Lessons learned from Trypanosoma cruzi test implementation

Selective Testing of At-Risk Blood Donors for Trypanosoma cruzi and Plasmodium spp. in Switzerland

“…The three confirmed positive cases from 6,978 donors (1:2,326) which were identified in Switzerland lies within the same range but is too low to be statistically significant. Transfusion-transmitted CD has been often reported, and it has been documented that several different blood components can be involved [3,4,12]. The infective capacity of each type of labile blood component varies from 10 to 25%.…”

“…A chronic asymptomatic carrier state in conjunction with an asymptomatic or non-specific clinical infection course in recipients of T. cruzi -infected blood results in transfusion-transmissioncases being undetected and thus unreported. Transfusion-based T. cruzi infections are already a major route of transmission in many non-endemic countries, with several cases reported recently in USA, Canada, Spain and Mexico [3,4,12]. It is estimated that on average 20% (range 0- 40%) of the transfusion recipients of parasitaemic blood became infected [13,14,15].…”

“…The effectiveness of a selective testing approach however does rely mainly upon the ability and the willingness of the donor to correctly answer questions of suspected risk situations. In a study conducted in the USA only 75% of the infected donors were identified via the questionnaire [12]. Thus although 100% safety will never be achieved, performing a selective testing in parallel with a specific questionnaire should detect the majority of infections.…”

Prevalence of Trypanosoma cruzi antibodies in blood donors from Veracruz State, Mexico

“…To date, seven cases of T. cruzi transfusion‐transmitted infection have been reported in the United States and Canada. In all seven cases, the donors of the infected units were from endemic Latin American countries . Although no cases of transfusion‐transmitted infections have been reported in Mexico yet, a study carried out during 1998 to 2001 in the Mexican states of Jalisco and Nayarit found four suspected cases of transmission by whole blood or blood component transfusion and it was estimated that about 100 new infections could be occurring each year by infected blood components …”

Making good policy decisions: a discipline we cannot afford to ignore

“…Rather, they suggest that key ethical principles should inform the exercise of the decision maker's judgment in a specific context, “serving primarily to elucidate normative dimensions of candidate decisions rather than to dictate outcomes.” Similarly, the RBDM framework articulates a series of risk management principles (several of which are ethics based) to inform the risk‐based decision‐making process: beneficence, fairness, transparency, consultation, evidence and judgment, practicality and proportionality, continuous improvement, and vigilance. To apply these principles and concepts in day‐to‐day decision making, we must be able to account for the complexity of our decision‐making environment: emerging risks, evolving technology, societal shifts, economic constraints, and risk trade‐offs across competing risks . Whether ethics based or risk based, it is of course not enough to articulate the principles alone.…”