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Emperador DM, Stone M, Grebe E, Escadafal C, Dave H, Lackritz E, Kelly-Cirino C, Rabe I, Rojas DP, Busch MP, Simmons G. Comparative Evaluation of Select Serological Assays for Zika Virus Using Blinded Reference Panels. Viruses 2024; 16:1075. [PMID: 39066237 PMCID: PMC11281645 DOI: 10.3390/v16071075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
In response to the 2015 Zika virus (ZIKV) epidemic that occurred in Brazil, numerous commercial serological assays have been developed for clinical and research applications. Diagnosis of recent infection in pregnant women remains challenging. Having standardized, comparative studies of ZIKV tests is important for implementing optimal diagnostic testing and disease surveillance. This is especially important for serology tests used to detect ZIKV infection given that antibodies against ZIKV can cross-react with other arboviruses in the same virus family, such as dengue virus (DENV), yellow fever virus (YFV) and West Nile virus (WNV). We looked at the sensitivity and specificity of tests detecting ZIKV antibodies (IgM, IgG) from multiple manufacturers using panels of samples previously collected with known exposure to ZIKV and other arboviruses. We found that performance of the IgM tests was highly variable, with only one test (Inbios 2.0 IgM capture ELISA) having both high sensitivity and specificity. All IgG tests showed good sensitivity; however, specificity was highly variable, with some assays giving false-positive results on samples infected by another flavivirus. Overall, the results confirmed that accurate ZIKV antibody testing is challenging, especially in specimens from regions endemic for multiple other flaviviruses, and highlight the importance of available and suitable reference samples to evaluate ZIKV diagnostics.
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Affiliation(s)
- Devy M. Emperador
- Pandemic Threats Programme, Foundation for Innovative New Diagnostics (FIND), 1218 Geneva, Switzerland; (D.M.E.)
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA 94105, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Eduard Grebe
- Vitalant Research Institute, San Francisco, CA 94105, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Camille Escadafal
- Pandemic Threats Programme, Foundation for Innovative New Diagnostics (FIND), 1218 Geneva, Switzerland; (D.M.E.)
| | - Honey Dave
- Vitalant Research Institute, San Francisco, CA 94105, USA
| | - Eve Lackritz
- Epidemic and Pandemic Preparedness and Prevention Department, Health Emergencies Programme, World Health Organization, 1211 Geneva, Switzerland
| | - Cassandra Kelly-Cirino
- Pandemic Threats Programme, Foundation for Innovative New Diagnostics (FIND), 1218 Geneva, Switzerland; (D.M.E.)
| | - Ingrid Rabe
- Epidemic and Pandemic Preparedness and Prevention Department, Health Emergencies Programme, World Health Organization, 1211 Geneva, Switzerland
| | - Diana P. Rojas
- Epidemic and Pandemic Preparedness and Prevention Department, Health Emergencies Programme, World Health Organization, 1211 Geneva, Switzerland
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA 94105, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA 94105, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
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2
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Bloch EM, Busch MP, Corash LM, Dodd R, Hailu B, Kleinman S, O'Brien S, Petersen L, Stramer SL, Katz L. Leveraging Donor Populations to Study the Epidemiology and Pathogenesis of Transfusion-Transmitted and Emerging Infectious Diseases. Transfus Med Rev 2023; 37:150769. [PMID: 37919210 PMCID: PMC10841704 DOI: 10.1016/j.tmrv.2023.150769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 11/04/2023]
Abstract
The tragedy of transfusion-associated hepatitis and HIV spurred a decades-long overhaul of the regulatory oversight and practice of blood transfusion. Consequent to improved donor selection, testing, process control, clinical transfusion practice and post-transfusion surveillance, transfusion in the United States and other high-income countries is now a very safe medical procedure. Nonetheless, pathogens continue to emerge and threaten the blood supply, highlighting the need for a proactive approach to blood transfusion safety. Blood donor populations and the global transfusion infrastructure are under-utilized resources for the study of infectious diseases. Blood donors are large, demographically diverse subsets of general populations for whom cross-sectional and longitudinal samples are readily accessible for serological and molecular testing. Blood donor collection networks span diverse geographies, including in low- and middle-income countries, where agents, especially zoonotic pathogens, are able to emerge and spread, given limited tools for recognition, surveillance and control. Routine laboratory storage and transportation, coupled with data capture, afford access to rich epidemiological data to assess the epidemiology and pathogenesis of established and emerging infections. Subsequent to the State of the Science in Transfusion Medicine symposium in 2022, our working group (WG), "Emerging Infections: Impact on Blood Science, the Blood Supply, Blood Safety, and Public Health" elected to focus on "leveraging donor populations to study the epidemiology and pathogenesis of transfusion-transmitted and emerging infectious diseases." The 5 landmark studies span (1) the implication of hepatitis C virus in post-transfusion hepatitis, (2) longitudinal evaluation of plasma donors with incident infections, thus informing the development of a widely used staging system for acute HIV infection, (3) explication of the dynamics of early West Nile Virus infection, (4) the deployment of combined molecular and serological donor screening for Babesia microti, to characterize its epidemiology and infectivity and facilitate routine donor screening, and (5) national serosurveillance for SARS-CoV-2 during the COVID-19 pandemic. The studies highlight the interplay between infectious diseases and transfusion medicine, including the imperative to ensure blood transfusion safety and the broader application of blood donor populations to the study of infectious diseases.
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Affiliation(s)
- Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence M Corash
- Cerus Corporation, Concord, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Roger Dodd
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Benyam Hailu
- Division of Blood Diseases Research, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | | | - Sheila O'Brien
- Canadian Blood Services, Epidemiology and Surveillance, Microbiology, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lyle Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, MD, USA
| | - Louis Katz
- ImpactLife Blood Services, Davenport, IA, USA
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3
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Van Rompay KK, Coffey LL, Yee JL, Singapuri A, Stuart J, Lanteri MC, Maria FS, Lu K, Singh I, Bakkour S, Stone M, Williamson PC, Muench MO, Busch MP, Simmons G. Plasma transfusion-transmission of Zika virus in mice and macaques. Transfusion 2023; 63:574-585. [PMID: 36621777 PMCID: PMC10134791 DOI: 10.1111/trf.17243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Zika virus (ZIKV) epidemics with infections in pregnant women are associated with severe neurological disease in newborns. Although an arbovirus, ZIKV is also blood transfusion-transmitted (TT). Greater knowledge of the efficiency of ZIKV TT would aid decisions on testing and pathogen reduction technologies (PRT). STUDY DESIGN AND METHODS Plasma units from ZIKV RNA-reactive blood donors were used to study infectivity in vitro, in mice, and in macaques. Furthermore, plasma units were subjected to PRT using amotosalen/ultraviolet light A (A/UVA) before transfusion. RESULTS In vitro infectivity of ZIKV RNA-reactive plasma varied between 100 and 1000 international units (IU) of ZIKV RNA. Immunodeficient mice were more sensitive with as low as 32 IU sufficient to infect 50% of mice. 50-5500 IU of RNA led to TT in macaques using dose escalation of three different RNA-positive, seronegative plasma units. In contrast, RNA-reactive units collected postseroconversion were not infectious in macaques, even at a dose of 9 million IU RNA. After A/UVA PRT, transfusion of plasma containing up to 18 million IU was no longer infectious in vitro and did not result in ZIKV TT in macaques. CONCLUSION Significant risks of ZIKV TT are likely confined to a relatively short viremic window before seroconversion, and that sensitive nucleic acid amplification testing likely identifies the majority of infectious plasma. PRT was demonstrated to be effective at preventing ZIKV TT. Considering that there is no approved ZIKV vaccine, these data are relevant to mitigate the risk of TT during the future ZIKV outbreaks.
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Affiliation(s)
- Koen K.A. Van Rompay
- California National Primate Research Center, University of California, Davis, CA, United States of America
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | - Lark L. Coffey
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | - JoAnn L. Yee
- California National Primate Research Center, University of California, Davis, CA, United States of America
| | - Anil Singapuri
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | - Jackson Stuart
- Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, United States of America
| | | | | | - Kai Lu
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Inderdeep Singh
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, United States of America
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | | | - Marcus O. Muench
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States of America
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4
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McCarthy EE, Odorizzi PM, Lutz E, Smullin CP, Tenvooren I, Stone M, Simmons G, Hunt PW, Feeney ME, Norris PJ, Busch MP, Spitzer MH, Rutishauser RL. A cytotoxic-skewed immune set point predicts low neutralizing antibody levels after Zika virus infection. Cell Rep 2022; 39:110815. [PMID: 35584677 PMCID: PMC9151348 DOI: 10.1016/j.celrep.2022.110815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/27/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022] Open
Abstract
Although generating high neutralizing antibody levels is a key component of protective immunity after acute viral infection or vaccination, little is known about why some individuals generate high versus low neutralizing antibody titers. Here, we leverage the high-dimensional single-cell profiling capacity of mass cytometry to characterize the longitudinal cellular immune response to Zika virus (ZIKV) infection in viremic blood donors in Puerto Rico. During acute ZIKV infection, we identify widely coordinated responses across innate and adaptive immune cell lineages. High frequencies of multiple activated cell types during acute infection are associated with high titers of ZIKV neutralizing antibodies 6 months post-infection, while stable immune features suggesting a cytotoxic-skewed immune set point are associated with low titers. Our study offers insight into the coordination of immune responses and identifies candidate cellular biomarkers that may offer predictive value in vaccine efficacy trials aimed at inducing high levels of antiviral neutralizing antibodies.
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Affiliation(s)
- Elizabeth E McCarthy
- Departments of Otolaryngology-Head and Neck Surgery and Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Pamela M Odorizzi
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Emma Lutz
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Carolyn P Smullin
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Iliana Tenvooren
- Departments of Otolaryngology-Head and Neck Surgery and Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA 94104, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA 94104, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Peter W Hunt
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Margaret E Feeney
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA 94110, USA
| | - Philip J Norris
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA; Vitalant Research Institute, San Francisco, CA 94104, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA 94104, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Matthew H Spitzer
- Departments of Otolaryngology-Head and Neck Surgery and Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143, USA; Gladstone-UCSF Institute for Genomic Immunology, San Francisco, CA 94158, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA 94143, USA; Chan Zuckerberg Biohub, San Francisco, CA 94158, USA.
| | - Rachel L Rutishauser
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA; Gladstone-UCSF Institute for Genomic Immunology, San Francisco, CA 94158, USA.
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5
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Saeed S, Uzicanin S, Lewin A, Lieshout-Krikke R, Faddy H, Erikstrup C, Osiowy C, Seed CR, Steele WR, Davison K, Custer B, O'Brien SF. Current challenges of severe acute respiratory syndrome coronavirus 2 seroprevalence studies among blood donors: A scoping review. Vox Sang 2021; 117:476-487. [PMID: 34862614 DOI: 10.1111/vox.13221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/04/2021] [Accepted: 09/23/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood donors are increasingly being recognized as an informative resource for surveillance. We aimed to review severe acute respiratory syndrome coronavirus 2 seroprevalence studies conducted among blood donors to investigate methodological biases and provide guidance for future research. MATERIALS AND METHODS We conducted a scoping review of peer-reviewed and preprint publications between January 2020 and January 2021. Two reviewers used standardized forms to extract seroprevalence estimates and data on methodology pertaining to population sampling, periodicity, assay characteristics, and antibody kinetics. National data on cumulative incidence and social distancing policies were extracted from publicly available sources and summarized. RESULTS Thirty-three studies representing 1,323,307 blood donations from 20 countries worldwide were included (sample sizes ranged from 22 to 953,926 donations). The majority of the studies (79%) reported seroprevalence rates <10% (ranging from 0% to 76% [after adjusting for waning antibodies]). Overall, less than 1 in 5 studies reported standardized seroprevalence rates to reflect the demographics of the general population. Stratification by age and sex were most common (64% of studies), followed by region (48%). A total of 52% of studies reported seroprevalence at a single time point. Overall, 27 unique assay combinations were identified, 55% of studies used a single assay and only 39% adjusted seroprevalence rates for imperfect test characteristics. Among the nationally representative studies, case detection was most underrepresented in Kenya (1:1264). CONCLUSION By the end of 2020, seroprevalence rates were far from reaching herd immunity. In addition to differences in community transmission and diverse public health policies, study designs and methodology were likely contributing factors to seroprevalence heterogeneity.
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Affiliation(s)
- Sahar Saeed
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Samra Uzicanin
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Antoine Lewin
- Surveillance and Biological Risk Assessment, Héma-Québec, Montreal, Québec, Canada
| | - Ryanne Lieshout-Krikke
- Department of Medical Affairs, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Helen Faddy
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Clive R Seed
- Donor and Product Safety Policy Unit, Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Whitney R Steele
- Epidemiology and Surveillance Group, Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Katy Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, London, UK
| | - Brian Custer
- Research and Scientific Programs, Vitalant, San Francisco, California, USA
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
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6
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The Specificity of the Persistent IgM Neutralizing Antibody Response in Zika Virus Infections among Individuals with Prior Dengue Virus Exposure. J Clin Microbiol 2021; 59:e0040021. [PMID: 33980647 DOI: 10.1128/jcm.00400-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Dengue viruses (DENV) and Zika virus (ZIKV) are related mosquito-borne flaviviruses with similar disease manifestations, vector ecologies, and geographic ranges. The ability to differentiate these viruses serologically is vital due to the teratogenic nature of ZIKV and the potential confounding of preexisting cross-reactive anti-DENV antibodies. Here, we illustrate the kinetics of the IgM neutralizing antibody (NAb) response using longitudinal samples ranging from acute ZIKV infection to late convalescence from individuals with evidence of prior DENV infection. By serially depleting antibody isotypes prior to the neutralization assay, we determined that IgM contributes predominantly to ZIKV neutralization and is less cross-reactive than the IgG NAb. The IgM NAb peaked around 14 days (95% confidence interval [95% CI], 13 to 15) and had a median duration of 257 days (95% CI, 133 to 427). These results demonstrate the persistence of IgM NAb after ZIKV infection and imply its potential role in diagnosis, vaccine evaluation, serosurveillance, and research on flavivirus-host interactions.
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7
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Oeller M, Laner-Plamberger S, Krisch L, Rohde E, Strunk D, Schallmoser K. Human Platelet Lysate for Good Manufacturing Practice-Compliant Cell Production. Int J Mol Sci 2021; 22:ijms22105178. [PMID: 34068404 PMCID: PMC8153614 DOI: 10.3390/ijms22105178] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/06/2023] Open
Abstract
Numerous cell-based therapeutics are currently being tested in clinical trials. Human platelet lysate (HPL) is a valuable alternative to fetal bovine serum as a cell culture medium supplement for a variety of different cell types. HPL as a raw material permits animal serum-free cell propagation with highly efficient stimulation of cell proliferation, enabling humanized manufacturing of cell therapeutics within a reasonable timeframe. Providers of HPL have to consider dedicated quality issues regarding identity, purity, potency, traceability and safety. Release criteria have to be defined, characterizing the suitability of HPL batches for the support of a specific cell culture. Fresh or expired platelet concentrates from healthy blood donors are the starting material for HPL preparation, according to regulatory requirements. Pooling of individual platelet lysate units into one HPL batch can balance donor variation with regard to essential platelet-derived growth factors and cytokines. The increasingly applied pathogen reduction technologies will further increase HPL safety. In this review article, aspects and regulatory requirements of whole blood donation and details of human platelet lysate manufacturing are presented. International guidelines for raw materials are discussed, and defined quality controls, as well as release criteria for safe and GMP-compliant HPL production, are summarized.
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Affiliation(s)
- Michaela Oeller
- Department of Transfusion Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.O.); (S.L.-P.); (L.K.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Sandra Laner-Plamberger
- Department of Transfusion Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.O.); (S.L.-P.); (L.K.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Linda Krisch
- Department of Transfusion Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.O.); (S.L.-P.); (L.K.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
- Cell Therapy Institute, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.O.); (S.L.-P.); (L.K.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
- GMP Laboratory, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Dirk Strunk
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
- Cell Therapy Institute, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
| | - Katharina Schallmoser
- Department of Transfusion Medicine, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.O.); (S.L.-P.); (L.K.); (E.R.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
- GMP Laboratory, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
- Correspondence:
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8
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Quandelacy TM, Healy JM, Greening B, Rodriguez DM, Chung KW, Kuehnert MJ, Biggerstaff BJ, Dirlikov E, Mier-y-Teran-Romero L, Sharp TM, Waterman S, Johansson MA. Estimating incidence of infection from diverse data sources: Zika virus in Puerto Rico, 2016. PLoS Comput Biol 2021; 17:e1008812. [PMID: 33784311 PMCID: PMC8034731 DOI: 10.1371/journal.pcbi.1008812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/09/2021] [Accepted: 02/17/2021] [Indexed: 01/25/2023] Open
Abstract
Emerging epidemics are challenging to track. Only a subset of cases is recognized and reported, as seen with the Zika virus (ZIKV) epidemic where large proportions of infection were asymptomatic. However, multiple imperfect indicators of infection provide an opportunity to estimate the underlying incidence of infection. We developed a modeling approach that integrates a generic Time-series Susceptible-Infected-Recovered epidemic model with assumptions about reporting biases in a Bayesian framework and applied it to the 2016 Zika epidemic in Puerto Rico using three indicators: suspected arboviral cases, suspected Zika-associated Guillain-Barré Syndrome cases, and blood bank data. Using this combination of surveillance data, we estimated the peak of the epidemic occurred during the week of August 15, 2016 (the 33rd week of year), and 120 to 140 (50% credible interval [CrI], 95% CrI: 97 to 170) weekly infections per 10,000 population occurred at the peak. By the end of 2016, we estimated that approximately 890,000 (95% CrI: 660,000 to 1,100,000) individuals were infected in 2016 (26%, 95% CrI: 19% to 33%, of the population infected). Utilizing multiple indicators offers the opportunity for real-time and retrospective situational awareness to support epidemic preparedness and response. Zika virus (ZIKV) infections, like many infections, are generally underreported due to asymptomatic, mild, or unrecognized cases. Using available surveillance indicators reflecting imperfect proxies of infection, we developed a modeling approach to estimate the weekly incidence of infection by combining independent surveillance indicators and assumptions about system-specific reporting biases in a Bayesian framework. Using our approach, we estimated that approximately 890,000 people in the population were infected with Zika in Puerto Rico in 2016, much higher than the 36,316 reported confirmed infections. Our framework has broad application to other diseases where cases may be underreported through traditional disease surveillance and can provide near real-time changes in incidences.
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Affiliation(s)
- Talia M. Quandelacy
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America
- * E-mail:
| | - Jessica M. Healy
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bradford Greening
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dania M. Rodriguez
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America
| | - Koo-Whang Chung
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew J. Kuehnert
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brad J. Biggerstaff
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Emilio Dirlikov
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Luis Mier-y-Teran-Romero
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America
| | - Tyler M. Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America
- United States Public Health Service, Silver Springs, Maryland, United States of America
| | - Stephen Waterman
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America
- United States Public Health Service, Silver Springs, Maryland, United States of America
| | - Michael A. Johansson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, United States of America
- Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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9
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Busch MP, Stone M. Serosurveillance for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Incidence Using Global Blood Donor Populations. Clin Infect Dis 2021; 72:254-256. [PMID: 33501953 PMCID: PMC7454349 DOI: 10.1093/cid/ciaa1116] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/30/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michael P Busch
- Vitalant Research Institute, Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mars Stone
- Vitalant Research Institute, Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
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Stone M, Bakkour S, Lanteri MC, Brambilla D, Simmons G, Bruhn R, Kaidarova Z, Lee TH, Orlando Alsina J, Williamson PC, Galel SA, Pate LL, Linnen JM, Kleinman S, Busch MP. Zika virus RNA and IgM persistence in blood compartments and body fluids: a prospective observational study. THE LANCET. INFECTIOUS DISEASES 2020; 20:1446-1456. [PMID: 32673593 PMCID: PMC10029720 DOI: 10.1016/s1473-3099(19)30708-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/01/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Characterisation of the dynamics of Zika virus persistence following acute infection is needed to inform blood donor and diagnostic testing policies and understand the natural history of Zika virus infection. We aimed to characterise the natural history, persistence, and clinical outcomes of Zika virus infection through a prospective study in initially asymptomatic Zika virus RNA-positive blood donors. METHODS Zika virus-infected blood donors identified through Zika virus nucleic acid amplification test (NAAT) screening at three blood collection organisations in the USA were enrolled into a 1-year follow-up study, with blood and body fluid samples and detailed symptom data collected at up to seven visits. All samples were tested for Zika virus RNA by real-time PCR (rtPCR); follow-up plasma, whole blood, and urine were also tested by replicate NAAT. Plasma was tested for flavivirus-specific IgM and IgG by ELISA. Zika virus RNA persistence for each assay or sample type and plasma antibody persistence from estimated date of plasma NAAT-detectable infection were calculated from follow-up data using survival statistical methods. FINDINGS Between July 6, 2016 and March 7, 2017, we enrolled 53 participants. From the estimated date of plasma NAAT-detectable infection, Zika virus RNA was detectable in plasma for 9·9 days (95% CI 8·1-12·0), in red blood cells for 95·4 days (62·8-129·1), and in whole blood for 73·5 days (39·8-107·5). Replicate NAATs (one or more of eight replicates positive) extended detection of Zika virus RNA in plasma to 34·8 days (19·9-56·2) and in whole blood (at least one of two tests positive) to 104·8 days (76·7-129·9). Urine was rtPCR reactive up to 14·5 days (10·5-20·3) and saliva up to 26·4 days (19·7-38·7). Zika virus IgM persisted for 237·7 days (128·7-459·5) from estimated time since plasma NAAT-detectable infection. Zika virus RNA fell below detectable limits more rapidly in the saliva of participants with pre-existing dengue virus IgG than in those without. Of 25 donors identified pre-seroconversion with symptom data at the first or second study visit, 16 (64%) developed multiple Zika virus-related symptoms after asymptomatic index donations, compared with nine (36%) of 25 donors detected after seroconversion. INTERPRETATION Determination of viral marker persistence is enhanced by follow-up of blood donors who are pre-symptomatic or asymptomatic, Zika virus RNA-positive, and antibody negative. Zika virus RNA persists in red blood cells for several months following clearance from plasma and body fluids, and replicate, highly sensitive NAATs extend RNA detection in all compartments. Whole blood testing can extend detection of acute infection for diagnostics and monitoring of pregnant women, sexual partners, and travellers. FUNDING National Heart, Lung, and Blood Institute, Biomedical Advanced Research and Development Authority.
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Affiliation(s)
- Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA.
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Marion C Lanteri
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA; Cerus Corporation, Concord, CA, USA
| | | | - Graham Simmons
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | | | | | | | | | | | - Lisa L Pate
- Roche Molecular Systems, Pleasanton, CA, USA
| | | | - Steve Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, BC, Canada
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
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Sharp TM, Quandelacy TM, Adams LE, Aponte JT, Lozier MJ, Ryff K, Flores M, Rivera A, Santiago GA, Muñoz-Jordán JL, Alvarado LI, Rivera-Amill V, Garcia-Negrón M, Waterman SH, Paz-Bailey G, Johansson MA, Rivera-Garcia B. Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico. PLoS Negl Trop Dis 2020; 14:e0008532. [PMID: 32956416 PMCID: PMC7529257 DOI: 10.1371/journal.pntd.0008532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/01/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. Methods and findings Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015–December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20–29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]: -0.22 [95% confidence interval -0.29, -0.14]), eastern longitude (log HR: -1.04 [-1.17, -0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR: -0.30 [-0.32, -0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature (log HR: -0.04 [-0.05, -0.03]). Higher incidence of ZIKV disease was associated with lower mean precipitation, but not socioeconomic factors. Conclusions During the ZIKV epidemic in Puerto Rico, 1% of residents were reported to public health authorities and had laboratory evidence of ZIKV disease. Transmission was first detected in urban areas of eastern Puerto Rico, where transmission also peaked earlier. These trends suggest that ZIKV was first introduced to Puerto Rico in the east before disseminating throughout the island. During epidemics of Zika virus disease in the Americas in 2015 and 2016, assessment of transmission dynamics was limited by inconsistent laboratory testing of patients with suspected Zika virus disease. This limitation was further complicated by co-circulation of dengue and chikungunya viruses, which cause illnesses clinically similar to Zika virus disease. In Puerto Rico, all reported suspect cases of arboviral disease were tested for Zika, dengue, and chikungunya virus infection throughout the epidemic, which allowed for fine-scale analysis of epidemiologic and spatiotemporal trends. In total, 39,717 cases of Zika virus disease were detected, or roughly 1% of all residents of Puerto Rico. Young adults and females were most affected. Disease was mostly mild, as only 1% of cases were hospitalized. Thirteen patients with Zika virus disease died, most of whom had Guillain-Barré syndrome or severe underlying illnesses. Early detection of Zika virus disease cases was associated with more populated areas of eastern Puerto Rico, where early detection of peak case numbers also occurred, particularly in warmer areas. These trends suggest that, in contrast to prior epidemics of dengue and chikungunya that started in the San Juan metropolitan region, the Zika virus epidemic appears to have begun in eastern Puerto Rico.
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Affiliation(s)
- Tyler M. Sharp
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Talia M. Quandelacy
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Laura E. Adams
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Jomil Torres Aponte
- Office of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Matthew J. Lozier
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Kyle Ryff
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Mitchelle Flores
- Biological and Chemical Emergencies Laboratory, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Aidsa Rivera
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A. Santiago
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | | | | | | | - Stephen H. Waterman
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Michael A. Johansson
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Brenda Rivera-Garcia
- Biological and Chemical Emergencies Laboratory, Puerto Rico Department of Health, San Juan, Puerto Rico
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Petersen LR, Cassetti MC. Learning about Zika virus epidemiology and diagnostics from blood donor studies. THE LANCET. INFECTIOUS DISEASES 2020; 20:1357-1359. [PMID: 32673592 DOI: 10.1016/s1473-3099(20)30125-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Lyle R Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, USA.
| | - M Cristina Cassetti
- Division of Microbiology and Infectious Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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