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This large health care-associated HCV outbreak was related to shared saline bags contaminated through syringe reuse. Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/oncology clinics.

T R A N S F U S I O N C O M P L I C A T I O N S West Nile virus blood transfusion-related infection despite nucleic acid testingAlexandre Macedo de Oliveira, Brady D. Beecham, Susan P. Montgomery, Robert S. Lanciotti, Jeffrey M. Linnen, Cristina Giachetti, Larry A. Pietrelli, Susan L. Stramer, and Thomas J. Safranek BACKGROUND: A case of West Nile virus (WNV) encephalitis associated with transfusion of blood that did not react when tested for WNV by minipool (MP) nucleic acid testing (NAT) is described. A Nebraska man developed clinical encephalitis 13 days after surgery and transfusion of 26 blood components. Antibody testing confirmed WNV infection. An investigation was initiated to determine the source of this infection. STUDY DESIGN AND METHODS:The patient's family members were interviewed to identify risk factors for WNV infection. Residual samples were retested for WNV RNA using transcription-mediated amplification (TMA) assay and two polymerase chain reaction (PCR) assays. Blood donors' follow-up serum samples were collected. All samples were tested for WNV-specific immunoglobulin M antibodies. RESULTS: The patient's family denied recent mosquito exposure. The 20 blood components collected after July 2003 did not react when tested for WNV in a six-member MP-NAT at the time of donation. Retrospective individual testing identified one sample as WNV-reactive by the TMA assay and one of the PCR assays. Seroconversion was demonstrated in the donor associated with this sample. CONCLUSION: WNV RNA detection by individual donation NAT demonstrates viremic blood escaping MP-NAT and supports transfusion-related WNV transmission. MP-NAT may not detect all WNV-infected blood donors, allowing WNV transmission to continue at low levels. WNV NAT assays might vary in sensitivity and pooling donations could further impact test performance. Understanding MP NAT limitations can improve strategies to maintain safety of the blood supply in the United States. 9,10 Because of automation constraints, the tests are performed with minipools (MPs) of either six (TaqScreen assay) or 16 (Procleix assay) donations. A limited number of blood centers have the capacity to routinely screen by individual donation testing (IDT); in addition, some programs converted to IDT for limited periods during the 2003 epidemic. Donated blood from reactive pools is individually retested to identify the WNVreactive donation. Donors associated with WNV-reactive individual tests are deferred from donation for at least 4 weeks. The WNV-reactive donation and any of that donor's unexpired blood components obtained in the 28 days before the reactive tests are discarded. In this report, we describe the investigation of a patient who developed WNV encephalitis after receiving blood that had did not react with NAT for WNV in a six-member MP. CASE REPORTOn August 4, 2003, an 80-year-old Nebraska man underwent open-heart surgery. During surgery, the patient received 26 blood components because of massive bleeding: 8 units of red blood cells, 6 units of fresh f...