Transfusion-associated Cases Research Articles

In vitro diagnostic methods of Chagas disease in the clinical laboratory: a scoping review.

Chagas disease (CD), caused by Trypanosoma cruzi, is a global health concern with expanding geographical reach. Despite improved and accessible test methods, diagnosing CD in its various phases remains complex. The existence of clinical scenarios, including immunosuppressed patients, transplant-related CD reactivation, transfusion-associated cases, and orally transmitted acute infections, adds to the diagnostic challenge. No singular gold standard test exists for all phases, and recommendations from PAHO and the CDC advocate for the use of two serological methods for chronic CD diagnosis, while molecular methods or direct parasite detection are suggested for the acute phase. Given the complexity in the diagnostic landscape of CD, the goal of this scoping review is to characterize available diagnostic tests for CD in the clinical laboratory. A literature search in PubMed was conducted on studies related to In vitro diagnosis (IVD) in humans published in English, Spanish, or Portuguese language as of 28 August 2023, and extended backward with no predefined time frame. Studies underwent title and abstract screening, followed by full-text review. Studies included were classified based on the diagnostic method used. Test methods were grouped as serological, molecular, and other methods. Performance, availability, and regulatory status were also characterized. Out of 85 studies included in the final review, 115 different tests were identified. These tests comprised 89 serological test types, 21 molecular test types, and 5 other test methods. Predominant serological tests included ELISA (38 studies, 44.70%), Rapid tests (19 studies, 22.35%), and chemiluminescence (10 studies, 11.76%). Among molecular tests, Polymerase Chain Reaction (PCR) assays were notable. Twenty-eight tests were approved globally for IVD or donor testing, all being serological methods. Molecular assays lacked approval for IVD in the United States, with only European and Colombian regulatory acceptance. Serological tests, specifically ELISAs, remain the most used and commercially available diagnostic methods. This makes sense considering that most Chagas disease diagnoses occur in the chronic phase and that the WHO gold standard relies on 2 serological tests to establish the diagnosis of chronic Chagas. ELISAs are feasible and relatively low-cost, with good performance with sensitivities ranging between 77.4% and 100%, and with specificities ranging between 84.2% and 100%. Molecular methods allow the detection of specific variants but rely on the parasite's presence, which limits their utility to parasitemia levels. Depending on the PCR method and the phase of the disease, the sensitivity ranged from 58.88 to 100% while the mean specificity ranged from 68.8% to 100%. Despite their performance, molecular testing remains mostly unavailable for IVD use. Only 3 molecular tests are approved for IVD, which are available only in Europe. Six commercial serological assays approved by the FDA are available for blood and organ donor screening. Currently, there are no guidelines for testing CD oral outbreaks. Although more evidence is needed on how testing methods should be used in special clinical scenarios, a comprehensive approach of clinical assessment and diagnostics tests, including not IVD methods, is required for an accurate CD diagnosis.

Risk of variant Creutzfeldt-Jakob disease in a simulated cohort of Canadian blood donors.

No transfusion-associated cases of variant Creutzfeldt-Jakob disease (vCJD) have occurred in more than 20 years. Yet, many countries have maintained blood donor deferral criteria for vCJD. We developed a risk simulation model to reassess the need for vCJD-related deferral criteria in Canada. The model provides results separately for Héma-Québec (HQ) and Canadian Blood Services (CBS). The model used a Monte Carlo simulation approach to estimate the risk of having a vCJD-contaminated blood donation ('risk of vCJD') in a simulated cohort of 10 million donors followed for up to 85 years. The model assumed current deferral criteria for vCJD were lifted, which would allow new 'at-risk' donors to give blood. The model accounted for disease prevalence, donors' travel/immigration history, PRNP genotype at codon 129, demographics and the type of labile blood product. In the base case, the risk of vCJD was estimated at zero at both blood services. In the most pessimistic scenario, the risk of vCJD was 6.4 × 10-9 (i.e., 1 in 157 million donations) at HQ, or ≤1 in 77 million based on the upper bound of the 95% confidence interval (CI). At CBS, this risk was 4.8 × 10-8 (i.e., 1 in 21 million donations), or ≤1 in 16 million based on the upper bound of the 95% CI. vCJD poses minimal risks to the Canadian blood supply. Current vCJD deferral criteria may, therefore, be lifted with virtually no impact on safety, while significantly expanding the donor base.

Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States.

Ehrlichiosis and anaplasmosis are emerging tickborne diseases that can also be transmitted through blood transfusions or organ transplants. Since 2000, ehrlichiosis and anaplasmosis cases in the United States have increased substantially, resulting in potential risk to transplant and transfusion recipients. We reviewed ehrlichiosis and anaplasmosis cases among blood transfusion and solid organ transplant recipients in the United States from peer-reviewed literature and Centers for Disease Control and Prevention investigations. We identified 132 cases during 1997-2020, 12 transfusion-associated cases and 120 cases in transplant recipients; 8 cases were donor-derived, and in 13 cases illness occurred <1 year after transplant. Disease in the remaining 99 cases occurred ≥1 year after transplant, suggesting donor-derived disease was unlikely. Severe illness or death were reported among 15 transfusion and transplant recipients. Clinicians should be alert for these possible infections among transfusion and transplant recipients to prevent severe complications or death by quickly treating them.

Babesiosis surveillance, new jersey, USA, 2006-2011.

Babesiosis surveillance, new jersey, USA, 2006-2011.

Uncertainty in the Tail of the Variant Creutzfeldt-Jakob Disease Epidemic in the UK

Despite low case numbers the variant Creutzfeldt-Jakob disease epidemic poses many challenges for public health planning due to remaining uncertainties in disease biology and transmission routes. We develop a stochastic model for variant CJD transmission, taking into account the known transmission routes (food and red-cell transfusion) to assess the remaining uncertainty in the epidemic. We use Bayesian methods to obtain scenarios consistent with current data. Our results show a potentially long but uncertain tail in the epidemic, with a peak annual incidence of around 11 cases, but the 95% credibility interval between 1 and 65 cases. These cases are predicted to be due to past food-borne transmissions occurring in previously mostly unaffected genotypes and to transmissions via blood transfusion in all genotypes. However, we also show that the latter are unlikely to be identifiable as transfusion-associated cases by case-linking. Regardless of the numbers of future cases, even in the absence of any further control measures, we do not find any self-sustaining epidemics.

Congenital Babesiosis in a Four-Week-Old Female Infant

To the Editors: Babesia, a tick-borne intraerythrocytic protozoa, is most commonly acquired after exposure to the Ixodes scapularis tick, or less commonly, via blood transfusion.1 In neonates, the course of illness ranges from mild to severe disease, requiring hospitalization, antibiotics, and blood transfusion.2 Only 3 cases of congenital babesiosis and 8 cases of acquired neonatal babesiosis (associated with blood transfusion or tick bite) have thus far been reported.2–6 In 2006, Fox et al2 reported a case of transfusion-associated neonatal babesiosis and reviewed 9 other cases, including 5 transfusion-associated cases. Of these 5 babies, 4 were preterm infants who received blood transfusions for anemia of prematurity. The other cases included 2 congenital3,4 cases and 2 tick transmitted cases.5 Recently there was a probable case of congenital babesiosis in a neonate with 15% parasitemia requiring blood transfusion.6 None of these 11 cases required exchange blood transfusion. Although all reported cases did well once identified and treated, this illness is potentially fatal if not identified. We evaluated a full term 4-week-old baby with a 1-day history of fever to 38.8°C. There was no history of tick bites and no history of maternal blood transfusion. Physical examination revealed fever and mild pallor. A complete blood count revealed anemia (hematocrit 24.3%). Her platelet count was clumped, which triggered doing a peripheral blood smear, revealing intraerythrocytic parasites, identified as Babesia microti. The parasite count was 2% and liver function tests were mildly elevated. Repeat platelet count was 101 × 103/mm3. She had been initially started on IV ampicillin and cefotaxime for presumed sepsis. Once the parasites were identified, the antibiotics were switched to oral atovaquone (40 mg/kg/d divided q 12 hours) and azithromycin (10 mg/kg/d). She subsequently defervesced and the parasite count decreased to 0.2%. Anemia worsened over 2 days (hematocrit 17.3%), requiring readmission for a red blood cell transfusion. The mother's serum Babesia polymerase chain reaction (PCR) was positive. At that time, she had a normal CBC, was asymptomatic, and therefore was not treated. Most cases of babesiosis in the United States are endemic to the Northeastern states, the majority occurring in adults. There have been few reported cases of neonatal babesiosis, perhaps related to a lack of recognition or severity of this infection in this age group. The advent of newer molecular diagnostic tools, such as Babesia PCR, may herald increased identification of cases of neonatal babesiosis. Recommended treatments for babesiosis include clindamycin and quinine; or azithromycin and atovaquone for 7 to 10 days; the latter combination is more effective in adults and has fewer adverse effects.2,4 The safety and efficacy of these combinations have not been evaluated in infants, but atovaquone and azithromycin therapy is well tolerated in HIV infected children.7 Exchange blood transfusion may be potentially life saving in patients with severe disease, high parasitemia (>10%), significant hemolysis, renal or pulmonary involvement, findings rarely present in reported infections in infants. It is important that physicians keep babesiosis in mind as a differential diagnosis of fever in neonates in endemic areas, especially if infants present with hemolytic anemia with or without thrombocytopenia. Omolara Aderinboye, MD Salma S. Syed, DO Division of Infectious Diseases, Department of Pediatrics, SUNY at Stony Brook Stony Brook, NY

The risk of dengue transmission by blood during a 2004 outbreak in Cairns, Australia

Dengue virus (DENV) is a Flavivirus transmitted by the Aedes mosquito. The related arbovirus, West Nile virus, has been shown to be transfusion transmitted, which, added to the four recorded dengue transfusion-associated cases, indicates that DENV is also transfusion transmitted. The purpose of this study was to assess the risk of transfusion-transmitted DENV during a 2004 outbreak in the Australian city of Cairns. A mathematical model was constructed to estimate the risk of transfusion-transmitted dengue. The model's central premise is that the transmission risk is proportional to the frequency of dengue-viremic donations and correlates with the incidence of asymptomatic dengue viremia among the population at large. The modeling predicted that the total number of DENV infections (clinical plus subclinical) among the population at large during the entire outbreak ranged from 156 to 569 with the epidemic peak occurring between February 8 and March 6, 2004. The overall transmission risk during the entire outbreak was estimated as 1 in 19,759 (range, 1 in 3404 to 75,486) peaking at 1 in 5968 (range 1 in 1028 to 22,800). By use of the most conservative estimates for key variables, the risk of collecting a viremic donation could have been as high as 1 in 1028 during the peak of the 2004 outbreak. The model can be used to determine transfusion transmission risk levels during DENV outbreaks and inform decisions as to when fresh component restriction measures are required to minimize transfusion transmission risk.

&lt;emph type="ital"&gt;Anaplasma phagocytophilum&lt;/emph&gt; Transmitted Through Blood Transfusion—Minnesota, 2007

Anaplasma phagocytophilum, a gram-negative, obligate intracellular bacterium of neutrophils, causes human anaplasmosis, a tickborne rickettsial disease formerly known as human granulocytic ehrlichiosis. In November 2007, the Minnesota Department of Health was contacted about A. phagocytophilum infection in a hospitalized Minnesota resident who had recently undergone multiple blood transfusions. Subsequent investigation indicated the infection likely was acquired through a transfusion of red blood cells. This report describes the patient's clinical history and the epidemiologic and laboratory investigations. Although a previous case of transfusion-transmitted anaplasmosis was reported, this is the first published report in which transfusion transmission of A. phagocytophilum was confirmed by testing of the recipient and a donor. Although polymerase chain reaction (PCR) assays provided reliable evidence of transmission in this case, no cost-effective method for screening blood donors for A. phagocytophilum exists. Screening donors for a recent history of tick bite is not likely to be sensitive or specific because such exposures are common and often not recalled by persons with anaplasmosis. Physicians should consider the possibility of anaplasmosis in patients who develop posttransfusion acute thrombocytopenia, especially if accompanied by fever, and should report suspected transfusion-associated cases to health authorities.

Hepatitis after blood transfusion in inpatients. Post-transfusion hepatitis, or infection of other etiology?

Hepatitis after a transfusion of blood products is often uncritically called post-transfusion hepatitis (PTH). It was the aim of this study to ascertain in how many reported cases of suspected PTH a causal relationship between transfusion and the infection in the recipient can be proven. Full investigations (look-back method) were made of 23 cases of PTH reported in the 10-year period of 1987-1997 (11 cases of PTH B and 12 of PTH non-A-non-B or C). The recipients had been given a mean of 7.7 blood components (range 1-57). The clinical diagnosis had been made a mean of 5.2 (range 1-27) months after transfusion. One case each of hepatitis B and C had been caused by transfusion of blood products. In 5 of 12 suspected cases of PTH non-A-non-B hepatitis C, PTH could not be definitively excluded (despite absent seroconversion for anti-hepatitis C virus [HCV]), because HCV-RNA findings were not available. In 16 of 23 investigated cases serological and molecular-biological tests firmly excluded PTH B or C. The small number of confirmed cases of PTH indicates that hepatitis that has occurred post-transfusion is frequently due to a cause not related to the transfusion. The number of transfusion-associated cases will be further reduced with the introduction (standard since 1.4.1999) of VCH-RNA screening of donors. This will raise the importance of hepatitis cases not associated with transfusion.

Experimental infection of rhesus macaques with West Nile virus: level and duration of viremia and kinetics of the antibody response after infection.

Reports of transfusion-associated cases of West Nile virus (WNV) infection indicate the need for sensitive screening methods to identify WNV-infected blood products. We experimentally infected 5 rhesus macaques with WNV, to determine the level and duration of viremia, the kinetics of the humoral immune response, and the sensitivity of various assay systems for detecting WNV in blood. All macaques developed subclinical infections with low levels of viremia; nested reverse-transcription polymerase chain reaction was the most sensitive method for detecting virus or viral RNA in blood. Specific WNV antibodies appeared during the second week of infection; the results of an IgM enzyme-linked immunosorbent assay became positive on the ninth or tenth day after infection, followed in 1-2 days by hemagglutination-inhibiting and neutralizing antibodies. Our results suggest that both nucleic acid and serological testing may be needed to determine exposure to WNV and to identify potentially infected blood donors.

New hepatitis virus discovered

In July, DiaSorin (part of the Medical Systems Group of American Standard Companies Inc.) announced the discovery of a new hepatitis virus. The virus could account for up to 80% of transfusion-associated cases of viral hepatitis that cannot be explained by an infection of the currently known hepatitis viruses A to E.Daniele Primi and his research team at the DiaSorin Biomolecular Research Center (Brescia, Italy) discovered the viral candidate when they were screening the blood of AIDS patients for hitherto undetected pathogens. Primi had constructed a library of conserved oligonucleotide sequences that comprise all evolutionary branches of viruses and used these in a degenerate polymerase chain reaction (PCR). Having searched for new pathogens for several years, he found a promising novel nucleotide sequence in the blood of a patient with the initials SEN, but not in healthy controls. Primi cloned and sequenced the so-called SEN-V virus and found that the genome shares less than 50% homology with any known virus. Details of the sequence are to be revealed this month, one year after DiaSorin filed a European patent application.In order to study the prevalence of the virus, Primi and his colleagues developed a PCR assay that selectively amplifies the virus. Using a DNA enzyme immunoassay (DEIA, DiaSorin), the amplicons can be hybridized to selected probes. Preliminary evidence suggested that the virus might be involved in viral hepatitis of unknown origin (hepatitis non-A–E). The investigation of coded blood samples sent by Harvey Alter at the National Institutes of Health (NIH; Bethesda, MD, USA) confirmed this. Ten out of 12 blood-transfused patients with non-A–E hepatitis were found to be SEN-V-positive compared with 4 out of 50 transfused and 1 out of 49 not-transfused controls. Further data suggest that the virus can co-infect patients who have other types of viral liver disease and can establish both acute and chronic infection. ‘The discovery closes the gap in the search for a hepatitis agent,’ says Jorge Leon, Chief Scientific Officer for the Medical Systems Group of American Standard Companies. ‘We also have evidence that the virus might be involved in liver cancer, which is a fascinating finding.’Despite this excitement, the company faces criticism for not having published the results in a peer-reviewed scientific journal. Leon explains that corporate responsibility to shareholders and regulatory requirements led to the decision to approach the media first before presenting detailed results to the scientific community. However, he adds ‘We do not want to make this a mere company issue. We are currently approaching the Centers for Disease Control and Prevention [CDC; Atlanta, GA, USA] and the Canadian Red Cross in order to achieve a collaboration, and we also plan to contact research centres in Italy and France.’ The American Red Cross has already provided more than 3000 blood samples to expand the clinical database. Moreover, the Medical Systems Group of American Standard Companies is transferring the PCR assay to Alter so that the results can be reproduced at the NIH.Research at DiaSorin is now concentrating on the isolation and physico-chemical characterization of the virus. Primi aims to prove the transmissibility and the pathogenicity of the virus, and his team is working on the development of a serology-based diagnostic test. An expression library of viral open-reading-frames was cloned in Escherichia coli, and the task now is to identify which of the viral proteins are relevant to the immune response.

Hepatitis C in a French population-based survey, 1994: seroprevalence, frequency of viremia, genotype distribution, and risk factors. The Collaborative Study Group.

The aims of this study were the following: 1) to estimate the prevalence of hepatitis C virus (HCV) antibody (anti-HCV) in a population-based survey of French residents not selected for risk factors; 2) to investigate the association between anti-HCV seropositivity, viremia, the infecting HCV genotype, and the alanine transaminase (ALT) level; and 3) to identify risk factors for HCV infection by a nested case control study within this survey sample. The anti-HCV seroprevalence survey was performed in 6,283 volunteers (20- to 59-years-old) randomly selected from 45,377 consecutive individuals undergoing routine medical checkup in social security medical centers covering 4 of the 22 "regions" of France. Seventy-two volunteers were anti-HCV positive, a crude prevalence of 1.15%. Fifty percent of these positive volunteers also had an abnormal ALT level and 81% were HCV-RNA positive by polymerase chain reaction (PCR). The prevalence weighted for age, sex, and place of residence was 1.05% (95% CI: 0.75-1.34). The weighted prevalence was lower among men > 40-years-old (0.5%; 95% CI: 0.1-1.0) and was close to 1% in all other age and sex groups. Prevalence was inversely correlated with socioprofessional status with the highest rate being found among those with no paid employment (2.2%; 95% CI: 1.3-3.0). The HCV prevalence (1.7%; 95% CI: 1.0-2.3) was highest in southeastern France. Seventy-eight percent of positive intervenous (I.V.) drug abusers were infected with HCV genotypes 1a or 3, whereas 80% of the transfusion-associated cases were infected by HCV genotypes 1b or 2a. Only three variables were significantly associated with HCV seropositivity in multivariate analysis: I.V. drug abuse (21 cases, 14 men all < 40-years-old), previous transfusion (22 cases, 18 women), and not having paid employment. Although routes of transmission other than I.V. drug abuse and transfusion may not be formally excluded they were not found to be statistically significant. Hepatitis C appears to be a major public health concern in France. A more active screening policy may be required because only 17 of 72 cases (24%) were aware of their HCV seropositivity before enrollment in the study.

Prevalence and disease association of hepatitis G virus infection in Japan.

A reverse transcriptase-polymerase chain reaction procedure (RT-PCR) for the detection of hepatitis G virus (HGV) RNA was used to examine the prevalence of HGV infection and HGV-related disease in Japan. Among 48 patients with acute non-A, B, C, D, E (non-A-E) hepatitis (five transfusion-associated cases and 43 sporadic cases), only one patient (2%), a transfusion recipient, was HGV RNA positive. Similarly, among 50 patients with established chronic non-A-E hepatitis, only two (4%) were positive for HGV RNA. These frequencies were not significantly different from those in 129 voluntary blood donors (0.8%). By contrast, HGV infection was relatively common among patients who were also infected with other hepatitis viruses. HGV co-infection or superinfection was found in seven of 53 (13%) patients with acute hepatitis C, in 15 of 126 (12%) patients with chronic hepatitis C, in three of 21 (14%) patients with acute hepatitis B and in four of 81 (5%) patients with chronic hepatitis B. Among the 29 dually infected patients, 15 (52%) had a history of blood transfusion. HGV was also detected in seven (10%) of 69 haemodialysis patients, of whom only one had a dual infection with hepatitis C virus (HCV) and an elevated aminotransferase level. HGV RNA was found in only a low percentage of patients with either acute or chronic non-A-E hepatitis: HGV appears to co-infect or superinfect in 10-15% of HCV infections and in 5-15% of HBV infections; the prevalence of HGV infection (0.8%) among voluntary blood donors in Japan is similar to that for HCV infection; a history of blood transfusion was obtained in 22 (55%) of the total 40 HGV-positive subjects; and isolated HGV infection appears to have a low disease burden.

Lichen planus and hepatitis C virus infection: An epidemiologic study

Hepatitis C virus (HCY) accounts for the majority of transfusion-associated cases of hepatitis. Parenteral transmission is well documented, especially in intravenous drug users. A low level of sexual transmission is also probable. The prevalence of HCY antibodies is constant worldwide and ranges from 0.3% to 1.5%.1 Because blood donors are now screened for HCY antibodies, the risk of posttransfusion hepatitis is declining.2 Many cutaneous eruptions associated with hepatitis A and B have been described, such as purpura, dermatomyositis-like syndrome, periarteritis nodosa, and Giannotti-Crosti syndrome. 3, 4 Essential mixed cryoglobulinemiaand porphyria cutanea tarda'' are strongly associated with HCY infection. Isolated cases of erythema multiforme.? erythema nodosum, and urticaria? associated with HCY infection have been reported, but they could be fortuitous because no controlled study has ever shown a significant association of these diseases with HCV infection. The association of chronic hepatitis with lichen planus was established by several studies, especially in Italian patients; LO recently, a few cases of concomitant lichen planus and HeV infection have been described.U'I Lichen planus is considered by certain authors as a possible marker of an HCY infection, but the link between these diseases has not been clearly established. We describe a prospective case-controlled study of the prevalence of HCY antibodies in a group of 52 patients with lichen planus.

Trends in transfusion-associated acquired immune deficiency syndrome in the United States, 1982 through 1991.

To evaluate the efficacy of measures for preventing the transmission of human immunodeficiency virus (HIV) by blood transfusion, trends in transfusion-associated cases of acquired immune deficiency syndrome (AIDS) reported through June 1992 were analyzed. By year of transfusion, cases rose from 56 in 1978 to 714 in 1984, dropped sharply to 288 in 1985 when screening of donated blood for HIV antibody began, and fell below 20 per year from 1986 through 1991. Reinvestigation of a sample of cases suggested that only one-fourth of those attributed in the trends analysis to post-1985 United States transfusions actually were due to that source. By year of AIDS diagnosis, cases climbed from 14 in 1982 to 824 in 1987 and subsequently remained relatively level. Of cases diagnosed in 1991 with known transfusion dates, almost all resulted from transfusions received before 1986. Cases in persons aged > or = 65 years at diagnosis fell steeply after 1987, while those in persons aged 45 to 64 years leveled and those in persons aged 25 to 44 years continued to increase; this caused the median age to decrease from 59 in 1986 to 47 in 1991. Thus, screening and other measures have almost completely prevented transmission, but, because of infections acquired before screening began, many cases continue to be diagnosed among increasingly younger persons.

A cohort study of 89 HIV-1 -infected adult patients contaminated by blood products

A hospital-based surveillance of HIV infection was implemented in the Bordeaux Regional University Hospital (France). This reporting system, initiated by the Groupe d'Epidemiologie Clinique du SIDA en Aquitaine, identified and followed-up 89 adult patients with transfusion-associated HIV-1 infection (7.2% of all reported cases). Contamination occurred between August 1981 and June 1985 and diagnosis was made between 1985 and 1989. By 30 June 1990, 43 patients (48.3%) had full-blown AIDS, and 28 of them had died. The mean follow-up period was 66 months (s.d. 16 months). The mean incubation period, i.e. The time interval between the contaminating transfusion and the development of full-blown AIDS, was 62 months [median 73 months; 95% confidence interval (CI) 66-82 months]. Five years after contamination, the cumulative probability of reaching the AIDS stage was 34.2% (95% CI 20.3-49.3%), and the probability of survival was 81.7% (95% CI 72.5-90.0%). From this surveillance system we estimate that in south-western France at the end of 1989 the cumulative incidence of transfusion-associated HIV-1 infection was at least 126 cases (45.6 per million inhabitants). Although we anticipate an increase in transfusion-associated AIDS cases over the next 5 years, there have been no reports of contamination after 1 August 1985, when systematic screening of HIV antibodies was implemented in French blood banks. This confirms the efficacy of screening in countries like France where the risk of contamination through blood products is now minimal.

Clinical, virological and epidemiological basis for the treatment of chronic non-A, non-B hepatitis

Non-A, non-B hepatitis is the most common serious complication of blood transfusion and also occurs in a sporadic form whose routes of transmission are currently unknown. While generally mild in its acute presentation, non-A, non-B hepatitis frequently progresses to chronic hepatitis which may eventuate in cirrhosis and hepatocellular carcinoma. The disease is caused by a small, enveloped RNA virus now designated hepatitis C virus, which has similarities to the flaviviruses. Studies using the recently developed antibody assay have indicated that hepatitis C virus is the predominant agent of both transfusion-associated and sporadic non-A, non-B hepatitis. In 50-85% of transfusion-associated cases, a donor can be found who is positive for antibodies to the hepatitis C virus. Current data indicate that these antibodies are present in approx. 0.5% of blood donors in the United States and Europe, 1.5% in Japan and 6% in Africa, as well as in 60-80% of haemophiliacs and intravenous drug abusers and approx. 20% of dialysis patients. With changes in donor selection and transfusion practices, the incidence of transfusion-associated non-A, non-B hepatitis has declined from rates of 5-10% prior to 1985 to estimated current rates of 2-4%. The introduction of the anti-HCV test should effect an additional 50% reduction in transfusion-associated non-A, non-B hepatitis. In addition to these preventive measures, effective therapy now appears at hand in the form of alpha-interferon. The efficacy of other antiviral agents and the potential for combination therapies also need to be explored.

Does Influx From Endemic Areas Mean More Transfusion-Associated Chagas' Disease?

BLOOD BANKS are facing another threat in addition to the hepatitis B and human immunodeficiency viruses (HIV). Two US cases of Chagas' disease have been traced to blood transfusions from asymptomatic donors who carried the causative parasite, Trypanosoma cruzi , from Central or South America, where it is endemic and a major cause of morbidity and mortality. Some experts fear more transfusion-associated cases will be seen unless measures are taken. Looking at Donors A transfusion-related case in California led Peter R. Kerndt, MD, Los Angeles County (Calif) Health Department; Louis V. Kirchhoff, MD, MPH, University of Iowa College of Medicine, Iowa City; and colleagues to survey blood donated at the Los Angeles County-University of Southern California Hospital blood bank, where annually about 40% of the 5000 donors are from Latin America, about half from Chagas' disease endemic areas. In their study of 1000 consecutive blood donors, Kerndt and colleagues found 1

Risk of human immunodeficiency virus infection from blood donors who later developed the acquired immunodeficiency syndrome.

Brief Reports1 January 1987Risk of Human Immunodeficiency Virus Infection from Blood Donors Who Later Developed the Acquired Immunodeficiency SyndromeJOHN W. WARD, M.D., DEBORAH A. DEPPE, B.S., SUSAN SAMSON, M.P.H., HERBERT PERKINS, M.D., PAUL HOLLAND, M.D., LEONOR FERNANDO, M.D., PAUL M. FEORINO, Ph.D, PAUL THOMPSON, M.D., STEVEN KLEINMAN, M.D., JAMES R. ALLEN, M.D.JOHN W. WARD, M.D.Search for more papers by this author, DEBORAH A. DEPPE, B.S.Search for more papers by this author, SUSAN SAMSON, M.P.H.Search for more papers by this author, HERBERT PERKINS, M.D.Search for more papers by this author, PAUL HOLLAND, M.D.Search for more papers by this author, LEONOR FERNANDO, M.D.Search for more papers by this author, PAUL M. FEORINO, Ph.DSearch for more papers by this author, PAUL THOMPSON, M.D.Search for more papers by this author, STEVEN KLEINMAN, M.D.Search for more papers by this author, JAMES R. ALLEN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-106-1-61 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBlood transfusions can transmit the human immunodeficiency virus (HIV; formerly HTLV-III/LAV), the etiologic agent of the acquired immunodeficiency syndrome (AIDS). Because serologic tests to identify HIV-infected persons were not commercially available until 1985, previous studies of HIV transmission via blood transfusion first identified transfusion-associated cases of AIDS and then, retrospectively, the respective blood donors (1-3). The blood donors implicated in HIV transmission have usually been asymptomatic at the time of donation but become viremic years after their donation (4). Thus, previous studies of transfusion-associated HIV infection could not assess the likelihood of HIV transmission from infected donors to recipients.As...

The Presentation by the CDC of Data on AIDS-Reply

In Reply.— Dr Caceres raises several concerns about AIDS patient data reported to the CDC and the ways in which these data are presented. The CDC has long recognized that some AIDS patients have multiple risk factors. 1-3 The patient classification system most commonly used is hierarchical 2-5 because it is both simple and straightforward. It will not always accurately reflect how each individual acquired HTLV-III/lymphadenopathy-associated virus (LAV) infection and AIDS, but it does reflect the most likely route of transmission. 6 For example, a homosexual/bisexual man who had received a blood transfusion may have acquired HTLV-III/LAV infection in a nonsexual way, but for surveillance purposes, would be classified in the homosexual/bisexual group. However, if 5% of the adult population are gay men and if they have the same risk of transfusionassociated AIDS as the rest of the US adult population, 6 then the number of transfusion-associated cases may actually