Efforts in Blood Safety: Integrated Approach for Serological Diagnosis of Syphilis

Recent efforts in transfusion medicine are focused on improving blood safety as well as establishing effective and efficient diagnostic algorithms for donor screening. To date, syphilis is a transfusion-transmitted infection re-emerged in many countries as a public health threat especially among populations at specific risk. 

This task requires new diagnostic tools and hemovigilance programs. The current diagnostic methodologies are debated, since presenting limitations and unresolved issues with special regard to the clinical interpretation of serological patterns, especially in asymptomatic patients and in blood donors. Furthermore, the switch from the traditional to alternative diagnostic algorithms underlines the lack of a gold standard, which has not been supported by shared guidelines. Besides, a lot of ongoing clinical trials on the performance of diagnostic assays, on the serological response associated with different pharmacological treatments, as well as on the prevention programs are currently under investigation. 

Here, we review the recent literature about the diagnosis of syphilis especially for low-risk populations proposing the adoption of an algorithm for blood donor screening that should satisfy the need of increasing safety for transfusion-transmitted infections in the modern blood transfusion centers.

Below:  The natural history of untreated syphilis in immunocompetent individuals

Below:  The actual testing algorithms for diagnosis of syphilis

Full article at:   http://goo.gl/X6O8mg

By:  Sommese L1, De Pascale MR1, Capuano M1, Napoli C1.

• 1Department of Transfusion Medicine and Transplant Immunology, U.O.C. Immunohematology, Regional Reference Laboratory of Transplant Immunology, Azienda Ospedaliera Universitaria, Second University of Naples, Italy. 
• Asian J Transfus Sci. 2016 Jan-Jun;10(1):22-30. doi: 10.4103/0973-6247.164267.

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Syphilis Screening Practices in Blood Transfusion Facilities in Ghana

OBJECTIVE:

The primary objective of the study was to compare laboratory practices for screening blood donors for syphilis at blood transfusion facilities in Ghana with WHO and The National Blood Service, Ghana (NBSG) recommendations. In addition we estimated the prevalence of syphilis antibodies in blood donors in Ghana.

METHODS:

Over an 11-month period from February 2014 to January 2015, we administered a semi-structured questionnaire to 122 laboratory technical heads out of a total of 149 transfusion facilities in Ghana and the response rate was 81.9%.

RESULTS:

A total of 58 (48%) transfusion facilities tested donors for syphilis with an estimated 3.7% seroprevalence (95% CI; 3.6% - 3.8%). A total of 62,782 out of 91,386 (68.7%) donations were tested with assays that are not recommended. Voluntary donations had an estimated syphilis seroprevalence of 2.9% compared with family donations of 4.0% (p=0.001). Only 6.9% of the health facilities were using Standard Operating Procedures (SOPs).

CONCLUSION:

Despite international and national recommendations more than half of the studied health facilities that provide blood transfusions in Ghana are not screening blood donations for syphilis. Our data show a considerable mismatch between recommendations and practice with serious consequences for blood safety and public health.

Full [PDF] article at:   http://goo.gl/ILRLKR

By:  Sarkodie F1, Hassall O2, Owusu-Dabo E3, Owusu-Ofori S4, Bates I2, Bygbjerg IC5, Ansah JK6, Ullum H7.

• 1Komfo Anokye Teaching Hospital, Kumasi, Ghana; Liverpool School of Tropical Medicine, UK. Electronic address: fsarkodie29@gmail.com.
• 2Liverpool School of Tropical Medicine, UK.
• 3School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Kumasi Centre for Collaborative Research, KNUST, Ghana.
• 4Komfo Anokye Teaching Hospital, Kumasi, Ghana.
• 5Department of Public Health, University of Copenhagen, Denmark.
• 6National Blood Service, Ghana.
• 7Department of Clinical Immunology, Copenhagen, University Hospital Denmark. 

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Hepatitis E virus Infection: Epidemiology and Treatment Implications

Hepatitis E virus (HEV) infection is now established as an emerging enteric viral hepatitis. Standard treatments in acute and chronic hepatitis E remain to be established. 

This study undertakes a review of the epidemiology, treatment implication and vaccine prevention from published literature. HEV infection is a worldwide public health problem and can cause acute and chronic hepatitis E. HEV genotypes 1 and 2 are primarily found in developing countries due to waterborne transmission, while the zoonotic potential of genotypes 3 and 4 affects mostly industrialized countries. An awareness of HEV transmission through blood donation, especially in the immunocompromised and solid organ transplant patients, merits an effective anti-viral therapy. 

There are currently no clear indications for the treatment of acute hepatitis E. Despite concerns for side effects, ribavirin monotherapy or in combination with pegylated interferon alpha for at least 3 mo appeared to show significant efficacy in the treatment of chronic hepatitis E. However, there are no available treatment options for specific patient population groups, such as women who are pregnant. Vaccination and screening of HEV in blood donors are currently a global priority in managing infection. 

New strategies for the treatment and control of hepatitis E are required for both acute and chronic infections, such as prophylactic use of medications, controlling large outbreaks, and finding acceptable antiviral therapy for pregnant women and other patient groups for whom the current options of treatment are not viable.

Full article at:  http://goo.gl/4drquV

By:  Ga Young Lee, Kittiyod Poovorawan, Duangnapa Intharasongkroh, Pattaratida Sa-nguanmoo, Sompong Vongpunsawad, Chintana Chirathaworn, and Yong Poovorawan

Ga Young Lee, Kittiyod Poovorawan, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand

Duangnapa Intharasongkroh, Pattaratida Sa-nguanmoo, Sompong Vongpunsawad, Yong Poovorawan, Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand

Duangnapa Intharasongkroh, National Blood Centre, Thai Red Cross Society, Bangkok 10330, Thailand

Chintana Chirathaworn, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand

Author contributions: Poovorawan Y designed and outlined the research; Lee GY, Poovorawan K, Intharasongkroh D, Sa-nguanmoo P, Vongpunsawad S and Chirathaworn C wrote the paper.

Correspondence to: Yong Poovorawan, MD, Professor, Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Rd, Bangkok 10330, Thailand. ht.ca.aluhc@p.gnoy

Telephone: +66-2-2564909 Fax: +66-2-2564929

 

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Estimating Window Period Blood Donations for Human Immunodeficiency Virus Type 1, Hepatitis C Virus, and Hepatitis B Virus By Nucleic Acid Amplification Testing in Southern Pakistan

Transfusion. 2014 Jan 3. doi: 10.1111/trf.12521. More at:  http://ht.ly/skZQ4

Recently, strategic planning was initiated by the National Blood Transfusion Services Pakistan to improve its blood bank facilities. Emphasis has been placed on appropriate screening of blood products. Located in the southern region, Aga Khan University Hospital is a 700-bed tertiary care academic institute with comprehensive blood banking. Screening of blood donors has been based on verbal screening and serologic testing to date. Additionally, the need of implementing nucleic acid testing (NAT) was considered in 2011 because of an upsurge in hepatitis epidemiology. The aim of this study was to analyze the efficacy of this additional donor screening program and to evaluate the impact of NAT on the yield and residual risk of transfusion-transmissible viral infections.

A total of 42,830 blood donations collected between 2011 and 2012 were screened for routine serologic assays. Only serologically negative donors (n = 41,304) were tested for NAT. The frequency of viral infections was evaluated through serologic techniques and NAT yield for viral agents was estimated for computing window period donors. Residual risk per million donors was computed for viral infections in seronegative blood donors.

Serologic work-up showed 1571 abnormal screening results in 1526 blood donors with the following results: hepatitis C virus antibodies (anti-HCV; n = 708), hepatitis B surface antigen (n = 555), human immunodeficiency virus antibodies (anti-HIV; n = 29), malaria (n = 30), VDRL (n = 249), and coinfection (n = 45). Thirty-five NAT-reactive samples were identified: HIV-1, one; HCV, 27; and hepatitis B virus (HBV), seven. Incident rates per 10⁵ donors were highest for HCV (453.3) followed by HBV (171.5) and HIV (72.2). Calculated residual risk per million donors was highest at 1 in 10,900 for HBV, intermediate at 1 in 13,900 for HCV, and least at 1 in 62,600 for HIV.

Incidence rates and estimated residual risk indicate that the current risk of transfusion-transmitted viral infections attributable to blood donation is relatively high in this country. The study recommends the parallel use of both serology and NAT screening of donated blood in countries that have high seroprevalence of these viral infections.

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