Risk reduction strategies for transfusion-transmissible arboviral infections

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Abstract

Background

Arthropod-borne viruses (arboviruses) are an expanding global threat to human health. Only dengue (DENV) and West Nile virus (WNV) have both been documented to be transfusion-transmissible although transfusion is a plausible route of infection for several others including chikungunya virus (CHIKV).

Aims

To describe possible risk management strategies to reduce the risk of transfusion-transmissible arboviral infection.

Materials/Methods

Management strategies include geographical donor deferral, donation testing and pathogen reduction techniques (PRT), which can be applied individually or in combination. Geographical donor deferral ranges from temporary implementation of a policy deferring donors returning from outbreak areas to a ‘blanket’ deferral of all donors returning for a defined period after return from overseas. Donation testing may be ‘targeted’ testing of ‘at risk’ donors or universal donation testing.

Results

Implementing temporary deferral policies for outbreaks of WNV, dengue and CHIKV has been an effective strategy in several countries. A ‘blanket’ deferral of all donors returning for a defined period after return from overseas has been implemented in the Netherlands. Universal nucleic acid testing (NAT) for WNV has applied in North America since 2003. Targeted testing of all donations made during local outbreaks has been applied in several countries in response to CHIKV (Réunion, Italy) DENV (Puerto Rico, Madeira) and WNV (Greece, Italy). PRT has been applied in combination with targeted NAT to safeguard platelet and RBC donations during outbreaks of CHIKV and WNV.

Conclusions

Mitigation strategies for transfusion-transmissible arboviral infection have to date been highly effective in minimizing recipient risk.

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