Residual risk of transfusion associated human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human T lymphotrophic virus

Australian Red Cross Blood Service, Perth, Western Australia, Australia.
Internal Medicine Journal (Impact Factor: 1.64). 11/2005; 35(10):592-8. DOI: 10.1111/j.1445-5994.2005.00926.x
Source: PubMed


The risk of transfusion transmitted viral infection is now so low that mathematical modelling is required to estimate the residual risk. The first national viral risk estimates for hepatitis B virus (HBV), human immunodeficiency virus (HIV) and hepatitis C virus (HCV) were recently published by the Australian Red Cross Blood Service. Using several refinements to the original methodology, as well as an additional 2 years of data, new risk estimates have been derived.
Viral screening data for Australian donors for 2000/2003 were retrospectively analysed. The data were applied to three published models to estimate the residual risk of transmitting HIV, HBV, HCV or human T lymphotrophic virus (HTLV) by blood transfusion in Australia.
Applying the three models to HBV, HIV and HCV, three point estimates of the residual risk per unit were calculated for each virus. The median point estimates were 1 in 1,339,000 for HBV, 1 in 1 in 7,299,000 for HIV, and 1 in 3,636,000 for HCV. Although the HTLV risk could not be equivalently calculated because of the lack of incident infection it was estimated to be considerably less than 1 in 1,000,000 using a separate method.
The most current and accurate estimate of residual risk of viral transmission in Australia has been provided in the present study. The residual risk in Australia is exceptionally small, continuing to decrease and is generally less than European or US risk estimates. These new estimates demonstrate that for viral transmission the Australian blood supply is amongst the safest in the world, and provide a basis for evaluating the cost benefit of future viral testing methodologies.

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    • "The residual HBV risk in screened blood transfusion ranges from 1 : 10,700 [14] to 1 : 62,734 [15] and is markedly higher compared to Europe [16], North America [17] [18], Australia [19], and Japan [20]. Further, the identification of blood donors with occult HBV infection (OBI) individuals negative for Hepatitis B antigen (HBsAg) with detectable circulating HBV DNA has created concern related to the safety of the blood supply [21] [22]. "
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    ABSTRACT: Background. During routine donor screening in the blood bank, it is not uncommon to find isolated reactivity for anti-HBc in the absence of detectable HBV DNA in a first donation but absence of reactivity to anti-HBc in subsequent donations, suggesting a false-positive result for anti-HBc. Study Design and Methods. The blood donor population was screened between January 2010 and October 2011. We selected 2,126 donations positive only for anti-HBc from a total of 125,068 donations. During the process, OBI donors were identified, and their HBcAg-specific T-cell response was analyzed and compared to donors with chronic (HBsAg positive) and recovered (anti-HBc only) infection. We analyzed correlations between signal levels (Co/s) in the competitive assay for anti-HBc and HBV DNA detection. Results. In the 21-month study period, 21 blood donors with anti-HBc alone were identified as OBI (1 in each 5955 donors). The relevant finding was the observation that anti-HBc only subjects with Co/s ≥ 0.1 did not have either HBcAg-specific T-cells or detectable HBV DNA and OBI subjects presented with Co/s ≤ 0.1 and HBcAg T-cell response. In the subset of 21 OBI subjects, 9 donors remained positive for HBcAg T-cell response after four collections. In all 9 samples, we observed HBV DNA fluctuation. Conclusion. Our data suggest that HBcAg-specific T-cell response could be used to confirm anti-HBc serological status, distinguishing previous exposure to Hepatitis B virus from anti-HBc false-positive results.
    Full-text · Article · Dec 2013
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    • "Because there is no routine confirmatory testing or anti-HBc testing in China, it is impossible to obtain epidemiological data regarding the prevalence, incidence, and RR for HBV. One study examined the RR of TTVI in Shenzhen, China, using a previously published method [21,22]. The estimated RR for HBV was estimated to be 1 in 17,501, with a lower RR for first-time donations than for repeat donations. "
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    ABSTRACT: The high prevalence of hepatitis B virus (HBV) among the Chinese population poses a threat to blood safety; however, few studies have examined epidemiological data regarding HBV infection of Chinese blood donors. The present study investigated the demographic characteristics of blood donors at the Anhui blood center in China, the prevalence, incidence, and residual risk (RR) associated with hepatitis B surface antigen (HBsAg) expression in terms of transfusion transmitted HBV (TTHBV) infections. The demographic characteristics and HBV status of people who donated blood at the Anhui blood center between 2009 and 2011 were retrospectively analyzed. The incidence of HBV was estimated through HBsAg yield approach. The window period model was then used to estimate the RR of TTHBV infection. The typical donor at the Anhui blood center was a first-time volunteer, aged less than 25 years, unmarried, of Han ethnicity, and with an education below high school level. The prevalence of HBV infection among repeat donors, first-time donors, and all donors was 28.9, 127.2 and 82.1 per 100,000, respectively. The incidence estimate was 333.9 per 10(5) person-years. Using an infectious window period of 59 days, the RR for HBV was estimated to be 1 in 1853 between 2009 and 2011. The incidence and RR of HBV in Chinese blood donors are much higher than those of donors in developed countries. This is because sensitive ELISAs and nucleic acid tests are not available in China. Further work is needed to improve both the safety and availability of blood products in China.
    Preview · Article · Sep 2013 · PLoS ONE
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    • "We have illustrated the use of our new informative Dorfman procedures using chlamydia and gonorrhea data collected as part of the Nebraska IPP. We believe that our informative algorithms could also find successful application in blood and plasma donation screening, mainly because (noninformative) Dorfman retesting is already widely used to screen donations in the United States and elsewhere (Dodd, Notari, and Stramer, 2002; Tabor and Epstein, 2002; Mine et al., 2003; Seed, Kiely, and Keller, 2005). Our procedures are only minimally more involved than classical Dorfman retesting, and they can provide a substantial reduction in the number of tests without sacrificing classification accuracy. "
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    ABSTRACT: Since the early 1940s, group testing (pooled testing) has been used to reduce costs in a variety of applications, including infectious disease screening, drug discovery, and genetics. In such applications, the goal is often to classify individuals as positive or negative using initial group testing results and the subsequent process of decoding of positive pools. Many decoding algorithms have been proposed, but most fail to acknowledge, and to further exploit, the heterogeneous nature of the individuals being screened. In this article, we use individuals' risk probabilities to formulate new informative decoding algorithms that implement Dorfman retesting in a heterogeneous population. We introduce the concept of "thresholding" to classify individuals as "high" or "low risk," so that separate, risk-specific algorithms may be used, while simultaneously identifying pool sizes that minimize the expected number of tests. When compared to competing algorithms which treat the population as homogeneous, we show that significant gains in testing efficiency can be realized with virtually no loss in screening accuracy. An important additional benefit is that our new procedures are easy to implement. We apply our methods to chlamydia and gonorrhea data collected recently in Nebraska as part of the Infertility Prevention Project.
    Preview · Article · Jul 2011 · Biometrics
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