Blood Safety Measures Research Articles

Characterization of transfusion-relevant bacteria reference strains in a lyophilized format.

Blood safety measures used by blood establishments to increase blood component safety can be validated using Transfusion-Relevant Bacterial Reference Strains (TRBRS). Ultra-cold storage conditions and manual preparation of the current TRBRS may restrict their practical use. To address this issue, the ISBT Transfusion-Transmitted Infectious Diseases Working Party's Bacterial Subgroup organized an international study to validate TRBRS in a user-friendly, lyophilised format. Two bacterial strains Klebsiella pneumoniae PEI-B-P-08 and Staphylococcus aureus PEI-B-P-63 were manufactured as lyophilised material. The lyophilised bacteria were distributed to 11 different labs worldwide to assess the robustness for enumeration, identification and determination of growth kinetics in platelet concentrates (PCs). Production of lyophilised TRBRS had no impact on the growth properties compared with the traditional format. The new format allows a direct low-quantity spiking of approximately 30 bacteria in PCs for transfusion-relevant experiments. In addition, the lyophilised bacteria exhibit long-term stability across a broad temperature range and can even be directly rehydrated in PCs without losing viability. Interlaboratory comparative study demonstrated the robustness of the new format as 100% of spiked PC exhibited growth. Lyophilised TRBRS provide a user-friendly material for transfusion-related studies. TRBRS in the new format have improved features that may lead to a more frequent use in the quality control of transfusion-related safety measures in the future.

Transfusion Therapy in HIV: Risk Mitigation and Benefits for Improved Patient Outcomes

Transfusion therapy is a pivotal aspect of healthcare, especially for individuals living with Human Immunodeficiency Virus (HIV). This comprehensive review aims to dissect the intricate landscape of transfusion therapy in HIV patients, emphasizing the delicate balance between risks and benefits to achieve enhanced patient outcomes. With advancements in blood safety measures and antiretroviral therapy (ART), navigating the complexities of transfusion therapy in HIV management becomes paramount for healthcare professionals. The review consolidates current knowledge and emerging trends, encompassing challenges, benefits, risks, and strategies to optimize transfusion therapy for improved patient care. The paper delineates key areas, including blood safety measures such as nucleic acid testing (NAT) and pathogen reduction technologies, emphasizing their role in ensuring safer blood products for transfusion in HIV patients. Furthermore, it explores the impact of HIV on hematological disorders, delving into transfusion-transmitted infections and strategies to mitigate these risks. Additionally, it scrutinizes the therapeutic benefits of transfusion therapy in managing hematologic complications in HIV, while addressing potential risks, including immune reactions and adverse effects. Optimizing transfusion therapy in HIV necessitates personalized approaches, considering the individual patient's HIV status, comorbidities, and specific transfusion needs. The role of ART in reducing transfusion requirements and associated risks is highlighted, alongside emerging trends like novel therapies and alternative transfusion practices. Keywords: Transfusion therapy, HIV, blood safety, antiretroviral therapy, risks, benefits, patient outcomes, transfusion-transmitted infections, personalized treatment, hematology, blood products

Analysis of Allergic Transfusion Reactions at a Children's Tertiary Care Center

Background: Transfusion reaction adverse events are a relatively rare occurrence in the United States. This is due to specific blood safety measures such as appropriate collection, preparation, testing, storage, and distribution of blood components as well as appropriate monitoring of patients receiving these transfusions. Several years of data have been collected by our institution's blood bank. Through our analysis, we have been able to describe the rate of transfusion- associated adverse events in pediatric patients at Children's Hospital of Michigan from 2018-2022. Objectives: The aim of this retrospective chart review was to assess the rate of allergic blood transfusion complications and reactions among pediatric patients at Children's Hospital of Michigan in Detroit, Michigan. Materials and Methods: An institution-based retrospective chart review was conducted for a total of 43,210 transfusions over a span of five years from 2018-2022. Results: There were a total of 43,210 transfusions. A total of 26,669 of these products were red blood cell (RBC) transfusions, 10,447 were platelets, 4,392 were plasma, and 1,702 were cryoprecipitate (combined plasma and cryoprecipitate was 6,094). A reported reaction was encountered in 176 of the 43,210 transfusions. These reported reactions were part of the patients' underlying diseases. A true acute transfusion reaction (ATR) was encountered in 116 of the 43,210 transfusions. Of the 116 transfusions, 66 (56.9%) were classified as allergic reactions. About 61% of those reactions were skin manifestations (urticaria, itching), 9% were respiratory symptoms (dyspnea, tachypnea), and the remaining 30% were both skin and respiratory symptoms. Of the total amount of RBC transfusions, 35 (0.131%) resulted in an allergic reaction. Similarly, 19 (0.182%) platelet and 12 (0.197%) plasma transfusions resulted in ATRs. ATRs were most associated with plasma, followed by platelets and RBC transfusions. Combining all transfusions received, these represented a total of 66 (0.153%) allergic transfusion reactions. These results are demonstrated in Figure 1. Conclusion: ATRs were observed in 0.268% of total transfusions (allergic reactions (0.153%) and other reactions (0.115%)) that occurred over the course of five years at our institution. This is about 1 in 655 blood components transfused that was associated with an allergic reaction (more commonly with plasma > platelets > packed RBCs). The rate of allergic reactions is less than what was reported by National Blood Collection and Utilization Survey 2017 (0.282%). This rate is also less than what is reported for children (0.53%) and adults (0.26%) in a meta-analysis (Wang Y, Sun W, Wang X, et al. Comparison of transfusion reactions in children and adults: A systematic review and meta-analysis. Pediatr Blood Cancer. 2022;69(9):e29842.). These lower rates could be secondary to changes in blood processing and under-reporting.

Trends in the Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infections in Iranian Patients with Hereditary Bleeding Disorders.

Patients with hereditary bleeding disorders (HBDs) have always been vulnerable to transfusion-transmitted infections (TTIs) such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections due to being regular recipients of blood and blood products. This study aimed to detect the trends in the prevalence of HBV, HCV, and HIV infections by birthyear in Iranian patients with HBDs to show the efficacy of national interventions implemented to administrate control and to prevent these infections, i.e., blood safety, newborn HBV vaccination, and safe replacement treatments. In this retrospective study, the trends in the prevalence of hepatitis B core antibody (HBcAb), HCV antibody (HCV-Ab), and HIV antibody (HIV-Ab) in Iranian patients with HBDs born before 2012 were assessed using patients' clinical archives. The determinants of HBV, HCV, and HIV infections were investigated in bivariable and multivariable logistic regression analyses. Out of 1475 patients with HBDs, most were male (87.7%) and diagnosed with hemophilia A (52.1%) and severe bleeding disorder (63.7%). The prevalence of HBcAb, HCV-Ab, and confirmed HIV-Ab was 22.9%, 59.8%, and 1.2%, respectively. The trends in HBcAb, HCV-Ab, and HIV-Ab were all decreasing by birthyear and reached a stable level of 0% for patients with birthyears in 1999, 2000, and 1984, respectively. In multivariable analysis, birthyear was significantly associated with HBcAb prevalence. In the multivariable analysis, type of HBD; birthyear; bleeding severity; histories of receiving packed cells, fresh frozen plasma, and cryoprecipitate before 1996; and history of receiving factor concentrate before 1997 were highly associated with the prevalence of HCV-Ab. Moreover, in the bivariable analysis, birthyear and type of HBD were associated with HIV-Ab prevalence. This study demonstrated the decreasing trends in HBV, HCV, and HIV seroprevalence in Iranian patients with HBDs following preventive interventions such as HBV vaccination, blood safety measures, and the provision of safe replacement treatments.

Characterizing trends and associations for hepatitis C virus antibody prevalence in the Middle East and North Africa: meta-regression analyses

This study characterized population-level trends and associations with hepatitis C virus (HCV) antibody (Ab) prevalence in the Middle East and North Africa (MENA). Data source was the standardized and systematically gathered MENA HCV Epidemiology Synthesis Project Database. Random-effects univariable and multivariable meta-regressions were conducted. 2,621 HCV Ab prevalence measures on 49,824,108 individuals were analyzed. In the analysis including all populations, 71% of the variation in prevalence was explained, mostly by at-risk population type. Compared to the general population, prevalence was 23-fold higher among people who inject drugs, and 14-fold higher among high-risk clinical populations. In the analysis including only the general population, 67% of the variation in prevalence was explained, mostly by country/subregion. Compared to Afghanistan, prevalence was highest in Egypt and Pakistan. Prevalence in the general population was declining at a rate of 4% per year, but outside the general population, the decline was at only 1% per year. HCV Ab prevalence in MENA is declining rapidly, but this decline is largely occurring in the general population following introduction of blood and injection safety measures. The decline in populations at higher risk of exposure is slow and below the level needed to achieve HCV elimination by 2030.

Toxoplasmosis Immunity Status of Blood Donors in Sidi Bel Abbès, West Algeria.

BackgroundToxoplasmosis is a zoonotic disease. It is due to an obligate intracellular protozoan called Toxoplasma gondii (T. gondii). Felids are considered definitive hosts, and humans take part as intermediate hosts. At least one-third of the world’s population is seropositive to the parasite. In addition, to the known modes of transmission, the infection can be transmitted through blood transfusions. The aim of this study is to assess the immune status of blood donors about this disease and estimate the potential risk by blood components.MethodologyA single cross-sectional study was conducted based on the search for T. gondii antibodies (IgG and IgM) in blood donors. This research was performed using a latex particle agglutination assay confirmed by an enzyme-linked immunosorbent assay (ELISA).ResultsIn all, 103 blood donors were involved in this study. The sex ratio of male/ female was 0.75. The recorded rate of exposure to toxoplasmosis in blood donors was 47.7% (95% CI: 35.1-54.3). Significant differences were observed between the prevalence and those of other African countries in West, East, and Central Africa, but not with those of Algerian pregnant women and neighboring North African countries. There was no association between T. gondii seropositivity and the following factors: sex, age, and blood group ABO or Rhesus. Antitoxoplasma IgG was detectable in all positive donors, while IgM was undetectable. All seropositive donors had an IgG titer ≥9 IU/ml. The potential risk of T. gondii transmission ranges from 1 per 100,000 to 17 per 100,000 blood donations.ConclusionThe seroprevalence of T. gondii infection was comparable to those found in Algerian pregnant women and neighboring North African countries. However, the seroprevalence rate was lower than recorded in other African countries. There is even a risk of transmission of toxoplasmosis through blood transfusions. There is a need to enhance blood safety measures for pregnant, immunocompromised, and multi-transfused people. As the immune status of blood donors may vary by region, there is a need to extend the national studies to the entire country. This study provides the first data on the seroprevalence of T. gondii infection among Algerian blood donors and the risk of its transmission by transfusion of blood components.

Supplemental findings of the 2019 National Blood Collection and Utilization Survey.

Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.

Transfusion-related adverse reactions: Data from the National Healthcare Safety Network Hemovigilance Module - United States, 2013-2018.

Despite current blood safety measures, transfusion recipients can experience transfusion-related adverse reactions. Monitoring these reactions can aid in understanding the effectiveness of current transfusion safety measures. Data from the National Healthcare Safety Network Hemovigilance Module were used to quantify adverse reaction risk. Facilities reporting at least one month of transfused blood components and transfusion-related adverse reactions during January 2013-December 2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for transfused components stratified by component type, collection, and modification methods. During 2013-2018, 201 facilities reported 18,308 transfusion-related adverse reactions among 8.34 million blood components transfused (220/100,000). Adverse reactions were higher among apheresis (486/100,000) and pathogen-reduced platelets (579/100,000) than apheresis red blood cells (197/100,000). Allergic reactions (41%) were most common. There were 23 fatalities and 9% of all adverse reactions were serious (severe, life-threatening, or fatal). Reactions involving pulmonary complications (transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnea) accounted for 35% of serious reactions but 65% of fatalities. Most (76%) of the 37 transfusion-transmitted infections were serious; none involved pathogen-reduced components. One in 455 blood components transfused was associated with an adverse reaction although the risk of serious reactions (1 in 6224) or transfusion-transmitted infections (1 in 225,440) was lower. Some serious reactions identified were preventable, suggesting additional safety measures may be beneficial. Higher reaction rates identified among pathogen-reduced platelets require further study. These findings highlight the importance of monitoring reactions through national hemovigilance to inform current safety measures and the need for strategies to increase healthcare facility participation.

Coronavirus Disease 2019: Corona Viruses and Blood Safety - A Review

The main aim of the study is to understand the current information of corona transmission and bloodsafety measures taken during handling blood safety products of corona infected patients.Coronaviruses arein the subfamily Ortho Coronaviridae of the Coronaviridae family.It is a type of viral virus that causesinflammation in your nose, sinus, or upper throat.Most coronaviruses are not harmful.The virus may resultfrom pneumonia, respiratory failure, septic shock, and death. Many complications of Coronavirus disease2019 (COVID 19) may result from a condition known as cytokine release syndrome or a cytokine storm.This study mainly aims at the awareness and perception of rural and urban people about covid-19 virus..Finding advance in blood safety to avoid blood contamination. It will help to provide a proper diagnosisof the disease and understand current information on coronavirus transmission and blood safety measuresduring the course of the infected patient’s blood safety procedures.To assess public health risks and therisk of occupationally acquired disease which may be associated with the management of infectious waste,understanding these factors is required.The storage, processing and examination of blood specimens fromCovid?19 patients must be carried out by qualified staff in suitably equipped laboratories, previously educatedon the technical and safety procedures.A blood-borne illness is a disease which can spread by blood andother body fluids contamination. Blood can contain various types of pathogens, mainly microorganisms likebacteria and parasites, and non-living infectious agents such as viruses. Through taking preventive steps inthe handling of blood products and storage of blood products for infection, contamination will be reducedand the public will not be affected.

Transfusion-associated adverse events and implementation of blood safety measures - findings from the 2017 National Blood Collection and Utilization Survey.

Serious transfusion-associated adverse events are rare in the United States. To enhance blood safety, various measures have been developed. With use of data from the 2017 National Blood Collection and Utilization Survey (NBCUS), we describe the rate of transfusion-associated adverse events and the implementation of specific blood safety measures. Data from the 2017 NBCUS were used with comparison to already published estimates from 2015. Survey weighting and imputation were used to obtain national estimates of transfusion-associated adverse events, and the number of units treated with pathogen reduction technology (PRT), screened for Babesia, and leukoreduced. The rate of transfusion-associated adverse events requiring any diagnostic or therapeutic interventions was stable (275 reactions per 100,000 transfusions in 2015 and 282 reactions per 100,000 transfusions in 2017). In 2017 among US blood collection centers, 16 of 141 (11.3%) reported screening units for Babesia and 28 of 144 (19.4%) reported PRT implementation; 138 of 2279 (6.1%) hospitals reported transfusing PRT-treated platelets. In 2017, 134 of 2336 (5.7%) hospitals reported performing secondary bacterial testing of platelets (50,922 culture-based and 63,220 rapid immunoassay tests); in 2015, 71 of 1877 (3.8%) hospitals performed secondary testing (87,155 culture-based and 21,779 rapid immunoassay tests). Nearly all whole blood/red blood cell units and platelet units were leukoreduced. Besides leukoreduction, implementation of most blood safety measures reported in this study remains low. Nationally, hospitals might be shifting from culture-based secondary bacterial testing to rapid immunoassays.

When are infection risks of blood transfusion tolerable? Towards understanding the ethical views of stakeholders in the blood supply.

Background and objectivesThe perception of transfusion‐transmitted infections (TTIs) is sensitive to various concerns besides the probability and impact of infection, and some of these concerns may be ethically relevant. This paper aims to advance thinking about blood safety policies by exploring and explaining stakeholders’ reasons to consider TTI risks tolerable or intolerable.Materials and methodsInspired by critical empirical ethics and phenomenological hermeneutics, we held interviews and focus group discussions to explore the moral experience of policymakers, hematologists, blood donors and recipients. Respondents were invited to discuss general concerns about the blood supply, to address the tolerability of TTI risks compared with other hazards and to comment on the costs of blood safety. Arguments for tolerance or intolerance towards TTI risks were analysed qualitatively.ResultsStakeholders’ views could be clustered into seven categories: (1) clinical impact; (2) probability of infection; (3) avoidability of infection; (4) cost and health benefits; (5) other consequences of safety measures; (6) non‐consequentialist ethical arguments; and (7) stakeholders’ interests. Various arguments were offered that resonate with current ethical thinking about blood safety. Assuming that resources spent on inefficient blood safety measures could be applied more beneficially elsewhere, for example, responders typically expressed tolerance towards TTI risks. Some other arguments seem novel, for instance arguments for risk intolerance based on the low probability of infection and arguments for risk tolerance if patients have a poor prognosis.ConclusionUnderstanding the moral experience of stakeholders enriches ethical debate about blood safety and prepares developing more widely acceptable policies.

West Nile and Usutu Virus Infections and Challenges to Blood Safety in the European Union.

West Nile virus (WNV) and Usutu virus (USUV) circulate in several European Union (EU) countries. The risk of transfusion-transmitted West Nile virus (TT-WNV) has been recognized, and preventive blood safety measures have been implemented. We summarized the applied interventions in the EU countries and assessed the safety of the blood supply by compiling data on WNV positivity among blood donors and on reported TT-WNV cases. The paucity of reported TT-WNV infections and the screening results suggest that blood safety interventions are effective. However, limited circulation of WNV in the EU and presumed underrecognition or underreporting of TT-WNV cases contribute to the present situation. Because of cross-reactivity between genetically related flaviviruses in the automated nucleic acid test systems, USUV-positive blood donations are found during routine WNV screening. The clinical relevance of USUV infection in humans and the risk of USUV to blood safety are unknown.

One Health approach for West Nile virus surveillance in the European Union: relevance of equine data for blood safety.

West Nile virus (WNV) infection is notifiable in humans and equids in the European Union (EU). An area where a human case is detected is considered affected until the end of the mosquito transmission season (week 48) and blood safety measures have to be implemented. We used human and equine case notifications between 2013 and 2017 to define the WNV distribution in the EU and to investigate the relevance of using equine cases as a complementary trigger for blood safety measures. Adding areas with equine cases to the definition of an affected area would have a major impact on blood safety measures. Adding areas with equine cases where human cases have been reported in the past would increase the timeliness of blood safety measures with only a limited impact. Although the occurrence of human and/or equine cases confirms virus circulation in the EU, no evidence was found that occurrence of equine cases leads to human cases and vice versa. We conclude that information about equine data should contribute to raising awareness among public health experts and trigger enhanced surveillance. Further studies are required before extending the definition of affected areas to areas with human and/or equine cases.

POTENTIAL RISK OF OCCUPATIONAL BLOOD HAZARDS AMONG STUDENTS AT THE HEALTH COLLEGES IN PRINCESS NOURAH BINT ABDULRAHMAN UNIVERSITY

Introduction: Clinical trainee students are potentially at high risk of exposure to blood-borne pathogens because of their underestimation of the risk of blood exposure and limited clinical experience. Aim of work: To assess the potential risk among health colleges’ students at Princess Nourah bint Abdulrahman University (PNU) regarding occupational blood hazards (OBHs), to determine the frequency of their exposure to OBHs incident during their clinical training and to assess their awareness towards potential risks of blood hazards, vaccination, and safety measures. Materials and methods: A questionnaire based on a cross-sectional study was carried out among 565 clinical trainee students of health colleges from December 2017 to March 2018. Results: The majority (83%) of the students had poor knowledge score. More than half of them did not receive any educational material or even orientation on standard precautions. Almost half of them had received HBV vaccine. Nearly 11% of them stated that they had been exposed to incident of blood hazards at least once duringtheir clinical practice, whereas only 7.6% of them reported the incident to their corresponding institute. Conclusion and recommendations: The study showed that there was inadequate knowledge of the students and their non-compliance with safety measures which necessitate the needs for effective curricular and extracurricular program with systemic evaluation of students about potential risk of occupational blood hazards. Further post educational clinical trial survey as well as direct observational study is needed

443. West Nile Virus in Humans in Greece, 2010–2017

BackgroundIn 2010, the first West Nile (WN) virus outbreak was recorded in Central Macedonia, northern Greece, with 197 WN neuroinvasive disease (WNND) cases; the largest reported in Europe since 1996. In the consecutive years, seasonal outbreaks continued to occur. We investigated the 2010–2017 outbreaks to determine their extent, describe the geographical and temporal distribution of human cases and implement appropriate control measures.MethodsWe supported the investigation of suspected human cases and strengthened the laboratory surveillance. We interviewed cases and treating physicians and recorded suspected place of exposure, type of disease (WNND or non-WNND) and disease outcome. We estimated case fatality (CF) of neuro-invasive disease (WNND). PCR-positive samples were sequenced.ResultsSince 2010, a total of 672 human cases were recorded, from June to October, including 474 (71%) WNND cases. Cases were recorded for five consecutive years, in 2010 (n = 262), 2011 (n = 100), 2012 (n = 161), 2013 (n = 86), and 2014 (n = 15); and then in 2017 (n = 48), after a 2-year period with no cases diagnosed. Since 2010, a total of 81 (CF=17%) fatalities occurred among WNND cases, with a median age of 80 (49–95) years. Cases were recorded, in both urban and rural areas, in half (37/74) of the Regional Units (NUT-3 level), in all 13 Regions. In 2011, the virus dispersed southwards to newly affected Regional Units, and in the following years cases were recorded both in previously affected and in new areas, during each transmission season. In 2017, cases were also recorded for the first time in the two last—previously non-affected—Regions of the country. Sequences from PCR-positive samples revealed WNV lineage 2, with high genetic similarity to the 2010 strain.ConclusionThe reoccurrence of human cases and the spread of the virus in newly affected areas suggests that WNV lineage 2 has been established in Greece; its circulation and occurrence of cases remain likely in the following transmission periods, in previously affected and in new areas. Enhanced surveillance throughout Greece is critical to timely implement targeted control and prevention measures (i.e., communication campaigns, vector control, and blood safety measures).Disclosures All authors: No reported disclosures.

Asymptomatic Visceral Leishmania infantum Infection in US Soldiers Deployed to Iraq.

Visceral leishmaniasis (VL), due to Leishmania infantum, is a persistent intracellular parasitic infection transmitted by the bite of infected sand flies. Symptomatic VL has been reported in U.S. soldiers with Iraq deployment. Untreated symptomatic VL can be fatal; asymptomatic VL (AVL) may establish a lifelong risk of reactivation. We report prevalence and AVL risk factors in Operation Iraqi Freedom (OIF) deployers during 2002-11. Healthy soldiers exposed to VL endemic areas in Iraq and 50 controls who never traveled to endemic regions were recruited through military healthcare facilities (2015-17). Responses to a risk factor survey and blood samples were obtained. Leishmania research diagnostics utilized included enzyme-linked immunosorbent assay (ELISA), rk39 test strips, quantitative polymerase chain reaction (PCR), and interferon gamma release (IGRA) assays. Statistical analyses included Fisher exact test, Pearson χ2 test, Mann-Whitney U test, and logistic regression. 200 deployed subjects were enrolled, mostly males (84.0%), of white ethnicity (79.0%), and median age 41 (range 24-61) years. 64% were seropositive for Phlebotomus alexandri saliva antibodies. Prevalence of AVL (any positive test result) was 39/200 (19.5%, 95% confidence interval 14.4%-25.8%). Two (1.0%) PCR, 10 (5%) ELISA, and 28 (14%) IGRA samples were positive. Travel to Ninewa governorate increased risk for AVL (P = .01). AVL was identified in 19.5% of OIF deployers; travel to northwest Iraq correlated with infection. Further studies are needed to inform risk for reactivation VL in US veterans and to target additional blood safety and surveillance measures.

Reflections on the dynamics of bacterial and viral contamination of blood components and the levels of efficacy for pathogen inactivation processes

Blood transfusion safety has been increasingly improving during the past two decades. However, threats from both known and emerging pathogens require continual improvement and re-assessment of blood safety measures. In this respect, we are currently witnessing the broader implementation of Pathogen reduction technology (PRT) for blood complements. These methods, combined with existing safety measures, have helped to reduce the pathogen risks of transfusion-transmitted infections. Currently multiple reviews have compared levels of inactivation between different commercialized PRTs. However, to analyze levels of pathogen inactivation, it is necessary to understand the dynamics of infectivity as well as the modes of disease transmission by blood transfusion for various pathogens. It is well known that contributing variables include donor characteristics through the processing of blood components to ultimately the recipient characteristics, which create enormous variability in overall outcomes relative to disease transmission. The aim of this paper is to discuss bacterial and viral contamination of blood components in order to determine adequate levels of efficacy and subsequent disease transmission safety of current pathogen inactivation protocols that are designed to reduce the risk of transfusion-transmitted infections. In such a conceptual analysis, however, it is important to understand several contributing factors including the measurement of pathogen load in blood products and the dynamics, infectivity and disease transmission of various pathogens via transfusion of blood components and products. In many cases, the log reduction values observed do not truly reflect the extent of reduction in the levels of infectivity that are observed clinically. Results from clinical trials and hemovigilance programs upon routine implementation of PRT methods provide a more direct insight into effectiveness with regard to clinical relevance of in vitro spiking studies. These issues are briefly addressed in this manuscript.

An early start of West Nile virus seasonal transmission: the added value of One Heath surveillance in detecting early circulation and triggering timely response in Italy, June to July 2018.

In Italy, the 2018 West Nile virus transmission season started early with a high number of cases reported. One-Health surveillance, within the Italian West Nile national preparedness and response plan, detected viral circulation 9 days before symptom-onset of the first confirmed human case; triggering timely implementation of blood and transplant safety measures. This is an example of how functional coordination allows health authorities to use early warning triggers from surveillance systems to implement preventive measures.

Early start of the West Nile fever transmission season 2018 in Europe.

In Europe, surveillance indicates that the 2018 West Nile fever transmission season started earlier than in previous years and with a steeper increase of locally-acquired human infections. Between 2014 and 2017, European Union/European Economic Area (EU/EEA) and EU enlargement countries notified five to 25 cases in weeks 25 to 31 compared with 168 cases in 2018. Clinicians and public health authorities should be alerted to ensure timely implementation of prevention measures including blood safety measures.

Hepatitis B Virus Blood Screening: Need for Reappraisal of Blood Safety Measures?

Over the past decades, the risk of HBV transfusion–transmission has been steadily reduced through the recruitment of volunteer donors, the selection of donors based on risk-behavior evaluation, the development of increasingly more sensitive hepatitis B antigen (HBsAg) assays, the use of hepatitis B core antibody (anti-HBc) screening in some low-endemic countries, and the recent implementation of HBV nucleic acid testing (NAT). Despite this accumulation of blood safety measures, the desirable zero risk goal has yet to be achieved. The residual risk of HBV transfusion–transmission appears associated with the preseroconversion window period and occult HBV infection characterized by the absence of detectable HBsAg and extremely low levels of HBV DNA. Infected donations tested false-negative with serology and/or NAT still persist and derived blood components were shown to transmit the virus, although rarely. Questions regarding the apparent redundancy of some safety measures prompted debates on how to reduce the cost of HBV blood screening. In particular, accumulating data strongly suggests that HBsAg testing may add little, if any HBV risk reduction value when HBV NAT and anti-HBc screening also apply. Absence or minimal acceptable infectious risk needs to be assessed before considering discontinuing HBsAg. Nevertheless, HBsAg remains essential in high-endemic settings where anti-HBc testing cannot be implemented without compromising blood availability. HBV screening strategy should be decided according to local epidemiology, estimate of the infectious risk, and resources.