west nile virus screening for viremic blood donors
DESCRIPTION
West Nile Virus Screening for Viremic Blood Donors. Karen A. Reiner, Ph.D. Student Walden University PUBH8165-10 Dr. Raymond W. Thron Fall Quarter, 2010. Intended Audience. Immunohematologists Blood banks specialists Transfusion medicine personnel Physicians. Learning Outcomes. - PowerPoint PPT PresentationTRANSCRIPT
KAREN A. REINER, PH.D. STUDENT
WALDEN UNIVERSITYPUBH8165-10
DR. RAYMOND W. THRONFALL QUARTER, 2010
West Nile Virus Screening for
Viremic Blood Donors
Intended Audience
ImmunohematologistsBlood banks specialistsTransfusion medicine personnelPhysicians
Learning Outcomes
After completing this presentation, participants should be able to:
Describe the etiology and epidemiology of West Nile Virus.
Describe the signs and symptoms of West Nile Virus.
Discuss potential interferences with current serological testing of West Nile Virus.
Discuss the importance of West Nile Virus screening of blood.
Introduction
West Nile Virus can cause serious illness Seasonal epidemic in the US Can be fatal Humans and animals affected
Cases reported to the CDC (so far in 2010) 789 cases 33 deaths
CDC. (2010). West Nile Virus: Statistics, surveillance, and control . Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount10_detailed.htm
Background
First isolated in 1937Recognized as etiologic agent of
meningoencephalitisFirst identified in the US in 1999
Etiology
Caused by a single-stranded RNA virusFamily FlaviviridaeGenus: Flavivirus
Viron
RedBloodCells
Epidemiology
Transmitted primarily by: Infected mosquitoes
Other transmission routes are: Blood transfusions Organ transplant Intra utero Breast feeding
Animated graphic available from http://www.co.washington.or.us/HHS/WestNileVirus/
West Nile Virus Transmission Cycle
WNV transmission cycle. Available from http://www.publichealth.lacounty.gov/acd/VectorWestNile.htm
The transmission cycle for the West Nile Virus is depicted on this diagram.
Humans are considered accidental hosts. Human to human transmission is also possible and of increasing concern.
Distribution of West Nile Virus in the US
CDC. (2010). West Nile Virus: Statistics, surveillance, and control . Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount10_detailed.htm
So far this year Arizona has the highest number of reported West Nile Virus cases.
Arizona: Cases per Week
CDC. (2010). West Nile Virus: Statistics, surveillance, and control . Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount10_detailed.htm
The graph below shows the increase in human disease cases during the summer months; consistent with increased
mosquito activity .
Epidemiology
CDC. (2010). West Nile Virus: Statistics, surveillance, and control . Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount10_detailed.htm
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NeuroinvasiveNonneuroinvasiveViremic DonorDeaths
CDC. (2010). West Nile Virus: Statistics, surveillance, and control . Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount10_detailed.htm
Cases by State as of October 2010
Disease Manifestation
West Nile Virus infections may be: Asymptomatic
80% of infections Mild
10-20% of infections Severe
1 in 150 infections Fatal
3-15%; mostly elderly individuals
CDC. (2010a). Cases of West Nile Virus human disease. Available from http://www.cdc.gov/ncidod/dvbid/westnile/qa/cases.htm
Signs and Symptoms
Asymptomatic Mild
Fever Headache Body aches Nausea Vomiting Stomach & back pain Swollen lymph glands Skin rash
Signs and Symptoms
Severe High fever Headache Stiff neck Disorientation Coma Tremors Convulsions Muscle weakness Loss of vision Numbness Paralysis
Diagnosis
Detection of increased IgM in serum or CFS
Serology ELISA Nucleic Acid Plaque reduction neutralization (PRN) test Indirect Immunofluorescence (IFA) Hemagglutination inhibition
Treatment
No specific treatmentSupportive care
Interferon Antisense nucleotides
Experimental Intravenous immunoglobulins
Prevention
Infection prevention Limit outdoor activities during peak biting times Use mosquito repellent Wear appropriate protective clothing
Long pants Long-sleeved shirts
Vector elimination Pesticides Eliminate water holding containers
Prevention (continued)
Environmental surveillance Sentinel birds Death birds Mosquito populations
Vaccine No human vaccine is
availableEducation
West Nile Virus Surveillance. Microbe World Video available from http://www.dailymotion.com/video/x6gsx0_west-nile-virus_tech
CLICK on picture to view video on separate window.
Timeline of West Nile Virus Screening
2002 - West Nile Virus screening begins after the first transfusion-related infection reported
2003 – Another case of transfusion-related West Nile Virus infection
2003 – National blood donation screening for West Nile virus started
2005 – DFA approves NAT for screening blood donors
MMWR. (2004b). Update: West Nile Virus screening of blood donations and transfusion-associated transmission --- United States, 2003. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5313a1.htm
Current Criteria for Blood Screening
Mandatory blood screens include: ABO Rh Other antigenic screening HIV-1 & HIV -2 Hep B Hep C HTLV-I and HTLV-II Syphillis
AABB. (2010). Blood FAQ. Available from http://www.aabb.org/resources/bct/Pages/bloodfaq.aspx#a4
Current Criteria for Blood Screening
Optional Screening include: West Nile Virus Chaga’s Disease
AABB. (2010). Blood FAQ. Available from http://www.aabb.org/resources/bct/Pages/bloodfaq.aspx#a4FDA. (2010). Testing donors for relevant communicable disease agents and diseases. Available from http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/TissueSafety/ucm095440.htm
First Donor Screening Test for West Nile Virus. Available from http://www.youtube.com/watch?v=DAqrL8mprm4
CLICK on picture to view video on separate window.
Challenges of Current Protocols
Current blood screening protocols: Do not reflect current needs
Example: Human T-Lymphotropic Virus (HTLV)
Last documented transfusion-related exposure was in 1985
Reportedly, less likely transmission for HTLV than for Hepatitis B
No other transfusion-related HTLV infections have been reported since
West Nile Virus Steady increase in cases since 1999
MMWR. (1986a). Current trends in human T-Lymphotropic virus type III/Lymphadenopathy-associated virus: Agent summary statement. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/00033677.htmMMWR. (1986b). Epidemiologic notes and reports transfusion-associated Human T-Lymphotropic Virus Type III/ Lymphadenopathy-associated virus infection from a seronegative donor – Colorado. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/00000749.htm
Challenges of Current Protocols
West Nile Virus transfusion-related infection reported in 2002 23 cases reported 500 viremic donations
Other transfusion-related West Nile Virus infections reported since
MMWR. (2004a). Update: Detection of West Nile Virus in blood donations --- United States, 2003. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm52d918a1.htmMMWR. (2004b). Update: West Nile Virus screening of blood donations and transfusion-associated transmission --- United States, 2003. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5313a1.htm
West Nile Virus Viremic Blood DonorActivity in the United States
CDC. (2010b). West Nile Virus: Statistics, surveillance, and control archive. Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&control_archive.htm
Proposed West Nile Virus Screening Methods
Approved methods for West Nile Virus testing: COBAS TaqScreen West
Nile Virus Test Roche Molecular System, Inc.
Procleix West Nile Virus (WNV) Assay Gen-Probe, Inc. (NAT)
FDA. (2009). West Nile Virus nucleic acid testing. Available from http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/BloodDonorScreening/InfectiousDisease/ucm173212.htm
How to test for West Nile Virus in blood. Available from http://www.youtube.com/watch?v=dxFsGx6G8l0
CLICK on picture to view video on separate window.
Summary
West Nile Virus infections can be seriousWest Nile Virus can be transmitted via blood
transfusionMany lives have been saved by screeningWest Nile Virus screening of blood should be
mandatory
References
AABB. (2010). Blood FAQ. Available from http://www.aabb.org/resources/bct/Pages/bloodfaq.aspx#a4
CDC. (2010). West Nile Virus: Statistics, surveillance, and control . Available from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount10_detailed.htm
FDA. (2009). West Nile Virus Nucleic Acid Testing. Available from http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/BloodDonorScreening/InfectiousDisease/ucm173212.htm
Macedo de Oliveira, A., Beecham, B. D., Montgomery, S. P., Lanciotti, R. S., Linnen, J. M., Giachtti, C., Stramer S.L., Safranek T. J. (2004). West Nile Virus blood transfusion-related infection despite nucleic acid testing. Transfusion, 44(12), 1695-1699.
MMWR. (1986a) Current trends Human T-Lymphotropic Virus Type III/ Lymphadenopathy-associated virus: Agent summary statement. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/00033677.htm
MMWR. (1986b). Epidemiologic notes and reports transfusion-associated Human T-Lymphotropic Virus Type III/ Lymphadenopathy-associated virus infection from a seronegative donor – Colorado. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/00000749.htm
MMWR. (2004a). Update: Detection of West Nile Virus in blood donations --- United States, 2003. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm52d918a1.htm
MMWR. (2004b). Update: West Nile Virus screening of blood donations and transfusion-associated transmission --- United States, 2003. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5313a1.htm
Recommended Additional Reading
Biggerstaff, B. J., Petersen, L. R. (2003). Estimated risk of transmission of the West Nile virus through blood transfusion in the US, 2002. Transfusion, 43:8, 1007-1017. doi: 10.1046/j.1537-2995.2003.00480.x.
Complete list of donor screening assays for infectious agents and HIV diagnostic assays. Available from http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/BloodDonorScreening/InfectiousDisease/ucm080466.htm
Diamond, M.S., Klein, R.S. (2004). West Nile virus: crossing the blood-brain barrier. National Medicine, 10(12), 1294-1295.
Harrington, T., Kuehnert, M. J., Kamel, H., Lanciotti, R. S., Hand, S., Currier, M., Chamberland, M. E., Petersen, L. R., Marfin, A. A. (2003). West Nile virus infection transmitted by blood transfusion. Transfusion, 43(8), 1018-1022. doi: 10.1046/j.1537-2995.2003.00481.x
Lanciotti, R. S., Roehrig, J. T., Deubel, V., Smith, J., Parker, M., Steele, K., et al. (1999). Origin of the West Nile Virus responsible for an outbreak of encephalitis in the Northeastern United States. Science, 286, 2333 – 2337. doi: 10.1126/science.286.5448.2333.
Macedo de Oliveira, A., Beecham, B. D., Montgomery, S. P., Lanciotti, R. S., Linnen, J. M., et al. (2004). West Nile Virus blood transfusion-related infection despite nucleic acid testing. Transfusion, 44(12), 1695-1699.
MMWR. (2005). West Nile Virus infections in organ transplant recipients --- New York and Pennsylvania, August--September, 2005. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm54d1005a1.htm
Montgomery, S. P., Brown, J. A., Kuehnert, M., Smith, T. L., Crall, N., Lanciotti, R. S., et al. (2006). Transfusion-associated transmission of West Nile virus, United States 2003 through 2005. Transfusion, 46(12), 2038-2046. doi: 10.1111/j.1537-2995.2006.01030.x
Recommended Additional Reading
Pealer, L. N., Marfin, A. A., Petersen, L. R., Lanciotti, R. S., Page, P.L., Stramer, S.L., et al. (2003). Transmission of West Nile Virus through blood transfusion in the United States in 2002. New England Journal of Medicine, 349, 1236-1245.
Weiss, D., Carr, J., Kellachan, C., Tan, M., Phillips, E., Bresnitz, M., et al. (2001). Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000. Emerging Infectious Diseases, 7(4): 654–658.