Dengue: a potential transfusion‐transmitted disease

Abstract

DENGUE VIRUS AND ITS TRANSMISSIOND engue is caused by four related RNA viruses of the genus Flavivirus, dengue virus (DENV)-1, -2, -3, and -4. Infection with DENV is usually asymptomatic but each DENV is capable of causing the full spectrum of clinical disease from mild, undifferentiated acute febrile illness, to classic dengue fever and more severe disease including dengue hemorrhagic fever and dengue shock syndrome. Severe disease manifestations including hypovolemic shock and clinically significant hemorrhage are more commonly observed among patients during their second or subsequent episodes of DENV infection. 1 Infection with one DENV produces lifelong immunity against that DENV type and short-term (Յ2 months) cross-protection against infection with the other three DENVs. Therefore, an individual has a lifetime risk of up to four DENV infections.DENVs are transmitted from person to person through the bite of an infected Aedes aegypti mosquito (less commonly Aedes albopictus or Aedes polynesiensis). 2 Unlike other related flaviviruses such as West Nile virus, humans are the main amplifying host for DENV. While there is a sylvatic nonhuman primate cycle of DENV transmission, it rarely crosses to humans, and antibodies to the sylvatic virus appear to protect against human DENV. The transmission cycle begins when a mosquito ingests DENV in a blood meal from an infected person (Fig. 1). DENV replicates and disseminates within the mosquito and reaches the salivary glands after 8 to 12 days (extrinsic incubation period). Higher ambient temperatures may reduce the extrinsic incubation period and increase the chance they will infect a human before dying. 3 The mosquito remains infectious for life (typically less than 1 month) and can transmit infection with 10 2 viral particles. 4 DENV replicates in humans for an intrinsic incubation period of 3 to 14 days before symptom onset. Infected persons can transmit DENV to mosquitoes as early as 1 to 2 days before symptoms develop 5 and throughout the approximately 7-day viremic period. Infected persons, even those who remain asymptomatic, have concentrations as high as 10 7 viral RNA copies per milliliter of blood. 6,7 During the viremic period, which occurs in symptomatic and asymptomatic infections, DENV can become a blood-borne infection. 8 Cases of dengue after receipt of blood products or donor organs or tissue and after occupational exposure in a health care setting have been reported. 8-10 However, the true incidence of transfusiontransmitted dengue is unknown because there is no surveillance for such events, and if a case is suspected, it is difficult to prove transfusion transmission (vs. vector-borne transmission) in recipients from endemic countries. Nevertheless, transfusion risk models and assessments of viremia prevalence among blood donations indicate the potential for transfusion transmission of DENV in endemic areas. [6][7][8]11,12 Risk is high in endemic areas as most DENV infections are asymptomatic and the viremia is high titered, long lasting, and detec...

Zika Virus

“…These results cannot be compared with those of the serosurvey conducted in Yap State, which detected IgM antibodies (16). However, this ratio is similar to the estimates of DENV (75,374) and WNV infections (375). During the ZIKV outbreak, 2.8% of the blood donors tested were positive for ZIKV (312), which suggests that about 2.8% of the asymptomatic adults were viremic during the outbreak.…”

“…Arbovirus transmission by transfusion of blood products has been documented for DENV (75,76), WNV (77,309), and RRV (78). Given its epidemiology, the possibility of ZIKV transmission via transfusion should be considered as well (310,311).…”

“…Nonvector arbovirus transmission has been reported to occur directly between vertebrates (64, 65), from mother to child (66)(67)(68)(69)(70)(71), nosocomially (72)(73)(74), by transfusion (75)(76)(77)(78), via bone marrow (79) or organ (80) transplantation, and sexually (81).…”

Zika Virus: A Review

“…The most ordinary approach of biological transmission is infection during a viremic blood meal and injection of infectious saliva during blood feeding (horizontal transmission). Non-vector arbovirus transmission has been reported to occur straight between vertebrates [27][28] , from mother to child [29][30][31][32][33][34] , nosocomially [35][36][37] , by transfusion [38][39][40][41] , via bone marrow [42] or organ transplantation, and sexually. Management commitment and employee involvement-Essential to implement effective infection management programs selected personnel should review, update and act on all steerage, as well as normal operational procedures and exposure management plans, and should communicate those policies and practices to any or all employees.…”

Zika Virus Infection: Damaging Consequences in Humans

“…The most common mode of biological transmission is infection during a viremic blood meal and injection of infectious saliva during blood feeding (horizontal transmission). Nonvector arbovirus transmission has been reported to occur directly between vertebrates [19], from mother to child [20], nosocomially [21], by transfusion [22], via bone marrow or organ [23] transplantation, and sexually [24]. Given its epidemiology, the possibility of ZIKV transmission via transfusion should be considered as well [25].…”