Transfusion transmitted dengue: One donor infects two patients

Karim, Farheen; Nasir, Nadia; Moiz, Bushra

doi:10.1016/j.transci.2016.10.013

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…However, the demonstration of nonvector-borne transmission through sexual contact and the transfusion of contaminated blood products has raised concerns over the safety of the blood supply in areas with epidemic and endemic ZIKV. 2 When comparing ZIKV with other arboviruses (Table 1), [3][4][5][6][7][8][9][10][11][12] infection results in a high percentage of asymptomatic viremic carriers, similar to DENV and WNV but unlike chikungunya virus (CHIKV). Notably, ZIKV, like WNV, causes various neurologic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Inactivation of Zika virus in platelet components using amotosalen and ultraviolet A illumination

et al. 2017

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BACKGROUND Concerned over the risk of Zika virus (ZIKV) transfusion transmission, public health agencies recommended the implementation of mitigation strategies for its prevention. Those strategies included the use of pathogen inactivation for the treatment of plasma and platelets. The efficacy of amotosalen/ultraviolet A to inactivate ZIKV in plasma had been previously demonstrated, and the efficacy of inactivation in platelets with the same technology was assumed. These studies quantify ZIKV inactivation in platelet components using amotosalen/ultraviolet A. STUDY DESIGN AND METHODS Platelet components were spiked with ZIKV, and ZIKV infectious titers and RNA loads were measured by cell culture‐based assays and real‐time polymerase chain reaction in spiked platelet components before and after photochemical treatment using amotosalen/ultraviolet A. RESULTS The mean ZIKV infectivity titers and RNA loads in platelet components before inactivation were either 4.9 log10 plaque forming units per milliliter, or 4.4 log10 50% tissue culture infective dose per milliliter and 7.5 log10 genome equivalents per milliliter, respectively. No infectivity was detected immediately after amotosalen/ultraviolet A treatment. No replicative virus remained after treatment, as demonstrated by multiple passages on Vero cell cultures; and ZIKV RNA was not detected from the first passage after inactivation. Additional experiments in this study demonstrated efficient inactivation to the limit of detection in platelets manufactured in 65% platelet additive solution, 35% plasma, or 100% plasma. CONCLUSION As previously demonstrated for plasma, robust levels of ZIKV inactivation were achieved in platelet components. With inactivation of higher levels of ZIKV than those reported in asymptomatic, RNA‐reactive blood donors, the pathogen‐inactivation system using amotosalen/ultraviolet A offers the potential to mitigate the risk of ZIKV transmission by plasma and platelet transfusion.

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Section: Discussionmentioning

confidence: 99%

Inactivation of Zika virus in platelet components using amotosalen and ultraviolet A illumination

et al. 2017

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“…DENV is the most internationally widespread arbovirus with high potential for TTI. Indeed, despite the fact that only few cases of DENV TTIs have been reported in Pakistan, Singapore, Puerto Rico, Hong Kong, and Brazil, high prevalences of DENV RNA–positive blood donors have been reported in Honduras (0.3% in 2004‐2005), Brazil (0.06% in 2003, 0.4 and 0.64% in 2012), French Polynesia (0.2% in 2013‐2014), Puerto Rico (0.07% in 2005, 0.19% in 2007, and 0.18% in 2010‐2012), and Madeira, Spain (1.5% in 2012) . In Brazil, it was estimated that DENV RNA can be detected by NAT for approximately 9 days in presymptomatic viremic patients .…”

Section: Discussionmentioning

confidence: 99%

“…DENV is transmitted by Aedes species mosquitoes, mainly Aedes aegypti and, to a lesser extent, Aedes albopictus ; however, non–vector‐borne transmission of DENV has been reported via blood transfusion, and DENV transfusion‐transmitted infections (TTIs) have been reported in multiple countries . DENV RNA and infectious DENV have been detected in all blood components and TTIs have been reported after transfusion of plasma, red blood cells (RBCs), and platelets (PLTs) . However, DENV TTIs may be largely underreported, as the infection remains asymptomatic in 75% of cases .…”

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confidence: 99%

Pathogen inactivation of Dengue virus in red blood cells using amustaline and glutathione

et al. 2017

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BACKGROUND Dengue virus (DENV) is an arbovirus primarily transmitted through mosquito bite; however, DENV transfusion‐transmitted infections (TTIs) have been reported and asymptomatic DENV RNA–positive blood donors have been identified in endemic countries. DENV is considered a high‐risk pathogen for blood safety. One of the mitigation strategies to prevent arbovirus TTIs is pathogen inactivation. In this study we demonstrate that the amustaline and glutathione (S‐303/GSH) treatment previously found effective against Zika virus in red blood cells (RBCs) is also effective in inactivating DENV. STUDY DESIGN AND METHODS Red blood cells were spiked with high levels of DENV. Viral RNA loads and infectious titers were measured in the untreated control and before and after pathogen inactivation treatment of RBC samples. DENV infectivity was also assessed over five successive cell culture passages to detect any potential residual replicative virus. RESULTS The mean ± SD DENV titer in RBCs before inactivation was 6.61 ± 0.19 log 50% tissue culture infectious dose (TCID50)/mL and the mean viral RNA load was 8.42 log genome equivalents/mL. No replicative DENV was detected either immediately after completion of treatment using S‐303/GSH or after cell culture passages. CONCLUSION Treatment using S‐303/GSH inactivated high levels of DENV in RBCs to the limit of detection. In combination with previous studies showing the effective inactivation of DENV in plasma and platelets using the licensed amotosalen/UVA system, this study demonstrates that high levels of DENV can be inactivated in all blood components.

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“…Fourthly, there is evidence that ZIKV is transfusion-transmissible as at least four probable TT cases have now been reported, all from Brazil during the current outbreak. [148,149,155,180,181] Therefore, there is now sufficient evidence that ZIKV is a transfusiontransmissible EID agent, similar to the phylogenetically related DENV [56,[182][183][184][185][186][187][188][189][190] and WNV [72][73][74][75]77,191,192].…”

Section: Why Zikv Represents a Potential Threat To Blood Safetymentioning

confidence: 99%

Emerging Infectious Diseases and Blood Safety: Modeling the Transfusion-Transmission Risk

Kiely

Gambhir

Cheng

et al. 2017

Transfusion Medicine Reviews

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While the transfusion-transmission (TT) risk associated with the major transfusion-relevant viruses such as HIV is now very low, during the last 20 years there has been a growing awareness of the threat to blood safety from emerging infectious diseases, a number of which are known to be, or are potentially, transfusion transmissible. Two published models for estimating the transfusion-transmission risk from EIDs, referred to as the Biggerstaff-Petersen model and the European Upfront Risk Assessment Tool (EUFRAT), respectively, have been applied to several EIDs in outbreak situations. We describe and compare the methodological principles of both models, highlighting their similarities and differences. We also discuss the appropriateness of comparing results from the two models. Quantitating the TT risk of EIDs can inform decisions about risk mitigation strategies and their cost-effectiveness. Finally, we present a qualitative risk assessment for Zika virus (ZIKV), an EID agent that has caused several outbreaks since 2007. In the latest and largest ever outbreak, several probable cases of transfusion-transmission ZIKV have been reported, indicating that it is transfusion-transmissible and therefore a risk to blood safety. We discuss why quantitative modeling the TT risk of ZIKV is currently problematic.

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Transfusion transmitted dengue: One donor infects two patients

Cited by 14 publications

References 13 publications

Inactivation of Zika virus in platelet components using amotosalen and ultraviolet A illumination

Inactivation of Zika virus in platelet components using amotosalen and ultraviolet A illumination

Pathogen inactivation of Dengue virus in red blood cells using amustaline and glutathione

Emerging Infectious Diseases and Blood Safety: Modeling the Transfusion-Transmission Risk

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