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van den Berg K, Murphy EL, Maartens G, Louw VJ, Grebe E. The impact of non-disclosure of HIV status and antiretroviral therapy on HIV recency testing and incidence algorithms. Vox Sang 2024. [PMID: 38622931 DOI: 10.1111/vox.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Accurate HIV incidence estimates among blood donors are necessary to assess the effectiveness of programs aimed at limiting transfusion-transmitted HIV. We assessed the impact of undisclosed HIV status and antiretroviral (ARV) use on HIV recency and incidence estimates using increasingly comprehensive recent infection testing algorithms. MATERIALS AND METHODS Using 2017 donation data from first-time and lapsed donors, we populated four HIV recency algorithms: (1) serology and limiting-antigen avidity testing, (2) with individual donation nucleic amplification testing (ID-NAT) added to Algorithm 1, (3) with viral load added to Algorithm 2 and (4) with ARV testing added to Algorithm 3. Algorithm-specific mean durations of recent infection (MDRI) and false recency rates (FRR) were calculated and used to derive and compare incidence estimates. RESULTS Compared with Algorithm 4, progressive algorithms misclassified fewer donors as recent: Algorithm 1: 61 (12.1%); Algorithm 2: 14 (2.8%) and Algorithm 3: 3 (0.6%). Algorithm-specific MDRI and FRR values resulted in marginally lower incidence estimates: Algorithm 1: 0.19% per annum (p.a.) (95% confidence interval [CI]: 0.13%-0.26%); Algorithm 2: 0.18% p.a. (95% CI: 0.13%-0.22%); Algorithm 3: 0.17% p.a. (95% CI: 0.13%-0.22%) and Algorithm 4: 0.17% p.a. (95% CI: 0.13%-0.21%). CONCLUSION We confirmed significant misclassification of recent HIV cases when not including viral load and ARV testing. Context-specific MDRI and FRR resulted in progressively lower incidence estimates but did not fully account for the context-specific variability in incidence modelling. The inclusion of ARV testing, in addition to viral load and ID-NAT testing, did not have a significant impact on incidence estimates.
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Affiliation(s)
- Karin van den Berg
- Medical Division, South African National Blood Service, Roodepoort, South Africa
- Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Edward L Murphy
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology, University of California, San Francisco, California, USA
- Vitalant Research Institute, San Francisco, California, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Eduard Grebe
- Vitalant Research Institute, San Francisco, California, USA
- Eduard Grebe Consulting, Cape Town, South Africa
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2
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Jentsch U, Vermeulen M, van den Berg K, Swanevelder R, Creel D, Jacobs G, Hemingway-Foday JJ, Nyoni C, Murphy EL, Custer B. A case-control study of risk factors for incident hepatitis B virus infection in South African blood donors. Int J Infect Dis 2024; 141:106958. [PMID: 38373648 PMCID: PMC11034725 DOI: 10.1016/j.ijid.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Hepatitis B virus (HBV) infection remains a global health problem. Risk factors for HBV infection are usually assessed in prevalent rather than incident infections. To identify demographic and behavioral risks associated with incident HBV among South African blood donors. METHODS A case-control study was performed between November 2014 and January 2018. Cases were blood donors testing positive for HBV DNA with or without hepatitis B surface antigen but negative for antibody to hepatitis B core antigen. Participants completed an audio computer-assisted structured interview on exposures during the previous 6 months. Sex-specific multivariable logistic regression yielded independent associations between risks and HBV infection. RESULTS 56 females and 37 males with incident HBV were compared to 438 female and 439 male controls, respectively. For females, risk factors were accepting money or goods for sex, using agents to prepare one's anus prior to anal sex, penetrating injury, non-Black race, and lower educational status. Men reporting homosexual or bisexual orientation or sex with other men, previous injury, referral for HBV testing, or lack of medical insurance were at increased risk. For both sexes, having more than two male sexual partners increased risk. CONCLUSIONS Sexual behaviors predominated over parenteral exposures as risks for incident HBV in both female and male blood donors.
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Affiliation(s)
- Ute Jentsch
- The South African National Blood Service, Johannesburg, South Africa.
| | - Marion Vermeulen
- The South African National Blood Service, Johannesburg, South Africa; University of the Free State, Bloemfontein, South Africa
| | - Karin van den Berg
- The South African National Blood Service, Johannesburg, South Africa; University of the Free State, Bloemfontein, South Africa
| | - Ronél Swanevelder
- The South African National Blood Service, Johannesburg, South Africa
| | | | - Genevieve Jacobs
- The South African National Blood Service, Johannesburg, South Africa
| | | | - Cynthia Nyoni
- The South African National Blood Service, Johannesburg, South Africa
| | - Edward L Murphy
- University of California San Francisco, San Francisco, USA; Vitalant Research Institute, San Francisco, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, USA; University of California San Francisco, San Francisco, USA
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3
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Vermeulen M, Mhlanga L, Sykes W, Cable R, Coleman C, Pietersen N, Swanevelder R, Glatt TN, Bingham J, van den Berg K, Grebe E, Welte A. The evolution and interpretation of seroprevalence of SARS-CoV-2 antibodies among South African blood donors from the Beta to Omicron variant-driven waves. Vox Sang 2024; 119:242-251. [PMID: 38156504 DOI: 10.1111/vox.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Confirmed COVID-19 diagnoses underestimate the total number of infections. Blood donors can provide representative seroprevalence estimates, which can be leveraged into reasonable estimates of total infection counts and infection fatality rate (IFR). MATERIALS AND METHODS Blood donors who donated after each of three epidemic waves (Beta, Delta and first Omicron waves) were tested for anti-SARS-CoV-2 nucleocapsid antibodies using the Roche Elecsys anti-SARS-CoV-2 total immunoglobulin assay. Roche Elecsys anti-spike antibody testing was done for the post-Omicron sampling. Prevalence of antibodies was estimated by age, sex, race and province and compared to official case reporting. Province and age group-specific IFRs were estimated using external excess mortality estimates. RESULTS The nationally weighted anti-nucleocapsid seroprevalence estimates after the Beta, Delta and Omicron waves were 47% (46.2%-48.6%), 71% (68.8%-73.5%) and 87% (85.5%-88.4%), respectively. There was no variation by age and sex, but there were statistically and epidemiologically significant differences by province (except at the latest time point) and race. There was a 13-fold higher seroprevalence than confirmed case counts at the first time point. Age-dependent IFR roughly doubled for every 10 years of age increase over 6 decades from 0.014% in children to 6.793% in octogenarians. CONCLUSION Discrepancies were found between seroprevalence and confirmed case counts. High seroprevalence rates found among Black African donors can be ascribed to historical inequities. Our IFR estimates were useful in refining previous large disagreements about the severity of the epidemic in South Africa. Blood donor-based serosurveys provided a valuable and efficient way to provide near real-time monitoring of the ongoing SARS-CoV-2 outbreak.
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Affiliation(s)
- Marion Vermeulen
- South African National Blood Service, Johannesburg, South Africa
- University of the Free State, Bloemfontein, South Africa
| | - Laurette Mhlanga
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
- Northwestern University, Chicago, Illinois, USA
| | - Wendy Sykes
- South African National Blood Service, Johannesburg, South Africa
| | | | - Charl Coleman
- South African National Blood Service, Johannesburg, South Africa
| | | | | | - Tanya Nadia Glatt
- South African National Blood Service, Johannesburg, South Africa
- University of Johannesburg, Johannesburg, South Africa
| | - Jeremy Bingham
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Karin van den Berg
- South African National Blood Service, Johannesburg, South Africa
- University of the Free State, Bloemfontein, South Africa
- University of Cape Town, Rondebosch, South Africa
| | - Eduard Grebe
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
- Vitalant Research Institute, San Francisco, California, USA
- University of California San Francisco, San Francisco, California, USA
| | - Alex Welte
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
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4
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Baggio D, Fox LC, Wood EM, Aditya RN, Goldman M, van den Berg K, Kayser S, Wuchter P, Namba N, Tsuno NH, Makino S, Lee CK, Akhtar N, Shah F, Miflin G, Prati D, La Raja M, La Rocca U, Richard P, Tiberghien P, Harley RJ, Raouf MY, Sharma R, Kaur S, Bruijns S, Prakke-Weekamp H, Dunbar N. International Forum on Blood Donation in Individuals with Current, Past or Germline Predisposition to Malignancy: Summary. Vox Sang 2023; 118:1115-1121. [PMID: 37966010 DOI: 10.1111/vox.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023]
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5
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Baggio D, Fox LC, Wood EM, Aditya RN, Goldman M, van den Berg K, Kayser S, Wuchter P, Namba N, Tsuno NH, Makino S, Lee CK, Akhtar N, Shah F, Miflin G, Prati D, La Raja M, Rocca UL, Richard P, Tiberghien P, Harley RJ, Raouf MY, Sharma R, Kaur S, Bruijns S, Prakke-Weekamp H, Dunbar N. International Forum on Blood Donation in Individuals with Current, Past or Germline Predisposition to Malignancy: Responses. Vox Sang 2023; 118:1122-1144. [PMID: 37966022 DOI: 10.1111/vox.13550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023]
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6
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Prithvi Raj S, Vermeulen M, Swanevelder R, van den Berg K, Bellairs GRM. Blood banking in South Africa. Transfus Apher Sci 2023; 62:103794. [PMID: 37679235 DOI: 10.1016/j.transci.2023.103794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Siemi Prithvi Raj
- Donor Services Division, South African National Blood Service, Johannesburg, South Africa.
| | - Marion Vermeulen
- Technical Services Division, South African National Blood Service, Johannesburg, South Africa
| | - Ronel Swanevelder
- Medical Division, South African National Blood Service, Johannesburg, South Africa
| | - Karin van den Berg
- Medical Division, South African National Blood Service, Johannesburg, South Africa; Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
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7
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Arora S, Goel R, Al-Riyami AZ, Al-Rawas AH, Al Hosni S, Montanari M, Costantini B, Ling CLL, Mustafa N, Joo CK, Dhawan HK, Malhotra S, Sharma RR, New H, Moss R, Davis J, Robitaille N, Arsenault V, Saifee NH, Taroc AM, Rahimi-Levene N, Peer V, Badawi M, Snijder PM, Huisman EJ, Salegui JZ, Pato JR, Navarro JS, Kutner JM, Yokoyama APH, Lam JCM, Zhong XN, Heng ML, Torres OW, Dhabangi A, van Zyl A, Mundey N, Louw V, van den Berg K, Dunbar N. International Forum on Small-Volume Transfusions in Neonates and Paediatric Patients: Responses. Vox Sang 2023; 118:230-251. [PMID: 36648446 DOI: 10.1111/vox.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
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8
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Arora S, Goel R, Al-Riyami AZ, Al-Rawas AH, Al Hosni S, Montanari M, Costantini B, Ling CLL, Mustafa N, Joo CK, Dhawan HK, Malhotra S, Sharma RR, New H, Moss R, Davis J, Robitaille N, Arsenault V, Saifee NH, Taroc AM, Rahimi-Levene N, Peer V, Badawi M, Snijder PM, Huisman EJ, Salegui JZ, Pato JR, Navarro JS, Kutner JM, Yokoyama APH, Lam JCM, Zhong XN, Heng ML, Torres OW, Dhabangi A, van Zyl A, Mundey N, Louw V, van den Berg K, Dunbar N. International Forum on Small-Volume Transfusions in Neonates and Paediatric Patients: Summary. Vox Sang 2023; 118:223-229. [PMID: 36648448 DOI: 10.1111/vox.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
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9
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van den Berg K, Murphy EL, Louw VJ, Maartens G, Hughes SD. Motivations for blood donation by HIV-positive individuals on antiretrovirals in South Africa: A qualitative study. Transfus Med 2023. [PMID: 36799902 PMCID: PMC10403373 DOI: 10.1111/tme.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We performed a mixed-methods study to explore the motivations associated with blood donation by donors with known, but undisclosed HIV-positive status and ARV use (HIV+/ARV+), seeking potential strategies to reduce such donations and mitigate risk for blood recipients. Here, we report predominantly the qualitative component. BACKGROUND A safe and sustainable blood supply is dependent in part, on effective pre-donation donor assessment. We previously described failure by HIV+/ARV+ blood donors to disclose their status. Such donations may lead to transfusion-transmitted HIV. METHODS The social ecological model provided the conceptual framework for this study. Previously identified HIV+/ARV+ donors were invited to complete a survey (including a validated stigma scale) and qualitative interview, which underwent inductive and deductive thematic analysis. RESULTS We uncovered two primary motivational paths to HIV+/ARV+ blood donations: privacy and altruism. The latter included a motivation not previously reported in the literature: donating specifically for other people living with HIV (PLWH). The other primary factor was a lack of privacy. These accounts often included donors encountering donation opportunities when accompanied by people to whom they had not and did not plan to disclose their HIV status. Most were highly confident their donations would be identified as HIV-positive and discarded. CONCLUSION We demonstrated a complex interaction between individual, social, cultural, and structural/policy factors in blood donations by PLWH who take ARV. Recommendations to limit HIV + ARV+ donations include: (1) Targeted communication strategies to increase knowledge among PLWH of their deferral from blood donation-without increasing stigma, and (2) development of procedures to assist those who feel unable to opt-out of donation due to privacy concerns.
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Affiliation(s)
- Karin van den Berg
- Medical Division, South African National Blood Service, Roodepoort, South Africa.,Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Edward L Murphy
- Department of Laboratory Medicine, University of California, San Franciscco, San Francisco, California, USA.,Department of Epidemiology/Biostatistics, University of California, San Franciscco, San Francisco, California, USA.,Epidemiology and Bioinformatics Core, Vitalant Research Institute, San Francisco, California, USA
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shana D Hughes
- Epidemiology and Bioinformatics Core, Vitalant Research Institute, San Francisco, California, USA
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10
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Patidar GK, Thachil J, Dhiman Y, Oreh A, Vrielink H, van den Berg K, Grubovic Rastvorceva RM, So-Osman C, Al-Riyami AZ. Management of blood transfusion services in low-resource countries. Vox Sang 2022; 117:1375-1383. [PMID: 36349461 DOI: 10.1111/vox.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Enabling universal access to safe blood components should be a key component of every country's national healthcare strategy. This study aimed to assess the current status of infrastructure and resources of blood transfusion services (BTS) in low- and middle-income countries. MATERIALS AND METHODS A cross-sectional survey was designed to gather information on blood donations, components, redistribution, testing resources and quality management systems (QMSs). The survey was distributed to the International Society of Blood Transfusion members between October 2021 and November 2021. RESULTS A total of 54 respondents from 20 countries responded to the survey. This included hospital-based BTS/blood centres (46%), national blood centres (11%)and national and regional blood services (11%). Voluntary non-remunerated, replacement and paid donors accounted for 94.2%, 84.6% and 21.1% of donations, respectively. Apheresis donation was available in 59.6% of institutions. National/regional criteria for redistribution of blood components were reported by 75.9% of respondents. Blood components incurred payment charges in 81.5% of respondents' institutions, and payments were borne by patients in 50% of them. Testing methods, such as manual (83%), semi-automated (68%) or fully automated (36.2%), were used either alone or in combination. QMSs were reported in 17 institutions, while accreditation and haemovigilance were reported in 12 and 8 countries, respectively. CONCLUSION QMS was implemented in most of the countries despite the common use of paid donations and the lack of advanced testing. Efforts to overcome persistent challenges and wider implementation of patient blood management programmes are required.
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Affiliation(s)
- Gopal K Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Yashaswi Dhiman
- Department of Immunohematology & Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Adaeze Oreh
- Department of Planning, Research and Statistics, National Blood Service Commission, Abuja, Nigeria.,Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Hans Vrielink
- Department of Transfusion medicine, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Karin van den Berg
- Translational Research Department, Medical Division, South African National Blood Service, Port Elizabeth, South Africa.,Medical Division, South African National Blood Service, Roodepoort, South Africa.,Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia.,Department of Transfusion Medicine, Faculty of Medical Sciences, University Goce Delcev Stip, Macedonia, North Macedonia
| | - Cynthia So-Osman
- Department of Transfusion medicine, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Departmentof Haematology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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11
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van den Berg K, Vermeulen M, Bakkour S, Stone M, Jacobs G, Nyoni C, Barker C, McClure C, Creel D, Grebe E, Roubinian N, Jentsch U, Custer B, Busch MP, Murphy EL. Blood Center Testing Allows the Detection and Rapid Treatment of Acute and Recent HIV Infection. Viruses 2022; 14:v14112326. [PMID: 36366424 PMCID: PMC9698357 DOI: 10.3390/v14112326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Blood donations in South Africa are tested for HIV RNA using individual donation NAT (ID-NAT), allowing detection and rapid antiretroviral therapy (ART) of acute HIV infections. We enrolled a cohort of acute and recent HIV-infected blood donation candidates in South Africa in 2015-2018, measured HIV antibody, ID-NAT, and recency of infection <195 days (Sedia LAg) at enrollment and initiated early ART. A small cohort of HIV elite controllers was followed without treatment. HIV reservoir measurements included ultrasensitive plasma RNA, cell-associated HIV RNA, and total DNA. Enrollment of 18 Fiebig I-III and 45 Fiebig IV-VI HIV clade C subjects occurred a median of 18 days after index blood donation. ART was administered successfully and compliance with follow-up visits was excellent. There were only minimal differences in HIV reservoir between ART initiation in Fiebig stages I-III vs. IV-VI, but ART noncompliance increased HIV reservoir. In 11 untreated HIV elite controllers, HIV reservoir levels were similar to or higher than those seen in our early treated cohort. National blood services can identify acute HIV cohorts for subsequent HIV cure research studies. Among HIV clade C-infected donors, HIV reservoir differed little by Fiebig stage at treatment initiation, but was smaller than in chronically treated HIV and those with ART noncompliance.
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Affiliation(s)
| | - Marion Vermeulen
- South African National Blood Service, Johannesburg 3610, South Africa
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, CA 94118, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA 94118, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Genevieve Jacobs
- South African National Blood Service, Johannesburg 3610, South Africa
| | - Cynthia Nyoni
- South African National Blood Service, Johannesburg 3610, South Africa
| | - Coreen Barker
- Clinical HIV Research Unit, University of the Witwatersr, Johannesburg 2092, South Africa
| | | | | | - Eduard Grebe
- Vitalant Research Institute, San Francisco, CA 94118, USA
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch 7602, South Africa
| | - Nareg Roubinian
- Vitalant Research Institute, San Francisco, CA 94118, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Ute Jentsch
- South African National Blood Service, Johannesburg 3610, South Africa
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA 94118, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA 94118, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Edward L. Murphy
- Vitalant Research Institute, San Francisco, CA 94118, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- 270 Masonic Avenue, San Francisco, CA 94118, USA
- Correspondence: ; Tel.: +1-415-749-6668
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12
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Al-Riyami AZ, Estcourt L, Rahimi-Levene N, Bloch EM, Goel R, Tiberghien P, Thibert JB, Bruun MT, Devine DV, Gammon RR, Wendel S, Toungouz Nevessignsky M, Grubovic Rastvorceva RM, Oreh A, Romon I, van den Berg K, Kitazawa J, Patidar G, So-Osman C, Wood EM. Early and out-of-hospital use of COVID-19 convalescent plasma: An international assessment of utilization and feasibility. Vox Sang 2022; 117:1202-1210. [PMID: 36102139 PMCID: PMC9538090 DOI: 10.1111/vox.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives The use of coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) in the treatment of patients with severe acute respiratory syndrome‐2 infection has been controversial. Early administration of CCP before hospital admission offers a potential advantage. This manuscript summarizes current trials of early use of CCP and explores the feasibility of this approach in different countries. Materials and Methods A questionnaire was distributed to the International Society of Blood Transfusion (ISBT) CCP working group. We recorded respondents' input on existing trials on early/outpatient CCP and out‐of‐hospital (OOH)/home transfusion (HT) practices in their countries and feedback on challenges in initiating home CCP infusion programmes. In addition, details of existing trials registered on clinicaltrials.gov were summarized. Results A total of 31 country representatives participated. Early/OOH CCP transfusion studies were reported in the United States, the Netherlands, Spain and Brazil. There were a total of six published and five ongoing trials on the prophylactic and therapeutic early use of CCP. HT was practised in Australia, the UK, Belgium, France, Japan, Nigeria, the Netherlands, Spain, Italy, Norway, the United States and some provinces in Canada. Thirty‐four representatives indicated a lack of OOH CCP or HT in their institutions and countries. Barriers to implementation of OOH/HT included existing legislation, lack of policies pertaining to outpatient transfusion, and associated logistical challenges, including lack of staffing and resources. Conclusion Early administration of CCP remains a potential option in COVID‐19 management in countries with existing OOH/HT programmes. Legislation and regulatory bodies should consider OOH/HT practice for transfusion in future pandemics.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Lise Estcourt
- NHS Blood and Transplant & Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,ImpactLife Blood Centre and Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | | | | | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Dana V Devine
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Richard R Gammon
- Scientific Medical and Technical Direction, OneBlood, Orlando, Florida, USA
| | - Silvano Wendel
- Blood Bank, Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
| | | | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia.,Faculty of Medical Sciences, University Goce Delcev, Štip, North Macedonia
| | - Adaeze Oreh
- National Blood Service Commission, Federal Ministry of Health, Abuja, Nigeria
| | - Iñigo Romon
- Hematology Department, University Hospital Marques de Valdecilla, Santander, Spain
| | - Karin van den Berg
- Transfusion Medicine and Technical Services Division, South African National Blood Service, Johannesburg, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Junichi Kitazawa
- Department of Genomic Medicine, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Cynthia So-Osman
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department of Haematology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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13
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Bingham J, Cable R, Coleman C, Glatt TN, Grebe E, Mhlanga L, Nyano C, Pieterson N, Swanevelder R, Swarts A, Sykes W, van den Berg K, Vermeulen M, Welte A. Estimates of prevalence of anti-SARS-CoV-2 antibodies among blood donors in South Africa in March 2022. Res Sq 2022:rs.3.rs-1687679. [PMID: 35665020 PMCID: PMC9164518 DOI: 10.21203/rs.3.rs-1687679/v1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In line with previous instalments of analysis from this ongoing study to monitor 'Covid Seroprevalence' among blood donors in South Africa, we report on an analysis of 3395 samples obtained in mid-March 2022 from all provinces of South Africa - a timepoint just after the fourth (primarily omicron) wave of infections. As in our previous analyses, we see no evidence of age and sex dependence of prevalence, but significant variation by race. Differences between provinces have largely disappeared, as prevalence appears to have saturated. In contrast to previous estimates from this study, which reported only prevalence of anti-nucleocapsid antibodies, this present work also reports results from testing for anti-spike antibodies. This addition allows us to categorise those donors whose only antibodies are from vaccination. Our race-weighted national extrapolation is that 98% of South Africans have some antibodies, noting that 10% have anti-spike antibodies but not anti-nucleocapsid antibodies - a reasonable proxy for having both 1) been vaccinated and 2) avoided infection.
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Affiliation(s)
- Jeremy Bingham
- South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University
| | | | | | | | | | | | | | | | | | | | | | | | | | - Alex Welte
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis
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14
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Bingham J, Cable R, Coleman C, Glatt TN, Grebe E, Mhlanga L, Nyano C, Pieterson N, Swanevelder R, Swarts A, Sykes W, van den Berg K, Vermeulen M, Welte A. Estimates of prevalence of anti-SARS-CoV-2 antibodies among blood donors in South Africa in March 2022. RESEARCH SQUARE 2022:rs.3.rs-1687679. [PMID: 36575763 PMCID: PMC9793839 DOI: 10.21203/rs.3.rs-1687679/v2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In line with previous instalments of analysis from this ongoing study to monitor 'Covid Seroprevalence' among blood donors in South Africa, we report on an analysis of 3395 samples obtained in mid-March 2022 from all provinces of South Africa - a timepoint just after the fourth (primarily omicron) wave of infections. As in our previous analyses, we see no evidence of age and sex dependence of prevalence, but significant variation by race. Differences between provinces have largely disappeared, as prevalence appears to have saturated. In contrast to previous estimates from this study, which reported only prevalence of anti-nucleocapsid antibodies, this present work also reports results from testing for anti-spike antibodies. This addition allows us to categorise those donors whose only antibodies are from vaccination. Our race-weighted national extrapolation is that 98% of South Africans have some antibodies, noting that 10% have anti-spike antibodies but not anti-nucleocapsid antibodies - a reasonable proxy for having both 1) been vaccinated and 2) avoided infection.
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Affiliation(s)
- Jeremy Bingham
- South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University
| | | | | | | | | | | | | | | | | | | | | | | | | | - Alex Welte
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis
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15
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Cable R, Coleman C, Glatt T, Grebe E, Mhlanga L, Nyoni C, Pieterson N, Swanevelder R, Swarts A, Sykes W, van den Berg K, Vermeulen M, Welte A. Estimates of prevalence of anti-SARS-CoV-2 antibodies among blood donors in eight provinces of South Africa in November 2021. Res Sq 2022:rs.3.rs-1359658. [PMID: 35194594 PMCID: PMC8863147 DOI: 10.21203/rs.3.rs-1359658/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In line with previous instalments of analysis from this ongoing study to monitor 'Covid Seroprevalence' among blood donors in South Africa, we report on analysis of 3395 samples obtained from 8 to 12 November 2021 in all provinces of South Africa except the Western Cape. As in our previous analyses, we see no evidence of age and sex dependence of prevalence, but substantial variation by province, and by race within each province, from which we generated provincial total point estimates (EC-74%; FS-75%; GP-68%; ZN-73%; LP-66; MP-73%; NC-63%; NW-81% ) and a 'South Africa minus Western Cape' national prevalence estimate of 71% (95%CI 69-74%). We note that sample collection occurred just before the omicron variant driven wave in South Africa, but otherwise present these results without significant interpretation.
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Affiliation(s)
| | | | | | - Eduard Grebe
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University
- Vitalant Research Institute
| | - Laurette Mhlanga
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University
| | | | | | | | | | | | | | | | - Alex Welte
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University
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16
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van den Berg K, Glatt TN, Vermeulen M, Little F, Swanevelder R, Barrett C, Court R, Bremer M, Nyoni C, Swarts A, Mmenu C, Crede T, Kritzinger G, Naude J, Szymanski P, Cowley J, Moyo-Gwete T, Moore PL, Black J, Singh J, Bhiman JN, Baijnath P, Mody P, Malherbe J, Potgieter S, van Vuuren C, Maasdorp S, Wilkinson RJ, Louw VJ, Wasserman S. Convalescent plasma in the treatment of moderate to severe COVID-19 pneumonia: a randomized controlled trial (PROTECT-Patient Trial). Sci Rep 2022; 12:2552. [PMID: 35169169 PMCID: PMC8847351 DOI: 10.1038/s41598-022-06221-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
There is a need for effective therapy for COVID-19 pneumonia. Convalescent plasma has antiviral activity and early observational studies suggested benefit in reducing COVID-19 severity. We investigated the safety and efficacy of convalescent plasma in hospitalized patients with COVID-19 in a population with a high HIV prevalence and where few therapeutic options were available. We performed a double-blinded, multicenter, randomized controlled trial in one private and three public sector hospitals in South Africa. Adult participants with COVID-19 pneumonia requiring non-invasive oxygen were randomized 1:1 to receive a single transfusion of 200 mL of either convalescent plasma or 0.9% saline solution. The primary outcome measure was hospital discharge and/or improvement of ≥ 2 points on the World Health Organisation Blueprint Ordinal Scale for Clinical Improvement by day 28 of enrolment. The trial was stopped early for futility by the Data and Safety Monitoring Board. 103 participants, including 21 HIV positive individuals, were randomized at the time of premature trial termination: 52 in the convalescent plasma and 51 in the placebo group. The primary outcome occurred in 31 participants in the convalescent plasma group and and 32 participants in the placebo group (relative risk 1.03 (95% CI 0.77 to 1.38). Two grade 1 transfusion-related adverse events occurred. Participants who improved clinically received convalescent plasma with a higher median anti-SARS-CoV-2 neutralizing antibody titre compared with those who did not (298 versus 205 AU/mL). Our study contributes additional evidence for recommendations against the use of convalescent plasma for COVID-19 pneumonia. Safety and feasibility in this population supports future investigation for other indications.
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Affiliation(s)
- Karin van den Berg
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa.
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Tanya Nadia Glatt
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Marion Vermeulen
- Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
- Operations Division, Operations Testing Department, South African National Blood Service, Roodepoort, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Observatory, South Africa
| | - Ronel Swanevelder
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Claire Barrett
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Richard Court
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Marise Bremer
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
| | - Cynthia Nyoni
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Avril Swarts
- Medical Division, Translational Research Department, South African National Blood Service, 1 Constantia Blvd, Roodepoort, 1715, South Africa
| | - Cordelia Mmenu
- Operations Division, Operations Testing Department, South African National Blood Service, Roodepoort, South Africa
| | - Thomas Crede
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Gerdien Kritzinger
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Jonathan Naude
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Patryk Szymanski
- Mitchells Plain Hospital and the University of Cape Town's Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - James Cowley
- Operations Division, Processing Department, South African National Blood Service, Roodepoort, South Africa
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Penny L Moore
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Black
- Department of Medicine, Walter Sisulu University, Livingstone Hospital, Gqeberha, South Africa
| | - Jaimendra Singh
- Capital Haematology Hospital and Bone Marrow Transplant Unit, Durban, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Priyesh Mody
- Life Westville Hospital, Westville, South Africa
| | - Jacques Malherbe
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
| | - Samantha Potgieter
- Division of Infectious Diseases, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Cloete van Vuuren
- 3 Military Hospital and Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
| | - Shaun Maasdorp
- Pulmonology and Critical Care, Universitas Academic Hospital and Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Francis Crick Institute, London, NW1 1AT, UK
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Observatory, South Africa
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17
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Rapodile T, Mitchel J, Swanevelder R, Murphy EL, van den Berg K. Re-engineering the medical assessment of blood donors in South Africa: The balance between supply and safety. Transfusion 2021; 61:3361-3371. [PMID: 34643286 DOI: 10.1111/trf.16702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The balance between ensuring blood donor and recipient safety while maintaining a sufficient blood supply can be affected by excessive deferral of blood donors. In 2018, a biannual regulatory review of donor eligibility criteria provided the South African National Blood Service (SANBS) the opportunity to review the existing criteria. Changes to these criteria were implemented in April 2019 after an extensive review. STUDY DESIGN AND METHODS We conducted a cross-sectional study of SANBS whole-blood donor presentations to determine the impact of the changed donor eligibility criteria on deferrals and blood safety. We compared donor presentations, deferrals, and HIV-positive cases for the 12-month period (April 2019-March 2020) after the implementation of the updated donor eligibility criteria to those of the previous year. RESULTS Of the 2,112,917 donor presentations, 51.1% (1079506) occurred in the post-implementation study period. Overall, deferrals decreased from 18.6% to 14.5%, whereas HIV-positive donations increased by 0.03%. A multivariable logistic regression analysis adjusted for sex, age, geographical location, donor, and clinic type showed significantly lower odds of deferral (OR 0.70; 95% CI: 0.69-0.70) and greater odds of HIV-positive cases in the study period than those in the control period (OR 1.17; 95% CI: 1.10-1.25). CONCLUSION We confirmed that the change in donor eligibility criteria was associated with a decrease in deferrals and an increase in the country's blood supply. The impact of the increased number of HIV-positive donations on blood safety in a country performing individual donation nucleic acid amplification testing requires further investigation.
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Affiliation(s)
- Thabiso Rapodile
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa
| | - Josephine Mitchel
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa
| | - Ronel Swanevelder
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa
| | - Edward L Murphy
- Departments of Laboratory Medicine and Epidemiology/Biostatistics, University of California San Francisco, San Francisco, California, USA.,Affiliate Investigator, Vitalant Research Institute, San Francisco, California, USA
| | - Karin van den Berg
- Medical department, Collections department, IT department, South African National Blood Service (SANBS), Johannesburg, South Africa.,Translational Research Department, Medical Division, South African National Blood Service, Roodepoort, South Africa.,Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
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18
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Glatt TN, Hilton C, Nyoni C, Swarts A, Swanevelder R, Cowley J, Mmenu C, Moyo-Gwete T, Moore PL, Kutama M, Jaza J, Phayane I, Brits T, Koekemoer J, Jentsch U, Nelson D, van den Berg K, Vermeulen M. Rapid and Successful Implementation of a COVID-19 Convalescent Plasma Programme-The South African Experience. Viruses 2021; 13:2050. [PMID: 34696480 PMCID: PMC8539971 DOI: 10.3390/v13102050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COVID-19 convalescent plasma (CCP) has been considered internationally as a treatment option for COVID-19. CCP refers to plasma collected from donors who have recovered from and made antibodies to SARS-CoV-2. To date, convalescent plasma has not been collected in South Africa. As other investigational therapies and vaccination were not widely accessible, there was an urgent need to implement a CCP manufacture programme to service South Africans. METHODS The South African National Blood Service and the Western Cape Blood Service implemented a CCP programme that included CCP collection, processing, testing and storage. CCP units were tested for SARS-CoV-2 Spike ELISA and neutralising antibodies and routine blood transfusion parameters. CCP units from previously pregnant females were tested for anti-HLA and anti-HNA antibodies. RESULTS A total of 987 CCP units were collected from 243 donors, with a median of three donations per donor. Half of the CCP units had neutralising antibody titres of >1:160. One CCP unit was positive on the TPHA serology. All CCP units tested for anti-HLA antibodies were positive. CONCLUSION Within three months of the first COVID-19 diagnosis in South Africa, a fully operational CCP programme was set up across South Africa. The infrastructure and skills implemented will likely benefit South Africans in this and future pandemics.
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Affiliation(s)
- Tanya Nadia Glatt
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
| | - Caroline Hilton
- Medical Division, Western Cape Blood Service, Cape Town 7405, South Africa;
| | - Cynthia Nyoni
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
| | - Avril Swarts
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
| | - Ronel Swanevelder
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
| | - James Cowley
- Operations Division, South African National Blood Service, Roodepoort 1709, South Africa; (J.C.); (C.M.); (M.K.); (J.J.); (I.P.); (M.V.)
| | - Cordelia Mmenu
- Operations Division, South African National Blood Service, Roodepoort 1709, South Africa; (J.C.); (C.M.); (M.K.); (J.J.); (I.P.); (M.V.)
| | - Thandeka Moyo-Gwete
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg 2192, South Africa; (T.M.-G.); (P.L.M.)
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Penny L. Moore
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg 2192, South Africa; (T.M.-G.); (P.L.M.)
- MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Munzhedzi Kutama
- Operations Division, South African National Blood Service, Roodepoort 1709, South Africa; (J.C.); (C.M.); (M.K.); (J.J.); (I.P.); (M.V.)
| | - Jabulisile Jaza
- Operations Division, South African National Blood Service, Roodepoort 1709, South Africa; (J.C.); (C.M.); (M.K.); (J.J.); (I.P.); (M.V.)
| | - Itumeleng Phayane
- Operations Division, South African National Blood Service, Roodepoort 1709, South Africa; (J.C.); (C.M.); (M.K.); (J.J.); (I.P.); (M.V.)
| | - Tinus Brits
- Information Technology Division, South African National Blood Service, Roodepoort 1709, South Africa; (T.B.); (J.K.)
| | - Johan Koekemoer
- Information Technology Division, South African National Blood Service, Roodepoort 1709, South Africa; (T.B.); (J.K.)
| | - Ute Jentsch
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
| | - Derrick Nelson
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
| | - Karin van den Berg
- Medical Division, South African National Blood Service, Roodepoort 1709, South Africa; (C.N.); (A.S.); (R.S.); (U.J.); (D.N.); (K.v.d.B.)
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
- Division of Clinical Haematology, University of the Free State, Bloemfontein 9301, South Africa
| | - Marion Vermeulen
- Operations Division, South African National Blood Service, Roodepoort 1709, South Africa; (J.C.); (C.M.); (M.K.); (J.J.); (I.P.); (M.V.)
- Division of Clinical Haematology, University of the Free State, Bloemfontein 9301, South Africa
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19
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Sibinga CTS, Louw VJ, Nedelcu E, Al-Riyami AZ, Bakhtari S, Johnson ST, Rambiritch V, Seoraij V, Callum J, van den Berg K, Vermeulen M, Barrett CB, Eichbaum QG. Modeling global transfusion medicine education. Transfusion 2021; 61:3040-3049. [PMID: 34469008 PMCID: PMC10936958 DOI: 10.1111/trf.16641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/08/2021] [Accepted: 08/08/2021] [Indexed: 11/27/2022]
Abstract
This document provides an analysis and oversight of the necessary educational infrastructure at national level needed for successful and sustainable education programs undergraduate and post-graduate and is focused on desired outcomes needed to secure general Transfusion Medicine (TM) competence and basic skills when appointed in a professional TM position. It provides a global model framework for TM education allowing individual countries to tailor the context and contents of the institutional curriculum. Education in transfusion medicine is a complex set of intimately interrelated and interconnected components that allow student and fellow exposure to knowledge and skills, the ultimate curriculum. The extent to which knowledge and skills, professionalism and leadership principles are offered depends on the expected outcomes needed for the desired roles, tasks and functions. A model for the development and implementation of an education (teaching and training) curriculum in Transfusion Medicine aimed at medical students and doctors, nurses and midwives, and laboratory professionals should ideally include an outcomes-based component, with clear recommendations on the required roles, skills, attitudes, and knowledge of a trainee completing such a curriculum. This should correspond to the environment and scope of practice required from such a vocational or academic professional and should address deficiencies in knowledge, skills and attitudes present before the curriculum is completed, while taking into account fundamental international standards of knowledge and the needs of their working climate and environment. Therefore, it is considered more practical to provide a set of outcomes that would be useful in most contexts and settings, while equipping students, as adult learners, with the tools for advancing their educational, professional and leadership development suited to their availability and socio-economic environment. The framework or model recognizes that no one set of education or training initiatives will be appropriate in all countries or settings and should be tailored to specific settings based on the assessment of local needs and available environments.
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Affiliation(s)
| | - Vernon J. Louw
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Elena Nedelcu
- Division of Transfusion Medicine, Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Arwa Z. Al-Riyami
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sara Bakhtari
- Division of Transfusion Medicine, Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Sue T. Johnson
- Versiti, Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vanitha Rambiritch
- South Africa African National Blood Service, Roodepoort, Johannesburg, South Africa
| | - Varsha Seoraij
- South Africa African National Blood Service, Roodepoort, Johannesburg, South Africa
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
| | - Karin van den Berg
- South Africa African National Blood Service, Roodepoort, Johannesburg, South Africa
| | - Marion Vermeulen
- South Africa African National Blood Service, Roodepoort, Johannesburg, South Africa
| | - Claire B. Barrett
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Quentin G. Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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van den Berg K, Vermeulen M, Louw VJ, Murphy EL, Maartens G. Undisclosed HIV status and antiretroviral therapy use among South African blood donors. Transfusion 2021; 61:2392-2400. [PMID: 34224581 PMCID: PMC8355170 DOI: 10.1111/trf.16571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Undisclosed antiretroviral drug (ARV) use among blood donors who tested HIV antibody positive, but RNA negative, was previously described by our group. Undisclosed ARV use represents a risk to blood transfusion safety. We assessed the prevalence of and associations with undisclosed ARV use among HIV-positive donors who donated during 2017. STUDY DESIGN AND METHODS South African National Blood Service (SANBS) blood donors are screened by self-administered questionnaire, semi-structured interview, and individual donation nucleic acid amplification testing for HIV. Stored samples from HIV-positive donations were tested for ARV and characterized as recent/longstanding using lag avidity testing. RESULTS Of the 1462 HIV-positive donations in 2017, 1250 had plasma availability for testing of which 122 (9.8%) tested positive for ARV. Undisclosed ARV use did not differ by gender (p = .205) or ethnicity (p = .505) but did differ by age category (p < .0001), donor (p < .0001), clinic type (p = .012), home province (p = .01), and recency (p < .0001). Multivariable logistic regression found older age (adjusted odds ratio [aOR] 3.73, 95% confidence interval [CI] 1.98-7.04 for donors >40 compared with those <21), first-time donation (aOR 5.24; 95% CI 2.48-11.11), and donation in a high HIV-prevalence province (aOR 9.10; 95% CI 2.70-30.72) compared with Northern Rural provinces to be independently associated with undisclosed ARV use. DISCUSSION Almost 1 in 10 HIV-positive blood donors neglected to disclose their HIV status and ARV use. Demographic characteristics of donors with undisclosed ARV use differed from those noted in other study. Underlying motivations for nondisclosure among blood donors remain unclear and may differ from those in other populations with significant undisclosed ARV use.
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Affiliation(s)
- Karin van den Berg
- Translational Research Department, Medical Division, South African National Blood Service, Roodepoort, South Africa
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Marion Vermeulen
- Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
- Operations Testing Department, Operations Division, South African National Blood Service, Roodepoort, 1715, South Africa
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Edward L Murphy
- Departments of Laboratory Medicine and Epidemiology/Biostatistics, University of California San Francisco, USA
- Affiliate Investigator, Vitalant Research Institute, San Francisco, California, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
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21
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Rambiritch V, Vermeulen M, Bell H, Knox P, Nedelcu E, Al-Riyami AZ, Callum J, van den Berg K. Transfusion medicine and blood banking education and training for blood establishment laboratory staff: A review of selected countries in Africa. Transfusion 2021; 61:1955-1965. [PMID: 33738810 PMCID: PMC8217161 DOI: 10.1111/trf.16372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Avoidable human error is a significant cause of transfusion adverse events. Adequately trained, laboratory staff in blood establishments and blood banks, collectively blood facilities, are key in ensuring high-quality transfusion medicine (TM) services. Gaps in TM education and training of laboratory staff exist in most African countries. We assessed the status of the training and education of laboratory staff working in blood facilities in Africa. STUDY DESIGN AND METHODS A cross-sectional study using a self-administered pilot-tested questionnaire was performed. The questionnaire comprised 26 questions targeting six themes. Blood facilities from 16 countries were invited to participate. Individually completed questionnaires were grouped by country and descriptive analysis performed. RESULTS Ten blood establishments and two blood banks from eight African countries confirmed the availability of a host of training programs for laboratory staff; the majority of which were syllabus or curriculum-guided and focused on both theoretical and practical laboratory skills development. Training was usually preplanned, dependent on student and trainer availability and delivered through lecture-based classroom training as well as formal and informal on the job training. There were minimal online didactic and self-directed learning. Teaching of humanistic values appeared to be lacking. CONCLUSION We confirmed the availability of diverse training programs across a variety of African countries. Incorporation of virtual learning platforms, rather than complete reliance on didactic, in-person training programs may improve the education reach of the existing programs. Digitalization driven by the coronavirus disease 2019 pandemic may provide an opportunity to narrow the knowledge gap in low- and middle-income countries (LMICs).
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Affiliation(s)
| | | | - Hazel Bell
- South African National Blood Service, Roodepoort, South Africa
| | - Patricia Knox
- South African National Blood Service, Roodepoort, South Africa
| | | | - Arwa Z. Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre
- Department of Laboratory Medicine and Pathobiology, University of Toronto
| | - Karin van den Berg
- South African National Blood Service, Roodepoort, South Africa
- Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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22
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Al-Riyami AZ, Burnouf T, Yazer M, Triulzi D, Kumaş LT, Sağdur L, Pelit NB, Bazin R, Hindawi SI, Badawi MA, Patidar GK, Pandey HC, Chaurasia R, Fachini RM, Scuracchio P, Wendel S, Ang AL, Ong KH, Young P, Ihalainen J, Vierikko A, Qiu Y, Yang R, Xu H, Rahimi-Levene N, Shinar E, Izak M, Gonzalez CA, Ferrari DM, Cini PV, Aditya RN, Sharma RR, Sachdev S, Hans R, Lamba DS, Nissen-Meyer LSH, Devine DV, Lee CK, Leung JNS, Hung IFN, Tiberghien P, Gallian P, Morel P, Al Maamari K, Al-Hinai Z, Vrielink H, So-Osman C, De Angelis V, Berti P, Ostuni A, Marano G, Nevessignsky MT, El Ekiaby M, Daly J, Hoad V, Kim S, van den Berg K, Vermeulen M, Glatt TN, Schäfer R, Reik R, Gammon R, Lopez M, Estcourt L, MacLennan S, Roberts D, Louw V, Dunbar N. International Forum on the Collection and Use of COVID-19 Convalescent Plasma: Protocols, Challenges and Lessons Learned: Summary. Vox Sang 2021; 116:1117-1135. [PMID: 34013968 PMCID: PMC8242386 DOI: 10.1111/vox.13113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/27/2022]
Affiliation(s)
| | - Thierry Burnouf
- College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nancy Dunbar
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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23
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Al-Riyami AZ, Burnouf T, Yazer M, Triulzi D, Kumaş LT, Sağdur L, Pelit NB, Bazin R, Hindawi SI, Badawi MA, Patidar GK, Pandey HC, Chaurasia R, Fachini RM, Scuracchio P, Wendel S, Ang AL, Ong KH, Young P, Ihalainen J, Vierikko A, Qiu Y, Yang R, Xu H, Rahimi-Levene N, Shinar E, Izak M, Gonzalez CA, Ferrari DM, Cini PV, Aditya RN, Sharma RR, Sachdev S, Hans R, Lamba DS, Nissen-Meyer LSH, Devine DV, Lee CK, Leung JNS, Hung IFN, Tiberghien P, Gallian P, Morel P, Al Maamari K, Al-Hinai Z, Vrielink H, So-Osman C, De Angelis V, Berti P, Ostuni A, Marano G, Nevessignsky MT, El Ekiaby M, Daly J, Hoad V, Kim S, van den Berg K, Vermeulen M, Glatt TN, Schäfer R, Reik R, Gammon R, Lopez M, Estcourt L, MacLennan S, Roberts D, Louw V, Dunbar N. International Forum on the Collection and Use of COVID-19 Convalescent Plasma: Responses. Vox Sang 2021; 116:e71-e120. [PMID: 34013981 PMCID: PMC8242651 DOI: 10.1111/vox.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Salwa I Hindawi
- King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Maha A Badawi
- King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | - Ai Leen Ang
- Health Sciences Authority, Singapore City, Singapore
| | - Kiat Hoe Ong
- Tan Tock Seng Hospital, Singapore City, Singapore
| | | | | | | | - Yan Qiu
- Beijing Red Cross Blood Centre, Beijing, China
| | - Ru Yang
- Wuhan Blood Centre, Wuhan, China
| | - Hua Xu
- Shaanxi Blood Center, Shaanxi, China
| | | | - Eilat Shinar
- Magen David Adom National Blood Services, Tel Aviv, Israel
| | - Marina Izak
- Magen David Adom National Blood Services, Tel Aviv, Israel
| | | | | | | | - Robby Nur Aditya
- Central Blood Transfusion Service Indonesia Red Cross (PMI), Jakarta, Indonesia
| | - Ratti Ram Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suchet Sachdev
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rekha Hans
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divjot Singh Lamba
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Cheuk Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong SAR, China
| | | | - Ivan Fan Ngai Hung
- Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | | | - Pierre Gallian
- Etablissement Français du Sang, La Plaine St Denis, France
| | - Pascal Morel
- Etablissement Français du Sang, La Plaine St Denis, France
| | | | - Zaid Al-Hinai
- Sultan Qaboos University Hospital, Seeb, Sultanate of Oman
| | | | | | | | - Pierluigi Berti
- Italian Society for Hemapheresis cell Manipulation (SIdEM), Bari, Italy
| | - Angelo Ostuni
- Italian Society for Hemapheresis cell Manipulation (SIdEM), Bari, Italy
| | | | | | | | - James Daly
- Australian Red Cross Lifeblood, Melbourne, Vic., Australia
| | - Veronica Hoad
- Australian Red Cross Lifeblood, Melbourne, Vic., Australia
| | - Sinyoung Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | - Karin van den Berg
- South African National Blood Service, University of Cape Town, Cape Town, South Africa
| | - Marion Vermeulen
- South African National Blood Service, University of Cape Town, Cape Town, South Africa
| | - Tanya Nadia Glatt
- South African National Blood Service, University of Cape Town, Cape Town, South Africa
| | - Richard Schäfer
- German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | | | | | | | | | | | | | - Vernon Louw
- Western Cape Blood Service, Cape Town, South Africa
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24
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Goel R, Bloch EM, Pirenne F, Al-Riyami AZ, Crowe E, Dau L, Land K, Townsend M, Jecko T, Rahimi-Levene N, Patidar G, Josephson CD, Arora S, Vermeulen M, Vrielink H, Montemayor C, Oreh A, Hindawi S, van den Berg K, Serrano K, So-Osman C, Wood E, Devine DV, Spitalnik SL. ABO blood group and COVID-19: a review on behalf of the ISBT COVID-19 working group. Vox Sang 2021; 116:849-861. [PMID: 33578447 PMCID: PMC8014128 DOI: 10.1111/vox.13076] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/30/2022]
Abstract
Growing evidence suggests that ABO blood group may play a role in the immunopathogenesis of SARS-CoV-2 infection, with group O individuals less likely to test positive and group A conferring a higher susceptibility to infection and propensity to severe disease. The level of evidence supporting an association between ABO type and SARS-CoV-2/COVID-19 ranges from small observational studies, to genome-wide-association-analyses and country-level meta-regression analyses. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues (notably endothelium). There are several hypotheses to explain the differences in SARS-CoV-2 infection by ABO type. For example, anti-A and/or anti-B antibodies (e.g. present in group O individuals) could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell infection. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinins (e.g. present in group O and group B individuals), which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entry into lung epithelial cells. ABO type-associated variations in angiotensin-converting enzyme-1 activity and levels of von Willebrand factor (VWF) and factor VIII could also influence adverse outcomes, notably in group A individuals who express high VWF levels. In conclusion, group O may be associated with a lower risk of SARS-CoV-2 infection and group A may be associated with a higher risk of SARS-CoV-2 infection along with severe disease. However, prospective and mechanistic studies are needed to verify several of the proposed associations. Based on the strength of available studies, there are insufficient data for guiding policy in this regard.
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Affiliation(s)
- Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood Center, Springfield, IL, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - France Pirenne
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Elizabeth Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laetitia Dau
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Land
- Vitalant, Scottsdale, AZ, USA.,Department of Pathology, UT, San Antonio, TX, USA
| | | | | | | | - Gopal Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satyam Arora
- Super Speciality Pediatric Hospital and Post Graduate Teaching Institute, Noida, India
| | - Marion Vermeulen
- The South African National Blood Service, Port Elizabeth, South Africa
| | - Hans Vrielink
- Dept Unit Transfusion Medicine, Sanquin Bloodbank, Amsterdam, the Netherlands
| | | | - Adaeze Oreh
- National Blood Transfusion Service, Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria
| | | | - Karin van den Berg
- Translational Research Department, Medical Division, South African National Blood Service, Port Elizabeth, South Africa.,Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Serrano
- Canadian Blood Services, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia So-Osman
- Dept Unit Transfusion Medicine, Sanquin Bloodbank, Amsterdam, the Netherlands.,Dept. of Haematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erica Wood
- Monash University, Melbourne, VIC, Australia
| | - Dana V Devine
- Canadian Blood Services, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
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25
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Sykes W, Mhlanga L, Swanevelder R, Glatt TN, Grebe E, Coleman C, Pieterson N, Cable R, Welte A, van den Berg K, Vermeulen M. Prevalence of anti-SARS-CoV-2 antibodies among blood donors in Northern Cape, KwaZulu-Natal, Eastern Cape, and Free State provinces of South Africa in January 2021. Res Sq 2021:rs.3.rs-233375. [PMID: 33594353 PMCID: PMC7885925 DOI: 10.21203/rs.3.rs-233375/v1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Population-level estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) is a crucial epidemiological indicator for tracking the Covid-19 epidemic. Such data are in short supply, both internationally and in South Africa. The South African blood services (the South African National Blood Service, SANBS and the Western Cape Blood Service, WCBS) are coordinating a nationally representative survey of blood donors, which it is hoped can become a cost-effective surveillance method with validity for community-level seroprevalence estimation. Methods Leveraging existing arrangements, SANBS human research ethics committee permission was obtained to test blood donations collected on predefined days (7th, 10th, 12th, 15th, 20th, 23th and 25th January) for anti-SARS-CoV-2 antibodies, using the Roche Elecsys Anti-SARS-CoV-2 assay on the cobas e411 platform currently available in the blood services' donation testing laboratories. Using standard methods, prevalence analysis was done by province, age and race, allowing age to be regarded as either a continuous or categorical variable. Testing was performed in the Eastern Cape (EC), Free State (FS), KwaZulu Natal (ZN) and Northern Cape (NC) provinces. Results We report on data from 4858 donors - 1457 in EC; 463 in NC; 831 in FS and 2107 in ZN. Prevalence varied substantially across race groups and between provinces, with seroprevalence among Black donors consistently several times higher than among White donors, and the other main population groups (Coloured and Asian) not consistently represented in all provinces. There is no clear evidence that seroprevalence among donors varies by age. Weighted net estimates of prevalence (in the core age range 15-69) by province (compared with official clinically-confirmed COVID-19 case rates in mid-January 2021) are: EC-63%(2.8%), NC-32%(2.2%), FS-46%(2.4%), and ZN-52%(2.4%). Conclusions Our study demonstrates substantial differences in dissemination of SARS-CoV-2 infection between different race groups, most likely explained by historically based differences in socio-economic status and housing conditions. As has been seen in other areas, even such high seroprevalence does not guarantee population-level immunity against new outbreaks - probably due to viral evolution and waning of antibody neutralization. Despite its limitations, notably a 'healthy donor' effect, it seems plausible that these estimates are reasonably generalisable to actual population level anti-SARS-CoV-2 seroprevalence, but should be further verified.
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Affiliation(s)
| | - Laurette Mhlanga
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University
| | | | | | - Eduard Grebe
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University
- Vitalant Research Institute
- University of California San Francisco
| | | | | | | | - Alex Welte
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University
| | - Karin van den Berg
- South African National Blood Service
- University of Cape Town
- University of the Free State
| | - Marion Vermeulen
- South African National Blood Service
- University of the Free State
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26
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Al‐Riyami AZ, Schäfer R, van den Berg K, Bloch EM, Estcourt LJ, Goel R, Hindawi S, Josephson CD, Land K, McQuilten ZK, Spitalnik SL, Wood EM, Devine DV, So‐Osman C. Clinical use of Convalescent Plasma in the COVID-19 pandemic: a transfusion-focussed gap analysis with recommendations for future research priorities. Vox Sang 2021; 116:88-98. [PMID: 32542847 PMCID: PMC7891452 DOI: 10.1111/vox.12973] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Use of convalescent plasma for coronavirus disease 2019 (COVID-19) treatment has gained interest worldwide. However, there is lack of evidence on its dosing, safety and effectiveness. Until data from clinical studies are available to provide solid evidence for worldwide applicable guidelines, there is a need to provide guidance to the transfusion community and researchers on this emergent therapeutic option. This paper aims to identify existing key gaps in current knowledge in the clinical application of COVID-19 convalescent plasma (CCP). MATERIALS AND METHODS The International Society of Blood Transfusion (ISBT) initiated a multidisciplinary working group with worldwide representation from all six continents with the aim of reviewing existing practices on CCP use from donor, product and patient perspectives. A subgroup of clinical transfusion professionals was formed to draft a document for CCP clinical application to identify the gaps in knowledge in existing literature. RESULTS Gaps in knowledge were identified in the following main domains: study design, patient eligibility, CCP dose, frequency and timing of CCP administration, parameters to assess response to CCP treatment and long-term outcome, adverse events and CCP application in less-resourced countries as well as in paediatrics and neonates. CONCLUSION This paper outlines a framework of gaps in the knowledge of clinical deployment of CPP that were identified as being most relevant. Studies to address the identified gaps are required to provide better evidence on the effectiveness and safety of CCP use.
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Affiliation(s)
- Arwa Z. Al‐Riyami
- Department of HaematologySultan Qaboos University HospitalMuscatSultanate of Oman
| | - Richard Schäfer
- Institute for Transfusion Medicine and ImmunohaematologyGerman Red Cross Blood Donor Service Baden‐Württemberg‐Hessen gGmbHGoethe University HospitalFrankfurt am MainGermany
| | - Karin van den Berg
- Medical DivisionTranslational Research DepartmentSouth African National Blood ServicePort ElizabethSouth Africa
- Division Clinical HaematologyDepartment of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Evan M. Bloch
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Lise J. Estcourt
- Radcliffe Department of MedicineUniversity of Oxford and NHS Blood and TransplantOxfordUK
| | - Ruchika Goel
- Division of Transfusion MedicineDepartment of PathologyJohns Hopkins HospitalBaltimoreMDUSA
- Division of Hematology/OncologySimmons Cancer Institute at SIU School of Medicine and Mississippi Valley Regional Blood CenterSpringfieldILUSA
| | - Salwa Hindawi
- Haematology DepartmentFaculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Cassandra D. Josephson
- Department of Pathology and Laboratory MedicineCenter for Transfusion and Cellular TherapiesEmory University School of MedicineAtlantaGEUSA
- Department of PediatricsAflac Cancer Center and Blood DisordersChildren's Healthcare of AtlantaEmory University School of MedicineAtlantaGEUSA
| | - Kevin Land
- Corporate Medical AffairsVitalantPhoenixAZUSA
- Department of PathologyUT Health Science San AntonioSan AntonioTXUSA
| | - Zoe K. McQuilten
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
- Department of Clinical HaematologyMonash HealthMelbourneVICAustralia
| | | | - Erica M. Wood
- Transfusion Research UnitSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
- Department of Clinical HaematologyMonash HealthMelbourneVICAustralia
| | - Dana V. Devine
- Canadian Blood ServicesVancouverBCCanada
- Department of Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Cynthia So‐Osman
- Department Unit Transfusion MedicineSanquin Blood Supply FoundationAmsterdamThe Netherlands
- Department HaematologyErasmus Medical CenterRotterdamThe Netherlands
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27
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Coleman C, Lelie N, Rademeyer R, van Drimmelen H, van den Berg K, Vermeulen M. Comparison of two nucleic acid amplification technology systems for detection of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus. Transfusion 2020; 60:2929-2937. [PMID: 33064884 PMCID: PMC10936959 DOI: 10.1111/trf.16137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic in South Africa while hepatitis C virus (HCV) infection is rare. Two nucleic acid amplification technology platforms, the Procleix Ultrio Elite assay on the Panther instrument (Elite) and the cobas MPX assay on the cobas 6800 or 8800 system (MPX), are used worldwide. In 2015 these were evaluated in South African context. STUDY DESIGN AND METHODS The sensitivity of HIV, HBV, and HCV was evaluated using reference panels and 2-fold dilutions of 51 positive plasma samples tested in 12 to 24 replicates. The 95% and 50% lower limits of detection (LOD) were estimated by probit analysis and window period (WP) risk days by the Weusten model. Specificity was established by testing 3646 blood donations individually and instrument performance by evaluating all runs. RESULTS Specificity was 99.94% for MPX and 99.97% for Elite. The following 95% LODs (95% confidence intervals [CIs]) were estimated for MPX and Elite, respectively: HBV, 17.8 (10.9-33.9) and 47.9 (29.1-92.4) cp/mL; HCV, 21.9 (15.3-34.6) and 13.8 (8.9-24.0) cp/mL; and HIV, 8.3 (5.5-14.7) and 10.4 (6.9-18.2) cp/mL. On SA HBV and HIV dilution panels, relative sensitivity (range) of MPX was 3.20 (1.26-6.50) and 1.42 (0.26-2.72) fold higher than Elite. Downtime on cobas 6800 was 26 hours vs 6.6 hours on Panther (P < .001). We estimated infectious WPs for HBV, HCV, and HIV-1 at 13.8, 1.8, and 2.6 days for Elite and 10.3, 2.1, and 2.4 days for MPX. CONCLUSION Although MPX was significantly more sensitive for HBV, Elite was implemented due to instrument reliability during evaluation.
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Affiliation(s)
- Charl Coleman
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
| | - Nico Lelie
- Lelie Research, Parkstraat 2, 1811DK Alkmaar
| | - Ronel Rademeyer
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
| | | | - Karin van den Berg
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
| | - Marion Vermeulen
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
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Bloemhoff A, Schoon Y, Smulders K, Akkermans R, Vloet LCM, van den Berg K, Berben SAA. Older persons are frailer after an emergency care visit to the out-of-hours general practitioner cooperative in the Netherlands: a cross-sectional descriptive TOPICS-MDS study. BMC Fam Pract 2020; 21:171. [PMID: 32819281 PMCID: PMC7441648 DOI: 10.1186/s12875-020-01220-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/14/2020] [Indexed: 12/02/2022]
Abstract
Background In the Netherlands, community-dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains an often unobserved hazard with adverse health outcomes. The aim of this study was to provide insight into differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use. Methods A cross-sectional descriptive study design was based on data from the public data repository of The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n = 32,149) was measured by comorbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analyses. A random intercept model was utilised to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. Results Compared to the reference group, older persons with GPC contact were frailer in the domain of comorbidity (mean difference 0.52; 95% CI 0.47–0.57, p < 0.0001) and functional limitations (mean difference 0.53; 95% CI 0.46–0.60, p < 0.0001), and they reported less emotional wellbeing (mean difference − 4.10; 95% CI -4.59- -3.60, p < 0.0001) and experienced a lower quality of life (mean difference − 0.057; 95% CI -0.064- -0.050, p < 0.0001). Moreover, older persons more often reported limited social functioning (OR = 1.50; 95% CI 1.39–1.62, p < 0.0001) and limited perceived health (OR = 1.50, 95% CI 1.39–1.62, p < 0.0001). Finally, older persons with GPC contact more often used home care (OR = 1.37; 95% CI 1.28–1.47, p < 0.0001) or were more often admitted to the hospital (OR = 2.88; 95% CI 2.71–3.06, p < 0.0001). Conclusions Older persons with out-of-hours GPC contact for an emergency care visit were significantly frailer in all domains and more likely to use home care or to be admitted to the hospital compared to the reference group. Potentially frail older persons seemed to require adequate identification of frailty and support (e.g., advanced care planning) both before and after a contact with the out-of-hours GPC.
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Affiliation(s)
- Anneke Bloemhoff
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kien Smulders
- General Practitioners Cooperative Gelderse Vallei, Ede, The Netherlands
| | - Reinier Akkermans
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Karin van den Berg
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sivera A A Berben
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Yazer MH, Shaz B, Seheult JN, Apelseth TO, de Korte D, Devin G, Devine D, Doncaster C, Field S, Flanagan P, Huet J, Mendrone A, O'Brien C, Pink J, Rashleigh M, Shinar E, Takanashi M, Tian E, Tiberghien P, van den Berg K, Schmitt C. Trends in platelet distributions from 2008 to 2017: a survey of twelve national and regional blood collectors. Vox Sang 2020; 115:703-711. [PMID: 32281137 DOI: 10.1111/vox.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND This multi-national study evaluated changes in platelet (PLT) unit distributions at 12 national or regional blood collectors over a 10-year period. METHODS Data on the total number of PLT distributions, the collection method, that is apheresis vs whole blood-derived (WBD), the PLT unit characteristics and post-collection modifications were obtained from 12 national or regional blood collectors from 2008 through 2017. Individual WBD PLT units were converted to apheresis equivalent units (i.e. a dose of PLTs) by dividing by 4, the typical pool size; WBD units that were pooled before distribution were counted as a single dose. RESULTS Overall at these 12 blood collectors, the total number of PLTs distributed in 2008 was 1 373 200, which rose by 10·2% to 1 513 803 in 2017. The Japanese Red Cross, which distributes only apheresis PLTs, had a 13·4% increase in the number of distributions between the years 2008 and 2017, while the other 11 blood collectors combined demonstrated a 6·8% increase in distributions between these two years. Between the years 2008 and 2017, the changes in the proportion of apheresis, platelet-rich plasma and buffy coat PLT distributions were -29·9%, -70·7% and 80·0%, respectively. CONCLUSION The number of PLT distributions increased during the 10-year study period despite prophylactic PLT transfusion thresholds having remained fairly consistent over the last decade. Perhaps this increase is in part driven by increased administration of platelets to patients with massive haemorrhage or an increase in stem cell transplantation. The use of buffy coat PLTs is increasing at these collectors.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.,Vitalant, Pittsburgh, PA, USA
| | - Beth Shaz
- New York Blood Center, New York, NY, USA
| | - Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.,Vitalant, Pittsburgh, PA, USA
| | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dirk de Korte
- Department Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Gerry Devin
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | | | | | | | - Julie Huet
- Etablissement Français du Sang, Saint-Denis, France
| | | | | | - Joanne Pink
- Australian Red Cross Blood Service, Melbourne, VIC, Australia
| | - Mark Rashleigh
- Australian Red Cross Blood Service, Melbourne, VIC, Australia
| | - Eilat Shinar
- Magen David Adom, National Blood Services, Ramat Gan, Israel
| | | | - Eka Tian
- Australian Red Cross Blood Service, Melbourne, VIC, Australia
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Mitchel J, Custer B, Kaidarova Z, Murphy EL, van den Berg K. Implementation of a script for predonation interviews: impact on human immunodeficiency virus risk in South African blood donors. Transfusion 2019; 59:2344-2351. [PMID: 30946490 PMCID: PMC6610781 DOI: 10.1111/trf.15288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The way in which the donor history questionnaire is conducted plays a crucial role in the self-disclosure of behavioral risk factors for human immunodeficiency virus (HIV) infection by prospective donors. The South African National Blood Service changed its policy on the process of donor assessment in May 2015 by implementing a compulsory interviewer script used to assess donor eligibility. STUDY DESIGN AND METHODS A pre- and postevaluation study to determine the impact of scripted interviews on high-risk deferrals and recently acquired HIV infections. We used historical data to compare 18 months before and after the implementation of the script. RESULTS We recorded a total of 3,169,656 donor presentations during the two 18-months periods, of which 52.2% (1,655,352) were made during the scripted period. A multivariable logistic regression analysis adjusting for donor and demographic characteristics found the odds of high-risk deferral to be slightly greater (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.05-1.07) during the scripted period. A separate multivariate logistic regression model, also adjusting for donor and demographic characteristics, showed that the odds of recently acquired HIV infection were significantly lower (OR, 0.88; 95% CI, 0.79-0.97) during the scripted period. CONCLUSION This study showed that implementation of a scripted interview was associated with increased HIV risk deferral and decreased recent HIV infection. This study indicates potential improvement in blood safety with the implementation of a scripted donor interview and has relevance to blood safety in other sub-Saharan African countries.
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Affiliation(s)
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, United States.,University of California San Francisco, San Francisco, California, United States
| | - Zhanna Kaidarova
- Vitalant Research Institute, San Francisco, California, United States
| | - Edward L. Murphy
- Vitalant Research Institute, San Francisco, California, United States.,University of California San Francisco, San Francisco, California, United States
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Vermeulen M, van den Berg K, Sykes W, Reddy R, Ingram C, Poole C, Custer B. Health economic implications of testing blood donors in South Africa for HTLV 1 & 2 infection. Vox Sang 2019; 114:467-477. [PMID: 31131453 DOI: 10.1111/vox.12788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, HTLV screening is not performed in South Africa (SA). This report describes an economic assessment (budget impact and cost-effectiveness) of implementing different HTLV screening strategies. METHODS A modified version of the Alliance of Blood Operators risk-based decision-making framework was used to assess the risk and consequences of HTLV in the blood supply in SA. We developed a deterministic model of the cost and consequences of four screening strategies: none, universal, all donors once and first time donors only assuming a transfusion-transmission (TT) efficiency of 10% and a manifestation of clinical disease of 6%. RESULTS Unscreened blood results in 3·55 symptomatic TT-HTLV cases and a total healthcare cost of Rand (R)3 446 950 (US Dollars (USD)229 800) annually. Universal screening would cost R24 000 000 (USD1 600 000) per annum and prevent 3·54 (99·8%) symptomatic TT-HTLV cases in the first year and 0·55 (98·4%) symptomatic TT-HTLV cases in the second year at a cost per TT-HTLV prevented of R6 780 000 (USD450 000) in year one and R43 254 000 (USD2 890 000) in year two. Screening all donors once would cost R16,200,000 (USD1 080 000) or R4 600 000 (USD306 000) per symptomatic TT-HTLV infection prevented in year one. Total costs decrease to R5 100 000 (USD340 000) in year 2 but the cost per TT-HTLV prevented increases to R10 700 000 (USD713 333). CONCLUSION This analysis contributed to the decision not to implement HTLV screening as the healthcare budget and particularly the budget for blood transfusion in SA is insufficient to provide appropriate treatment. Arguably, available resources can be more efficiently utilized in other healthcare programs.
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Affiliation(s)
- Marion Vermeulen
- South African National Blood Service, Weltevreden Park, South Africa
| | | | - Wendy Sykes
- South African National Blood Service, Weltevreden Park, South Africa
| | - Ravi Reddy
- South African National Blood Service, Weltevreden Park, South Africa
| | | | - Colwyn Poole
- South African National Blood Service, Weltevreden Park, South Africa
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
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van den Berg K, Swanevelder R, Ingram C, Lawrie D, Glencross DK, Hilton C, Nieuwoudt M. The iron status of South African blood donors: balancing donor safety and blood demand. Transfusion 2018; 59:232-241. [PMID: 30383295 DOI: 10.1111/trf.15001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Several studies in developed countries have demonstrated high levels of iron deficiency (ID) among blood donors. There is a paucity of data for developing countries where blood shortages remain a major concern. STUDY DESIGN AND METHODS A total of 4412 donors were enrolled in the study. Specimens were collected for full blood count, iron, transferrin saturation, and ferritin assessment. Donor demographics were recorded. ID was indicated by a ferritin level of less than 20 ng/mL for men and less than 12 ng/mL for women. Anemia was defined as hemoglobin levels less than 12.5 g/dL. Regression models for predictors of ID were developed. RESULTS A total of 17.5% of all donors had ID, with 16.3% prevalence in women and 18.6% in men. Low hemoglobin had the highest association with ID (adjusted odds ratio [AOR], 11.078; 95% confidence interval [CI], 7.915-15.505); male donors had twice the odds of ID compared to female donors (AOR, 2.501; 95% CI, 1.964-3.185), while increasing age was associated with lower odds (AOD, 0.965; 95% CI, 0.956-0.975). Among male donors, an interdonation interval of less than 3 months (AOR, 2.679; 95% CI, 1.929-3.720) was associated with ID. Compared to other females combined, colored female donors (AOR, 2.335; 95% CI, 1.310-4.160) had higher odds and black female donors (AOR, 0.559; 95% CI, 0.369-0.845) lower odds of ID. CONCLUSION ID is common among South African donors; low hemoglobin, gender, ethnicity, and past donation history is independently associated with ID. Recommendations aimed at protecting donor health may increase blood shortages in South Africa.
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Affiliation(s)
- Karin van den Berg
- Medical Department, South African National Blood Service, Port Elizabeth, South Africa
| | - Ronel Swanevelder
- Business Intelligence Department, South African National Blood Service, Roodepoort, South Africa
| | - Charlotte Ingram
- South African Bone Marrow Registry (SABMR), Cape Town, South Africa
| | - Denise Lawrie
- Department of Molecular Medicine and Haematology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Kim Glencross
- Department of Molecular Medicine and Haematology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Hilton
- Medical Department, Western Province Blood Transfusion Service, Cape Town, South Africa
| | - Martin Nieuwoudt
- South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa.,Institute for Biomedical Engineering (IBE), Stellenbosch University, Stellenbosch, South Africa
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van den Berg K, Murphy EL, Pretorius L, Louw VJ. The impact of HIV-associated anaemia on the incidence of red blood cell transfusion: implications for blood services in HIV-endemic countries. Transfus Apher Sci 2014; 51:10-8. [PMID: 25457008 DOI: 10.1016/j.transci.2014.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cytopaenias, especially anaemia, are common in the HIV-infected population. The causes of HIV related cytopaenias are multi-factorial and often overlapping. In addition, many of the drugs used in the management of HIV-positive individuals are myelosuppresive and can both cause and exacerbate anaemia. Even though blood and blood products are still the cornerstone in the management of severe cytopaenias, how HIV may affect blood utilisation is not well understood. The impact of HIV/AIDS on blood collections has been well documented. As the threat posed by HIV on the safety of the blood supply became clearer, South Africa introduced progressively more stringent donor selection criteria, based on the HIV risk profile of the donor cohort from which the blood collected. The implementation of new testing technology in 2008 which significantly improved the safety of the blood supply enabled the removal of what was perceived by many as a racially based donor risk model. However, this new technology had a significant and sustained impact on the cost of blood and blood products in South Africa. In contrast, it would appear little is known of how HIV influences the utilisation of blood and blood products. Considering the high prevalence of HIV among hospitalised patients and the significant risk for anaemia among this group, there would be an expectation that the transfusion requirements of an HIV-infected patient would be higher than that of an HIV-negative patient. However, very little published data is available on this topic which emphasises the need for further large-scale studies to evaluate the impact of HIV/AIDS on the utilisation of blood and blood products and how the large-scale roll-out of ARV programs may in future play a role in determining the country's blood needs.
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Affiliation(s)
- Karin van den Berg
- South African National Blood Service, Port Elizabeth, South Africa; Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Edward L Murphy
- University of California, San Francisco, United States; Blood Systems Research Institute, San Francisco, United States
| | - Lelanie Pretorius
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa; Ampath Laboratories, Bloemfontein, South Africa
| | - Vernon J Louw
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
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Abstract
BACKGROUND Blood centers rely heavily on adolescent donors to meet blood demand, but presyncope and syncope are more frequent in younger donors. Studies have suggested administration of water before donation may reduce syncope and/or presyncope in this group. STUDY DESIGN AND METHODS We conducted a randomized, controlled trial to establish the effect of preloading with 500 mL of water on the rate of syncope and presyncope in adolescent donors. School collection sites in Eastern Cape Province of South Africa were randomized to receive water or not. Incidence of syncope and presyncope was compared between randomization groups using multivariable logistic regression. RESULTS Of 2464 study participants, 1337 received water and 1127 did not; groups differed slightly by sex and race. Syncope or presyncope was seen in 23 (1.7%) of the treatment and 18 (1.6%) of the control arm subjects. After adjusting for race, sex, age, and donation history, there was no difference in outcome between the water versus no water arms (adjusted odds ratio [OR], 0.80; 95% confidence interval [CI], 0.42-1.53). Black donors had sevenfold lower odds of syncope or presyncope than their white counterparts (adjusted OR, 0.14; 95% CI, 0.04-0.47). CONCLUSION Preloading adolescent donors with 500 mL of water did not have a major effect in reducing syncope and presyncope in South African adolescent donors. Our adolescent donors had lower overall syncope and presyncope rates than similar populations in the United States, limiting the statistical power of the study. We confirmed much lower rates of syncope and presyncope among young black donors.
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van den Berg K, van Hasselt J, Bloch E, Crookes R, Kelley J, Berger J, Ingram C, Dippenaar A, Thejpal R, Littleton N, Elliz T, Reubenson G, Cotton M, Hull JC, Moodley P, Goga Y, Eldridge W, Patel M, Hefer E, Bird A. A review of the use of blood and blood products in HIV-infected patients. South Afr J HIV Med 2012; 13:87-104. [PMID: 28479876 DOI: 10.4102/sajhivmed.v13i2.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Despite numerous publications on the appropriate use of blood and blood products, few specifically consider the role of transfusion in the management of HIV. This review is a synthesis of conditions encountered in the management of HIV-infected patients where the transfusion of blood or blood products may be indicated. A consistent message emerging from the review is that the principles of transfusion medicine do not differ between HIV-negative and -positive patients. The aim of the review is to provide clinicians with a practical and succinct overview of the haematological abnormalities and clinical circumstances most commonly encountered in the HIV setting, while focusing on the rational and appropriate use of blood and blood products for HIV patients. Important ethical considerations in dealing with both the collection and transfusion blood and blood products in the HIV era have also been addressed.
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Abstract
Outbreaks of infectious coryza have been reported in vaccinated flocks in different countries, indicating that new serotype(s) of Haemophilus paragallinarum may have evolved. Several field isolates from vaccinated flocks in the US, Ecuador, Argentina and Zimbabwe were examined and, apart from one serotype C strain, all were typed as serotype B. An inactivated commercial trivalent vaccine, containing serotypes A, B and C, protected against challenge with the serotype C isolate but protection against challenge with serotype B isolates was weaker, suggesting that they might represent a new variant immunotype. An experimental tetravalent oil adjuvant vaccine, containing one of the serotype B isolates, appeared immunogenic against all isolates after one vaccination. Its efficacy and safety were further tested in layer chickens housed under field conditions. Chickens were vaccinated at 8 and 16 weeks of age while controls were unvaccinated. Vaccinates and controls were challenged with type A, B, C and variant type B at 25, 45 or 65 weeks of age. There was good protection (P<0.05) against all four immunotypes after all challenges. No systemic reactions were observed and local reactions were similar to those found with the commercial trivalent vaccine. The tetravalent vaccine may therefore be a good choice for control of new field isolates.
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Affiliation(s)
- Anton A C Jacobs
- Intervet International BV 5830 P.O. Box 31 AA Boxmeer, The Netherlands.
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