Prevention of transfusion‐transmitted Zika virus in French Polynesia, nucleic acid testing versus pathogen inactivation

Abstract

Background and ObjectivesFrench Polynesia (FP) experienced a large Zika virus (ZIKV) outbreak in 2013–2014. Flavivirus transfusion‐transmission infections (TTIs) had been previously reported. We evaluated several mitigating strategies to prevent ZIKV TTIs in FP.Material and MethodsMitigation strategies consisted of pre/postdonation symptom reporting, donor deferral, importation of plasma units from non‐endemic areas, quarantine of blood components, blood screening using a laboratory‐developed nucleic acid testing (NAT) assay and platelet pathogen inactivation (PI) using the INTERCEPT Blood Systems. The pros and cons of NAT versus PI to prevent ZIKV TTIs were determined.ResultsDonor interview, deferral and component quarantine strategies were not sensitive enough to prevent subsequent detection of ZIKV RNA NAT‐positive donations. A 12‐week delay between the onset of outbreak and NAT implementation allowed for 30 blood products collected from 30 asymptomatic blood donors who retrospectively tested positive for ZIKV RNA by NAT to be transfused while platelet PI which was in routine use since 2010 in FP potentially prevented several cases of ZIKV TTIs.ConclusionNucleic acid testing and PI were used in FP to prevent ZIKV TTIs. NAT was an effective measure once implemented but is not a proactive solution. PI is a proactive solution but with only systems approved for platelets and plasma. Based on the FP experience, there is an urgent need for approved whole blood and/or red blood cell PI systems and to develop multiplex NAT to maintain the availability of the blood supply in remote areas during arbovirus epidemics.