Minipool Research Articles

Cost-benefit analysis of serological and nucleic acid testing for hepatitis B virus in blood donors in southern China

BackgroundMost Chinese blood centers have implemented mini pool (MP) HBV nucleic acid testing (NAT) together with HBsAg ELISA in routine blood donor screening for HBV infection since 2015, and a few centers upgraded MP to individual donation (ID) NAT screening recently, raising urgent need for cost-benefit analysis of different screening strategies. In an effort to prevent transfusion-transmitted infections (TTIs) for HBV, cost-benefit analyses of three different screening strategies: HBsAg alone, HBsAg plus MP NAT and HBsAg plus ID NAT were performed in blood donors from southern China where HBV infection was endemic.MethodsMP-6 HBV NAT and ID NAT were adopted in parallel to screen blood donors for further comparative analysis. On the basis of screening data and the documented parameters, the number of window period (WP) infection, HBV acute infection, chronic hepatitis B infection (CHB) and occult hepatitis B infection (OBI) was evaluated, and the potential prevented HBV TTIs and benefits of these three strategies were predicted based on cost-benefit analysis by an estimation model.ResultsOf 132,323 donations, the yield rate for HBsAg-/DNA + screened by ID NAT (0.12%) was significantly higher than that by MP NAT (0.058%, P < 0.05). Furthermore, the predicted transfusion-transmitted HBV cases prevented was 1.25 times more by ID NAT compared to MP-6 NAT. The cost-benefit ratio of the universal HBsAg screening, HBsAg plus ID NAT and HBsAg plus MP NAT were 1:58, 1:27 and 1:22, respectively.ConclusionsUniversal HBsAg ELISA screening in combination with HBV ID NAT or MP-6 NAT strategies was highly cost effective in China. To further improve blood safety, HBsAg plus HBV DNA ID NAT screening should be considered in HBV endemic regions/countries.

Sulfate-rich spring seeps and seasonal formation of terraced, crystalline mirabilite mounds along the shores of Great Salt Lake, Utah: Hydrologic and chemical expression during declining lake elevation

As Great Salt Lake (GSL) elevation declined below ∼1278.6 m (4195 ft) beginning in the fall of 2019, crystalline mounds formed on the southeastern shore, near Great Salt Lake State Park, Utah. Soon after, several more mound complexes were discovered on nearby Antelope Island. Recent historic low lake levels permitted sulfate-saturated spring brines to emerge on the exposed shoreline. When the spring waters encountered cold winter air, sodium sulfate precipitated in the form of the mineral mirabilite (Na2SO4·10H2O). Mirabilite-saturated spring waters pool in shallow sediment-collapse depressions or, with sufficient hydraulic head, precipitate subaerial crystalline spring terraced mounds. The mounds are composed of clear, bladed, and tabular mirabilite crystals (1 to 10 cm in length; 1 to 5 cm in width) that form mini pools and rimstone dams due to cascading spring water flow. The waters have elavated μM concentrations of sulfide, an oxidation-reduction potential (ORP) of −250 mV, pH of 7, densities of 1.103–1.1169 g/cm3, and temperatures of 10°–15 °C, as compared to nearby lake waters that had undetectable sulfide, an ORP of 12 mV, pH of 8.2, density of 1.0872 g/cm3, and temperatures of 0°–3 °C. Green algae and probable sulfide oxidizing bacteria thrive in the spring waters and some are occluded within the mirabilite matrix and fluid inclusions. Sulfur δ34S and oxygen δ18O isotopes of brine and mirabilite sulfate are enriched +18.8–20.41‰ and + 12.2–14.5‰, respectively, indicating groundwater and mirabilite are in equilibrium for oxygen. Brine sulfide is heavily fractionated (δ 34S of ∼ − 30 ‰) relative to sulfate, indicating active sulfate reduction in subsurface aquifers that feed the spring seeps and which is consistent with higher HS− concentrations relative to adjacent lake waters. The recognition of such biosignatures retained in mirabilite provides further insights for the preservation potential of biological material in extraterrestrial sulfate minerals.Today, Gilbert Bay (south arm of GSL) is undersaturated with respect to mirabilite. However, pre-earthen causeway historical reports (prior to 1959) indicate mirabilite precipitated in the south arm during the winter and through wave action accumulated along the leeward southeastern oolitic shore (similar to current processes occurring in the hypersaline Gunnison Bay, the north arm of GSL). Upon solar irradiance in the spring, the shoreline mirabilite dissolved and reprecipitated in the shallow subsurface (<1 m) as an ooid cement. We hypothesize that this subsurface layer of mirabilite is the source for active lake margin sodium sulfate-saturated spring brines. The emergence and surface exposure of the brines and associated chemical sediments are an additional contributing solute source that may increase GSL salinity during lake level decline more than evaporation alone.

A NOVEL B7H3/NKP30 BISPECIFIC NK CELL ENGAGER FOR CANCER IMMUNOTHERAPY

Abstract Background and Significance Biological therapies harnessing the adaptive immune system have achieved a great success, given the clinical efficacy of CAR-T therapies and CD3 based T cell engagers in treating hematologic tumors, and the application of T cell immune checkpoint inhibitors in various indications. However, the challenges still exist due to the limitation of CAR-T therapies and T cell engagers in treating solid tumors. Side effects such as cytokine release storm and neurotoxicity remain a concern in the selection of CAR-T therapies and CD3-based T cell engagers as therapeutics. For PD1/L1-based immunotherapy, the relatively low objective response rate (ORR), short progression-free survival (PFS) of patients, and drug resistance and recurrence especially for solid malignancy, are the major clinical challenges. In contrast, innate effector cells such as NK cells and macrophages are naturally existing in human body as front line to defeat general pathogens and cancers，which will have a better safety profile. Also, NK cell activation is not limited by the antigen presentation of the MHC on the cell surface which makes it has broader anti-tumor effects. However, the innate effector cell based therapy is facing the limitation of low cell number, poor in vitro activation, and short effective duration in vivo. SunHo has generated a B7H3/NKp30 NK cell engager bispecific antibody which can directly activate and enrich NK cells to the TME when used alone or enhance the efficacy when used in combination NK cell therapy. NKp30 is a potent NK cell activation receptor with wide and persistent expression compared with other NK markers. B7H3 as a tumor associate antigen is also widely expressed on many kinds of tumor cells with great potential for multiple indications, especially for solid tumors. Methods Three anti-NKp30 VHHs were identified from Alpaca immunized library. The VHHs were fused to the N-terminus or C-terminus of an anti-B7H3 mAb heavy chain with different IgG isotypes (IgG1 or IgG4). The binding activity to NK cells was evaluated by FACS. IFNγ level was detected in the NK cell activation assay. The NK cell mediated target cell killing was evaluated using either NK92MI-cd16a or Primary NK cells as effector cells. To evaluate the non-specific self-killing of NK cell without target cell, the B7H3/NKp30 candidates were incubated with NK92MI-cd16a and cell lysis percentage were calculated. NSG mice bearing Hs.746T tumors were used to evaluate the in vivo efficacy of B7H3/NKp30 candidates. Results The B7H3/NKp30 candidates showed good binding activity and better activation to NK cells compared with benchmarks. Notably, the B7H3/NKp30 candidate IAN0982-VHH25 with NKp30 fused to the C-terminal with an IgG1 isotype showed lowest risk of non-specific NK cell killing. In the in vivo study, B7H3/NKp30 candidates in combination with 1x106 NK cells showed excellent anti-tumor activity with TGI over 95%. And we didn’t observe any significant change in body weight of the animals demonstrating good safety profile of the candidates. Moreover, even with lower NK cell amount (5x105), IAN0982-VHH25 showed great anti-tumor efficacy. We have also generated three mini pools of stably transfected cells for IAN0982-VHH25 for the commercial stable cell line development. Conclusion IAN0982-VHH25 is a first-in-class B7H3/NKp30 bispecific NK cell engager for cancer immunotherapy with excellent NK cell activation and in vivo anti-tumor efficacy, and also low risk of non-specific NK cell killing. It is expected to lift the limitations of current adaptive and innate effector cells-based therapies.

Hepatitis A virus (HAV) RNA detection in Polish blood donors and likely transmissions through blood components during the 2017-2019 epidemic.

In Poland, hepatitis A virus (HAV) RNA screening was performed in plasma for fractionation usually immediately before shipment. Our goal was to study epidemiology, rate of transfusion transmitted HAV during epidemic (2017-2019), and viral characteristics of infected plasma donors. HAV RNA was tested in 1,866,590 donations from 1,210,423 donors using RT-PCR in mini pools of 96 (MP96) or TMA in MP16. Virological characteristics included RNA level (RL), antibody testing, and sequencing. Twenty-one HAV infections were identified (1.13/100,000 donations; 95% confidence interval [95% CI]: 0.74-1.72) and (1.73/100,000 donors; 95% CI: 1.35-2.65). The Blood Transfusion Centers were also informed about three donors, who were hospitalized for hepatitis A soon after their blood donation. In addition, we identified a donor, who had reactive result for HAV after receiving HAV vaccination. He tested positive twice 10 days after receiving the first and the second dose. The highest RL was 16 million IU/ml, mean 1,706,905 IU/ml, and median 220 IU/ml. The longest detectable RL lasted for 113 days. HAV-infected donors were seronegative (36%) or IgM positive (64%). We followed up on 12 HAV contaminated blood components issued for transfusion. In two out of seven identified patients viral transmission was confirmed (28.6%). Based on our results, we propose a 6 month deferral after HAV infection and 14 days post HAV vaccination. The infectivity rate was below 30%. The HAV RNA testing could be considered as an additional safeguard against HAV transmission at the time of increased incidence of HAV infections in the general population.

Second hepatitis C virus transmission by blood components since introduction of mandatory NAT screening in Germany.

Viral safety of blood products in Germany has improved significantly over the last two decades. We describe the second documented transfusion-transmitted (TT) episode for the hepatitis C virus (HCV) in Germany since mandatory nucleic acid amplification techniques (NAT) screening was introduced in 1999. When a repeat donor who had tested negative for anti-HCV tested positive for HCV RNA by NAT in a minipool (MP) of eight, a look-back procedure was initiated. Qualitative, quantitative and genotyping assays were used to investigate the titers of the quarantined fresh frozen plasma (FFP) from the donor and a serum sample from the recipient of the pooled platelet concentrate (PPC). Amplified products of 5'UTR and HVR1 were used for sequence comparison to characterize the HCV genomic identity of donor and recipient samples. All NAT tests utilized in this procedure were able to detect a low HCV RNA titer (~15 IU/ml) in the FFP from the donation. Dilution of FFP by factor 8 was performed to mimic an MP, and the detection rate correlated well with the claimed sensitivity of the tests. Analysis of donor and recipient samples revealed genotype 3a viral transmission confirmed by sequence analysis. This TT HCV case could have been prevented by individual donation (ID) NAT. However, a low titer blood donation in the window period (WP) is very rare. Residual risk calculation for TT HCV in the WP revealed that, compared to MP-NAT testing, ID-NAT would improve blood safety only marginally.

Field Experimental Study on the Infiltration and Clogging Processes at Aksu Research Site, Kazakhstan

The challenge of a good quality drinking water supply to southeastern Kazakhstan’s local population from far-away natural surface water sources motivates groundwater utilization from local aquifers. To prevent groundwater resource deficits, artificial groundwater recharge is needed. To this end, infiltration and clogging processes were evaluated through comprehensive field research in southeastern Kazakhstan’s typical river drainage basin (Aksu experimental site). The infiltration scenario included constructed mini pools and their typical soil profile clogging and silting processes. The local aquifer unsaturated and upper saturated zones underwent a detailed study of water balance, hydrodynamic setting, and filtration properties. The research results suggest that the infiltration rate decreased from 15 m/day until the saturation steady state and remained at 0.75 m/day until the end of the experiment. In summer, clogging layers with thicknesses ranging from 3 mm for the clayey silt layer to 6 mm for muddy clay began to form at the mini pools nearly one month after the test began. During infiltration, the mini pools’ upper soil layer dirt-holding capacity varied from 3.72 to 5.25 kg/m2. The field study results serve as a factual basis for artificial replenishment system design and groundwater replenishment methodology optimization in southeastern Kazakhstan and similar regions.

Risk of a blood donation contaminated with hepatitis E virus entering the blood supply before the implementation of universal RNA screening in France.

The risk of a blood donation contaminated with hepatitis E virus (HEV) entering the blood supply before introducing universal HEV-RNA screening in France was estimated to assess the benefit of such a measure. The results of selective HEV nucleic acid testing (HEV-NAT) performed in mini pool of six plasma donations between 2018 and 2020 were extrapolated to the whole blood donor (BD) population after adjustment on three variables: regional establishment, sex and age group. Among the 246,285 plasma donations collected from 172,635 BDs tested for HEV-RNA, 248 (10.1/10,000) were positive. The extrapolation to all BDs led to an estimated rate of 5.9/10,000 donations (95% confidence interval [CI]: 4.5-7.4) which would be positive to HEV-RNA and a prevalence of 9.9/10,000 BDs (95% CI: 7.5-12.3). This prevalence was 4.4 times higher in males than females (16.8/10,000 vs. 3.8/10,000, p < 10-4 ). The highest prevalence was observed in males in the 30-39 age group (20.5/10,000) and the lowest in females in the 50-70 age group (2.8/10,000). The risk of an HEV-RNA-positive donation entering the blood supply was estimated at 1 in 1682 donations. This risk does not translate directly to the risk of HEV transfusion transmission, which mainly depends on the total number of viral particles in the transfused blood component and the sensitivity of NAT.

Efficacy of Different Testing Scenarios in Reducing Transfusion-Transmitted Hepatitis B Virus (TT-HBV) Infection Risk.

The efficacy of different screening scenarios in reducing hepatitis B virus (HBV) transmission risk as compared to the risk without screening was modeled in 9,337,110 donations from four geographical regions that had been subjected to hepatitis B surface antigen (HBsAg) and individual donation nucleic acid amplification testing (ID-NAT). We used the Weusten models for estimating infectivity risk for Red Blood Cell (RBC) transfusions in eight HBV infection stages and then evaluated multiple screening strategies based on minipool (MP) and ID-NAT options of different sensitivity for their efficacy in reducing this risk. The efficacy in reducing HBV transmission risk by screening scenarios across the regions varied between 81% (HBsAg only) and 99.2% (ID-NAT and anti-HBc). Highly sensitive ID-NAT alone achieved a slightly higher risk reduction (97.6–99.0%) than minipool of 6 donations (MP6)-NAT in combination with HBsAg and anti-HBc (96.3–98.7%). In ID-NAT screened lapsed and repeat donors, the additional risk removed by HBsAg testing was minimal (<0.1%). The modeling outcomes in this and two previous reports using this multi-regional database suggest that one could consider an ID-NAT alone testing scenario as an alternative to MP-NAT and serology-based testing algorithms and restrict serologic testing to first-time donors only.

UTILITY OF MINI-POOL NAT STRATEGY FOR IMPROVING BLOOD SAFETY BY DETECTING OCCULT HEPATITIS B VIRUS INFECTION : A 5 YEAR STUDY

Introduction: The prevalence of transfusion transmitted infections (TTIs) is high in India. The aim of our study was to evaluate the sero-prevalence of TTIs using Nucleic acid technology (NAT) and detection of Occult Hepatitis B virus infection by Minipool NAT Strategy. A total of 89,639 units of blood donated at Dhanvanta Materials and Methods: ri Voluntary Blood Bank, Rajahmundry during the period from January 2012 to July 2016. The sero-prevalence for HIV, HBV and HCV was tested by 4th generation ELISA. Only sero-negative samples were tested on mini pool nucleic acid test (MP-NAT) to detect HIV1, HIV2, HCV and HBV viral nucleic acids. Combined NAT yield was calculated and compared the NAT yield with MPX test and MPX V2.0. We also evaluated the optical density (OD) values of ELISA for MP-NAT reactive donor samples to evaluate the efcacy of NAT in detecting window period cases. The Results: overall sero-prevalence of TTIs was 2.41% and HBV was predominantly present (66%). Total 29 ELISA negative blood donor samples were found reactive on NAT. All NAT reactive donors were of HBV only. Out of 29 cases, 12 were detected by MPX test from 26,008 donations and 17 by MPX V2.0 from 25,619 donations, providing NAT yield of 1:2169 and 1:1507 respectively. OD and Signal cut off values of ELISA for NAT reactive samples were found to be much below extended grey zone value (&lt;0.3). Additiona Conclusion: l testing of nucleic acids by MP-NAT in combination of mandated primary serology by ELISA provides 99.99% of safe blood to needy patients; thus signicantly reduces the risk of TTIs by identifying the window period cases.

High-Frequency Notable HBV Mutations Identified in Blood Donors With Occult Hepatitis B Infection From Heyuan City of Southern China.

BackgroundAll Chinese blood centers have implemented mini pool (MP) HBV nucleic acid testing (NAT) together with HBsAg ELISA in routine donor screening since 2015. The prevalence of occult hepatitis B virus infection (OBI) in donors from different regions varies, and the molecular characterization of the HBV DNA and clinical outcomes of these OBIs remain largely unexplored.MethodsBlood donations from Heyuan city in Southern China were screened by HBsAg ELISA and HBV MP8 NAT. Donations with HBsAg-/HBV DNA+ were collected for this study. Molecular characterizations of HBV DNAs were further analyzed by various DNA amplification assays including quantitative PCR (qPCR) and nested PCR, amplifying the basic core and pre-core promoter regions (BCP/PC). The HBsAg (S) region from HBV DNA was isolated by high-volume nucleic acid extraction. Notable mutations were identified by comparison to the HBV reference sequences. The clinical outcomes of the donors with OBIs were further followed for nearly 3 years.ResultsSeventy OBIs from 44,592 donations (0.15%) that we identified and reported previously were enrolled for this current study. HBV sequences were obtained from 44/70 OBIs, and genotyping analysis showed that 42/44 (95.2%) OBIs were genotype B, and 2/44 (4.8%) were genotype C. Interestingly, mutation analysis revealed that various mutations including M133L/T, F134L, P142L, V168A, R169H, S174N, L175S, and V177A of HBV DNA affecting HBsAg detection were observed in genotype B OBIs. Two notable mutations, T47K and L53S, were identified in genotype C OBIs. Follow-up studies showed that 3/31 (9.7%) OBIs converted to HBsAg+ as chronic infections while 1/31 (3.2%) HBV DNA was undetectable (classified as recovery) and 27/31 (87.1%) remained as OBIs.ConclusionVarious notable mutations affecting HBsAg detection were observed in blood donors with OBIs in Heyuan city of Southern China. Follow-up studies showed that most OBIs remained as OBIs with fluctuating or low viral loads. Higher sensitive HBV ID NAT is recommended for donor screening to further reduce the transmission risk of OBIs.

The impact of nucleic acid testing to detect human immunodeficiency virus, hepatitis C virus, and hepatitis B virus yields\xa0from a single blood center in China with 10-years review

BackgroundSince 2010, the Blood Center of Zhejiang province, China, has conducted a pilot nucleic acid amplification testing (NAT) screening of blood donors for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). This study aims to assess the results of NAT testing over 10 years to establish the effects and factors influencing NAT yields of HBV, HCV, and HIV.MethodsBlood donations from seven different blood services were screened for HBV DNA, HCV RNA, and HIV RNA using 6 mini pools (6MP) or individual donation (ID)-NAT method between August 1, 2010, and December 31, 2019, at the NAT centralized screening center. We compared 3 transcription-mediated amplification (TMA) assays and 2 polymerase chain reaction (PCR) assays. Further, HBV, HCV, and HIV NAT yields were calculated and donor characteristics and prevalence of HBV NAT yields analyzed. Donors with HCV and HIV NAT yield were also followed up.Results1916.31 per million donations were NAT screening positive overall. The NAT yields for HBV, HCV, HIV and non-discriminating reactive were 1062.90 per million, 0.97 per million, 1.45 per million, and 850.99 per million, respectively, which varied in the seven blood services and different years. HBV NAT yields were higher than those of HCV and HIV and varied across demographic groups. Risk factors included being male, old age, low education level, and first-time donors. We found no differences in NAT yields of HBV, HCV, and HIV between the 3 TMA and 2 PCR assays; nonetheless, statistically, significant differences were noted between the five assays.ConclusionIn summary, NAT screening in blood donations reduces the risk of transfusion-transmitted infections and shortens the window period for serological marker screening. Therefore, a sensitive NAT screening method, ID-NAT workflow, and recruitment of regular low-risk donors are critical for blood safety.

Effectiveness of the HCV blood screening strategy through eighteen years of surveillance of HCV infection in blood donors in France.

The question of maintaining blood screening based on both Hepatitis C virus (HCV) infection antibodies (Ab) and Nucleic Acid Testing (NAT) has been raised in several countries. The French blood donor surveillance database was used to address this issue. In France, HCV-NAT was implemented in mini pools (MP) in 2001 and in individual testing (ID) in 2010. HCV-positive donations are further investigated including detection of RNA with an alternative polymerase chain reaction assay: Amplicor HCV v2.0 (Roche; LOD95 50 IU/mL) from 2001 to 2006 and CobasTaqMan (CTM) HCV 2.0 assay (Roche; LOD95 9.3 IU/mL) since 2007. From 2001 to 2018, 3,058/48.8 million donations were confirmed HCV positive: 64.4% were Ab+/NAT+, 35.1% Ab+/NAT- and 0.5% Ab-/NAT+. From 2001 to 2018, the NAT yield decreased from 0.65 per million donations to 0, and NAT+ donations dropped from 77% to 46% of the total of HCV donations. 2,491/3,058 were further tested for HCV-RNA: 1,032 (816 NAT+, 216 NAT-) with Amplicor and 1,459 (897 NAT+, 562 NAT-) with CTM. Four (3 MP and 1 ID-NAT, 0.5%) of the 778 NAT negative donations had low viral loads. The decline in HCV-NAT yield cases raises the question of the relevance of NAT. Conversely, the increase in Ab+/NAT-donors, suggesting a growing number of resolved infections, argue for Ab discontinuation. In our experience, at least 0.5% of Ab+/NAT-donations had low RNA level when retested. Although the risk of viral transmission by such donations is probably low, the uncertainty associated with their infectivity goes against the removal of Ab in blood screening in our country.

Background rate of low-level HCV RNA in anti-HCV confirmed-positive and minipool nucleic acid test-nonreactive blood donations.

In 2019, the Food and Drug Administration revised the requirement for further testing of anti-HCV-reactive donations testing nucleic acid (NAT)-nonreactive via routine mini-pool (MP)-NAT. Individual donation (ID)-HCV NAT was required as a supplemental test prior to a second FDA-licensed anti-HCV assay; if ID-HCV-NAT is reactive, no further testing is required. This study investigated the rate of low-level RNA in anti-HCV-reactive donation samples prior to and following the implementation of supplemental ID-HCV NAT. A retrospective analysis was conducted on frozen plasma unit samples from 1161 anti-HCV confirmed-positive/HCV-NAT-nonreactive donations collected from December 2014 to January 2020. Samples were tested by multiple replicates on the Grifols Procleix Ultrio Elite (UE) assay and corresponding discriminatory HCV (dHCV) assay on the Procleix Panther System. Prospectively, the prevalence of low-level RNA in 2912 anti-HCV-reactive donations detected through routine screening from April 2020 through March 2021 was determined. In retrospective analyses, 10 (0.86%) of 1161 plasma samples were UE reactive, of which four (0.34%) were dHCV reactive (in all replicates of UE and dHCV). Of 2912 anti-HCV-reactive donation samples testing NAT-nonreactive via routine MP-NAT, three (0.1%; 95% CI: 0.04-0.30) were dHCV reactive; 37% of the remaining samples were reactive by a second anti-HCV assay and thus serologically confirmed. Retrospective and prospective analysis in comparison to earlier studies revealed that low-level HCV-RNA reactivity is decreasing over time. The very low HCV-RNA rates may be due to the widespread use of highly effective, direct-acting anti-viral treatments for those diagnosed with HCV infection.

High Frequency Occult Hepatitis B Virus Infection Detected in Non-Resolved Donations Suggests the Requirement of Anti-HBc Test in Blood Donors in Southern China.

BackgroundMost Chinese Blood Centers adopted mini pool (MP) nucleic acid testing (NAT) for HBV screening due to high cost of Individual donation (ID) NAT, and different proportions of MP-reactive but ID-non-reactive donations (MP+/ID−, defined as non-resolved donations) have been observed during daily donor screening process. Some of these non-resolved donations are occult HBV infections (OBIs), which pose potential risk of HBV transmission if they are not deferred. This study is aimed to further analyze these non-resolved donations.MethodsThe non-resolved plasma samples were further analyzed by serological tests and various HBV DNA amplification assays including quantitative PCR (qPCR) and nested PCR amplifying the basic core and pre-core promoter regions (BCP/PC; 295 base pairs) and HBsAg (S) region (496 base pairs). Molecular characterizations of HBV DNA+ non-resolved samples were determined by sequencing analysis.ResultsOf 17,226 MPs from 103,356 seronegative blood donations, 98 MPs were detected reactive for HBV. Fifty-six out of these 98 (57.1%) reactive MPs were resolved as HBV DNA+, but the remaining 42 pools (42.9%, 252 donations) were left non-resolved with a high rate (53.2%) of anti-HBc+. Surprisingly, among 42 non-resolved MPs, 17 contained one donation identified as OBIs by alternative NAT assays. Sequence analysis on HBV DNAs extracted from these OBI donations showed some key mutations in the S region that may lead to failure in HBsAg detection and vaccine escape.ConclusionA total of 53.2% of the non-resolved donations were anti-HBc+, and OBIs were identified in 40.5% of these non-resolved pools. Therefore, non-resolved donations with anti-HBc+ might pose potential risk for HBV transmission. Our present analysis indicates that anti-HBc testing in non-resolved donations should be used to identify OBIs in order to further increase blood safety in China.

Minipool testing for SARS-CoV-2 RNA in United States blood donors.

SARS-CoV-2 RNA prevalence in blood donors from large geographic areas of high community transmission is limited. We tested residual donor plasma minipools (MPs) to determine SARS-CoV-2 RNAemia prevalence in six United States areas. Blood donations collected from 7 March 2020 to 25 September 2020 were tested for SARS-CoV-2 RNA (vRNA) in MP of 6 or 16 donations using the Grifols Procleix SARS-CoV-2 research-use only (RUO) transcription-mediated amplification (TMA) assay. Reactive results were confirmed using an alternate target region TMA assay. Reactive MPs were tested by TMA after serial dilution to estimate viral load. Testing for anti-SARS-CoV-2 antibodies and infectivity was performed. A total of 17,995 MPs corresponding to approximately 258,000 donations were tested for vRNA. Three confirmed reactive MP16 were identified. The estimated prevalence of vRNA reactive donations was 1.16/100,000 (95% CI 0.40, 3.42). The vRNA-reactive samples were non-reactive for antibody, and the estimated viral loads of the (presumed single) positive donations within each MP ranged from <1000 to <4000 copies/ml. When tested, no infectivity was observed in inoculated permissive cell cultures. Blood donation MP-nucleic acid testing (NAT) indicated that SARS-CoV-2 RNAemia is infrequent and, when detected, the vRNA was at low concentrations. Only one RNA-reactive MP could be tested for infectivity for operational reasons and was not infectious in cell culture. These findings support current recommendations from international and national regulatory agencies to not screen donors by NAT.

Astrovirus Outbreak in an Animal Shelter Associated With Feline Vomiting.

An outbreak of cat vomiting was observed in an animal shelter. Testing for known enteric feline pathogens did not identify a causative agent. Viral metagenomics on four mini pools of feces from cases and controls housed in the same area revealed the presence of feline astrovirus in all pools. Also found with fewer reads in one pool each were rotavirus I, carnivore bocaparvovirus 3, norovirus (NoV) GVI, and a novel dependovirus. The genome of the highly prevalent astrovirus was sequenced and classified into mamastrovirus species two, also known as feline astrovirus. Real-time RT-PCR on longitudinally acquired fecal samples from 11 sick cases showed 10 (91%) to be shedding astrovirus for as long as 19 days. Affected cats were sick for an average of 9.8 days, with a median of 2.5 days (range = 1–31 days). Unaffected control cats housed in the same areas during the outbreak showed five out of nine (56%) to also be shedding astrovirus. Feline fecal samples collected from the same animal shelter ~1 year before (n = 8) and after (n = 10) showed none to be shedding astrovirus, indicating that this virus was temporarily associated with the vomiting outbreak and is not part of the commensal virome for cats in this shelter. Together with the absence of highly prevalent known pathogens, our results support a role for feline astrovirus infection, as well as significant asymptomatic shedding, in an outbreak of contagious feline vomiting.

No evidence of SARS-CoV-2 RNA among blood donors: A multicenter study in Hubei, China.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA could be detected in the blood of infected cases. From February 9, all blood establishments in Hubei province, China, implemented nucleic acid testing (NAT) for SARS‐CoV‐2 RNA among blood donors to ensure blood safety.Study Design and MethodsNucleic acid test screening individually (ID) or by minipool (MP) testing was performed according to the manufacturerʼs instructions. Inactivated culture supernatant of SARS‐CoV‐2–infected Vero cells was quantified by droplet digital polymerase chain reaction (ddPCR) and series diluted with negative plasma to evaluate the assayʼs performance.ResultsThe limit of detection of the kit for MP testing was 62.94 and 33.14 copies/mL for N and ORF1ab region, respectively. ID testing could achieve 3.87 and 4.85 copies/mL for two regions using 1600 μL of plasma. Coefficients of variations of two different concentrations of reference samples were all less than 5% in MP testing. As of April 30, 2020, a total of 98,342 blood donations including 87,095 whole blood donations and 11,247 platelet donations were tested by ID or MP testing, and no RNAemia was found. In addition, Hubei province suffered precipitously decreased blood supply, especially in February: 86% reduction compared with the same period of 2019.ConclusionNucleic acid test screening of SARS‐CoV‐2 on blood donations is suitable in blood establishments using the commercial real‐time PCR detection kit based on available instruments. The negative result indicated that SARS‐CoV‐2 appears to be no direct threat to blood safety but raises some serious issues for general blood supply.

Predictive model for Zika virus RNA minipool nucleic acid testing in outbreak scenarios.

Zika virus (ZIKV), a mosquito-borne flavivirus, causes asymptomatic infections in blood donors and can be transmitted by transfusion. During the 2016 US outbreak, universal individual-donation nucleic acid testing (ID-NAT) was used to screen the blood supply for ZIKV. Testing pooled samples from multiple donations with minipool (MP)-NAT is less sensitive than ID-NAT, which raised questions about its utility in ZIKV outbreaks. A mathematical model and computer simulation determined the risk of missing ID-NAT-reactive and immunoglobulin (Ig) M-negative donations in a ZIKV outbreak if MP-NAT is used initially instead of ID-NAT. The model calculated the time required for ZIKV RNA to replicate to a concentration detectable by testing donations individually or in pools of 6 (MP6) or 16 (MP16). A computer simulation then randomly selected infection times to determine the probability of detection by the candidate tests. The probability of detecting the first ID-NAT-reactive unit in an outbreak is 92% (2.5th-97.5th percentile, 79%-99%) by MP6 and 85% (2.5th-97.5th percentile, 67%-99%) by MP16. When one donation is detected by MP-NAT, the model predicts that the chance of having missed one or more ID-NAT-reactive donations is 8% to 15%. The probability of missing a unit by MP-NAT is constant over the course of the outbreak (8% by MP6, 15% by MP16). The model predicts that the probability that a candidate MP-NAT will detect the first ID-NAT-reactive unit in a ZIKV outbreak is 85% to 92% and remains constant over time.

Blood donor testing for hepatitis B virus in the United States: is there a case for continuation of hepatitis B surface antigen detection?

In the United States, blood donor testing for hepatitis B surface antigen (HBsAg) was initiated in the early 1970s. More recently, testing for antibody to hepatitis B core antigen (anti-HBc) and hepatitis B virus (HBV) DNA have been added. The incidence of hepatitis B has been declining. This study reviews the current status of testing and questions the need for continuation of HBsAg testing. From July 2011 to June 2015, a total of 22.4 million donations were serologically tested for HBsAg and anti-HBc and for HBV-DNA by nucleic acid testing (NAT). All reactive results were evaluated and a subset of donations that were either potential NAT yield (seronegative) or serologically positive but nonreactive by HBV NAT in minipools (MPs) of 16 were further evaluated by individual donation (ID)-NAT. Samples with detectable HBV DNA were defined as actively infected and considered potentially infectious. Routine testing plus supplemental ID-NAT identified 2035 samples representing active infection including 1965 with anti-HBc, 1602 with HBsAg, and 1453 with HBV DNA by MP-NAT, for respective rates per hundred-thousand donations of 9.10, 8.78, 7.16, and 6.50, continuing the downward trend previously observed. There were 29 HBV DNA-yield samples (1:771,389), 35 HBsAg-yield samples (anti-HBc nonreactive), and 404 with occult hepatitis B infection. There were six samples with HBsAg and HBV DNA detectable only by ID-NAT in the absence of anti-HBc; additional testing was consistent with extremely low or negligible levels of DNA. Point estimates of HBV infection rates among blood donors continue to decline, as do those for incidence and residual risk. Elimination of HBsAg screening would have negligible impact, with a risk less than 1 per 4 million donations.

Cost projections for implementation of safety interventions to prevent transfusion-transmitted Zika virus infection in the United States.

In August 2016, the Food and Drug Administration advised US blood centers to screen all whole blood and apheresis donations for Zika virus (ZIKV) with an individual-donor nucleic acid test (ID-NAT) or to use approved pathogen reduction technology (PRT). The cost of implementing this guidance nationally has not been assessed. Scenarios were constructed to characterize approaches to ZIKV screening, including universal ID-NAT, risk-based seasonal allowance of minipool (MP) NAT by state, and universal MP-NAT. Data from the 2015 National Blood Collection and Utilization Survey (NBCUS) were used to characterize the number of donations nationally and by state. For each scenario, the estimated cost per donor ($3-$9 for MP-NAT, $7-$13 for ID-NAT) was multiplied by the estimated number of relevant donations from the NBCUS. Cost of PRT was calculated by multiplying the cost per unit ($50-$125) by the number of units approved for PRT. Prediction intervals for costs were generated using Monte Carlo simulation methods. Screening all donations in the 50 states and DC for ZIKV by ID-NAT would cost $137 million (95% confidence interval [CI], $109-$167) annually. Allowing seasonal MP-NAT in states with lower ZIKV risk could reduce NAT screening costs by 18% to 25%. Application of PRT to all platelet (PLT) and plasma units would cost $213 million (95% CI, $156-$304). Universal ID-NAT screening for ZIKV will cost US blood centers more than $100 million annually. The high cost of PRT for apheresis PLTs and plasma could be mitigated if, once validated, testing for transfusion transmissible pathogens could be eliminated.