Aims To provide an update on state-of-the-art testing technologies for infectious disease (ID) blood donation screening, including emerging molecular methods such as multiplexed nucleic acid testing (NAT) platforms, mass spectrometry, nucleic acid and protein microarrays, and next-generation sequencing.Background Testing donated blood for ID markers plays a major role in establishing and maintaining blood safety. The norm for ID testing has been serology, but increasingly, NAT is used where resources allow, including testing for emerging infectious disease (EID) agents. The appropriate mix of ID tests and associated algorithms depends on local epidemiology, infrastructure and economic considerations. Although NAT will detect acute infections, not all pathogens have adequate concentrations of nucleic acid for detection in the early acute or later chronic phases of infection. Thus, both NAT and serological approaches may be required to detect recent, current or past infection. The advent of new technologies to augment or potentially replace current NAT and/or serologic testing has spurred debate as to their optimal future role in blood-borne pathogen screening.
Methods and ResultsInfectious disease testing has progressed from manual technologies using single markers to highly multiplexed automated assays. Emerging technologies allow the simultaneous detection and differentiation of hundreds of pathogens and will likely play an important role in future testing, but there are many hurdles prior to routine adoption.Conclusions Blood systems worldwide must be ready to adapt to EID agents, availability of new diagnostic technologies, and shifts in economic conditions and public expectations to accommodate the changing landscape of ID testing.