BACKGROUND: The National Blood Collection and Utilization Survey (NBCUS) is conducted biennially to estimate US blood collection and utilization. Supplemental data from the 2023 NBCUS not presented elsewhere are described here. METHODS: Data on blood donor characteristics, donation deferrals, component costs, transfusion-associated adverse reactions, and use of pathogen-reduced platelets during 2023 were collected from US blood collecting and transfusing facilities. National estimates were produced using weighting and imputation methods. RESULTS: Compared with 2021, successful blood donations from donors aged 45-64 decreased (11%) in 2023 but still accounted for most donations overall (39%). Donations from donors aged 16-18 years, Black or African American, and Hispanic donors increased by 66%, 38%, and 9%, respectively, since 2021. Donation deferrals for travel increased since 2021 (+162%). From 2021 to 2023, the median price hospitals paid per unit of leukoreduced red blood cells, fresh frozen plasma, and leukoreduced and pathogen-reduced apheresis platelets increased. Apheresis platelets experienced the largest price increase per unit (+$65). Compared with 2021, the proportion of transfusing facilities using pathogen-reduced platelets increased in 2023 (60% vs. 64%). The overall rate of transfusion-associated adverse reactions per 100,000 components transfused was higher in 2023 than in 2021 (312.3 vs. 273.8), although the rate of transfusion-transmitted infections (bacterial, viral, and parasitic) declined in 2023 (0.25 vs. 0.43). CONCLUSION: From 2021 to 2023, blood donations among older donors decreased, while donations from younger and Black or African American donors increased. Adoption of pathogen-reduced platelets and cost of all blood products increased.

BACKGROUND: Data from the National Blood Collection and Utilization Survey (NBCUS) suggest a stabilization in blood collections and transfusions following years of decline. Data from the 2023 NBCUS were analyzed to further understand national trends in US blood availability. STUDY DESIGN AND METHODS: In February 2024, all community-based (53) and hospital-based (104) blood collection centers, and a sample of transfusing hospitals were surveyed. National estimates were calculated for the number of blood and blood components collected, distributed, transfused, rejected on testing, and outdated in 2023, compared with 2021. Weighting and imputation were used for nonresponses and missing data, respectively. RESULTS: Overall, 96% of community-based blood centers and 85.7% of transfusing hospitals responded. During 2023, 11,586,000 units of whole blood and apheresis RBCs were collected (95% confidence interval (CI): 11,180,000-11,991,000), and 10,328,000 (95% CI: 9922,000-10,733,000) were transfused, a 1.7% and 4.1% decline compared with 2021, respectively. The total available supply (after outdates and rejections) declined by 0.5%. Total platelet units distributed (2618,000; 95% CI: 2483,000-2753,000) and transfused (2220,000; 95% CI: 2040,000-2400,000) increased by 3.6% and 2.1%, respectively, since 2021. Transfusion of pathogen-reduced platelet units (1258,000) increased by 49.2% since 2021. Plasma distributions (3032,000; 95% CI: 2764,000-3300,000) and transfusions (1882,000; 95% CI: 1765,000-1998,000) declined since 2021. Overall, 123,000 units were rejected on testing for transfusion-transmitted infections. DISCUSSION: The 2023 NBCUS indicates further stabilization in the blood supply, suggesting the establishment of a new baseline for blood availability.

Seventy percent of tuberculosis (TB) cases in the United States occur among non-US-born persons; cases usually result from reactivation of latent TB infection (LTBI) likely acquired before the person's US arrival. We conducted a prospective study among US immigrant visa applicants undergoing the required overseas medical examination in Vietnam. Consenting applicants >15 years of age were offered an interferon-γ release assay (IGRA); those 12-14 years of age received an IGRA as part of the required examination. Eligible participants were offered LTBI treatment with 12 doses of weekly isoniazid and rifapentine. Of 5,311 immigrant visa applicants recruited, 2,438 (46%) consented to participate; 2,276 had an IGRA processed, and 484 (21%) tested positive. Among 452 participants eligible for treatment, 304 (67%) initiated treatment, and 268 (88%) completed treatment. We demonstrated that using the overseas medical examination to provide voluntary LTBI testing and treatment should be considered to advance US TB elimination efforts.

For all practical purposes … the prognosis of primary pneumonic plague may be considered as well-nigh hopeless. | | - Dr. Wu Lien-teh, lead physician during Chinese plague epidemics, 1910–1921 [1] | | For the first time in the nefarious history of plague, a drug which will cure the pneumonic form has been found. | | - K. F. Meyer and S. F. Quan, 1949, referring to streptomycin [2] | | Plague is an infectious disease that has haunted the human species for millennia. The Justinian Plague in the 6th century and the Black Death beginning in the 14th century were civilization-shattering events, the effects of which were felt long after plague had dissipated [3]. What conferred this capacity on plague was its virulence, its transmission characteristics, and a lack of effective countermeasures, which did not appear until the 20th century.

BACKGROUND: Laboratory tests that can distinguish recent from long-term HIV infection are used to estimate HIV incidence in a population but can potentially misclassify a proportion of long-term HIV infections as recent. Correct application of an assay requires determination of the proportion false recents (PFR) as part of the assay characterization and for calculating HIV incidence in a local population using a HIV incidence assay. METHODS: From April 2009 to December 2010, blood specimens were collected from HIV-infected individuals attending 9 outpatient clinics (OPCs) in Vietnam (4 from northern and 5 from southern Vietnam). Participants were living with HIV for ≥1 year and reported no antiretroviral drug (ARV) treatment. Basic demographic data and clinical information were collected. Specimens were tested with the BED capture enzyme immunoassay (BED-CEIA) and the Limiting-antigen (LAg)-Avidity EIA. PFR was estimated by dividing the number of specimens classified as recent by the total number of specimens; 95% confidence intervals (CI) were calculated. Specimens that tested recent had viral load testing performed. RESULTS: Among 1,813 specimens (north, n= 942 and south, n = 871), the LAg-Avidity EIA PFR was 1.7% (CI 1.2-2.4) and differed by region [north 2.7% (CI 1.8, 3.9) versus south 0.7% (CI 0.3, 1.5); p=0.002]. The BED-CEIA PFR was 2.3% (CI 1.7, 3.0) and varied by region [north 3.4% (CI: 2.4, 4.7) versus south 1.0% (CI 0.5, 1.2), p<0.001]. Excluding specimens with an undetectable VL, the LAg-Avidity EIA PFR was 1.2% (CI: 0.8, 1.9) and the BED-CEIA PFR was 1.7% (CI: 1.2, 2.4). CONCLUSIONS: The LAg-Avidity EIA PFR was lower than the BED-CEIA PFR. After excluding specimens with an undetectable VL, the PFR for both assays was similar. A low PFR should facilitate the implementation of the LAg-Avidity EIA for cross-sectional incidence estimates in Vietnam.

BACKGROUND: An estimated 120,000 HIV-associated cryptococcal meningitis (CM) cases occur each year in South and Southeast Asia; early treatment may improve outcomes. The World Health Organization (WHO) recently recommended screening HIV-infected adults with CD4<100 cells/mm(3) for serum cryptococcal antigen (CrAg), a marker of early cryptococcal infection, in areas of high CrAg prevalence. We evaluated CrAg prevalence and cost-effectiveness of this screening strategy in HIV-infected adults in northern and southern Vietnam. METHODS: Serum samples were collected and stored during 2009-2012 in Hanoi and Ho Chi Minh City, Vietnam, from HIV-infected, ART-naive patients presenting to care in 12 clinics. All specimens from patients with CD4<100 cells/mm(3) were tested using the CrAg lateral flow assay. We obtained cost estimates from laboratory staff, clinicians and hospital administrators in Vietnam, and evaluated cost-effectiveness using WHO guidelines. RESULTS: Sera from 226 patients [104 (46%) from North Vietnam and 122 (54%) from the South] with CD4<100 cells/mm(3) were available for CrAg testing. Median CD4 count was 40 (range 0-99) cells/mm(3). Nine (4%; 95% CI 2-7%) specimens were CrAg-positive. CrAg prevalence was higher in South Vietnam (6%; 95% CI 3-11%) than in North Vietnam (2%; 95% CI 0-6%) (p = 0.18). Cost per life-year gained under a screening scenario was $190, $137, and $119 at CrAg prevalences of 2%, 4% and 6%, respectively. CONCLUSION: CrAg prevalence was higher in southern compared with northern Vietnam; however, CrAg screening would be considered cost-effective by WHO criteria in both regions. Public health officials in Vietnam should consider adding cryptococcal screening to existing national guidelines for HIV/AIDS care.

A cohort of Japanese encephalitis (JE) survivors in Cambodia and Viet Nam were assessed at least 4 months after hospital discharge in order to understand the extent of disability after JE. We used a simple assessment tool which focuses on the impact on daily life. In total, 64 disability assessments were conducted: 38 in Cambodia and 26 in Viet Nam. In Cambodia, 4 (11%) children had severe sequelae, suggesting the children would likely be dependent, 15 (39%) had moderate sequelae and 17 (45%) had mild sequelae. In Viet Nam, two (8%) persons had severe sequelae, five (19%) had moderate sequelae and eight (31%) had mild sequelae. In many JE-endemic areas there are no multi-disciplinary teams with sophisticated equipment to assess patients after JE disease. This assessment tool can assist with patient management and generate data to support the need for programmes to prevent disease and improve outcomes for survivors.