Last data update: Oct 28, 2024. (Total: 48004 publications since 2009)
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Query Trace: Kuehnert MJ[original query] |
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Notes from the field: Severe bartonella quintana infections among persons experiencing unsheltered homelessness - New York City, January 2020-December 2022
Rich SN , Beeson A , Seifu L , Mitchell K , Wroblewski D , Juretschko S , Keller M , Gnanaprakasam R , Agladze M , Kodama R , Kupferman T , Bhatnagar J , Martines RB , Reagan-Steiner S , Slavinski S , Kuehnert MJ , Bergeron-Parent C , Corvese G , Marx GE , Ackelsberg J . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1147-1148 Bartonella quintana infection is a vectorborne disease transmitted by the human body louse (1). In the United States, homelessness is the principal risk factor for B. quintana infection (2), likely attributable to limited access to hygiene facilities (1). This infection is not nationally notifiable in the United States, and its incidence is unknown. Acute B. quintana infection can cause fever, headache, and bone pain; severe manifestations include chronic bacteremia, bacillary angiomatosis, and infective endocarditis (3). Because the bacterium requires special conditions to grow in culture, standard blood cultures are usually negative (4). Diagnosis by serology is most common; however, cross-reactivity with other Bartonella species (e.g., B. henselae) can hamper interpretation. Molecular assays specific for B. quintana have been developed (5), but availability is limited to a few laboratories. Once diagnosed, infection can be cured by several weeks to months of antibiotic therapy. |
Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: Report of an investigation
Gould CV , Free RJ , Bhatnagar J , Soto RA , Royer TL , Maley WR , Moss S , Berk MA , Craig-Shapiro R , Kodiyanplakkal RPL , Westblade LF , Muthukumar T , Puius YA , Raina A , Hadi A , Gyure KA , Trief D , Pereira M , Kuehnert MJ , Ballen V , Kessler DA , Dailey K , Omura C , Doan T , Miller S , Wilson MR , Lehman JA , Ritter JM , Lee E , Silva-Flannery L , Reagan-Steiner S , Velez JO , Laven JJ , Fitzpatrick KA , Panella A , Davis EH , Hughes HR , Brault AC , St George K , Dean AB , Ackelsberg J , Basavaraju SV , Chiu CY , Staples JE . Lancet Microbe 2023 4 (9) e711-e721 BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. FINDINGS: We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. INTERPRETATION: This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains. FUNDING: US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases. |
Estimating incidence of infection from diverse data sources: Zika virus in Puerto Rico, 2016 (preprint)
Quandelacy TM , Healy JM , Greening B , Rodriguez DM , Chung KW , Kuehnert MJ , Biggerstaff BJ , Dirlikov E , Mier YTeran-Romero L , Sharp TM , Waterman S , Johansson MA . medRxiv 2020 2020.10.14.20212134 Emerging epidemics are challenging to track. Only a subset of cases is recognized and reported, as seen with the Zika virus (ZIKV) epidemic where large proportions of infection were asymptomatic. However, multiple imperfect indicators of infection provide an opportunity to estimate the underlying incidence of infection. We developed a modeling approach that integrates a generic Time-series Susceptible-Infected-Recovered epidemic model with assumptions about reporting biases in a Bayesian framework and applied it to the 2016 Zika epidemic in Puerto Rico using three indicators: suspected arboviral cases, suspected Zika-associated Guillain-Barré Syndrome cases, and blood bank data. Using this combination of surveillance data, we estimated the peak of the epidemic occurred during the week of August 15, 2016 (the 33rd week of year), and 120 to 140 (50% credible interval [CrI], 95% CrI: 97 to 170) weekly infections per 10,000 population occurred at the peak. By the end of 2016, we estimated that approximately 890,000 (95% CrI: 660,000 to 1,100,000) individuals were infected in 2016 (26%, 95% CrI: 19% to 33%, of the population infected). Utilizing multiple indicators offers the opportunity for real-time and retrospective situational awareness to support epidemic preparedness and response.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThe author(s) received no specific funding for this work.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Exemption was obtained from the CDC Human Subjects Research Office as the data were collected as part of regular surveillance activities.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll relevant data are within the manuscript and its Supporting Information files. |
Estimating incidence of infection from diverse data sources: Zika virus in Puerto Rico, 2016
Quandelacy TM , Healy JM , Greening B , Rodriguez DM , Chung KW , Kuehnert MJ , Biggerstaff BJ , Dirlikov E , Mier YTeran-Romero L , Sharp TM , Waterman S , Johansson MA . PLoS Comput Biol 2021 17 (3) e1008812 Emerging epidemics are challenging to track. Only a subset of cases is recognized and reported, as seen with the Zika virus (ZIKV) epidemic where large proportions of infection were asymptomatic. However, multiple imperfect indicators of infection provide an opportunity to estimate the underlying incidence of infection. We developed a modeling approach that integrates a generic Time-series Susceptible-Infected-Recovered epidemic model with assumptions about reporting biases in a Bayesian framework and applied it to the 2016 Zika epidemic in Puerto Rico using three indicators: suspected arboviral cases, suspected Zika-associated Guillain-Barré Syndrome cases, and blood bank data. Using this combination of surveillance data, we estimated the peak of the epidemic occurred during the week of August 15, 2016 (the 33rd week of year), and 120 to 140 (50% credible interval [CrI], 95% CrI: 97 to 170) weekly infections per 10,000 population occurred at the peak. By the end of 2016, we estimated that approximately 890,000 (95% CrI: 660,000 to 1,100,000) individuals were infected in 2016 (26%, 95% CrI: 19% to 33%, of the population infected). Utilizing multiple indicators offers the opportunity for real-time and retrospective situational awareness to support epidemic preparedness and response. |
Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection - U.S. Public Health Service Guideline, 2020.
Jones JM , Kracalik I , Levi ME , Bowman JS3rd , Berger JJ , Bixler D , Buchacz K , Moorman A , Brooks JT , Basavaraju SV . MMWR Recomm Rep 2020 69 (4) 1-16 The recommendations in this report supersede the U.S Public Health Service (PHS) guideline recommendations for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through organ transplantation (Seem DL, Lee I, Umscheid CA, Kuehnert MJ. PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Rep 2013;128:247-343), hereafter referred to as the 2013 PHS guideline. PHS evaluated and revised the 2013 PHS guideline because of several advances in solid organ transplantation, including universal implementation of nucleic acid testing of solid organ donors for HIV, HBV, and HCV; improved understanding of risk factors for undetected organ donor infection with these viruses; and the availability of highly effective treatments for infection with these viruses. PHS solicited feedback from its relevant agencies, subject-matter experts, additional stakeholders, and the public to develop revised guideline recommendations for identification of risk factors for these infections among solid organ donors, implementation of laboratory screening of solid organ donors, and monitoring of solid organ transplant recipients. Recommendations that have changed since the 2013 PHS guideline include updated criteria for identifying donors at risk for undetected donor HIV, HBV, or HCV infection; the removal of any specific term to characterize donors with HIV, HBV, or HCV infection risk factors; universal organ donor HIV, HBV, and HCV nucleic acid testing; and universal posttransplant monitoring of transplant recipients for HIV, HBV, and HCV infections. The recommendations are to be used by organ procurement organization and transplant programs and are intended to apply only to solid organ donors and recipients and not to donors or recipients of other medical products of human origin (e.g., blood products, tissues, corneas, and breast milk). The recommendations pertain to transplantation of solid organs procured from donors without laboratory evidence of HIV, HBV, or HCV infection. Additional considerations when transplanting solid organs procured from donors with laboratory evidence of HCV infection are included but are not required to be incorporated into Organ Procurement and Transplantation Network policy. Transplant centers that transplant organs from HCV-positive donors should develop protocols for obtaining informed consent, testing and treating recipients for HCV, ensuring reimbursement, and reporting new infections to public health authorities. |
A mathematical model to describe survival among liver recipients from deceased donors with risk of transmitting infectious encephalitis pathogens
Smalley HK , Anand N , Buczek D , Buczek N , Lin T , Rajore T , Wacker M , Basavaraju SV , Gurbaxani BM , Hammett T , Keskinocak P , Sokol J , Kuehnert MJ . Transpl Infect Dis 2019 21 (4) e13115 BACKGROUND: Between 2002 and 2013, the organs of thirteen deceased donors with infectious encephalitis were transplanted, causing infections in 23 recipients. As a consequence, organs from donors showing symptoms of encephalitis (increased probability of infectious encephalitis (IPIE) organs) might be declined. We had previously characterized the risk of IPIE organs using data available to most transplant teams and not requiring special diagnostic tests. If the probability of infection is low, the benefits of a transplant from a donor with suspected infectious encephalitis might outweigh the risk and could be lifesaving for some transplant candidates. METHODS: Using organ transplant data and Cox Proportional Hazards models, we determined liver donor and recipient characteristics predictive of post-transplant or waitlist survival and generated 5-year survival probability curves. We also calculated expected waiting times for an organ offer based on transplant candidate characteristics. Using a limited set of actual cases of infectious encephalitis transmission via transplant, we estimated post-transplant survival curves given an organ from an IPIE donor. RESULTS: 54% (1,256) of patients registered from 2002-2006 who died or were removed from the waiting list due to deteriorated condition within 1 year could have had an at least marginal estimated benefit by accepting an IPIE liver with some probability of infection, with the odds increasing to 86% of patients if the probability of infection was low (5% or less). Additionally, 54% (1,252) were removed from the waiting list prior to their estimated waiting time for a non-IPIE liver and could have benefited from an IPIE liver. CONCLUSION: Improved allocation and utilization of IPIE livers could be achieved by evaluating the patient-specific trade-offs between (i) accepting an IPIE liver and (ii) remaining on the waitlist and accepting a non-IPIE liver after the estimated waiting time. This article is protected by copyright. All rights reserved. |
Transfusion-transmitted infections reported to the National Healthcare Safety Network Hemovigilance Module
Haass KA , Sapiano MRP , Savinkina A , Kuehnert MJ , Basavaraju SV . Transfus Med Rev 2019 33 (2) 84-91 Transfusion-transmitted infections (TTIs) can be severe and result in death. Transfusion-transmitted viral pathogen transmission has been substantially reduced, whereas sepsis due to bacterial contamination of platelets and transfusion-transmitted babesiosis may occur more frequently. Quantifying the burden of TTI is important to develop targeted interventions. From January 1, 2010, to December 31, 2016, health care facilities participating in the National Healthcare Safety Network Hemovigilance Module monitored transfusion recipients for evidence of TTI and recorded the total number of units transfused. Facilities use standard criteria to report TTIs. Incidence rates of TTIs, including for bacterial contamination of platelets and transfusion-transmitted babesiosis, are presented. One hundred ninety-five facilities reported 111 TTIs and 7.9 million transfused components to the National Healthcare Safety Network Hemovigilance Module. Of these 111 reports, 54 met inclusion criteria. The most frequently reported pathogens were Babesia spp in RBCs (16/23, 70%) and Staphylococcus aureus in platelets (12/30, 40%). There were 1.95 (26 apheresis, 4 whole blood derived) TTIs per 100000 transfused platelet units and 0.53 TTI per 100000 transfused RBC components, compared to 0.68 TTI per 100000 all transfused components. Bacterial contamination of platelets and transfusion-transmitted babesiosis were the most frequently reported TTIs. Interventions that reduce the burden of bacterial contamination of platelets, particularly collected by apheresis, and Babesia transmission through RBC transfusion would reduce transfusion recipient morbidity and mortality. These analyses demonstrate the value and importance of facility participation in national recipient hemovigilance using standard reporting criteria. |
Evaluation of the National Healthcare Safety Network Hemovigilance Module for transfusion-related adverse reactions in the United States
Edens C , Haass KA , Cumming M , Osinski A , O'Hearn L , Passanisi K , Eaton L , Visintainer P , Savinkina A , Kuehnert MJ , Basavaraju SV , Andrzejewski C . Transfusion 2018 59 (2) 524-533 INTRODUCTION: The National Healthcare Safety Network (NHSN) Hemovigilance Module (HM) collects data on the frequency, severity, and imputability of transfusion-associated adverse events. These events contribute to significant morbidity and mortality among transfusion patients. We report results from the first systematic assessment of eight attributes of the HM. MATERIALS AND METHODS: Standard methods were used to assess the HM. Evaluation data included training materials, system modification history, and facility survey information. A concordance analysis was performed using data from the Baystate Medical Center's (Boston, MA) electronic transfusion reporting system. RESULTS: In 2016, system representativeness remained low, with 6% (277 of 4690) of acute care facilities across 43 jurisdictions enrolled in the HM. In 2016, 48% (2147 of 4453) and 89% (3969 of 4,453) of adverse reactions were reported within 30 and 90 days of the reaction date, respectively, compared to 21% (109 of 511) and 56% (284 of 511) in 2010, demonstrating improved reporting timeliness. Data quality from most reactions was adequate, with 10% (45 of 442) misclassified transfusion-associated circulatory overload reactions, and no incomplete transfusion-transmitted infection data reported from 2010 to 2013. When compared to the Baystate system to assess concordance, 43% (24 of 56) of NHSN-reported febrile reactions were captured in both systems (unweighted kappa value, 0.47; confidence interval, 0.33-0.61). CONCLUSION: Since the 2010 HM pilot, improvements have led to enhanced simplicity, timeliness, and strengthened data quality. The HM serves an important and unique role despite incomplete adoption nationwide. Facility efforts to track and prevent transfusion-associated adverse events through systems like the NHSN HM are a key step toward improving transfusion safety in the United States. |
Assessment of risk for transplant-transmissible infectious encephalitis among deceased organ donors
Smalley HK , Anand N , Buczek D , Buczek N , Lin T , Rajore T , Wacker M , Basavaraju SV , Gurbaxani BM , Hammett T , Keskinocak P , Sokol J , Kuehnert MJ . Transpl Infect Dis 2018 20 (5) e12933 BACKGROUND: There were 13 documented clusters of infectious encephalitis transmission via organ transplant from deceased donors to recipients during 2002-2013. Hence, organs from donors diagnosed with encephalitis are often declined due to concerns about the possibility of infection, given that there is no quick and simple test to detect causes of infectious encephalitis. METHODS: We constructed a database containing cases of infectious and non-infectious encephalitis. Using statistical imputation, cross-validation, and regression techniques, we determined deceased organ donor characteristics, including demographics, signs, symptoms, physical exam, and laboratory findings, predictive of infectious versus non-infectious encephalitis, and developed a calculator which assesses risk of infection. RESULTS: Using up to 12 predictive patient characteristics, (with a minimum of 3, depending on what information is available), the calculator provides the probability that a donor may have infectious versus non-infectious encephalitis, improving the prediction accuracy over current practices. These characteristics include gender, fever, immunocompromised state (other than HIV), cerebrospinal fluid elevation, altered mental status, psychiatric features, cranial nerve abnormality, meningeal signs, focal motor weakness, Babinski's sign, movement disorder, and sensory abnormalities. CONCLUSION: In the absence of definitive diagnostic testing in a potential organ donor, infectious encephalitis can be predicted with a risk score. The risk calculator presented in this paper represents a prototype, establishing a framework that can be expanded to other infectious diseases transmissible through solid organ transplantation. This article is protected by copyright. All rights reserved. |
Modes of transmission of Zika virus
Gregory CJ , Oduyebo T , Brault AC , Brooks JT , Chung KW , Hills S , Kuehnert MJ , Mead P , Meaney-Delman D , Rabe I , Staples E , Petersen LR . J Infect Dis 2017 216 S875-s883 For >60 years, Zika virus (ZIKV) has been recognized as an arthropod-borne virus with Aedes species mosquitoes as the primary vector. However in the past 10 years, multiple alternative routes of ZIKV transmission have been identified. We review the available data on vector and non-vector-borne modes of transmission and interventions undertaken, to date, to reduce the risk of human infection through these routes. Although much has been learned during the outbreak in the Americas on the underlying mechanisms and pathogenesis of non-vector-borne ZIKV infections, significant gaps remain in our understanding of the relative incidence of, and risk from, these modes compared to mosquito transmission. Additional research is urgently needed on the risk, pathogenesis, and effectiveness of measures to mitigate non-vector-borne ZIKV transmission. |
Cost projections for implementation of safety interventions to prevent transfusion-transmitted Zika virus infection in the United States.
Ellingson KD , Sapiano MRP , Haass KA , Savinkina AA , Baker ML , Henry RA , Berger JJ , Kuehnert MJ , Basavaraju SV . Transfusion 2017 57 Suppl 2 1625-1633 BACKGROUND: 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. STUDY DESIGN AND METHODS: 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. RESULTS: 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). CONCLUSION: 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. |
Mycoplasma hominis Infections Transmitted Through Amniotic Tissue Product.
Novosad SA , Basavaraju SV , Annambhotla P , Mohr M , Halpin A , Foy L , Chmielewski R , Winchell JM , Benitez AJ , Morrison SS , Johnson T , Crabb DM , Ratliff AE , Waites K , Kuehnert MJ . Clin Infect Dis 2017 65 (7) 1152-1158 Background: Mycoplasma hominis is a commensal genitourinary tract organism that can cause infections outside the genitourinary tract. We investigated a cluster of M. hominis surgical site infections in patients who underwent spine surgery, all associated with amniotic tissue linked to a common donor. Methods: Laboratory tests of tissue product from the donor, including culture, quantitative real-time PCR (qPCR), and whole genome sequencing were performed. Use of this amniotic tissue product was reviewed. A multi-state investigation to identify additional cases and locate any unused products was conducted. Results: Twenty-seven tissue product vials from a donor were distributed to facilities in seven states; at least 20 vials from this donor were used in 14 patients. Of these, 4/14 (29%) developed surgical site infections, including two M. hominis infections. M. hominis was detected by culture and qPCR in two unused vials from the donor. Sequencing indicated >99% similarity between patient and unopened vial isolates. For five of 27 (19%) vials, the final disposition could not be confirmed. Conclusions: M. hominis was transmitted through amniotic tissue from a single donor to two recipients. Current routine donor screening and product testing does not detect all potential pathogens. Clinicians should be aware that M. hominis can cause surgical site infections, and may not be detected by routine clinical cultures. The lack of a standardized system to track tissue products in healthcare facilities limits the ability of public health agencies to respond to outbreaks and investigate other adverse events associated with these products. |
Supplemental findings from the National Blood Collection and Utilization Surveys, 2013 and 2015
Sapiano MRP , Savinkina AA , Ellingson KD , Haass KA , Baker ML , Henry RA , Berger JJ , Kuehnert MJ , Basavaraju SV . Transfusion 2017 57 Suppl 2 1599-1624 The largest change in RBC use between 2013 and 2015 occurred in surgical settings, with a statistically significant decrease of 41.5%. RBC use was unchanged from 2013 to 2015 in critical care and emergency department settings. There was a statistically significant increase in the number of PLT units used in critical care settings, however, there were no statistically significant changes in PLT use in other settings. | The number of donations and donors presenting for donation have decreased steadily since 2011. In 2013 and 2015, a greater proportion of donors were <18 years of age (13.4% in 2015), ≥65 years of age (12.4% in 2015), and repeat donors (63.6% in 2015). | Prices paid per unit decreased for all major component categories between 2013 and 2015, with statistically significant declines in price paid per unit for leukoreduced red blood cells (median price per unit: $211 in 2015; $221 in 2013), and apheresis PLTs (median price per unit: $524 in 2015; $540 in 2013). Higher surgical volume hospitals paid the lowest prices per unit across component types. | ADDITIONAL FINDINGS | Rates of adverse recipient reactions requiring any diagnostic or therapeutic intervention out of all transfusions were similar between 2013 (1:363) and 2051 (1:373), although there was an increase in the observed rate of reactions that were life threatening (1:41,874 in 2013 and 1:10,925 in 2015). | In 2015, relative parity between donor adverse reaction rates was observed for manual (1:854) and automated (1:786) collections in blood centers and automated collections (1:752) in hospital-based blood centers. There was a higher reaction rate for manual collections (1:237) in hospital-based blood centers. | In 2015, 2% of hospitals and 19% of blood centers reported genotyping for RBC antigens, although at these facilities a small proportion of all units were typed. |
Continued decline in blood collection and transfusion in the United States-2015
Ellingson KD , Sapiano MRP , Haass KA , Savinkina AA , Baker ML , Chung KW , Henry RA , Berger JJ , Kuehnert MJ , Basavaraju SV . Transfusion 2017 57 Suppl 2 1588-1598 BACKGROUND: In 2011 and 2013, the National Blood Collection and Utilization Survey (NBCUS) revealed declines in blood collection and transfusion in the United States. The objective of this study was to describe blood services in 2015. STUDY DESIGN AND METHODS: The 2015 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS: Response rates for the 2015 NBCUS were 78.4% for blood collection centers and 73.9% for transfusing hospitals. In 2015, 12,591,000 units of red blood cells (RBCs) (95% confidence interval [CI], 11,985,000-13,197,000 units of RBCs) were collected, and 11,349,000 (95% CI, 10,592,000-11,747,000) were transfused, representing declines since 2013 of 11.6% and 13.9%, respectively. Total platelet units distributed (2,436,000; 95% CI, 2,230,000-2,642,000) and transfused (1,983,000; 95% CI, 1,816,000 = 2,151,000) declined by 0.5% and 13.1%, respectively, since 2013. Plasma distributions (3,714,000; 95% CI, 3,306,000-4,121,000) and transfusions (2,727,000; 95% CI, 2,594,000-2,859,000) in 2015 declined since 2013. The median price paid per unit in 2015-$211 for leukocyte-reduced RBCs, $524 for apheresis platelets, and $54 for fresh frozen plasma-was less for all components than in 2013. CONCLUSIONS: The 2015 NBCUS findings suggest that continued declines in demand for blood products resulted in fewer units collected and distributed Maintaining a blood inventory sufficient to meet routine and emergent demands will require further monitoring and understanding of these trends. |
Use of blood donor screening data to estimate Zika virus incidence, Puerto Rico, April-August 2016
Chevalier MS , Biggerstaff BJ , Basavaraju SV , Banez Ocfemia MC , Alsina JO , Climent-Peris C , Moseley RR , Chung KW , Rivera-Garcia B , Bello-Pagan M , Pate LL , Galel SA , Williamson P , Kuehnert MJ . Emerg Infect Dis 2017 23 (5) 790-795 Puerto Rico has been heavily impacted by Zika virus, a mosquitoborne flavivirus that emerged in the Americas during 2015. Although most persons with Zika virus show no symptoms, the virus can cause neurologic and other complications, including fetal microcephaly. Local Zika virus transmission in Puerto Rico has been reported since December 2015. To prevent transfusion-associated transmission, local blood collection ceased in March 2016 but resumed in April 2016 after Zika virus screening of blood donations became available. Using data from screening of blood donations collected by the 2 largest blood centers in Puerto Rico during April 3-August 12, 2016, and assuming a 9.9-day duration of viremia, we estimated that 469,321 persons in Puerto Rico were infected during this period, for an estimated cumulative incidence of 12.9%. Results from blood donation screening during arboviral outbreaks can supplement routine clinical and surveillance data for improved targeting of prevention efforts., |
Transmission of hepatitis A virus through combined liver-small intestine-pancreas transplantation
Foster MA , Weil LM , Jin S , Johnson T , Hayden-Mixson TR , Khudyakov Y , Annambhotla PD , Basavaraju SV , Kamili S , Ritter JM , Nelson N , Mazariegos G , Green M , Himes RW , Kuhar DT , Kuehnert MJ , Miller JA , Wiseman R , Moorman AC . Emerg Infect Dis 2017 23 (4) 590-596 Although transmission of hepatitis A virus (HAV) through blood transfusion has been documented, transmission through organ transplantation has not been reported. In August 2015, state health officials in Texas, USA, were notified of 2 home health nurses with HAV infection whose only common exposure was a child who had undergone multi-visceral organ transplantation 9 months earlier. Specimens from the nurses, organ donor, and all organ recipients were tested and medical records reviewed to determine a possible infection source. Identical HAV RNA sequences were detected from the serum of both nurses and the organ donor, as well as from the multi-visceral organ recipient's serum and feces; this recipient's posttransplant liver and intestine biopsy specimens also had detectable virus. The other organ recipients tested negative for HAV RNA. Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to the healthcare workers. |
Three cases of neurologic syndrome caused by donor-derived microsporidiosis
Smith RM , Muehlenbachs A , Schaenmann J , Baxi S , Koo S , Blau D , Chin-Hong P , Thorner AR , Kuehnert MJ , Wheeler K , Liakos A , Jackson JW , Benedict T , da Silva AJ , Ritter JM , Rollin D , Metcalfe M , Goldsmith CS , Visvesvara GS , Basavaraju SV , Zaki S . Emerg Infect Dis 2017 23 (3) 387-395 In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent. |
A model to estimate the probability of human immunodeficiency virus and hepatitis C infection despite negative nucleic acid testing among increased-risk organ donors.
Annambhotla PD , Gurbaxani BM , Kuehnert MJ , Basavaraju SV . Transpl Infect Dis 2017 19 (2) BACKGROUND: In 2013, guidelines were released for reducing the risk of viral bloodborne pathogen transmission through organ transplantation. Eleven criteria were described that result in a donor being designated at increased infectious risk. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission risk from an increased-risk donor (IRD), despite negative nucleic acid testing (NAT), likely varies based on behavior type and timing. METHODS: We developed a Monte Carlo risk model to quantify probability of HIV among IRDs. The model included NAT performance, viral load dynamics and per-act risk of acquiring HIV by each behavior. The model also quantifies the probability of HCV among IRDs by non-medical intravenous drug use (IVDU). RESULTS: Highest risk is among donors with history of unprotected, receptive anal male-to-male intercourse with partner of unknown HIV status (MSM), followed by sex with HIV-infected partner, IVDU, and sex with a commercial sex worker. CONCLUSION: With NAT screening, the estimated risk of undetected HIV remains small even at 1 day following a risk behavior. The estimated risk for HCV transmission through IVDU is likewise small and decreases quicker with time owing to the faster viral growth dynamics of HCV compared with HIV. These findings may allow for improved organ allocation, utilization, and recipient informed consent. |
Zika virus -10 public health achievements in 2016 and future priorities
Oussayef NL , Pillai SK , Honein MA , Ben Beard C , Bell B , Boyle CA , Eisen LM , Kohl K , Kuehnert MJ , Lathrop E , Martin SW , Martin R , McAllister JC , McClune EP , Mead P , Meaney-Delman D , Petersen B , Petersen LR , Polen KN , Powers AM , Redd SC , Sejvar JJ , Sharp T , Villanueva J , Jamieson DJ . MMWR Morb Mortal Wkly Rep 2017 65 (52) 1482-1488 The introduction of Zika virus into the Region of the Americas (Americas) and the subsequent increase in cases of congenital microcephaly resulted in activation of CDC's Emergency Operations Center on January 22, 2016, to ensure a coordinated response and timely dissemination of information, and led the World Health Organization to declare a Public Health Emergency of International Concern on February 1, 2016. During the past year, public health agencies and researchers worldwide have collaborated to protect pregnant women, inform clinicians and the public, and advance knowledge about Zika virus (Figure 1). This report summarizes 10 important contributions toward addressing the threat posed by Zika virus in 2016. To protect pregnant women and their fetuses and infants from the effects of Zika virus infection during pregnancy, public health activities must focus on preventing mosquito-borne transmission through vector control and personal protective practices, preventing sexual transmission by advising abstention from sex or consistent and correct use of condoms, and preventing unintended pregnancies by reducing barriers to access to highly effective reversible contraception. |
Update: Interim guidance for preconception counseling and prevention of sexual transmission of Zika virus for persons with possible Zika virus exposure - United States, September 2016
Petersen EE , Meaney-Delman D , Neblett-Fanfair R , Havers F , Oduyebo T , Hills SL , Rabe IB , Lambert A , Abercrombie J , Martin SW , Gould CV , Oussayef N , Polen KN , Kuehnert MJ , Pillai SK , Petersen LR , Honein MA , Jamieson DJ , Brooks JT . MMWR Morb Mortal Wkly Rep 2016 65 (39) 1077-1081 CDC has updated its interim guidance for persons with possible Zika virus exposure who are planning to conceive and interim guidance to prevent transmission of Zika virus through sexual contact, now combined into a single document. Guidance for care for pregnant women with possible Zika virus exposure was previously published. Possible Zika virus exposure is defined as travel to or residence in an area of active Zika virus transmission (http://www.cdc.gov/zika/geo/index.html), or sex without a condom with a partner who traveled to or lived in an area of active transmission. Based on new though limited data, CDC now recommends that all men with possible Zika virus exposure who are considering attempting conception with their partner, regardless of symptom status, section sign wait to conceive until at least 6 months after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Recommendations for women planning to conceive remain unchanged: women with possible Zika virus exposure are recommended to wait to conceive until at least 8 weeks after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic). Couples with possible Zika virus exposure, who are not pregnant and do not plan to become pregnant, who want to minimize their risk for sexual transmission of Zika virus should use a condom or abstain from sex for the same periods for men and women described above. Women of reproductive age who have had or anticipate future Zika virus exposure who do not want to become pregnant should use the most effective contraceptive method that can be used correctly and consistently. These recommendations will be further updated when additional data become available. |
Update: Ongoing Zika virus transmission - Puerto Rico, November 1, 2015-July 7, 2016
Adams L , Bello-Pagan M , Lozier M , Ryff KR , Espinet C , Torres J , Perez-Padilla J , Febo MF , Dirlikov E , Martinez A , Munoz-Jordan J , Garcia M , Segarra MO , Malave G , Rivera A , Shapiro-Mendoza C , Rosinger A , Kuehnert MJ , Chung KW , Pate LL , Harris A , Hemme RR , Lenhart A , Aquino G , Zaki S , Read JS , Waterman SH , Alvarado LI , Alvarado-Ramy F , Valencia-Prado M , Thomas D , Sharp TM , Rivera-Garcia B . MMWR Morb Mortal Wkly Rep 2016 65 (30) 774-9 Zika virus is a flavivirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes, and infection can be asymptomatic or result in an acute febrile illness with rash. Zika virus infection during pregnancy is a cause of microcephaly and other severe birth defects. Infection has also been associated with Guillain-Barre syndrome (GBS) and severe thrombocytopenia. In December 2015, the Puerto Rico Department of Health (PRDH) reported the first locally acquired case of Zika virus infection. This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico. A confirmed case of Zika virus infection is defined as a positive result for Zika virus testing by reverse transcription-polymerase chain reaction (RT-PCR) for Zika virus in a blood or urine specimen. A presumptive case is defined as a positive result by Zika virus immunoglobulin M (IgM) enzyme-linked immunosorbent assay (MAC-ELISA) and a negative result by dengue virus IgM ELISA, or a positive test result by Zika IgM MAC-ELISA in a pregnant woman. An unspecified flavivirus case is defined as positive or equivocal results for both Zika and dengue virus by IgM ELISA. During November 1, 2015-July 7, 2016, a total of 23,487 persons were evaluated by PRDH and CDC Dengue Branch for Zika virus infection, including asymptomatic pregnant women and persons with signs or symptoms consistent with Zika virus disease or suspected GBS; 5,582 (24%) confirmed and presumptive Zika virus cases were identified. Persons with Zika virus infection were residents of 77 (99%) of Puerto Rico's 78 municipalities. During 2016, the percentage of positive Zika virus infection cases among symptomatic males and nonpregnant females who were tested increased from 14% in February to 64% in June. Among 9,343 pregnant women tested, 672 had confirmed or presumptive Zika virus infection, including 441 (66%) symptomatic women and 231 (34%) asymptomatic women. One patient died after developing severe thrombocytopenia (4). Evidence of Zika virus infection or recent unspecified flavivirus infection was detected in 21 patients with confirmed GBS. The widespread outbreak and accelerating increase in the number of cases in Puerto Rico warrants intensified vector control and personal protective behaviors to prevent new infections, particularly among pregnant women. |
Assuring blood safety and availability: Zika virus, the latest emerging infectious disease battlefront
Kuehnert MJ , Epstein JS . Transfusion 2016 56 (7) 1669-72 Threats to blood safety from infectious agents, and subsequent public health action, are hardly novel. Transfusion transmission of Treponema pallidum, the etiologic agent of syphilis, was recognized in the early 20th century soon after the first successful transfusions, and in response, donor tests for syphilis-related antibodies were introduced.1 Later in the 1960s, hepatitis B virus was found to cause posttransfusion jaundice, and sensitive donor screening tests for hepatitis B surface antigen (HBsAg) were added to donor testing in the early 1970s. The AIDS epidemic in the 1980s presented an entirely new kind of challenge to blood safety, with the need to respond urgently to a newly emerging blood-borne and sexually transmitted infection with catastrophic implications. A massive scientific and public health response to AIDS resulted in discovery of human immunodeficiency virus (HIV) as the etiologic agent and then licensure of blood donor screening tests a year later. Since the emergence of HIV, numerous recognized and emerging blood safety concerns (e.g., human T-lymphotropic virus, hepatitis C virus [HCV], cytomegalovirus, malaria, variant Creutzfeldt-Jakob disease, Chagas disease, and bacterial contamination) have been addressed by a multitiered approach comprising donor deferrals through education and risk factor–based screening with questionnaires; a limited physical examination; use of deferral registries to prevent future unsuitable collections; laboratory testing for markers of infection including nucleic acid tests (NATs) for some agents; and use of pathogen reduction technologies (PRTs) for certain blood components, all within a system highly regulated by the US Food and Drug Administration (FDA). Nevertheless, more recently emerging threats, including arboviruses and parasites, have presented novel challenges related to unpredictable local vector-borne spread and have exposed continued vulnerabilities to blood safety that call for urgent action. |
Transmission of Balamuthia mandrillaris by organ transplantation
Farnon EC , Kokko K , Budge PJ , Mbaeyi C , Lutterloh E , Qvarnstrom Y , da Silva AJ , Shieh WJ , Roy S , Paddock CD , Sriram R , Zaki SR , Visvesvara G , Kuehnert MJ . Clin Infect Dis 2016 63 (7) 878-888 BACKGROUND: During 2009 and 2010, two clusters of organ transplant-transmitted Balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor. METHODS: We investigated all recipients and the two donors through interview, medical record review, and testing of available specimens retrospectively. Surviving recipients were tested and treated prospectively. RESULTS: In the 2009 cluster of illness, two kidney recipients were infected and one died. The donor had Balamuthia encephalitis confirmed on autopsy. In the 2010 cluster, the liver and kidney-pancreas recipients developed Balamuthia encephalitis and died. The donor had a clinical syndrome consistent with Balamuthia infection and serologic evidence of infection. In both clusters, the two asymptomatic recipients were treated expectantly and survived; one asymptomatic recipient in each cluster had serologic evidence of exposure that decreased over time. Both donors had been presumptively diagnosed with other neurologic diseases prior to organ procurement. CONCLUSIONS: Balamuthia can be transmitted through organ transplantation with an observed incubation time of 17-24 days. Clinicians should be aware of Balamuthia as a cause of encephalitis with high rate of fatality, and should notify public health and evaluate transplant recipients from donors with signs of possible encephalitis to facilitate early diagnosis and targeted treatment. Organ procurement organizations and transplant centers should be aware of the potential for Balamuthia infection in donors with possible encephalitis and also assess donors carefully for signs of neurologic infection that may have been misdiagnosed as stroke or as non-infectious forms of encephalitis. |
Screening of blood donations for Zika virus infection - Puerto Rico, April 3-June 11, 2016
Kuehnert MJ , Basavaraju SV , Moseley RR , Pate LL , Galel SA , Williamson PC , Busch MP , Alsina JO , Climent-Peris C , Marks PW , Epstein JS , Nakhasi HL , Hobson JP , Leiby DA , Akolkar PN , Petersen LR , Rivera-Garcia B . MMWR Morb Mortal Wkly Rep 2016 65 (24) 627-8 Transfusion-transmitted infections have been documented for several arboviruses, including West Nile and dengue viruses. Zika virus, a flavivirus transmitted primarily by Aedes aegypti mosquitoes that has been identified as a cause of congenital microcephaly and other serious brain defects, became recognized as a potential threat to blood safety after reports from a 2013-2014 outbreak in French Polynesia. Blood safety concerns were based on very high infection incidence in the population at large during epidemics, the high percentage of persons with asymptomatic infection, the high proportion of blood donations with evidence of Zika virus nucleic acid upon retrospective testing, and an estimated 7-10-day period of viremia. At least one instance of transfusion transmission of Zika virus has been documented in Brazil after the virus emerged there, likely in 2014. Rapid epidemic spread has followed to other areas of the Americas, including Puerto Rico. |
Declining blood collection and utilization in the United States
Chung KW , Basavaraju SV , Mu Y , van Santen KL , Haass KA , Henry R , Berger J , Kuehnert MJ . Transfusion 2016 56 (9) 2184-92 BACKGROUND: The Department of Health and Human Services National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and utilization. STUDY DESIGN AND METHODS: The 2013 Department of Health and Human Services NBCUS is a cross-sectional survey of all US blood collection centers and hospitals as listed in the 2012 American Hospital Association Annual Survey database that perform at least 100 inpatient surgical procedures annually. The study objective was to estimate, with 95% confidence intervals (CIs), the number of blood and blood components collected and transfused in the United States. RESULTS: In 2013, a total of 14,237,000 whole blood and apheresis red blood cell (RBC) units (95% CI, 13,639,000-14,835,000) were collected with 13,395,000 available for transfusion. Of these, 13,180,000 (95% CI, 12,389,000-13,972,000) whole blood and RBC units were transfused. This represented a 4.4% decline in the number of transfused units compared to 2011. Outdated (i.e., expired without being transfused) whole blood and RBC units declined by 17.3%. Apheresis (2,318,000; 95% CI, 2,154,000-2,482,000) and whole blood-derived platelet (PLT; 130,000; 95% CI, 23,000-237,000) distribution declined in 2013. Total PLT transfusions increased in 2013 (2,281,000) in comparison to 2011 (2,169,000). Total plasma units distributed (4,338,000) and transfused (3,624,000) declined. CONCLUSION: Both blood collection and utilization have declined, but the gap between collection and utilization is narrowing. As collections decline further and hospitals decrease transfusions and manage products more efficiently, the decline in surplus inventory may be a concern for disaster preparedness or other unexpected utilization needs. |
Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection - Puerto Rico, 2016
Vasquez AM , Sapiano MR , Basavaraju SV , Kuehnert MJ , Rivera-Garcia B . MMWR Morb Mortal Wkly Rep 2016 65 (14) 375-8 Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus (1). Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic (2), the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pathogen reduction technology (PRT)* for treatment of blood components can be implemented (3). To inform efforts to maintain the safety and availability of the blood supply in Puerto Rico, CDC, in collaboration with the Puerto Rico Department of Health, conducted a rapid assessment of blood collection and use on the island. A total of 139,369 allogeneic red blood cell (RBC) units,(dagger) 45,243 platelet units, and 56,466 plasma units were collected in or imported to Puerto Rico during 2015, and 135,966 allogeneic RBC units, 13,526 therapeutic platelet units,( section sign) and 25,775 plasma units were transfused. Because of the potential for local Zika virus transmission in areas with a competent mosquito vector (4), other areas of the United States should develop plans to ensure local blood safety and adequacy. Blood collection organizations and public health agencies should collaborate to maintain the safety and availability of local blood supplies in accordance with FDA guidance. |
Cognitive evaluation of the AABB Uniform Donor History Questionnaire
Willson S , Miller K , Seem D , Kuehnert MJ . Transfusion 2016 56 1662-7 BACKGROUND: This article reports key findings of an evaluation of the AABB Uniform Donor History Questionnaire (a self-administered form completed before blood donation). The purpose of the study was to examine how respondents understand the questions and assess the nature of inaccurate responses. Another goal was to determine whether men who have sex with men (MSM) interpreted questions differently from non-MSM and whether questions were interpreted differently in various regions of the country. STUDY DESIGN AND METHODS: Cognitive interviewing was used for the study. This is a qualitative method that investigates how survey questions perform. It consists of semistructured interviews that explore whether respondents understand questions as intended and whether they can provide accurate answers. A total of 166 interviews were conducted. RESULTS: Respondents had an overwhelmingly similar understanding of the purpose of the questionnaire as assessing the safety of their blood for donation. This understanding framed respondents' interpretations such that each question was understood as asking the same thing; that is, "Is my blood safe to donate?" This interpretation did not vary among MSM versus non-MSM or by region. CONCLUSION: Respondents understood the questionnaire as assessing the safety of their blood. This interpretation served as the backdrop for the question-response process for each individual question. Specifically, rationale for answers was framed as much or more by the questionnaire's general purpose as by the specific topic of individual questions. This pattern of interpretation was the key factor responsible for both false-positive and false-negative response errors and did not vary by demographic, including in MSM. |
Custodes invicem custodiunt (the watchmen can watch each other)
Basavaraju SV , Kuehnert MJ . Transfusion 2015 55 (9) 2293-4 The editorial by Dodd and Katz, “Qui custodiet ipsos custodes?” often translated as “Who will watch the watchmen?” in response to our recent summary of National Healthcare Safety Network (NHSN) Hemovigilance Module results raises good points, but some comments are misleading and would benefit from additional clarification.1,2 | | Dodd and Katz assert that participating facilities in the NHSN Hemovigilance Module do not comprise a “legitimate sample,” because we did not apply statistical tests for rate comparisons. Statistical tests for comparison are used to allow one to extrapolate conclusions about a larger population based on data collected from a smaller, representative sample. Participation in the NHSN hemovigilance module is voluntary, and the participating health care facilities comprise a “convenience” sample of module participants, not a statistically representative sample. Moreover, these facilities report data on all transfusions, not just a sample of transfusions and/or blood components. Therefore, the adverse reaction rates and differences that are observed (e.g., among apheresis and whole blood–derived components) are reported from actual transfusion cohorts and are not representative of all facilities or transfused blood units nationally. As pointed out by Dodd and Katz, although not from a nationally representative sample, the validity of our findings are supported by their similarity to rates reported by other major hemovigilance systems world-wide.1 Specifically, higher rates of adverse reactions among apheresis platelets (PLTs) have been reported by the French hemovigilance system and are biologically plausible.3 While we acknowledge that differences in adverse reaction rates observed between apheresis and whole blood–derived PLTs may be attributable to variations in denominator reporting or other methodologic factors, further studies are needed before suggesting that this entirely explains these observations. |
Incident hepatitis among repeat blood donors: a sentinel event signaling possible health care-associated infection and need for reporting to public health authorities
Moorman AC , Stramer SL , Schaefer MK , Collier MG , Suryaprasad A , Kuehnert MJ , Moore Z , Rowan E , Habicht K , Bradley K , Fucci MC , Hopkins C , Xu F . Transfusion 2015 55 (10) 2531-3 Identification of a recently acquired viral hepatitis infection among repeat blood donors can be a sentinel event signaling a possible healthcare-associated infection (HAI) in the donor, especially in individuals who did not disclose self-reported behavioral risk factors and were test-negative at prior successful donations. With the 2012 update to the Council of State and Territorial Epidemiologists (CSTE) acute hepatitis B and hepatitis C surveillance case definitions, asymptomatic individuals who meet the laboratory criteria for these case definitions should be included among the cases reportable to public health authorities (1,2). This report serves as a reminder of the importance of recognizing incident hepatitis infections in blood donors as a possible sentinel event to uncover previous healthcare-associated transmission clusters, and that identification of a hepatitis B virus (HBV) or hepatitis C virus (HCV) nucleic acid test (NAT) confirmed positive result within six months of a NAT negative result (as may be identified in a repeat blood donor) is reportable to public health authorities. Recent data suggest consideration that this six month period be extended to within one year. |
Transmission of Hepatitis C Virus From Organ Donors Despite Nucleic Acid Test Screening.
Suryaprasad A , Basavaraju SV , Hocevar SN , Theodoropoulos N , Zuckerman RA , Hayden T , Forbi J , Pegues D , Levine M , Martin SI , Kuehnert MJ , Blumberg EA . Am J Transplant 2015 15 (7) 1827-35 Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV infection. Donor's and recipients' medical records were reviewed. Newly infected recipients were interviewed. Donor-derived HCV infection was considered when infection was newly detected after transplantation in recipients of organs from increased risk donors. Stored donor sera and tissue samples were tested for HCV RNA with high-sensitivity quantitative PCR. Posttransplant and pretransplant recipient sera were tested for HCV RNA. Quasispecies analysis of hypervariable region-1 was used to establish genetic relatedness of recipient HCV variants. Each donor had evidence of injection drug use preceding death. Of 12 recipients, 8 were HCV-infected-6 were newly diagnosed posttransplant. HCV RNA was retrospectively detected in stored samples from donor immunologic tissue collected at organ procurement. Phylogenetic analysis showed two clusters of closely related HCV variants from recipients. These investigations identified the first known HCV transmissions from increased risk organ donors with negative NAT screening, indicating very recent donor infection. Recipient informed consent and posttransplant screening for blood-borne pathogens are essential when considering increased risk donors. |
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