Risk behavior-based donor selection procedures are widely
used to mitigate the risk of transfusion-transmissible infections (TTIs), but
their effectiveness is disputed in countries with low residual risks of TTIs.
In 1995 to 2014, Dutch blood donors infected with hepatitis
B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human
T-lymphotropic virus (HTLV), or syphilis were interviewed by trained medical
counselors to identify risk factors associated with TTIs. Trends in the
prevalence and incidence of TTIs were analyzed using binomial regression models.
A total of 972 new donors and 381 repeat donors had TTIs.
New donors had higher rates of TTIs compared to repeat donors. Although the HBV
and HCV prevalence gradually decreased over time, the incidence of all five
TTIs remained stable during the past two decades. In new donors the TTIs had
the following risk profiles: "blood-blood contact" for HCV,
"unprotected sex" for HIV and syphilis, and "country of
birth" for HBV and HTLV. In infected repeat donors, sexual risk factors
predominated for all TTIs. At posttest counseling, 28% of infected repeat
donors admitted to risk factors leading to permanent donor exclusion if
revealed during the donor selection procedure (predominantly male-to-male sex
and recent diagnosis of syphilis).
The prevalence and incidence of TTIs among Dutch blood
donors are six- to 60-fold lower than in the general Dutch population,
illustrating the effectiveness of donor selection procedures.
However, at least
a quarter of infected donors appeared noncompliant to the donor health questionnaire
(DHQ), suggesting that DHQs, or the way donor questioning is implemented, can
be improved.
- 1Department of Blood-Borne Infections, Division Research, Sanquin Blood Supply Foundation, Amsterdam.
- 2Department of Transfusion Technology Assessment, Division Research, Blood Supply Foundation, Amsterdam, the Netherlands.
- 3Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands.
- 4Department of Medical Donor Affairs, Division Blood Bank, Sanquin Blood Supply Foundation, Amsterdam.
- 5Department of Clinical Virology (CINIMA), Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands.
- 6Department of Virology, Division Diagnostics, Sanquin Blood Supply Foundation, Amsterdam.
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