Pathogen inactivation methods to prevent transfusion‐transmissible arboviruses: A systematic review and meta‐analysis

Abstract

Objective: Arboviruses are emerging as a relevant threat to transfusion safety. Pathogen inactivation methods (PIMs) may reduce the risk of transmission through transfusion, as long as they meet minimum standards for effectiveness. This study aims to assess the log reduction of viral load achieved with different PIMs, according to the blood product they are used on and the arbovirus targeted. Methods: Systematic literature review and meta-analysis. Searches were conducted in MEDLINE and Embase. The study protocol was registered in PROSPERO CRD42022312061. We selected records reporting the log reduction of viral load achieved with the main PIMs (amotosalen), applied to any blood product (plasma, platelets, red blood cells or whole blood) and for any arbovirus. The log reduction of viral loads was assessed by obtaining the mean log reduction factor (LRF). We compared and classified the LRF of different techniques using statistical methods. Results: We included 59 publications reporting LRF results in 17 arboviruses. For 13 arboviruses, including Chikungunya virus, Dengue virus, West Nile virus and Zika virus, at least one of the methods achieves adequate or optimal log reduction of viral loadÀmean LRF ≥4. The LRF achieved with riboflavin + UV light is inferior to the rest of the techniques, both overall and specifically for plasma, platelets preserved in platelet additive solution (PAS)/plasma, and red blood cells/whole blood. The LRF achieved using Mirasol is also lower for inactivating Chikungunya virus, Dengue virus and Zika virus. For West Nile virus, we found no significant differences. In plasma, the method that achieves the highest LRF is solvent/detergent; in platelets, THERA-FLEX and INTERCEPT; and in red blood cells/whole blood, PEN110 (Inactine). Conclusion: Not all PIMs achieve the same LRF, nor is this equivalent between the different arboviruses or blood products. Overall, the LRFs achieved using riboflavin + UV light (Mirasol) are inferior to those achieved with the rest of the PIMs. Regarding the others, LRFs vary by arbovirus and blood product. In light of the threat of different arboviruses, blood establishments should have already validated PIMs and be logistically prepared to implement these techniques quickly.

Dengue virus transmission risk in blood donation: Evidence from Thailand

“…Similar trends have been observed in various regions, such as the Philippines, French Polynesia, Puerto Rico, Brazil, Bolivia, Guadeloupe, Martinique, and the Dominican Republic, with anti-DENV IgG seroprevalence exceeding 80% in healthy blood donors. 25 In comparison to the general population, the seropositivity in this study is higher than that reported among individuals residing in central and southern Thailand (79%). 17 Regarding IgM antibodies against DENV, the prevalence in blood donor populations ranges from 0% to 13.5%, 25 with the highest reported value in India, followed by Brazil.…”

“…25 In comparison to the general population, the seropositivity in this study is higher than that reported among individuals residing in central and southern Thailand (79%). 17 Regarding IgM antibodies against DENV, the prevalence in blood donor populations ranges from 0% to 13.5%, 25 with the highest reported value in India, followed by Brazil. Several studies also tested donors in endemic regions or areas experiencing an epidemic outbreak using the dengue NS1 antigen, revealing a prevalence from 0% to 5.3%.…”

“…Based on nucleic acid amplification tests (NAT) screening, the viremic rates of the dengue virus in blood donor populations vary from 0% to 5.5% in areas experiencing outbreaks. 25 The highest prevalence was recorded in Saudi Arabia from 2015 to 2016…”

Implementation of amotosalen plus ultraviolet A‐mediated pathogen reduction for all platelet concentrates in France: Impact on the risk of transfusion‐transmitted infections

“…Such risk may be further mitigated by applying PR technology. In addition, applying PR to platelets in the setting of arboviruses outbreaks, notably those associated with a transfusion risk such as West Nile virus [14], allows for an immediately available alternative to specific testing or targeted donor deferral [15].…”

Transfusion-Transmitted Disorders 2023 with Special Attention to Bone Marrow Transplant Patients

“…Similar to malaria and Zika viruses, they are transmitted through the bite of infected Aedes species mosquitoes. While the dengue virus and the chikungunya virus are not prevalent in Europe or the continental United States, outbreaks in Asia, Pacific countries, South and Central America, and Caribbean islands have raised concerns about transfusion transmission in those regions and among returning travellers [ 56 , 57 ].…”