1
|
Roy Choudhury A, Hoad VC, Seed C, Bentley P. Is dual testing for hepatitis C necessary? Modelling the risk of removing hepatitis C antibody testing for Australian blood donations. Vox Sang 2023; 118:480-487. [PMID: 37183505 PMCID: PMC10952898 DOI: 10.1111/vox.13430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Parallel testing of blood donations for hepatitis C virus (HCV) antibody and HCV RNA by nucleic acid testing (NAT) has been standard practice in Australia since 2000. Meanwhile, NAT technologies have improved, and HCV has become a curable disease. This has resulted in a significant reduction in the risk and clinical consequences of HCV transmission through transfusion. This study aimed to estimate the residual risk (RR) under various testing options to determine the optimal testing strategy. MATERIALS AND METHODS A developed deterministic model calculated the RR of HCV transmission for four testing strategies. A low, mid and high estimate of the RR was calculated for each. The testing strategies modelled were as follows: universal dual testing, targeted dual testing for higher risk groups (first-time donors or transfusible component donations) and universal NAT only. RESULTS The mid estimate of the RR was 1 in 151 million for universal dual testing, 1 in 111 million for targeted dual testing of first-time donors, 1 in 151 million for targeted dual testing for transfusible component donations and 1 in 66 million for universal NAT only. For all testing strategies, all estimates were considerably less than 1 in 1 million. CONCLUSION Antibody testing in addition to NAT does not materially change the risk profile. Even conservative estimates for the cessation of anti-HCV predict an HCV transmission risk substantially below 1 in 1 million. Therefore, given that it is not contributing to blood safety in Australia but consuming resources, anti-HCV testing can safely be discontinued.
Collapse
Affiliation(s)
- Avijoy Roy Choudhury
- UWA Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Clive Seed
- Australian Red Cross LifebloodPerthWestern AustraliaAustralia
| | - Peter Bentley
- UWA Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
- Australian Red Cross LifebloodPerthWestern AustraliaAustralia
| |
Collapse
|
2
|
Enok Bonong PR, Buteau C, Delage G, Tanner JE, Lacroix J, Duval M, Laporte L, Tucci M, Robitaille N, Spinella PC, Cuvelier G, Vercauteren S, Lewis V, Fearon M, Drews SJ, Alfieri C, Trottier H. Transfusion-related Epstein-Barr virus (EBV) infection: A multicenter prospective cohort study among pediatric recipients of hematopoietic stem cell transplants (TREASuRE study). Transfusion 2020; 61:144-158. [PMID: 33089891 DOI: 10.1111/trf.16149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV) is carried in the blood of most adults, and transfusion-related infections have been reported. EBV is particularly deleterious in immunosuppressed transplant patients. The aim was to determine if EBV transmission occurred through leukodepleted blood product transfusion in pediatric recipients of hematopoietic stem cell transplants (HSCT). STUDY DESIGN AND METHODS This prospective Canadian multi-center cohort study includes 156 allogeneic HSCT pediatric recipients. The association between EBV and transfusion was analyzed using Cox regressions. EBV infection, defined by a PCR+ test in the blood of seronegative recipients of an EBV-negative graft, was monitored in order to correlate the recipient EBV strain with that of the blood donors. EBV genotypes were determined by PCR amplification followed by DNA sequencing at two loci (EBNA3b and LMP1). RESULTS No statistically significant associations were found between transfusions and EBV. One case of post-transplant EBV infection was identified among the 21 EBV-seronegative recipients receiving an EBV-negative graft. A total of 22 blood donors were retraced to determine whether the recipient's EBV strain matched that of a donor. One donor strain showed 100% sequence homology at the EBNA3b locus, but differed by one or two point mutations and by a 132-bp deletion at the LMP1 locus. The blood donor in question was alone among the 22 donors to show amplifiable virus in plasma. Blood from this donor readily produced an immortalized lymphoblastoid cell line in culture. CONCLUSION While considered a rare event, EBV transmission through transfusion may occur in the context of severe immunosuppression.
Collapse
Affiliation(s)
- Pascal R Enok Bonong
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Chantal Buteau
- Division of Infectious Diseases, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Delage
- Medical Affairs, Microbiology, Héma-Québec, Ville St-Laurent, Quebec, Canada
| | - Jerome E Tanner
- Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Jacques Lacroix
- Division of Pediatric Intensive Care Medicine, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Michel Duval
- Division of Hematology-Oncology, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Louise Laporte
- Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Marisa Tucci
- Division of Pediatric Intensive Care Medicine, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Nancy Robitaille
- Division of Hematology-Oncology, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal and Medical Affairs, Transfusion Medicine, Héma-Québec, Ville Saint-Laurent, Quebec, Canada
| | - Philip C Spinella
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Geoffrey Cuvelier
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne Vercauteren
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, University of British Colombia, Vancouver, British Columbia, Canada
| | - Victor Lewis
- Department of Pediatrics and Department of Oncology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Margaret Fearon
- Medical Microbiology, Canadian Blood Services, Toronto, Ontario, Canada
| | - Steven J Drews
- Medical Affairs and Innovation, Microbiology, Canadian Blood Services and University of Alberta, Laboratory Medicine and Pathology, Edmonton, Alberta, Canada
| | - Carolina Alfieri
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Sainte-Justine University Hospital Research Centre, Université de Montréal, Montreal, Quebec, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Smatti MK, Al-Sadeq DW, Ali NH, Pintus G, Abou-Saleh H, Nasrallah GK. Epstein-Barr Virus Epidemiology, Serology, and Genetic Variability of LMP-1 Oncogene Among Healthy Population: An Update. Front Oncol 2018; 8:211. [PMID: 29951372 PMCID: PMC6008310 DOI: 10.3389/fonc.2018.00211] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022] Open
Abstract
The Epstein-Barr virus (EBV) is a DNA lymphotropic herpesvirus and the causative agent of infectious mononucleosis. EBV is highly prevalent since it affects more than 90% of individuals worldwide and has been linked to several malignancies including PTLDs, which are one of the most common malignancies following transplantation. Among all the EBV genes, most of the recent investigations focused on studying the LMP-1 oncogene because of its high degree of polymorphism and association with tumorigenic activity. There are two main EBV genotypes, Type 1 and 2, distinguished by the differences in the EBNA-2 gene. Further sub genotyping can be characterized by analyzing the LMP-1 gene variation. The virus primarily transmits through oral secretions and persists as a latent infection in human B-cells. However, it can be transmitted through organ transplantations and blood transfusions. In addition, symptoms of EBV infection are not distinguishable from other viral infections, and therefore, it remains questionable whether there is a need to screen for EBV prior to blood transfusion. Although the process of leukoreduction decreases the viral copies present in the leukocytes, it does not eliminate the risk of EBV transmission through blood products. Here, we provide a review of the EBV epidemiology and the genetic variability of the oncogene LMP-1. Then, we underscore the findings of recent EBV seroprevalence and viremia studies among blood donors as a highly prevalent transfusion transmissible oncovirus.
Collapse
Affiliation(s)
- Maria K Smatti
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Duaa W Al-Sadeq
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Nadima H Ali
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Gianfranco Pintus
- Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Haissam Abou-Saleh
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| |
Collapse
|
4
|
Leucoreduction of blood components: an effective way to increase blood safety? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:214-27. [PMID: 26710353 DOI: 10.2450/2015.0154-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
Over the past 30 years, it has been demonstrated that removal of white blood cells from blood components is effective in preventing some adverse reactions such as febrile non-haemolytic transfusion reactions, immunisation against human leucocyte antigens and human platelet antigens, and transmission of cytomegalovirus. In this review we discuss indications for leucoreduction and classify them into three categories: evidence-based indications for which the clinical efficacy is proven, indications based on the analysis of observational clinical studies with very consistent results and indications for which the clinical efficacy is partial or unproven.
Collapse
|
5
|
Trottier H, Delage G, Hu J, Robitaille N, Buteau C, Tucci M, Lacroix J, Alfieri C. Detection of Epstein-Barr virus in leucoreduced blood products. Vox Sang 2015; 110:199-201. [PMID: 26383177 DOI: 10.1111/vox.12330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
Abstract
This study examined the prevalence of three human herpesviruses (HHV), namely HHV-4 (Epstein-Barr virus/EBV), HHV-6b and HHV-7 in leucoreduced blood products obtained from the Sainte-Justine Hospital blood bank. A total of 100 specimens, including 34 red blood cell concentrates, 33 platelet bags and 33 plasma units, were collected and screened by a sensitive PCR assay using virus-specific primers. Positive units were then retested by quantitative PCR. Of the 100 specimens, one platelet unit tested positive for EBV.
Collapse
Affiliation(s)
- H Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine Hospital, Montreal, QC, Canada
| | - G Delage
- Medical Affairs, Héma-Québec, Ville Saint-Laurent, QC, Canada
| | - J Hu
- Research Center, Sainte-Justine Hospital, Montreal, QC, Canada
| | - N Robitaille
- Department of Pediatrics, Division of Hematology-Oncology, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - C Buteau
- Department of Pediatrics, Division of Infectious Diseases, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - M Tucci
- Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - J Lacroix
- Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - C Alfieri
- Department of Pediatrics, Division of Infectious Diseases, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|