Transfusion-Transmitted Malaria: Two Pediatric Cases From the United States and Their Relevance in an Increasingly Globalized World

Stubbs, Leigh A.; Price, Michael R.; Noland, Daniel K.; Fuchs, Jennifer; Filkins, Laura; McElvania, Erin; Luu, Hung S.; Sebert, Michael; Waters, Ami; Hsiang, Michelle S.

doi:10.1093/jpids/piab083

Cited by 10 publications

(10 citation statements)

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“…49 The findings in this study are promising and should trigger various levels of interest depending on current strategies in place to mitigate the risk of TTIs by vectorborne pathogens in the United States. Of note, TTIs continue to be reported, albeit infrequently, for WNV 10,55,56 and Plasmodium, [57][58][59] as examples, even with the current interventions of donor health histories and/or testing in place. In Europe, seasonal deferrals and blood donation screening for WNV, [60][61][62][63][64][65][66] DENV, and CHIKV have been implemented in some of the Mediterranean countries, but regulatory authorities such as PEI in Germany, 8 are now recommending the use of PRT as an alternative to WNV deferrals and screening to maintain the platelet supply.…”

Section: Discussionmentioning

confidence: 99%

Mitigating the risk of transfusion‐transmitted infections with vector‐borne agents solely by means of pathogen reduction

Stramer

Lanteri

Brodsky³

et al. 2022

Transfusion

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Background: This study evaluated whether pathogen reduction technology (PRT) in plasma and platelets using amotosalen/ultraviolet A light (A/UVA) or in red blood cells using amustaline/glutathione (S-303/GSH) may be used as the sole mitigation strategy preventing transfusion-transmitted West Nile (WNV), dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viral, and Babesia microti, Trypanosoma cruzi, and Plasmodium parasitic infections. Methods: Antibody (Ab) status and pathogen loads (copies/mL) were obtained for donations from US blood donors testing nucleic acid (NAT)positive for WNV, DENV, ZIKV, CHIKV, and B. microti. Infectivity titers derived from pathogen loads were compared to published PRT log 10 reduction factors (LRF); LRFs were also reviewed for Plasmodium and T. cruzi. The potential positive impact on donor retention following removal of deferrals from required questioning and testing for WNV, Babesia, Plasmodium, and T. cruzi was estimated for American Red Cross (ARC) donors.Results: A/UVA and S-303/GSH reduced infectivity to levels in accordance with those recognized by FDA as suitable to replace testing for all agents evaluated. If PRT replaced deferrals resulting from health history questions and/or NAT for WNV, Babesia, Plasmodium, and T. cruzi, 27,758 ARC donors could be retained allowing approximately 50,000 additional donations/year based on 1.79 donations/donor for calendar year 2019 (extrapolated to an estimated 125,000 additional donations nationally). Conclusion: Pathogen loads in donations from US blood donors demonstrated that robust PRT may provide an opportunity to replace deferrals associated with donor questioning and NAT for vector-borne agents allowing for significant donor retention and likely increased blood availability.

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Section: Discussionmentioning

confidence: 99%

Mitigating the risk of transfusion‐transmitted infections with vector‐borne agents solely by means of pathogen reduction

Stramer

Lanteri

Brodsky³

et al. 2022

Transfusion

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“…Rarely, infection occurs via vertical transmission during pregnancy or at birth, through blood transfusion, from needle sharing, or after an organ transplant from malaria-infected donors. 3,4 P vivax and P ovale also have a hypnozoite stage in the liver, which remains dormant for weeks to years before becoming activated into hepatic merozoites, entering the bloodstream, and initiating a blood-stage infection. The hypnozoite stage requires specific therapy, discussed later.…”

Section: General Overview and Approach To The Diagnosis Of Malariamentioning

confidence: 99%

“…Some merozoites develop into sexual forms (gametocytes) and, when taken up by a mosquito during a blood meal, develop into sporozoites capable of transmitting infection into a new host. Rarely, infection occurs via vertical transmission during pregnancy or at birth, through blood transfusion, from needle sharing, or after an organ transplant from malaria-infected donors . P vivax and P ovale also have a hypnozoite stage in the liver, which remains dormant for weeks to years before becoming activated into hepatic merozoites, entering the bloodstream, and initiating a blood-stage infection.…”

Section: General Overview and Approach To The Diagnosis Of Malariamentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Malaria in the US

Daily

Minuti

Khan

2022

JAMA

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n 2020, approximately 241 million cases of malaria occurred in 85 countries with endemic malaria. Travelers to these regions are at risk for infection. 1 The number of people with malaria who arrive in the US has increased each year since 1972, from approximately 614 cases in 1972 to an 2161 cases in 2017. 2 Patients with malaria typically present to frontline US health care workers, who need to diagnose and manage this infection. This Review summarizes current evidence regarding the prevention, diagnosis, and treatment of malaria. MethodsWe searched the PubMed and Cochrane Library databases for English-language randomized clinical trials, meta-analyses, systematic reviews, and observational studies of the epidemiology, diagnosis, and treatment of malaria, published from January 2016 to March 2022. References were searched manually for additional relevant publications, including World Health Organization IMPORTANCE Malaria is caused by protozoa parasites of the genus Plasmodium and is diagnosed in approximately 2000 people in the US each year who have returned from visiting regions with endemic malaria. The mortality rate from malaria is approximately 0.3% in the US and 0.26% worldwide. OBSERVATIONS In the US, most malaria is diagnosed in people who traveled to an endemic region. More than 80% of people diagnosed with malaria in the US acquired the infection in Africa. Of the approximately 2000 people diagnosed with malaria in the US in 2017, an estimated 82.4% were adults and about 78.6% were Black or African American. Among US residents diagnosed with malaria, 71.7% had not taken malaria chemoprophylaxis during travel. In 2017 in the US, P falciparum was the species diagnosed in approximately 79% of patients, whereas P vivax was diagnosed in an estimated 11.2% of patients. In 2017 in the US, severe malaria, defined as vital organ involvement including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia, occurred in approximately 14% of patients, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died. P falciparum has developed resistance to chloroquine in most regions of the world, including Africa. First-line therapy for P falciparum malaria in the US is combination therapy that includes artemisinin. If P falciparum was acquired in a known chloroquine-sensitive region such as Haiti, chloroquine remains an alternative option. When artemisinin-based combination therapies are not available, atovaquone-proguanil or quinine plus clindamycin is used for chloroquine-resistant malaria. P vivax, P ovale, P malariae, and P knowlesi are typically chloroquine sensitive, and treatment with either artemisinin-based combination therapy or chloroquine for regions with chloroquine-susceptible infections for uncomplicated malaria is recommended. For severe malaria, intravenous artesunate is first-line therapy. Treatment of mild malaria due to a chloroquine-resistant parasite consists ...

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“…The most recent US TTM case, in 2020, involved a P. falciparum transmission from a donor from Nigeria. The donor had malaria in childhood, had emigrated 4 years prior to donation, and had not subsequently visited an endemic country [61]. A donor sample was reportedly seropositive but polymerase chain reaction (PCR) negative; however, the PCR was performed on a retained segment from the donation that had undergone prolonged storage in the refrigerator (M. Hsiang, personal communication).…”

Section: Ttm Cases In Nonendemic Countriesmentioning

confidence: 99%

“…In the USA, 12 cases of TTM were reported for the period of 2000 through 2020 [ 9 , 15 , 42 , 61 ]. All of the implicated donors were former residents of Africa.…”

Section: Ttm Cases In Nonendemic Countriesmentioning

confidence: 99%

Transfusion-Transmitted Malaria and Mitigation Strategies in Nonendemic Regions

Niederhauser

Galel

2022

Transfus Med Hemother

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Background: Malaria is a mosquito-borne infectious disease caused by protozoan parasites of the genus Plasmodium. These parasites can be transmitted by blood transfusion especially through Red Cell Blood Concentrates collected from asymptomatic and parasitemic donors. As migration of populations from endemic areas to Europe and overseas recreational travel to endemic regions increase, there is growing risk of transfusion-transmitted malaria (TTM) in nonendemic regions of the world. The present work provides an overview of the mitigation strategies in nonendemic countries and their effectiveness and discusses possible approaches to evolve the strategies in order to maintain both a safe and adequate blood supply. Summary: The historical and current situation of malaria and TTM in Europe and on the North American continent are described. The infectivity of Plasmodium in blood components and the consequences of TTM are presented, along with the regulations and guidelines for TTM mitigation in Europe, USA, and Canada. The regulations/guidelines currently in place in Europe allow a certain amount of leeway for local policies. A questionnaire was used to survey European countries regarding their current strategies and recent TTM cases. From the questionnaire and published cases, approximately 20 cases of TTM were identified in the past 20 years in the USA and Europe. The vast majority of implicated donors have been former residents of malaria-endemic areas, particularly former residents of hyperendemic areas in Africa. The most recent TTM cases are discussed in detail to provide insight into the gaps in current strategies. The utility and uncertainties of pathogen reduction and serological and molecular testing methods are discussed. Key Messages: Overall, the risk of transfusion-associated malaria in nonendemic countries is considered to be low and very few TTM cases occurred in these regions in the last 20 years. The questionnaire-based strategy with questions about risk in relation to malaria exposure with or without selective testing based on questioning seems to be relatively effective, although rare and sometimes fatal transmissions still occur. An outstanding question is whether in the future molecular methods may further improve the safety of blood products and help constrain the loss of donors.

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Transfusion-Transmitted Malaria: Two Pediatric Cases From the United States and Their Relevance in an Increasingly Globalized World

Cited by 10 publications

References 10 publications

Mitigating the risk of transfusion‐transmitted infections with vector‐borne agents solely by means of pathogen reduction

Mitigating the risk of transfusion‐transmitted infections with vector‐borne agents solely by means of pathogen reduction

Diagnosis, Treatment, and Prevention of Malaria in the US

Transfusion-Transmitted Malaria and Mitigation Strategies in Nonendemic Regions

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