturally safe prevention programs that foster a shared knowledge of HTLV-1. The interview data suggests that a successful public health program is likely to require a dual approach that includes clinical care and community-driven health promotion. Aspects of this approach, which would raise awareness and potentially reduce transmission and lower HTLV-1 prevalence in Central Australia, may be applicable to other endemic settings with similar conditions of social disadvantage, geographic remoteness, resource limitations and cross-cultural challenges.
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Affiliation(s)
- Fiona Fowler
- Department of Social Work, Alice Salomon University of Applied Sciences, Berlin, Germany
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4
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Miranda AE, Rosadas C, Assone T, Pereira GFM, Vallinoto ACR, Ishak R. Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis of the Implementation of Public Health Policies on HTLV-1 in Brazil. Front Med (Lausanne) 2022; 9:859115. [PMID: 35462992 PMCID: PMC9021745 DOI: 10.3389/fmed.2022.859115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Human T lymphotropic virus 1 (HTLV-1) is a public health issue for most countries and imposes important consequences on patients' health and socioeconomic status. Brazil is one of the global leaders of the public health response to these viruses. The country has challenges to overcome to implement meaningful policies aiming to eliminate HTLV-1/2. An analysis of strengths, weaknesses, opportunities, and threats (SWOT) for the implementation of public health policies on HTLV-1/2 was performed. The strengths identified were the Brazilian Unified Health System (SUS); Brazilian expertise in public health programs successfully implemented; currently available policies targeting HTLV; and strong collaboration with researchers and patient's representative. Lack of awareness about HTLV, insufficient epidemiological data, lack of reference centers for patient care, insufficient availability of confirmatory tests, lack of universal antenatal screening, and absence of cost-effectiveness studies were identified as weaknesses. Some interesting opportunities included the increased interest from international organizations on HTLV, possibility of integrating HTLV into other programs, external funding for research, available online platforms, opportunity to acquire data from HTLV-1/2 surveillance to gather epidemiological information, and HTLV policies that were implemented independently by states and municipalities. In addition to the COVID-19 pandemic, existing demands from different diseases, the country's demography and its marked sociocultural diversity and the volatility of the technical team working with HTLV-1/2 at the Brazilian Ministry of Health are threats to the implementation of public policies on HTLV-1/2. This SWOT analysis will facilitate strategic planning to allow continuous progress of the Brazilian response to HTLV-1/2 infection.
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Affiliation(s)
- Angelica Espinosa Miranda
- Departamento de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
- Departamento de Medicina Social, Universidade Federal do Espírito Santo, Vitória, Brazil
- *Correspondence: Angelica Espinosa Miranda
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tatiane Assone
- Departamento de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
- Laboratório de Investigação Médica em Neurologia, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Universidade São Paulo, São Paulo, Brazil
| | - Gerson Fernando Mendes Pereira
- Departamento de Condições Crônicas e Infecções Sexualmente Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | | | - Ricardo Ishak
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
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5
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Talukder MR, Clauss CS, Cherian S, Woodman R, Einsiedel L. Risk factors for HTLV-1, acute kidney injury, and urinary tract infection among aboriginal adults with end stage kidney disease in central Australia. J Med Virol 2021; 93:6362-6370. [PMID: 34173977 DOI: 10.1002/jmv.27163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 12/25/2022]
Abstract
Central Australia is a human T-cell leukemia virus type 1c (HTLV-1c) endemic region and has the highest incidence of chronic kidney disease (CKD) in Australia. The factors associated with HTLV-1 seropositivity among Aboriginal Australian adults with CKD receiving hemodialysis (HD) were determined. A retrospective observational study of Aboriginal adults (≥ 18 years) who were receiving regular HD at the two main dialysis units in Alice Springs, December 1, 2010 to December 31, 2015. Demographic and clinical data before commencing HD were extracted from hospital records from the first presentation to Alice Springs Hospital (ASH) to HD commencement and associations were determined using logistic regression. Among 373 patients receiving HD, 133 (35.9%) were HTLV-1 infected. Identifiable factors associated with HTLV-1 status included increasing age, male gender, and diabetes before HD. The odds of diabetes mellitus were significantly higher among patients with HTLV-1 (adjusted odds ratio [aOR]: 2.76, 95% confidence interval [CI]: 1.19, 6.39; p = 0.017). More than one-fifth of participants had an acute kidney injury, the risk of which was increased among those with a previous blood stream infection (aOR: 3.02, 95% CI: 1.71, 5.34, p < 0.001). Men with a high HTLV-1 proviral load (≥500 copies per 105 peripheral blood leukocytes) had an increased risk of urinary tract infection (UTI) before HD (aOR: 5.15, 95% CI: 1.62, 16.40; p = 0.006). A strong association between HTLV-1 and diabetes, and an increased risk of UTI among men with a high HTLV-1 PVL, suggest that interactions between HTLV-1 infection and conventional risk factors may increase the risk for CKD in this population.
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Affiliation(s)
- Mohammad R Talukder
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Cornelia S Clauss
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sajiv Cherian
- Central Australia Renal Services, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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6
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Gordon CA, Shield JM, Bradbury RS, Muhi S, Page W, Judd JA, Lee R, Biggs BA, Ross K, Kurscheid J, Gray DJ, McManus DP. HTLV-I and Strongyloides in Australia: The worm lurking beneath. ADVANCES IN PARASITOLOGY 2021; 111:119-201. [PMID: 33482974 DOI: 10.1016/bs.apar.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5-10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well.
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Affiliation(s)
- Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jennifer M Shield
- Department of Pharmacy and Biomedical Sciences, La Trobe University, Bendigo, VIC, Australia; Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick, VIC, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Page
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia; Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD, Australia
| | - Rogan Lee
- Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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7
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Ramassamy JL, Cassar O, Toumbiri M, Diané A, Idam Mamimandjiami A, Bengone C, Ntsame-Ndong JM, Mouinga-Ondémé A, Gessain A. High prevalence of human T-cell leukemia virus type-1b genotype among blood donors in Gabon, Central Africa. Transfusion 2020; 60:1483-1491. [PMID: 32415686 PMCID: PMC7496943 DOI: 10.1111/trf.15838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The African continent is considered to be the largest endemic area of HTLV‐1 infection, with at least several million infected individuals. Systematic screening of blood donors can prevent the transmission of HTLV‐1 in blood. Gabon is one of the countries with the highest prevalence of HTLV‐1 worldwide, and yet the routine testing of blood donors has still not been introduced. METHODS All blood donations collected between April and July 2017 at the Centre National de Transfusion Sanguine of Gabon were studied. Plasma samples were screened by ELISA for the presence of HTLV‐1/2 antibodies. Western blot (WB) and polymerase chain reaction (PCR) tests were used for confirmation. RESULTS In total, 3123 blood donors were tested, including 1740 repeat and 1378 first‐time blood donors (FTBDs). Of them, 132 samples tested positive for HTLV‐1/2 by ELISA (4.2%). WB and PCR confirmed HTLV‐1 infection for 23 individuals. The overall prevalence of HTLV‐1 was 0.74% [95% CI 0.47%‐1.10%], 1% in FTBD, and 0.5% in repeat donors. Age and sex‐adjusted prevalence was five‐fold lower in FTBD than in the general adult population of rural areas of Gabon. All detected HTLV‐1 strains belonged to the central African HTLV‐1b genotype but were highly diverse. CONCLUSION We report an overall prevalence of HTLV‐1 of 0.74%, one of the highest values reported for blood donors in Africa. Given the high risk of HTLV‐1 transmission in blood, it is necessary to conduct cost‐effectiveness studies to determine the need and feasibility of implementing screening of HTLV‐1 in blood donors in Gabon.
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Affiliation(s)
- Jill-Léa Ramassamy
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, UMR 3569, CNRS, Paris, France.,Université de Paris, Paris, France
| | - Olivier Cassar
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, UMR 3569, CNRS, Paris, France
| | - Manoushka Toumbiri
- Unité des infections rétrovirales et pathologies associées, Centre International de Recherches Médicales de Franceville, Franceville, Gabon
| | - Abdoulaye Diané
- Unité des infections rétrovirales et pathologies associées, Centre International de Recherches Médicales de Franceville, Franceville, Gabon
| | - Antony Idam Mamimandjiami
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, UMR 3569, CNRS, Paris, France.,Unité des infections rétrovirales et pathologies associées, Centre International de Recherches Médicales de Franceville, Franceville, Gabon.,Ecole Doctorale Régionale d'Afrique Centrale, Infectiologie Tropicale, Franceville, Gabon
| | - Calixte Bengone
- Centre National de Transfusion sanguine (CNTS), Libreville, Gabon
| | | | - Augustin Mouinga-Ondémé
- Unité des infections rétrovirales et pathologies associées, Centre International de Recherches Médicales de Franceville, Franceville, Gabon
| | - Antoine Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, UMR 3569, CNRS, Paris, France
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Storch EK, Custer BS, Jacobs MR, Menitove JE, Mintz PD. Review of current transfusion therapy and blood banking practices. Blood Rev 2019; 38:100593. [PMID: 31405535 DOI: 10.1016/j.blre.2019.100593] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 01/28/2023]
Abstract
Transfusion Medicine is a dynamically evolving field. Recent high-quality research has reshaped the paradigms guiding blood transfusion. As increasing evidence supports the benefit of limiting transfusion, guidelines have been developed and disseminated into clinical practice governing optimal transfusion of red cells, platelets, plasma and cryoprecipitate. Concepts ranging from transfusion thresholds to prophylactic use to maximal storage time are addressed in guidelines. Patient blood management programs have developed to implement principles of patient safety through limiting transfusion in clinical practice. Data from National Hemovigilance Surveys showing dramatic declines in blood utilization over the past decade demonstrate the practical uptake of current principles guiding patient safety. In parallel with decreasing use of traditional blood products, the development of new technologies for blood transfusion such as freeze drying and cold storage has accelerated. Approaches to policy decision making to augment blood safety have also changed. Drivers of these changes include a deeper understanding of emerging threats and adverse events based on hemovigilance, and an increasing healthcare system expectation to align blood safety decision making with approaches used in other healthcare disciplines.
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Affiliation(s)
| | - Brian S Custer
- UCSF Department of Laboratory Medicine, Blood Systems Research Institute, USA.
| | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, USA; Department of Clinical Microbiology, University Hospitals Cleveland Medical Center, USA.
| | - Jay E Menitove
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, USA
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9
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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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10
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Vermeulen M, van den Berg K, Sykes W, Reddy R, Ingram C, Poole C, Custer B. Health economic implications of testing blood donors in South Africa for HTLV 1 & 2 infection. Vox Sang 2019; 114:467-477. [PMID: 31131453 DOI: 10.1111/vox.12788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, HTLV screening is not performed in South Africa (SA). This report describes an economic assessment (budget impact and cost-effectiveness) of implementing different HTLV screening strategies. METHODS A modified version of the Alliance of Blood Operators risk-based decision-making framework was used to assess the risk and consequences of HTLV in the blood supply in SA. We developed a deterministic model of the cost and consequences of four screening strategies: none, universal, all donors once and first time donors only assuming a transfusion-transmission (TT) efficiency of 10% and a manifestation of clinical disease of 6%. RESULTS Unscreened blood results in 3·55 symptomatic TT-HTLV cases and a total healthcare cost of Rand (R)3 446 950 (US Dollars (USD)229 800) annually. Universal screening would cost R24 000 000 (USD1 600 000) per annum and prevent 3·54 (99·8%) symptomatic TT-HTLV cases in the first year and 0·55 (98·4%) symptomatic TT-HTLV cases in the second year at a cost per TT-HTLV prevented of R6 780 000 (USD450 000) in year one and R43 254 000 (USD2 890 000) in year two. Screening all donors once would cost R16,200,000 (USD1 080 000) or R4 600 000 (USD306 000) per symptomatic TT-HTLV infection prevented in year one. Total costs decrease to R5 100 000 (USD340 000) in year 2 but the cost per TT-HTLV prevented increases to R10 700 000 (USD713 333). CONCLUSION This analysis contributed to the decision not to implement HTLV screening as the healthcare budget and particularly the budget for blood transfusion in SA is insufficient to provide appropriate treatment. Arguably, available resources can be more efficiently utilized in other healthcare programs.
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Affiliation(s)
- Marion Vermeulen
- South African National Blood Service, Weltevreden Park, South Africa
| | | | - Wendy Sykes
- South African National Blood Service, Weltevreden Park, South Africa
| | - Ravi Reddy
- South African National Blood Service, Weltevreden Park, South Africa
| | | | - Colwyn Poole
- South African National Blood Service, Weltevreden Park, South Africa
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
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Vermeulen M, Sykes W, Coleman C, Custer B, Jacobs G, Jaza J, Kaidarova Z, Hlela C, Gessain A, Cassar O, Poole C, Ingram C, Murphy EL, Reddy R. The prevalence of human T-lymphotropic virus type 1 & 2 (HTLV-1/2) in South African blood donors. Vox Sang 2019; 114:451-458. [PMID: 30950074 DOI: 10.1111/vox.12778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Donated blood is not currently screened for human T-cell lymphotropic virus (HTLV) in South Africa. Several small studies have detected HTLV-1 in South Africa, but prevalence by geographic region or population group is unavailable. MATERIALS AND METHODS We performed a large seroprevalence study of South African blood donors during 3 months in 2013. All geographic regions except the Western Cape were included, and Black and Coloured (local term for mixed race) donors were oversampled. Identity-unlinked plasma samples were screened with the Abbott Prism HTLV-1/2 assay, and repeatedly reactive samples were tested by the Inno-LIA HTLV-1/2 Score confirmatory assay. Odds ratios were calculated with multivariable logistic regression. RESULTS Of 46 752 donors tested, 133 (0·28%) were initially reactive, 111 (0·24%) repeatedly reactive and 57 (0·12%) confirmed positive for HTLV-1; none were HTLV-2 positive. Prevalence was 0·062% weighted to annual blood donations but highly concentrated in the Black population group (OR = 20·24 CI: 2·77-147·88); higher in females than males (OR = 1·81 CI: 1·06-3·08); and in donors aged >50 years compared to ages 16-19 (OR = 6·4 CI: 2·95-13·86). After controlling for age, sex and population group, there was no difference in prevalence between new and repeat blood donors or among geographic regions within South Africa. CONCLUSIONS We conclude that HTLV-1 infection is widespread among the Black population of South Africa and its epidemiology is similar to other endemic areas. Because South Africa is increasing its recruitment of Black blood donors, the implications for blood screening require further consideration.
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Affiliation(s)
| | - Wendy Sykes
- South African National Blood Service, Roodepoort, South Africa
| | - Charl Coleman
- South African National Blood Service, Roodepoort, South Africa
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | | | - Jabulisile Jaza
- South African National Blood Service, Roodepoort, South Africa
| | | | - Carol Hlela
- Red Cross Children's Hospital, Cape Town, South Africa
| | - Antoine Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, Paris, France.,CNRS, UMR3569, Paris, France
| | - Olivier Cassar
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Institut Pasteur, Paris, France.,CNRS, UMR3569, Paris, France
| | - Colwyn Poole
- South African National Blood Service, Roodepoort, South Africa
| | | | - Edward L Murphy
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | - Ravi Reddy
- South African National Blood Service, Roodepoort, South Africa
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Malaria blood safety policy in five non-endemic countries: a retrospective comparison through the lens of the ABO risk-based decision-making framework. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:94-102. [PMID: 30865584 DOI: 10.2450/2019.0222-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/16/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In non-endemic countries, malaria risk is addressed by selectively testing or deferring at-risk donors. These policy decisions were made using a variety of decision-making frameworks prior to the development of the Alliance of Blood Operators Risk Based Decision-Making Framework. It is unclear whether the range of items assessed in the decision-making process would be increased if the Framework were used. We compared assessments considered in France, England and Australia for decisions to implement selective testing, plus donor selection criteria (Canada and the USA included) with those recommended by the Framework. MATERIALS AND METHODS Elements of the Framework were identified: the intervention, safety threat, availability threat, donor impact, financial implications, risk communication, stakeholder and regulatory aspects. Decisions about selective testing and donor selection criteria were analysed separately. Assessments were compared against elements of the Framework and the level of concern for considerations rated. RESULTS Sufficiency of the blood supply (plus safety in France) were the drivers for selective testing; main trade-offs were high operational impact and cost. In three donor criteria examples, transfusion-transmitted malaria cases prompted the change. Social concerns were high in France and Australia, political/regulatory concerns influenced decisions in France, Australia and Canada, while sufficiency was a consideration in Canada and the USA. Decision trade-offs involved moderate operational impact. DISCUSSION The assessments considered in each country were generally consistent with the assessments recommended by the Framework. When data supported quantified risk assessment, safety and operational feasibility had the greatest weight. When risk was not well defined, contextual factors such as social and political concern had greater weight.
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13
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De Mendoza C, Pirón M, Gonzalez R, Jiménez A, Caballero E, Roc L, Benito R, Ramos JM, Soriano V. Clinical Presentation of Individuals With Human T-Cell Leukemia Virus Type-1 Infection in Spain. Open Forum Infect Dis 2019; 6:ofz036. [PMID: 30815504 PMCID: PMC6386801 DOI: 10.1093/ofid/ofz036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background Although only 8%–10% of persons infected with human T-cell leukemia virus type 1 (HTLV-1) may develop virus-associated diseases lifelong, misdiagnosis of asymptomatic infected carriers frequently leads to late diagnoses. Methods A nationwide HTLV-1 register was created in Spain in 1989. A total of 351 infected persons had been reported by the end of 2017. We examined all new HTLV-1 diagnoses during the last decade and compared their clinical presentation. Results A total of 247 individuals with HTLV-1 infection had been reported in Spain since year 2008. The incidence has remained stable with 20–25 new diagnoses yearly. Women represented 62%. Only 12% were native Spaniards, most of whom were foreigners from Latin America (72.5%). Up to 57 (23%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (n = 24; 42.1%), T-cell lymphoma (n = 19; 33.3%), or Strongyloides stercoralis infestation (n = 8; 14%). Human T-cell leukemia virus type 1 diagnosis had been made either at blood banks (n = 109; 44%) or at clinics (n = 138; 56%). It is interesting to note that Spaniards and especially Africans were overrepresented among patients presenting with HTLV-1-associated illnesses, suggesting that misdiagnosis and late presentation are more frequent in these populations compared to Latin Americans. Conclusions Given that 23% of new HTLV-1 diagnoses in Spain are symptomatic, underdiagnosis must be common. Although screening in blood banks mostly identifies asymptomatic Latin American carriers, a disproportionately high number of Spaniards and Africans are unveiled too late, that is, they already suffer from classic HTLV-1 illnesses.
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Affiliation(s)
- Carmen De Mendoza
- Puerta de Hierro Research Institute and University Hospital, Majadahonda, Madrid
| | | | | | - Ana Jiménez
- Centro de Hemoterapia de Castilla-León, Valladolid
| | | | | | - Rafael Benito
- Hospital Clínico Universitario Lozano Blesa, Zaragoza
| | | | - Vicente Soriano
- UNIR Health Sciences School, Madrid.,La Paz University Hospital, Madrid, Spain
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14
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O'Brien SF, Yi QL, Goldman M, Grégoire Y, Delage G. Human T-cell lymphotropic virus: A simulation model to estimate residual risk with universal leucoreduction and testing strategies in Canada. Vox Sang 2018; 113:750-759. [DOI: 10.1111/vox.12722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sheila F. O'Brien
- Canadian Blood Services; Ottawa ON Canada
- School of Epidemiology & Public Health; University of Ottawa; Ottawa ON Canada
| | - Qi-Long Yi
- Canadian Blood Services; Ottawa ON Canada
- School of Epidemiology & Public Health; University of Ottawa; Ottawa ON Canada
| | - Mindy Goldman
- Canadian Blood Services; Ottawa ON Canada
- Department of Pathology & Laboratory Medicine; University of Ottawa; Ottawa ON Canada
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15
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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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Styles CE, Hoad VC, Seed CR. Estimation of human T-lymphotropic virus incidence in blood donors from observed prevalence. Vox Sang 2018; 113:814-815. [DOI: 10.1111/vox.12721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/09/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Claire E. Styles
- Clinical Services and Research; Australian Red Cross Blood Service; Perth WA Australia
| | - Veronica C. Hoad
- Clinical Services and Research; Australian Red Cross Blood Service; Perth WA Australia
| | - Clive R. Seed
- Clinical Services and Research; Australian Red Cross Blood Service; Perth WA Australia
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17
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Leach Bennett J, Devine DV. Risk-based decision making in transfusion medicine. Vox Sang 2018; 113:737-749. [DOI: 10.1111/vox.12708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Dana V. Devine
- Canadian Blood Services; Ottawa ON Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
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