Significant Risk Of Transmission Research Articles

1645Do asymptomatic carriers of toxigenic Clostridium difficile identified through inappropriate testing represent a significant risk for transmission?

1645Do asymptomatic carriers of toxigenic Clostridium difficile identified through inappropriate testing represent a significant risk for transmission?

Assessment of ultrasound equipment as a possible source of nosocomial infection in Lagos state hospitals and radio-diagnostic centres

AimTo assess the role of ultrasound equipment as a possible source of nosocomial infection in Lagos metropolis, Nigeria. MethodsMicrobiological cultures were carried out on samples obtained from ultrasound probes, gel and couch before and after scanning period. Cultures were incubated in a culture plate (Chocolate and MacConkey agar) for 48 h at a temperature of 37° in order to grow microorganism, after which the culture plate was examined microscopically against a bright light in order to identify the isolated organisms based on their colonial characteristics. ResultsTransabdominal ultrasound probes, transvaginal probe, ultrasound couch and ultrasound gel all were contaminated with microorganisms. Staphylococcus aureus was the most frequent and most common organisms found (33.8%). Other organisms such as Staphylococcus epidermidis (15.4%), Candida albicans (6.2%), aerobic spore formers (26.2%), Klebsiella pneumonia (6.2%), Pseudomonas aeruginosa (3.1%), among others were also identified. ConclusionThe ultrasound equipment posed a significant risk for infection transmission. Patients who underwent ultrasonography within the period of the study had significant chances of being infected with Staphylococcus aureus, S. epidermidis and Aerobic spore formers.

NEEDLE STICK INJURIES AMONG STAFF NURSES IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA

Background: Percutaneous injuries caused by needlesticks, pose a significant risk of occupational transmission of bloodborne pathogens. Their incidence is considerab ly higher than current estimates, and hence a low i njury rate should not be interpreted as a non existent problem . Aims and Objectives : To Study prevalence of needle Stick injuries amon g staff nurses during patient care and some factors influencing the prevalence of needle stick injury. Methods: Study design- Cross sectional Study, Study setting ‐ Tertiary care hospital in Nagpur. Study duration Aug 2009 to Feb-2011, Sample size ‐ 450 Staff nurses working in hospital involved in patient care directly . Using interview technique information regarding needle st ick injury (NSI) was recorded in predesigned and pr etested proforma. Data was analysed using STATA software. Results: Mean age of Staff nurse was 44.63 + 7.90 years. Maximum nurses were posted in Medicine 18.22%, Surgery (15.56%), OBGY (12.22%). OT 11.78%) and Pediatrics (10%). Mean duration of service is 19.48 + 7.77 years The case incidence of NSIs was 31.78% (143/450). The total number of episodes of NSIs among respondents was 341 (range: 1-5 episodes) with incidence rate o f episodes i.e. 2.39 per person/Year among them. Th e causal devices in 215 cases (63.64%) were hypodermic needles and the main causes of percutaneous injuries wit h hypodermic needles were during injecting drugs (38.4%) and handling sharp wastes (32.9%). Conclusion: Nurses working in Govt Medical College and Hospital Nagpur are frequently exposed to blood-borne infection. NSIs were highly prevalent in these nurs es therefore more intensive education programs shou ld be directed at nurses to increase their awareness of a nd compliance with universal precautions (UP). We recommend a surveillance system and a center for managing injur ed persons.

Measles investigation: A moving target

Measles is a highly contagious respiratory infection with significant transmission risk once thought to be on the verge of elimination. Outbreaks in Europe have resulted in resurgence; however, experience with measles is limited in the United States. We describe the impact of 2 measles cases presenting to our emergency department in May 2011. Exposure criteria were defined and revised. Guidance documents were developed and distributed. Suspect cases were masked and escorted to negative pressure. Lack of prompt IgM and polymerase chain reaction testing resulted in delayed disease confirmation. Computerized flagging systems were established. Exposed individuals were screened to determine the need for prophylaxis. Investigation costs were calculated. A total of 171 patients and visitors and 94 employees met exposure criteria. Employees had proof of immunity to measles. Of these, 43 patients and visitors returned for prophylaxis. No subsequent transmission occurred. The conservative cost for these investigations was $63,176.39. Multiple challenges were identified. Inexperience with measles can result in significant outbreaks. Although transmission did occur at another facility, it was prevented at our facility because of rapid case recognition, isolation, health care worker immunity, and multidisciplinary response. Discordance between the Healthcare Infection Control Practices Advisory Committee and public health guidelines for measles control created unnecessary challenges.

Prevention of measles spread on a paediatric ward.

Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.

The Scarlet H

The Scarlet H

Effects of hormonal contraceptive use on HIV acquisition and transmission among HIV-discordant couples

The risk of HIV associated with hormonal contraceptives is controversial. We assessed hormonal contraceptive use and HIV incidence in HIV-discordant couples in Rakai, Uganda. HIV-discordant couples were retrospectively identified from a cohort between 1999 and 2009. Hormonal contraception included oral contraception, depomedroxyprogesterone acetate (DMPA), and implants (Norplant). Poisson regression estimated adjusted incidence rate ratios (adjIRRs) associated with hormonal contraceptive methods. A case-control subanalysis estimated odds ratios (ORs) of HIV associated with hormonal contraceptive, adjusted for viral load and age. We identified 190 male HIV-positive/female HIV-negative (M+F-) and 159 male HIV- negative/female HIV-positive (M-F+) couples not using antiretroviral therapy or condoms. Female HIV incidence was 5.8/100 person-years (py) among nonhormonal contraceptive users, 12.0/100 py among oral contraceptive users [adjIRR 2.65, 95% confidence interval (CI) 0.82-8.60], 4.5 among Norplant users (adjIRR: 0.89, 95% CI 0.11-7.10), and 7.5/100 py among DMPA users (adjIRR 1.42, 95% CI 0.60-3.36). Male HIV incidence was 7.4/100 py during nonhormonal contraceptive use, 16.5/100 py during female oral contraceptive use (adjIRR 2.52, 95% CI 0.49-12.95), and 4.9/100 py with DMPA use (adjIRR 0.57, 95% CI 0.19-1.70). The number of female seroconverters was three among oral contraceptive users, one among Norplant users, and seven among DMPA users. Male seroconverters were two during female oral contraceptive use, none with Norplant use, and three with DMPA use. In a nested case-control analysis after adjustment for HIV viral load, the adjOR associated with oral contraceptive use was 1.59 (95% CI 0.32-97.85) for M+F- and 2.11 (95% CI 0.18-25.26) for M-F+ couples. For DMPA use, the adjOR was 1.44 (95% CI 0.46-4.51) for M+F- and 1.40 (95% CI 0.30-6.49) for M-F+ couples. We did not observe significant risk of HIV acquisition or transmission with oral contraceptives or DMPA use in HIV discordant couples, but several point estimates were above 1.0 and statistical power was limited.

Family planning and HIV

This AIDS supplement brings to the forefront the latest advances in family planning/HIV integration research programs and policy. It also offers insights into strategic directions for future investments in this area. Topics include: biomedical and basic science research on the relationship between reproductive health and HIV transmission and disease behavioral research examining contraceptive practices and fertility choices among women and couples affected by HIV implementation science evaluating integrated service delivery innovations and evidence-based recommendations for programming.

Performance of a new oxygen delivery device for potentially infectious critically ill patients

In patients with highly contagious diseases that are spread by respiratory droplets or air-borne particles, the use of high-flow oxygen may carry a significant risk of nosocomial transmission. We tested a new oxygen delivery device designed to address these problems by simulating 108 patients with sepsis and respiratory failure. The device being tested consisted of an airtight mask, a bacterial and viral filter, a T-shaped reservoir (50 and 100 ml) and oxygen delivery tubing connected directly to the mask. When tested with a 50-ml reservoir, a high fractional oxygen concentration was achieved: mean (SD) 0.83 (0.11) at a flow of 15 l.min(-1) oxygen. The 50-ml reservoir, when compared with the 100-ml reservoir, was associated with reduced carbon dioxide rebreathing (mean (SD) inspired fractional carbon dioxide concentration 2.5 (1.0) vs 3.0 (1.1), respectively, p = 0.009) and reduced inspiratory resistive work of breathing (mean (SD) 1.0 (0.6) J.l(-1) vs 1.2 (0.5) J.l(-1), respectively, p = 0.028). However, rebreathing and work of breathing were relatively high if a high respiratory rate was simulated. We conclude that the novel oxygen device we describe, equipped with the 50-ml T-shaped reservoir, is suitable for potentially infectious patients with type-1 respiratory failure but without marked tachypnoea.

Infectious agent screening in canine blood donors in the United Kingdom

Transfusion of blood products is an important component of veterinary emergency medicine. Donors must be carefully selected to minimise risk of transmission of blood-borne infectious agents. This study was devised to assess the prevalence of such agents in healthy, non-travelled UK dogs screened as prospective donors. Ethylenediaminetetraacetic acid blood samples from dogs donating blood between August 2007 and January 2012 were screened by polymerase chain reaction for haemotropic mycoplasmas, Bartonella, Babesia, Leishmania, Ehrlichia and Anaplasma spp. Dogs with positive or inconclusive results underwent repeat polymerase chain reaction testing. Four of 262 dogs had positive or inconclusive results at initial screening. Repeat polymerase chain reaction testing in each dog was negative, and none of the dogs developed clinical signs of disease. The positive results on initial screening may have represented false positives from sample contamination or amplification of non-target DNA. It is also possible that dogs were infected at initial sampling but successfully cleared infection before repeat testing. The low number of positive results obtained suggests that prevalence of these agents in a population of healthy UK dogs is low and that use of blood products is unlikely to represent a significant risk of transmission of these diseases.

Outpatient Healthcare Settings and Transmission of Clostridium difficile

BackgroundRecent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI.MethodsWe performed a 6-month prospective study of CDI patients to determine frequency of and risk factors for skin and environmental shedding during outpatient visits and to derive a prediction rule for positive cultures. We performed a point–prevalence culture survey to assess the frequency of C. difficile contamination in outpatient settings and evaluated the frequency of prior outpatient visits in patients with community-associated CDI.ResultsOf 67 CDI patients studied, 54 (81%) had 1 or more outpatient visits within 12 weeks after diagnosis. Of 44 patients cultured during outpatient visits, 14 (32%) had skin contamination and 12 (27%) contaminated environmental surfaces. Decreased mobility, fecal incontinence, and treatment with non-CDI antibiotics were associated with positive cultures, whereas vancomycin taper therapy was protective. In patients not on CDI therapy, a prediction rule including incontinence or decreased mobility was 90% sensitive and 79% specific for detection of spore shedding. Of 84 clinic and emergency department rooms cultured, 12 (14%) had 1 or more contaminated environmental sites. For 33 community-associated CDI cases, 31 (94%) had an outpatient visit during the 12 weeks prior to onset of diarrhea.ConclusionsPatients with recent CDI present a significant risk for transmission of spores during outpatient visits. The outpatient setting may be an underappreciated source of community-associated CDI cases.

Gene Polymorphisms in African Buffalo Associated with Susceptibility to Bovine Tuberculosis Infection

Bovine tuberculosis (BTB) is a chronic, highly infectious disease that affects humans, cattle and numerous species of wildlife. In developing countries such as South Africa, the existence of extensive wildlife-human-livestock interfaces poses a significant risk of Mycobacterium bovis transmission between these groups, and has far-reaching ecological, economic and public health impacts. The African buffalo (Syncerus caffer), acts as a maintenance host for Mycobacterium bovis, and maintains and transmits the disease within the buffalo and to other species. In this study we aimed to investigate genetic susceptibility of buffalo for Mycobacterium bovis infection. Samples from 868 African buffalo of the Cape buffalo subspecies were used in this study. SNPs (n = 69), with predicted functional consequences in genes related to the immune system, were genotyped in this buffalo population by competitive allele-specific SNP genotyping. Case-control association testing and statistical analyses identified three SNPs associated with BTB status in buffalo. These SNPs, SNP41, SNP137 and SNP144, are located in the SLC7A13, DMBT1 and IL1α genes, respectively. SNP137 remained significantly associated after permutation testing. The three genetic polymorphisms identified are located in promising candidate genes for further exploration into genetic susceptibility to BTB in buffalo and other bovids, such as the domestic cow. These polymorphisms/genes may also hold potential for marker-assisted breeding programmes, with the aim of breeding more BTB-resistant animals and herds within both the national parks and the private sector.

Associations Between Perceived Characteristics of the Peer Social Network Involving Significant Others and Risk of HIV Transmission Among Men Who Have Sex with Men in China

The HIV epidemic among men who have sex with men (MSM) in China is severe. Peer can induce risky and preventive behaviors among MSM. We interviewed 220 MSM who had at least one significant other who was a peer MSM (SOPM). Interviews were conducted at two gay venues in Suzhou, China, which reported five HIV-related outcomes: HIV (8.2 %), syphilis (16.4 %), self-reported sexually transmitted infection symptoms (14.6 %), unprotected anal intercourse (UAI; 58.6 %) and having had taken up HIV testing (40.4 %). Adjusting for significant background variables, participants' perceived characteristics of the social network of SOPM, such as practicing risk behavior (e.g. UAI) or preventive behaviors (e.g. HIV antibody testing), or possessing HIV-related perceptions (e.g. dislike in condom use), were significantly associated with some of the five aforementioned outcomes (p < 0.05). Peer education and peer-based interventions involving significant others are hence potentially important in HIV prevention targeting MSM. Future pilot intervention studies are warranted.

Self-reported use of personal protective equipment among Chinese critical care clinicians during 2009 H1N1 influenza pandemic.

BackgroundCritically ill patients with 2009 H1N1 influenza are often treated in intensive care units (ICUs), representing significant risk of nosocomial transmission to critical care clinicians and other patients. Despite a large body of literature and guidelines recommending infection control practices, numerous barriers have been identified in ICUs, leading to poor compliance to the use of personal protective equipment (PPE). The use of PPE among critical care clinicians has not been extensively evaluated, especially during the pandemic influenza. This study examined the knowledge, attitudes, and self-reported behaviors, and barriers to compliance with the use of PPE among ICU healthcare workers (HCWs) during the pandemic influenza.Methodology/Principal FindingsA survey instrument consisting of 36 questions was developed and mailed to all HCWs in 21 ICUs in 17 provinces in China. A total of 733 physicians, nurses, and other professionals were surveyed, and 650 (88.7%) were included in the analysis. Fifty-six percent of respondents reported having received training program of pandemic influenza before they cared for H1N1 patients, while 77% reported to have adequate knowledge of self and patient protection. Only 18% of respondents were able to correctly identify all components of PPE, and 55% reported high compliance (>80%) with PPE use during patient care. In multivariate analysis, vaccination for 2009 H1N1 influenza, positive attitudes towards PPE use, organizational factors such as availability of PPE in ICU, and patient information of influenza precautions, as well as reprimand for noncompliance by the supervisors were associated with high compliance, whereas negative attitudes towards PPE use and violation of PPE use were independent predictors of low compliance.Conclusion/SignificanceKnowledge and self-reported compliance to recommended PPE use among Chinese critical care clinicians is suboptimal. The perceived barriers should be addressed in order to close the significant gap between perception and knowledge or behavior.

Criminalisation and Moral Responsibility for the Sexual Transmission of HIV

The essay that follows is an effort to take on a narrow but important question in a serious, though limited, way. The question is whether there is a MORAL case for lifting primary responsibility for Human immunodeficiency virus (HIV) prevention from the shoulders of those who know they are infected. The question is important because, for many people, it feels so obviously right to require those with HIV to accept this responsibility that punishing them as criminals if they fail to do so seems a natural, logical and entirely fair next step. As far as we can tell, objections to HIV exposure or transmission laws to date have rested on practical, rather than moral concerns. We will ask whether there is a good moral case to be made against criminalisation.There are two important things we will not do. We will not address the use of criminal law to deter or punish people who deliberately expose others to HIV with the aim of causing harm or with callous disregard of a significant risk of transmission. Like other commentators, we regard trying to harm others as wrongful and subject to prosecution regardless of the weapon used; our only concern in such a case, from the HIV perspective, is that a defendant not be punished more harshly only because the chosen weapon was the virus3 The second thing we will not do is attempt a moral analysis that is culturally comprehensive. The people of the world have developed many powerful systems of moral thought. We investigate our moral question within just one, the Western tradition of deontological ethics and liberal political philosophy. Our purpose is not, ultimately, to define for all people and all places a morality of HIV exposure, but to test whether the case for assigning primary moral responsibility for HIV to the person infected is as strong as it is assumed to be.

Successful liver transplantation from a living donor with asymptomatic pulmonary cryptococcosis

Successful liver transplantation from a living donor with asymptomatic pulmonary cryptococcosis

HIV-1 co-receptor usage:influence on mother-to-child transmission and pediatric infection

Viral CCR5 usage is not a predictive marker of mother to child transmission (MTCT) of HIV-1. CXCR4-using viral variants are little represented in pregnant women, have an increased although not significant risk of transmission and can be eventually also detected in the neonates. Genetic polymorphisms are more frequently of relevance in the child than in the mother. However, specific tissues as the placenta or the intestine, which are involved in the prevalent routes of infection in MTCT, may play an important role of selective barriers.The virus phenotype of the infected children, like that of adults, can evolve from R5 to CXCR4-using phenotype or remain R5 despite clinical progression to overt immune deficiency. The refined classification of R5 viruses into R5narrow and R5broad resolves the enigma of the R5 phenotype being associated with the state of immune deficiency. Studies are needed to address more in specific the relevance of these factors in HIV-1 MTCT and pediatric infection of non-B subtypes.

Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial

Breastfeeding is essential for child health and development in low-resource settings but carries a significant risk of transmission of HIV-1, especially in late stages of maternal disease. We aimed to assess the efficacy and safety of triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis in pregnant women infected with HIV. Pregnant women with WHO stage 1, 2, or 3 HIV-1 infection who had CD4 cell counts of 200-500 cells per μL were enrolled at five study sites in Burkina Faso, Kenya, and South Africa to start study treatment at 28-36 weeks' gestation. Women were randomly assigned (1:1) by a computer generated random sequence to either triple antiretroviral prophylaxis (a combination of 300 mg zidovudine, 150 mg lamivudine, and 400 mg lopinavir plus 100 mg ritonavir twice daily until cessation of breastfeeding to a maximum of 6·5 months post partum) or zidovudine and single-dose nevirapine (300 mg zidovudine twice daily until delivery and a dose of 600 mg zidovudine plus 200 mg nevirapine at the onset of labour and, after a protocol amendment in December, 2006, 1 week post-partum zidovudine 300 mg twice daily and lamivudine 150 mg twice daily). All infants received a 0·6 mL dose of nevirapine at birth and, from December, 2006, 4 mg/kg twice daily of zidovudine for 1 week after birth. Patients and investigators were not masked to treatment. The primary endpoints were HIV-free infant survival at 6 weeks and 12 months; HIV-free survival at 12 months in infants who were ever breastfed; AIDS-free survival in mothers at 18 months; and serious adverse events in mothers and babies. Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISRCTN71468401. From June, 2005, to August, 2008, 882 women were enrolled, 824 of whom were randomised and gave birth to 805 singleton or first, liveborn infants. The cumulative rate of HIV transmission at 6 weeks was 3·3% (95% CI 1·9-5·6%) in the triple antiretroviral group compared with 5·0% (3·3-7·7%) in the zidovudine and single-dose nevirapine group, and at 12 months was 5·4% (3·6-8·1%) in the triple antiretroviral group compared with 9·5% (7·0-12·9%) in the zidovudine and single-dose nevirapine group (p=0·029). The cumulative rate of HIV transmission or death at 12 months was 10·2% (95% CI 7·6-13·6%) in the triple antiretroviral group compared with 16·0% (12·7-20·0%) in the zidovudine and single-dose nevirapine group (p=0·017). In infants whose mothers declared they intended to breastfeed, the cumulative rate of HIV transmission at 12 months was 5·6% (95% CI 3·4-8·9%) in the triple antiretroviral group compared with 10·7% (7·6-14·8%) in the zidovudine and single-dose nevirapine group (p=0·02). AIDS-free survival in mothers at 18 months will be reported in a different publication. The incidence of laboratory and clinical serious adverse events in both mothers and their babies was similar between groups. Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV transmission to infants. Revised WHO guidelines now recommend antiretroviral prophylaxis (either to the mother or to the baby) during breastfeeding if the mother is not already receiving antiretroviral treatment for her own health. Agence nationale de recherches sur le sida et les hépatites virales, Department for International Development, European and Developing Countries Clinical Trials Partnership, Thrasher Research Fund, Belgian Directorate General for International Cooperation, Centers for Disease Control and Prevention, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and UNDP/UNFPA/World Bank/WHO Special Programme of Research, Development and Research Training in Human Reproduction.

Eighteen-Month Follow-Up of HIV-1–Infected Mothers and Their Children Enrolled in the Kesho Bora Study Observational Cohorts

To assess the effectiveness and safety of antiretrovirals (ARVs) used for treatment or prophylaxis in a breastfeeding population of HIV-1-infected women (Burkina-Faso, Kenya, South Africa). HIV-1-infected pregnant women with <200 CD4 cells per cubic millimeter or with World Health Organization stage 4 disease (cohort A) and asymptomatic women with >500 CD4 cells per cubic millimeter (cohort B) were enrolled into 2 prospective cohorts. Women with 200-500 CD4 cells per cubic millimeter were enrolled in a parallel randomized trial. Women in cohort A initiated antiretroviral therapy. Women in cohort B received zidovudine from 34 to 36 weeks gestation until delivery, with single-dose nevirapine in labor (cohort B). All children received single-dose nevirapine. Of 248 women enrolled, 111 (cohort A) and 125 (cohort B) infants alive at 24 hours after birth were analyzed. Sixty-nine percent and 42% of women had undetectable viral load at delivery, respectively. Ten children in each cohort died. The 18-month cumulative incidences of HIV-1 infection were 7.5% (95% confidence interval: 3.8% to 14.5%) (cohort A) and 5.8% (2.8% to 11.8%) (cohort B). Sixty-one percent (cohort A) and 78% (cohort B) were breastfed for a median duration of 20 weeks. Four children in cohort A and only 1 in cohort B became HIV-1 infected after 6 weeks of age. Antiretroviral therapy initiated a median of 7 weeks before delivery in women with advanced HIV-1 disease was associated with a significant residual risk of HIV-1 transmission due to insufficient decrease in viral load by the time of delivery. Among women with >500 CD4 cells per cubic millimeter, the risk of breast-milk transmission was very low despite lack of postnatal prophylaxis.

Tissue donation and virus safety: more nucleic acid amplification testing is needed

In tissue and organ transplantation, it is of great importance to avoid the transmission of blood-borne viruses to the recipient. While serologic testing for anti-human immunodeficiency virus (HIV)-1 and -2, anti-hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antigen (HBc), and Treponema pallidum infection is mandatory, there is until now in most countries no explicit demand for nucleic acid amplification testing (NAT) to detect HIV, hepatitis B virus (HBV), and HCV infection. After a review of reports in the literature on viral transmission events, tissue-specific issues, and manufacturing and inactivation procedures, we evaluated the significance of HIV, HCV, and HBV detection using NAT in donors of various types of tissues and compared our results with the experiences of blood banking organizations. There is a significant risk of HIV, HCV, and HBV transmission by musculoskeletal tissues because of their high blood content and the high donor-recipient ratio. If no effective virus inactivation procedure for musculoskeletal tissue is applied, donors should be screened using NAT for HIV, HCV, and HBV. Serologically screened cardiovascular tissue carries a very low risk of HIV, HCV, or HBV transmission. Nevertheless, because effective virus inactivation is impossible (retention of tissue morphology) and the donor-recipient ratio may be as high as 1:10, we concluded that NAT should be performed for HIV, HCV, and HBV as an additional safety measure. Although cornea allografts carry the lowest risk of transmitting HIV, HCV, and HBV owing to corneal physiology, morphology, and the epidemiology of corneal diseases, NAT for HCV should still be performed. If the NAT screening of a donor for HIV, HCV, and HBV is negative, quarantine storage of the donor tissue seems dispensable. In view of numerous synergistic effects with transfusion medicine, it would be advantageous for tissue banks to cooperate with blood bank laboratories in performing virological tests.