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Quee FA, Hogema BM, Slot E, Kruijer S, Molier M, van den Hurk K, Zaaijer HL. Booster vaccinations and Omicron: the effects on SARS-CoV-2 antibodies in Dutch blood donors. BMC Infect Dis 2023; 23:464. [PMID: 37438703 DOI: 10.1186/s12879-023-08448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) booster vaccination campaign and the emergence of SARS-CoV-2 Omicron variants impact the prevalence and levels of SARS-CoV-2 antibodies in the Netherlands. In this study we determined antibody levels across age groups, the impact of Omicron variant infections, and the effect of booster vaccinations on antibody levels. METHODS In September and December 2021 and in February 2022, over 2000 Dutch blood donors were tested for presence of SARS-CoV-2 antibodies. Donations were selected based on age, sex, and region of residence, to provide an optimal coverage and representation of the Dutch population. RESULTS Levels of vaccination-induced spike antibodies decreased over time in all age groups. Donors vaccinated with Janssen or AstraZeneca had significantly lower antibody levels than donors vaccinated with Pfizer or Moderna vaccine. Boostering with an mRNA vaccine elevated antibody levels in all age-groups irrespective of the initial vaccine. In donors aged < 56 years, the proportion of infected donors almost doubled between December 2021 and February 2022. CONCLUSION The booster vaccination campaign increased antibody levels in all age-groups. After a booster vaccination, donors initially vaccinated with AstraZeneca or Janssen vaccine showed antibody levels similar to donors initially vaccinated with an mRNA vaccine. The emergence of the SARS-CoV-2 Omicron variant in the Netherlands caused a substantial increase in donors with infection-induced antibodies, especially among younger donors.
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Affiliation(s)
- F A Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - B M Hogema
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - E Slot
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Medical Affairs, Sanquin Corporate Staff, Amsterdam, the Netherlands
| | - S Kruijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands
| | - M Molier
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - K van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - H L Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Clinical Virology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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2
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van den Hurk K, Merz EM, Prinsze FJ, Spekman ML, Quee FA, Ramondt S, Slot E, Vrielink H, Huis in ’t Veld EM, Zaaijer HL, Hogema BM. Low awareness of past SARS-CoV-2 infection in healthy plasma donors. Cell Rep Med 2021; 2:100222. [PMID: 33681828 PMCID: PMC7917439 DOI: 10.1016/j.xcrm.2021.100222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/15/2020] [Accepted: 02/19/2021] [Indexed: 01/05/2023]
Abstract
Awareness of infection with SARS-CoV-2 is crucial for the effectiveness of COVID-19 control measures. Here, we investigate awareness of infection and symptoms in relation to antibodies against SARS-CoV-2 in healthy plasma donors. We asked individuals donating plasma across the Netherlands between May 11th and 18th 2020 to report COVID-19-related symptoms, and we tested for antibodies indicative of a past infection with SARS-CoV-2. Among 3,676 with antibodies, and from questionnaire data, 239 (6.5%) are positive for SARS-CoV-2 antibodies. Of those, 48% suspect no COVID-19, despite the majority reporting symptoms; 11% of seropositive individuals report no symptoms and 27% very mild symptoms at any time during the first peak of the epidemic. Anosmia/ageusia and fever are most strongly associated with seropositivity. Almost half of seropositive individuals do not suspect SARS-CoV-2 infection. Improved recognition of COVID-19 symptoms, in particular, anosmia/ageusia and fever, is needed to reduce widespread SARS-CoV-2 transmission.
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Affiliation(s)
- Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Eva-Maria Merz
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Femmeke J. Prinsze
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Marloes L.C. Spekman
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Franke A. Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Steven Ramondt
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Communication Science, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ed Slot
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Medical Affairs, Sanquin Corporate Staff, Sanquin Research, Amsterdam, the Netherlands
| | - Hans Vrielink
- Unit of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Elisabeth M.J. Huis in ’t Veld
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
| | - Hans L. Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, the Netherlands
| | - Boris M. Hogema
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, the Netherlands
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3
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Oja AE, Saris A, Ghandour CA, Kragten NAM, Hogema BM, Nossent EJ, Heunks LMA, Cuvalay S, Slot E, Linty F, Swaneveld FH, Vrielink H, Vidarsson G, Rispens T, van der Schoot E, van Lier RAW, Ten Brinke A, Hombrink P. Divergent SARS-CoV-2-specific T- and B-cell responses in severe but not mild COVID-19 patients. Eur J Immunol 2020; 50:1998-2012. [PMID: 33073359 DOI: 10.1002/eji.202048908] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/15/2020] [Indexed: 12/24/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the current coronavirus disease 2019 (COVID-19) pandemic. Understanding the immune response that provides specific immunity but may also lead to immunopathology is crucial for the design of potential preventive and therapeutic strategies. Here, we characterized and quantified SARS-CoV-2-specific immune responses in patients with different clinical courses. Compared to individuals with a mild clinical presentation, CD4+ T-cell responses were qualitatively impaired in critically ill patients. Strikingly, however, in these patients the specific IgG antibody response was remarkably strong. Furthermore, in these critically ill patients, a massive influx of circulating T cells into the lungs was observed, overwhelming the local T-cell compartment, and indicative of vascular leakage. The observed disparate T- and B-cell responses could be indicative of a deregulated immune response in critically ill COVID-19 patients.
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Affiliation(s)
- Anna E Oja
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anno Saris
- Centre for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam UMC COVID Study Group, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cherien A Ghandour
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Natasja A M Kragten
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Boris M Hogema
- Sanquin Diagnostic Services and Sanquin Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther J Nossent
- Amsterdam UMC COVID Study Group, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leo M A Heunks
- Amsterdam UMC COVID Study Group, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Susan Cuvalay
- Unit of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Ed Slot
- Laboratory of Blood-borne Infections, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Federica Linty
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Francis H Swaneveld
- Unit of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Hans Vrielink
- Unit of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - René A W van Lier
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pleun Hombrink
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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4
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Chandrasekar A, Paulus U, Bokhorst A, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, van Kraaij M, Merz EM, van den Hurk K, Hansen MB, Slot E, Ullum H. How donor selection criteria can be evaluated with limited scientific evidence: lessons learned from the TRANSPOSE project. Vox Sang 2020; 116:342-350. [PMID: 33191514 DOI: 10.1111/vox.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Donor selection criteria (DSC) are a vital link in the chain of supply of Substances of Human Origin (SoHO) but are also subject to controversy and differences of opinion. Traditionally, DSC have been based on application of the precautionary principle. MATERIALS AND METHODS From 2017 to 2020, TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors), a European research project, aimed to identify discrepancies between current DSC by proposing a standardized risk assessment method for all SoHO (solid organs excluded) and all levels of evidence. RESULTS The current DSC were assessed using a modified risk assessment method based on the Alliance of Blood Operators' Risk-based decision-making framework for blood safety. It was found that with limited or diverging scientific evidence, it was difficult to reach consensus and an international standardized method for decision-making was lacking. Furthermore, participants found it hard to disregard their local guidelines when providing expert opinion, which resulted in substantial influence on the consensus-based decision-making process. CONCLUSIONS While the field of donation-safety research is expanding rapidly, there is an urgent need to formalize the decision-making process regarding DSC. This includes the need for standardized methods to increase transparency in the international decision-making process and to ensure that this is performed consistently. Our framework provides an easy-to-implement approach for standardizing risk assessments, especially in the context of limited scientific evidence.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Livia Cannata
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | | | | | | | - Arlinke Bokhorst
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | | | - Eva-Maria Merz
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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5
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Slot E, Hogema BM, Reusken CBEM, Reimerink JH, Molier M, Karregat JHM, IJlst J, Novotný VMJ, van Lier RAW, Zaaijer HL. Low SARS-CoV-2 seroprevalence in blood donors in the early COVID-19 epidemic in the Netherlands. Nat Commun 2020; 11:5744. [PMID: 33184284 PMCID: PMC7665189 DOI: 10.1038/s41467-020-19481-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
The world is combating an ongoing COVID-19 pandemic with health-care systems, society and economies impacted in an unprecedented way. It is unclear how many people have contracted the causative coronavirus (SARS-CoV-2) unknowingly and are asymptomatic. Therefore, reported COVID-19 cases do not reflect the true scale of outbreak. Here we present the prevalence and distribution of antibodies to SARS-CoV-2 in a healthy adult population of the Netherlands, which is a highly affected country, using a high-performance immunoassay. Our results indicate that one month into the outbreak (i) the seroprevalence in the Netherlands was 2.7% with substantial regional variation, (ii) the hardest-hit areas showed a seroprevalence of up to 9.5%, (iii) the seroprevalence was sex-independent throughout age groups (18-72 years), and (iv) antibodies were significantly more often present in younger people (18-30 years). Our study provides vital information on the extent of exposure to SARS-CoV-2 in a country where social distancing is in place.
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Affiliation(s)
- Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.
- Department of Medical Affairs, Sanquin Corporate Staff, Amsterdam, The Netherlands.
| | - Boris M Hogema
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Chantal B E M Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Johan H Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michel Molier
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - Jan H M Karregat
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Johan IJlst
- National Screening Laboratory, Sanquin Laboratory Services, Amsterdam, The Netherlands
| | - Věra M J Novotný
- Department of Medical Affairs, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - René A W van Lier
- Landsteiner Laboratory, Sanquin Research, Amsterdam, The Netherlands
- Department of Experimental Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands.
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6
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, Pozenel P, van Kraaij M, Hansen MB, Slot E, Ullum H. Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors? Vox Sang 2020; 116:313-323. [PMID: 33103801 DOI: 10.1111/vox.13014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks. MATERIALS AND METHODS National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence. RESULTS Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available. CONCLUSIONS These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, Berne and University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | - Livia Cannata
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | | | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Primoz Pozenel
- Blood transfusion Center of Slovenia, Ljubljana, Slovenia
| | | | - Morten Bagge Hansen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Henrik Ullum
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
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7
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van Bilsen WPH, Zaaijer HL, Matser A, van den Hurk K, Slot E, Schim van der Loeff MF, Prins M, van de Laar TJW. Infection Pressure in Men Who Have Sex With Men and Their Suitability to Donate Blood. Clin Infect Dis 2020; 68:1001-1008. [PMID: 30052873 DOI: 10.1093/cid/ciy596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deferral of men who have sex with men (MSM) from blood donation is highly debated. We therefore investigated their suitability to donate blood. METHODS We compared the antibody prevalence of 10 sexually and transfusion-transmissible infections (TTIs) among 583 MSM and 583 age-matched repeat male blood donors. MSM were classified as low risk (lr) or medium-to-high risk (hr) based on self-reported sexual behavior and as qualified or unqualified using Dutch donor deferral criteria. Infection pressure (IP) was defined as the number of antibody-reactive infections, with class A infections (human immunodeficiency virus-1/2, hepatitis B virus, hepatitis C virus, human T-cell lymphotropic virus-1/2, syphilis) given double weight compared to class B infections (cytomegalovirus, herpes simplex virus-1/2, human herpesvirus 8, hepatitis E virus, parvovirus B19). RESULTS Donors had a lower median IP than qualified lr-MSM and qualified hr-MSM (2 [interquartile range {IQR}, 1-2] vs 3 [IQR, 2-4]; P < .001). Low IP was found in 76% of donors, 39% of qualified lr-MSM, and 27% of qualified hr-MSM. The prevalence of class A infections did not differ between donors and qualified lr-MSM but was significantly higher in qualified hr-MSM and unqualified MSM. Recently acquired class A infections were detected in hr-MSM only. Compared to blood donors, human herpesviruses were more prevalent in all MSM groups (P < .001). CONCLUSIONS IP correlates with self-reported risk behavior among MSM. Although lr-MSM might form a low threat for blood safety with regard to class A infections, the high seroprevalence of human herpesviruses in lr-MSM warrants further investigation.
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Affiliation(s)
- Ward P H van Bilsen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Academic Medical Center, Amsterdam, The Netherlands
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8
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Zaaijer HL, Slot E, Molier M, Reusken CBEM, Koppelman MHGM. Usutu virus infection in Dutch blood donors. Transfusion 2019; 59:2931-2937. [PMID: 31270821 DOI: 10.1111/trf.15444] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The screening of Dutch blood donations for West Nile virus (WNV) may be imminent, as WNV emerges in nearby countries and more donors travel to WNV-affected regions. Since 2016 the related, mosquito-borne Usutu virus (USUV) causes seasonal mortality in Dutch birds. To what extent will human USUV infections affect Dutch WNV donor screening? STUDY DESIGN AND METHODS From April through September 2018, plasma samples from blood donations in blackbird-rich regions were stored. When increased bird mortality was reported in August, samples from July, August, and September were tested for USUV-RNA in pools of eight, using a home-brew combined WNV/USUV-PCR assay. Reactive pools were deconstructed. Original plasma units and samples of previous and follow-up donations of reactive donors were tested for USUV- and WNV-RNA, and for antibody responses. RESULTS The number of USUV RNA-positive, WNV RNA-negative donations was 0 of 2688 donations in July, 6 of 4416 in August (1:736), and 1 of 4936 in September. The seven infected donors tested negative for USUV-RNA in preceding and follow-up donations. For 6 donors, seroconversion for USUV-antibodies was demonstrated. All index donations tested positive in a commonly used PCR-assay for WNV donor screening. Three exposed recipients did not show signs of infection. Screening a random subset of 1092 donations from September for USUV-IgG antibodies showed that 22 donors tested reactive; for three donors retrospective testing identified an USUV PCR-positive pre-seroconversion donation. CONCLUSION Seasonal USUV infection in Dutch blood donors is common. Cross-reactivity in molecular assays for WNV-screening occurs, but can be resolved using USUV- and WNV-specific PCR-primers and sequencing of viral RNA.
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Affiliation(s)
- Hans L Zaaijer
- Laboratory of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Ed Slot
- Laboratory of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Michel Molier
- Laboratory of Blood-Borne Infections, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Chantal B E M Reusken
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands
| | - Marco H G M Koppelman
- National Screening Laboratory, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
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9
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Prinsze FJ, van de Laar T, Slot E, de Jong M, Bokhorst A, de Kort W, Zaaijer H, van den Hurk K. No increased risk of transfusion-transmissible infections after tattooing, body piercing, or acupuncture among blood donors in the Netherlands. Transfusion 2019; 59:2575-2583. [PMID: 31228271 DOI: 10.1111/trf.15421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the Netherlands, needle-related events (NREs) including tattoos, piercings, and acupuncture are a reason for temporary blood donor deferral. This study aims to evaluate whether donors with recent NREs had a higher risk of transfusion-transmissible infections (TTIs) compared to donors without recent NREs. STUDY DESIGN AND METHODS Data from 2006 through 2015 on all blood donation attempts in the Netherlands were collected. Multivariate regression models (for repeated measurements) were used to assess the associations between recent NREs and the acquisition of TTIs. Posttest counseling data were used to determine the most likely risk factor in TTI-positive new and repeat donors. RESULTS Recent NREs were documented in 97,518 out of 9,266,036 (1.1%) donation attempts; 14,097 (14.5%) NREs resulted in NRE-based donor deferral. Recent NREs reported pre-donation were not associated with an increased risk for TTIs. A total of 29 out of 287 TTI-positive donors (11 repeat donors, 18 new donors) reported a recent NRE pre- and/or post-donation. Recent NREs, all needle-stick injuries, were the likely route of transmission in 12 out of 287 (4.2%) of TTI-positive donors. The donor health questionnaire (DHQ) identified only 1 out of 12 TTI-linked NREs. Non-return after NRE deferral, any deferral, or no deferral was 24, 15, and 5%, respectively. DISCUSSION Recent tattoos, body piercings, or acupuncture were not associated with an increased risk for TTIs in Dutch donors. Given the lower return rates of donors following a temporary NRE-based deferral, we advocate ending blood donor deferral policies for acupuncture, tattooing, and body piercings, but not needle-stick injuries, in countries where these practices can be considered safe.
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Affiliation(s)
- Femmeke J Prinsze
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Laboratory of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Maarten de Jong
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Arlinke Bokhorst
- Department of Medical Donor Affairs, Sanquin Blood Bank, Amsterdam, The Netherlands.,TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - Wim de Kort
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Public Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Hans Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Department of Clinical Virology (CINIMA), Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
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10
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Slot E, Zaaijer HL, Molier M, Van den Hurk K, Prinsze F, Hogema BM. Meat consumption is a major risk factor for hepatitis E virus infection. PLoS One 2017; 12:e0176414. [PMID: 28448527 PMCID: PMC5407615 DOI: 10.1371/journal.pone.0176414] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/09/2017] [Indexed: 12/31/2022] Open
Abstract
Background The incidence of autochthonous hepatitis E virus genotype 3 (HEV gt3) infections in Western Europe is high. Although pigs are a major reservoir of the virus, the exact sources and transmission route(s) of HEV gt3 to humans remain unclear. Methods To determine the role of meat consumption at a population level, the seroprevalence of anti-HEV IgG antibodies was compared between Dutch blood donors with a vegetarian lifestyle and donors who consume meat on a daily basis. Results The age-weighted anti-HEV IgG seroprevalence among donors not eating meat was significantly lower than among meat-eating donors (12.4% vs 20.5%, p = 0.002). For both groups the prevalence strongly increased with age and the difference in prevalence was apparent for all age groups. Conclusions Compared with meat-eating donors, the incidence of HEV infection is significantly lower among donors not eating meat, indicating that meat consumption is a major risk factor for HEV infection.
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Affiliation(s)
- Ed Slot
- Sanquin Research, Department of Blood-borne infections, Amsterdam, the Netherlands
| | - Hans L. Zaaijer
- Sanquin Research, Department of Blood-borne infections, Amsterdam, the Netherlands
- Academic Medical Center, Department of Clinical Virology (CINIMA), Amsterdam, the Netherlands
| | - Michel Molier
- Sanquin Research, Department of Blood-borne infections, Amsterdam, the Netherlands
| | - Katja Van den Hurk
- Sanquin Research, Department of Donor Studies, Amsterdam, the Netherlands
| | - Femmeke Prinsze
- Sanquin Research, Department of Donor Studies, Amsterdam, the Netherlands
| | - Boris M. Hogema
- Sanquin Research, Department of Blood-borne infections, Amsterdam, the Netherlands
- * E-mail:
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11
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Hartholt RB, Wroblewska A, Herczenik E, Peyron I, Ten Brinke A, Rispens T, Nolte MA, Slot E, Claassens JW, Nimmerjahn F, Verbeek JS, Voorberg J. Enhanced uptake of blood coagulation factor VIII containing immune complexes by antigen presenting cells. J Thromb Haemost 2017; 15:329-340. [PMID: 27868337 DOI: 10.1111/jth.13570] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Indexed: 02/01/2023]
Abstract
Essentials Anti-factor (F) VIII antibody formation is a major complication in the treatment of hemophilia A. We investigated uptake of FVIII and FVIII immune complex by bone marrow derived dendritic cells. Immune complex formation increased uptake of FVIII 3-4 fold in a Fcγ receptor dependent manner. FVIII immune complex binding to Fcγ receptors may modulate immune tolerance induction. SUMMARY Background A major complication in the treatment of hemophilia A is the development of inhibitory antibodies targeting coagulation factor VIII (FVIII). Eradication of these inhibitors can be established by immune tolerance induction (ITI), which consists of daily administration of high dosages of FVIII. FVIII immune complexes (FVIII-IC) could be formed following FVIII infusion in patients with pre-existing anti-FVIII antibodies. Objectives Here we studied endocytosis of FVIII-IC by bone marrow-derived dendritic cells (BMDCs). Methods BMDCs were pulsed with FVIII/FVIII-IC and uptake was assessed by flow cytometry and confocal imaging. Results BMDCs were able to efficiently internalize FVIII-IC in a dose-dependent manner, 3-4-fold more efficiently when compared with equimolar concentrations of non-complexed FVIII. Uptake of FVIII-IC, but not FVIII alone, could be inhibited with anti-Fcγ receptor (FcγR) antibody 2.4G2, indicating functional involvement of FcγR. No internalization of FVIII-IC was observed in BMDCs lacking FcγRI, FcγRIIb, FcγRIII and FcγRIV. Genetic ablation of FcγRIIb, FcγRIII or FcγRIV individually did not affect the ability of anti-FVIII IgG to promote the uptake of FVIII. BMDCs lacking FcγRI showed lower FVIII-IC uptake levels when compared with other single FcγR null BMDCs. Expression of the inhibitory FcγRIIb alone was sufficient to internalize FVIII-IC more efficiently than FVIII. Conclusions FcγR are critical in the internalization of FVIII-IC by BMDCs and multiple FcγR can contribute independently to this process. Our findings provide a basis for future studies to address whether the outcome of ITI is dependent on the interplay between FVIII-IC and inhibitory and activating FcγR.
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Affiliation(s)
- R B Hartholt
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - A Wroblewska
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - E Herczenik
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - I Peyron
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - A Ten Brinke
- Department of Immunopathology, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - T Rispens
- Department of Immunopathology, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - M A Nolte
- Department of Hematopoiesis, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - E Slot
- Department of Hematopoiesis, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
| | - J W Claassens
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - F Nimmerjahn
- Chair of Genetics, Department of Biology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - J S Verbeek
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - J Voorberg
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Amsterdam, the Netherlands
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12
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de Vos AS, Lieshout-Krikke RW, Slot E, Cator EA, Janssen MP. A novel approach to detect test-seeking behaviour in the blood donor population: making the invisible visible. Vox Sang 2016; 111:274-280. [PMID: 27281653 DOI: 10.1111/vox.12422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals may donate blood in order to determine their infection status after exposure to an increased infection risk. Such test-seeking behaviour decreases transfusion safety. Instances of test seeking are difficult to substantiate as donors are unlikely to admit to such behaviour. However, manifestation in a population of repeat donors may be determined using statistical inference. MATERIALS AND METHODS Test-seeking donors would be highly motivated to donate following infection risk, influencing the timing of their donation. Donation intervals within 2005-2014 of all Dutch blood donors who acquired syphilis (N = 50), HIV (N = 13), HTLV (N = 4) or HCV (N = 2) were compared to donation intervals of uninfected blood donors (N = 7 327 836) using the Anderson-Darling test. We adjusted for length bias as well as for age, gender and donation type of the infected. Additionally, the power of the proposed method was investigated by simulation. RESULTS Among the Dutch donors who acquired infection, we found only a non-significant overrepresentation of short donation intervals (P = 0·54). However, we show by simulation that both relatively short and long donation intervals among infected donors can reveal test seeking. The power of the method is >90% if among 69 infected donors >35 (51%) are test seeking, or if among 320 infected donors >90 (30%) are test seeking. CONCLUSION We show how statistical analysis may be used to reveal the extent of test seeking in repeat blood donor populations. In the Dutch setting, indications for test-seeking behaviour were not statistically significant. This may, however, be due to the low number of infected individuals.
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Affiliation(s)
- A S de Vos
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands.
| | - R W Lieshout-Krikke
- Department of Blood-Borne Infections, Sanquin Research, Amsterdam, the Netherlands
| | - E Slot
- Department of Blood-Borne Infections, Sanquin Research, Amsterdam, the Netherlands
| | - E A Cator
- Institute of Mathematics, Astrophysics and Particle Physics, Radboud University, Nijmegen, the Netherlands
| | - M P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, the Netherlands. .,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
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13
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Slot E, Hogema BM, Molier M, Bart A, Zaaijer HL. Risk Factors and Screening for Trypanosoma cruzi Infection of Dutch Blood Donors. PLoS One 2016; 11:e0151038. [PMID: 26950434 PMCID: PMC4780700 DOI: 10.1371/journal.pone.0151038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Blood donors unaware of Trypanosoma cruzi infection may donate infectious blood. Risk factors and the presence of T. cruzi antibodies in at-risk Dutch blood donors were studied to assess whether specific blood safety measures are warranted in the Netherlands. METHODOLOGY Birth in a country endemic for Chagas disease (CEC), having a mother born in a CEC, or having resided for at least six continuous months in a CEC were considered risk factors for T. cruzi infection. From March through September 2013, risk factor questions were asked to all donors who volunteered to donate blood or blood components. Serum samples were collected from donors reporting one or more risk factors, and screened for IgG antibodies to T. cruzi by EIA. RESULTS Risk factors for T. cruzi infection were reported by 1,426 of 227,278 donors (0.6%). Testing 1,333 at-risk donors, none (0.0%; 95%, CI 0.0-0.4%) was seroreactive for IgG antibodies to T. cruzi. A total of 472 donors were born in a CEC; 553 donors reported their mother being born in a CEC; and 1,121 donors reported a long-term stay in a CEC. The vast majority of reported risk factors were related to Suriname and Brazil. Overall, the participants resided for 7,694 years in CECs, which equals 2.8 million overnight stays. Of those, 1.9 million nights were spent in Suriname. CONCLUSIONS/SIGNIFICANCE Asymptomatic T. cruzi infection appears to be extremely rare among Dutch blood donors. Blood safety interventions to mitigate the risk of T. cruzi transmission by transfusion would be highly cost-ineffective in the Netherlands, and are thus not required.
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Affiliation(s)
- Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- * E-mail:
| | - Boris M. Hogema
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Virology, Sanquin Diagnostic Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Michel Molier
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Aldert Bart
- Department of Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
| | - Hans L. Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Virology, Sanquin Diagnostic Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
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14
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Slot E, Janssen MP, Marijt-van der Kreek T, Zaaijer HL, van de Laar TJ. Two decades of risk factors and transfusion-transmissible infections in Dutch blood donors. Transfusion 2015; 56:203-14. [PMID: 26355711 DOI: 10.1111/trf.13298] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Risk behavior-based donor selection procedures are widely used to mitigate the risk of transfusion-transmissible infections (TTIs), but their effectiveness is disputed in countries with low residual risks of TTIs. STUDY DESIGN AND METHODS In 1995 to 2014, Dutch blood donors infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), or syphilis were interviewed by trained medical counselors to identify risk factors associated with TTIs. Trends in the prevalence and incidence of TTIs were analyzed using binomial regression models. RESULTS A total of 972 new donors and 381 repeat donors had TTIs. New donors had higher rates of TTIs compared to repeat donors. Although the HBV and HCV prevalence gradually decreased over time, the incidence of all five TTIs remained stable during the past two decades. In new donors the TTIs had the following risk profiles: "blood-blood contact" for HCV, "unprotected sex" for HIV and syphilis, and "country of birth" for HBV and HTLV. In infected repeat donors, sexual risk factors predominated for all TTIs. At posttest counseling, 28% of infected repeat donors admitted to risk factors leading to permanent donor exclusion if revealed during the donor selection procedure (predominantly male-to-male sex and recent diagnosis of syphilis). CONCLUSION The prevalence and incidence of TTIs among Dutch blood donors are six- to 60-fold lower than in the general Dutch population, illustrating the effectiveness of donor selection procedures. However, at least a quarter of infected donors appeared noncompliant to the donor health questionnaire (DHQ), suggesting that DHQs, or the way donor questioning is implemented, can be improved.
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Affiliation(s)
- Ed Slot
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam
| | - Mart P Janssen
- Department of Transfusion Technology Assessment, Division Research, Blood Supply Foundation, Amsterdam, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | | | - Hans L Zaaijer
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Clinical Virology (CINIMA), Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs J van de Laar
- Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.,Department of Virology, Division Diagnostics, Sanquin Blood Supply Foundation, Amsterdam
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15
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Slot E, Hogema BM, Molier M, Zaaijer HL. Screening of blood donors for chronicCoxiella burnetiiinfection after large Q fever outbreaks. Transfusion 2014; 54:2867-70. [DOI: 10.1111/trf.12749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/20/2014] [Accepted: 03/30/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Ed Slot
- Departments of Blood-borne Infections and Virology; Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | - Boris M. Hogema
- Departments of Blood-borne Infections and Virology; Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | - Michel Molier
- Departments of Blood-borne Infections and Virology; Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | - Hans L. Zaaijer
- Departments of Blood-borne Infections and Virology; Sanquin Blood Supply Foundation; Amsterdam the Netherlands
- Medical Microbiology (CINIMA); Academic Medical Center; Amsterdam the Netherlands
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16
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Hogema BM, Molier M, Slot E, Zaaijer HL. Past and present of hepatitis E in the Netherlands. Transfusion 2014; 54:3092-6. [PMID: 24889277 PMCID: PMC4280434 DOI: 10.1111/trf.12733] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/26/2014] [Accepted: 04/15/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Recent studies show that endemic hepatitis E virus (HEV) infection occurs frequently in some developed countries. In the Netherlands in 2013, the routine screening of 35,220 plasma donations for HEV RNA showed 20 donors to be viremic (1:1761), which seems to contradict reports of declining HEV seroprevalence in the recent past. STUDY DESIGN AND METHODS To asses HEV infection pressure changes over time, archived samples from Dutch blood donations collected in 1988 and 2000 were tested for anti-HEV immunoglobulin (Ig)G. The findings were compared to the HEV seroprevalence among donors in 2011. RESULTS The age-adjusted prevalence of anti-HEV IgG for Dutch donors aged 18 to 64 declined from 46.6% in 1988 to 27.3% in 2000 and to 20.9% in 2011. The reduction of seroprevalence was apparent for all age groups between 1988 and 2000, and for donors older than 40 between 2000 and 2011, but the seroprevalence among donors aged 18 to 29 increased between 2000 and 2011. Recent changes in HEV infection pressure are more apparent in the youngest donors, who to a lesser extent reflect cumulative exposure to HEV in the past. Donors aged 18 to 21 showed decreasing HEV seroprevalence from 19.8% in 1988 to 7.0% in 1995 and to 4.3% in 2000, followed by an increase to 12.7% in 2011. CONCLUSION HEV antibody patterns in young and old Dutch donors, in 1988 to 2011, suggest that decades ago, HEV was ubiquitous and most persons acquired infection. Subsequently HEV incidence was low during a prolonged period, to increase again in recent years.
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Affiliation(s)
- Boris M Hogema
- Department of Blood-borne Infections, Sanquin Blood Supply Foundation; Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
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17
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Brouwer EE, van Hellemond JJ, van Genderen PJ, Slot E, van Lieshout L, Visser LG, Wismans PJ. A case report of transfusion-transmitted Plasmodium malariae from an asymptomatic non-immune traveller. Malar J 2013; 12:439. [PMID: 24304475 PMCID: PMC3866504 DOI: 10.1186/1475-2875-12-439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of transfusion-transmitted malaria is very low in non-endemic countries due to strict donor selection. The optimal strategy to mitigate the risk of transfusion-transmitted malaria in non-endemic countries without unnecessary exclusion of blood donations is, however, still debated and asymptomatic carriers of Plasmodium species may still be qualified to donate blood for transfusion purposes. Case description In April 2011, a 59-year-old Dutch woman with spiking fevers for four days was diagnosed with a Plasmodium malariae infection. The patient had never been abroad, but nine weeks before, she had received red blood cell transfusion for anaemia. The presumptive diagnosis of transfusion-transmitted quartan malaria was made and subsequently confirmed by retrospective PCR analysis of donor blood samples. The donor was a 36-year-old Dutch male who started donating blood in May 2006. His travel history outside Europe included a trip to Kenya, Tanzania and Zanzibar in 2005, to Thailand in 2006 and to Costa Rica in 2007. He only used malaria prophylaxis during his travel to Africa. The donor did not show any abnormalities upon physical examination in 2011, while laboratory examination demonstrated a thrombocytopenia of 126 × 109/L as the sole abnormal finding since 2007. Thick blood smear analysis and the Plasmodium PCR confirmed an ongoing subclinical P. malariae infection. Chloroquine therapy was started, after which the infection cleared and thrombocyte count normalized. Fourteen other recipients who received red blood cells from the involved donor were traced. None of them developed malaria symptoms. Discussion This case demonstrates that P. malariae infections in non-immune travellers may occur without symptoms and persist subclinically for years. In addition, this case shows that these infections pose a threat to transfusion safety when subclinically infected persons donate blood after their return in a non-endemic malaria region. Since thrombocytopenia was the only abnormality associated with the subclinical malaria infection in the donor, this case illustrates that an unexplained low platelet count after a visit to malaria-endemic countries may be an indicator for asymptomatic malaria even when caused by non-falciparum Plasmodium species.
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Affiliation(s)
| | | | | | | | | | | | - Pieter J Wismans
- Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2 3011 TD, Rotterdam, The Netherlands.
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Abstract
In Europe, the dynamics of endemic hepatitis E virus (HEV) infection remain enigmatic. We studied the presence of silent HEV infection among Dutch blood donors. Using donations collected throughout the Netherlands in 2011 and 2012, 40,176 donations were tested for HEV RNA in 459 pools of 48 or 480 donations. Deconstruction of the reactive pools identified 13 viraemic donors. In addition, 5,239 donors were tested for presence of anti-HEV IgG and IgM and for HEV RNA when IgM-positive. Of the 5,239 donations, 1,401 (27%) tested repeat-positive for HEV IgG, of which 49 (3.5%) also tested positive for anti-HEV IgM. Four of the HEV IgM-positive donors tested positive for HEV RNA. HEV IgG seroprevalence ranged from 13% among donors younger than 30 years to 43% in donors older than 60 years. The finding of 17 HEV RNA-positive donations among 45,415 donations corresponds to one HEV-positive blood donation per day in the Netherlands. For 16 of the 17 HEV RNA-positive donors, genotyping succeeded, revealing HEV genotype 3, which is circulating among Dutch pigs. Apparently, silent HEV infection is common in the Netherlands, which possibly applies to larger parts of Europe.
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Affiliation(s)
- E Slot
- Department of Blood-borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
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Monge M, Van Pel M, Aleksinskaya M, Siebelt M, Koekkoek K, Slot E, Massy Z, Rabelink T, Van Zonneveld A. L’insuffisance rénale chronique est associée à des anomalies de la niche hématopoïétique chez la souris. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Since 2007, large outbreaks of Q fever occurred in the Netherlands. The unprecedented number of Q fever infections resulted in the need for the Dutch blood transfusion service to evaluate the risk of transmission of Coxiella burnetii via blood. STUDY DESIGN AND METHODS A lookback procedure (recipient tracing) was performed for transfused blood products of whole blood donors with confirmed C. burnetii infection within 3 weeks before to 3 weeks after blood donation. Repository samples of index donations were tested with real-time polymerase chain reaction (PCR) for C. burnetii DNA. Hospitals were asked to review the medical records of recipients and-if considered necessary-to test the recipients for infection with C. burnetii. RESULTS From 2007 through 2011, a total of 33 blood donors notified the blood bank of infection with C. burnetii. Thirteen donations fulfilled the criteria for a lookback procedure (18 blood products). C. burnetii PCR was positive in 1 of 13 repository samples of index donations. Blood products were transfused to 18 recipients. Information was retrieved from 12 of them; seven were tested for C. burnetii. Two recipients showed positive serology. However, transmission of C. burnetii via transfusion was unlikely, especially since most recipients lived in the same Q fever-affected area as the donors. CONCLUSION Blood donors who have clinical Q fever around the time of blood donation are unlikely to test positive for C. burnetii by PCR in repository samples. Transmission of C. burnetii via transfusion of blood products could not be demonstrated in a lookback exercise.
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Lieshout-Krikke RW, van ‘t Ende EA, Slot E, Karomi S, Kivit RMH, Zaaijer HL. Infectivity of pre-seroconversion donations: an analysis of lookback exercises in the Netherlands, 2000-2006. Vox Sang 2011; 102:193-7. [DOI: 10.1111/j.1423-0410.2011.01537.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hogema BM, Slot E, Molier M, Schneeberger PM, Hermans MH, van Hannen EJ, van der Hoek W, Cuijpers HT, Zaaijer HL. Coxiella burnetii infection among blood donors during the 2009 Q-fever outbreak in The Netherlands. Transfusion 2011; 52:144-50. [PMID: 21756265 DOI: 10.1111/j.1537-2995.2011.03250.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2007, 2008, and 2009 outbreaks of Q-fever occurred in The Netherlands with increasing magnitude. The 2009 outbreak with 2354 reported cases is the largest human Q-fever outbreak ever recorded. To assess the extent of infection and the safety of donated blood, we tested local blood donations for presence of Coxiella burnetii antibodies and DNA. STUDY DESIGN AND METHODS Starting May 2009, more than 40,000 serum samples were collected from all consenting blood donors in the areas with high Q-fever incidence. The 1004 samples from the areas with the highest number of reported cases were tested for C. burnetii DNA by polymerase chain reaction; seroprevalence and incidence were determined using enzyme-linked immunosorbent assay and immunofluorescence assays (IFAs) in the subset of 543 donors of whom a follow-up sample was available. RESULTS A total of 6 of 1004 donor samples tested reactive for C. burnetii DNA. Confirmatory testing (IFA) on the index and follow-up samples demonstrated seroconversion in two donors, high-level preexisting antibodies in one donor, and no seroconversion in three donors. Immunoglobulin (Ig)G testing of the 543 serum pairs showed that 66 were reactive in the latest sample, of which 10 represented seroconversions. CONCLUSION In the area with highest incidence during a large Q-fever outbreak, 3 of 1004 blood donations contained C. burnetii DNA (0.3%; 95% confidence interval, 0.1%-1.0%). A total of 66 of 543 (12.2%) donors tested positive for anti-Coxiella IgG. Ten seroconversions were detected, resulting in an incidence of 5.7% per year, which is more than 10-fold higher than the local number of reported clinical cases (0.47% per year).
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Affiliation(s)
- Boris M Hogema
- Department of Blood-borne Infections, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
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Abstract
BACKGROUND Blood donations resulting in "nontransparent turbid milky" plasma must be discarded. The aim of this study was to objectively determine opacity and to identify risk factors for turbid plasma donations. STUDY DESIGN AND METHODS This case-control study included 238 whole blood donors who provided turbid plasma (cases) and 309 random control subjects with normal plasma. Participants filled in a questionnaire regarding cardiovascular risk factors. Fat intake was assessed using a validated questionnaire. Opacity and lipids were measured. Additional data were retrieved from the blood bank information system. Mean differences and odds ratios were calculated with 95% confidence intervals. RESULTS Cases had a less favorable cardiovascular profile compared to control subjects. The usual intake of fat was not associated with turbid plasma donation. In a multivariate model, having dinner before donation (OR, 4.9; 95% CI, 2.2-11.1), triglyceride levels (OR, 7.1; 95% CI, 4.6-10.8), and smoking (OR(yes vs. no) , 2.5; 95% CI, 0.9-6.7; and OR(ever vs. no) , 5.7; 95% CI, 1.8-18.4) were associated with an increased risk. Opacity was clearly increased in turbid plasma. Total cholesterol levels were 0.51 (95% CI, 0.35-0.66) mmol/L and triglyceride levels 4.28 (95% CI, 3.92-4.68) mmol/L higher in cases. High-density lipoprotein cholesterol levels were 0.34 (95% CI, -0.39 to -0.30) mmol/L lower. Forty-two percent of all cases had very high triglyceride levels (≥ 5.65 mmol/L) compared to less than 1% of control subjects. CONCLUSION Donors who provided a turbid donation have a less favorable cardiovascular profile compared to other donors. Having dinner, high triglyceride levels, and smoking are independent risk factors for turbid plasma donations.
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Affiliation(s)
- Karlijn Peffer
- Sanquin Blood Bank Southeast Region, Nijmegen, The Netherlands
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O'Neill K, Slot E, Thorne RE, van der Zant HSJ. In-chain tunneling through charge-density-wave nanoconstrictions and break junctions. Phys Rev Lett 2006; 96:096402. [PMID: 16606288 DOI: 10.1103/physrevlett.96.096402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Indexed: 05/08/2023]
Abstract
We have fabricated longitudinal nanoconstrictions in the charge-density wave conductor (CDW) NbSe3 using a focused ion beam and using a mechanically controlled break-junction technique. Conductance peaks are observed below the TP1=145 K and TP2=59 K CDW transitions, which correspond closely with previous values of the full CDW gaps 2Delta1 and 2Delta2 obtained from photoemission. These results can be explained by assuming CDW-CDW tunneling in the presence of an energy gap corrugation epsilon2 comparable to Delta2, which eliminates expected peaks at +/-|Delta1+Delta2|. The nanometer length scales our experiments imply indicate that an alternative explanation based on tunneling through back-to-back CDW-normal-conductor junctions is unlikely.
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Affiliation(s)
- K O'Neill
- Kavli Institute of Nanoscience Delft, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
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Slot E, Holst MA, van der Zant HSJ, Zaitsev-Zotov SV. One-dimensional conduction in charge-density-wave nanowires. Phys Rev Lett 2004; 93:176602. [PMID: 15525099 DOI: 10.1103/physrevlett.93.176602] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Indexed: 05/12/2023]
Abstract
We report a systematic study of the transport properties of coupled one-dimensional metallic chains as a function of the number of parallel chains. When the number of parallel chains is less than 2000, the transport properties show power-law behavior on temperature and voltage, characteristic for one-dimensional systems.
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Affiliation(s)
- E Slot
- Kavli Institute of NanoScience Delft, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
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27
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van der Zant HS, Slot E, Zaitsev-Zotov SV, Artemenko SN. Negative resistance and local charge-density-wave dynamics. Phys Rev Lett 2001; 87:126401. [PMID: 11580531 DOI: 10.1103/physrevlett.87.126401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2001] [Indexed: 05/23/2023]
Abstract
Charge-density-wave (CDW) dynamics is studied on a submicron length scale in NbSe(3) and o-TaS(3). Regions of negative absolute resistance are observed in the CDW sliding regime at sufficiently low temperatures. The origin of the negative resistance is attributed to the different forces that the deformed CDW and quasiparticles feel: the force on the CDW is merely caused by a difference of the electric potentials, while the quasiparticle current is governed by a difference of the electrochemical potentials.
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Affiliation(s)
- H S van der Zant
- Department of Applied Sciences and DIMES, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
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Vrba M, Blasko M, Goetz P, Chrz R, Izakovic V, Kovarík J, Kuliffay P, Losan F, Michalová K, Macek M, Musilová J, Petráková A, Popovic M, Slot E, Svec J, Svejda J, Thurzo V, Zajac V, Zizka J. [Cytogenetics of human neoplasms in Czechoslovakia up to 1977 (author's transl)]. Cas Lek Cesk 1979; 118:937-42. [PMID: 509445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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29
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Slot E, Wallik V. [Inflammatory complications following therapy for gynecologic cancer using ionizing radiation (proceedings)]. Cesk Gynekol 1978; 43:528. [PMID: 687382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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Belkov AI, Slot E. [Progesterone in the treatment of endometrial cancer (author's transl)]. Cesk Gynekol 1976; 41:728-9. [PMID: 1009606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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31
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Slot E. [Significance of mitotic activity of bone marrow and peripheral cultures for the evauluation of the toxicity of chemotherapy (author's transl)]. Cesk Gynekol 1976; 41:756-8. [PMID: 1009612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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32
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Slot E. [Irradiation injury of the urinary bladder (author's transl)]. Cesk Gynekol 1976; 41:494-5. [PMID: 975308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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33
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Slot E. [Legal responsibility during chemotherapy (author's transl)]. Cesk Gynekol 1975; 40:718. [PMID: 1204028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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34
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Slot E. [Actinotherapy of climacteric bleeding (author's transl)]. Cesk Gynekol 1974; 39:616-7. [PMID: 4434529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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35
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Matýsek P, Slot E, Smid J. [Contribution of lymphography to the clinical aspects of dysgerminoma]. Cesk Gynekol 1974; 39:95-6. [PMID: 4452024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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36
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Slot E. [On work incapacity of patients with chorionepitheloma and destructive mole (author's transl)]. Cesk Gynekol 1973; 38:497-8. [PMID: 4749333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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37
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Slot E, Kepák J, Páleníková K. [Premature separation of the placenta and its effects on the perinatal mortality and morbidity]. Cesk Gynekol 1972; 37:251-2. [PMID: 5027216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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38
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Slot E, Matýsek P. [Importance of vital staining of the lymphatic system in operations on gynecologic carcinomas]. Cesk Gynekol 1971; 36:528. [PMID: 5135582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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39
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Matýsek P, Slot E, Uher M. [Treatment results of ovarian neoplasms during the years 1960-5]. Cesk Gynekol 1971; 36:459-61. [PMID: 5119855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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Slot E. [Cytogenetic profiles of ovarian neoplasms and their relation to treatment outcome]. Cesk Gynekol 1971; 36:467-8. [PMID: 5119860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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41
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Uher M, Slot E. [Clinical evaluation of the effect of chemotherapy in ovarian neoplasms]. Cesk Gynekol 1971; 36:433-4. [PMID: 5110666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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42
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Slot E, Krenar J. [Inguinal part of radical vulvectomy]. Cesk Gynekol 1971; 36:232-3. [PMID: 5087915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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43
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Matýsek P, Slot E. [Color lymphography in detection of lymphatic metastases of vulvar cancer]. Cesk Gynekol 1971; 36:227-8. [PMID: 5087914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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44
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Mendl V, Slot E. [Improved surgical technic in cervix conization]. Cesk Gynekol 1970; 35:451-2. [PMID: 5484337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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45
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Slot E. [Malignant ovarian neoplasms in young women]. Zentralbl Gynakol 1970; 92:805-11. [PMID: 5483988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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46
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Slot E. [Chemotherapy of gynecologic malignancies]. Cesk Gynekol 1969; 34:606-8. [PMID: 5360770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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47
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Uher M, Slot E. [Uterine carcinoma and its early detection]. Zentralbl Gynakol 1969; 91:589-92. [PMID: 5373289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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48
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Slot E. [Combined treatment of advanced ovarian cancers with radiation and cytostatics]. BRATISL MED J 1968; 50:229-36. [PMID: 4971851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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49
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Slot E. [Urinary incontinence after extended hysterectomies]. Cesk Gynekol 1968; 33:436-8. [PMID: 5678354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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50
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Slot E. [The number of chromosomes in the formative cell of ovarian carcinoma and its relation to the therapeutic result achieved by chemotherapy]. Zentralbl Gynakol 1968; 90:210-213. [PMID: 5662445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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