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Latest Trends in Transfusion-Transmitted Chagas’ Disease

Latest Trends in Transfusion-Transmitted Chagas’ Disease. Blood Products Advisory Committee September 12, 2002. David A. Leiby, Ph.D. Holland Laboratory. Trypanosoma cruzi. small protozoan parasite chronic, asymptomatic, and untreatable infection

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Latest Trends in Transfusion-Transmitted Chagas’ Disease

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  1. Latest Trends in Transfusion-Transmitted Chagas’ Disease Blood Products Advisory Committee September 12, 2002 David A. Leiby, Ph.D. Holland Laboratory

  2. Trypanosoma cruzi • small protozoan parasite • chronic, asymptomatic, and untreatable infection • endemic to portions of Mexico, Central America, and South America • transmission: • vectorial • congenital • organ transplant • blood transfusion

  3. Immigration and Demographics Mexico8,770,534 C. America 1,960,740 S. America 1,676,595 12,407,869

  4. Chagas Disease After Organ Transplantation • U.S. case – 2001 • MMWR: 2002;51:210-212 • single donor • 3 recipients – all culture positive • kidney/pancreas -died of acute Chagasic myocarditis • liver • kidney

  5. Transfusion Cases: 1987: California - Mexican donor 1989: New York City - Bolivian donor Manitoba - Paraguayan donor 1993: Houston - unknown donor 1999: Miami - Chilean donor 2000:Manitoba - German/Paraguayan donor

  6. Why So Few? • reported cases are “sentinels” • immunosuppressed • fulminate disease • easily detected/diagnosed • many cases missed • immunocompetent • misdiagnosed • not recognized

  7. Cardiac Surgery Patients • 11,430 multiply tx patients tested by EIA • 6 (0.05%) confirmed seropositive • 4 had positive pre-op samples • 2 pre-op samples not available • excised hearts from transplants positive by PCR • 5 of 6 were Hispanic • 2.7% of Hispanic patients seropositive • no medical history of Chagas’

  8. Seroprevalence Data: Los AngelesMiami Total no. donations1,104,030 181,139 “Yes” to risk question78,736(7.1%) 25,908 (14.3%) Number tested77,967 25,352 EIA repeat reactive329 75 Confirmed by RIPA147 (0.2%) 20 (0.1%) Seropositivity rate1 in 7,500 1 in 9,000

  9. 1/5,400 0.018 0.016 1/7,200 0.014 0.012 1/9,900 0.010 % Donors Positive 0.008 0.006 0.004 0.002 0.000 1996 1997 1998 LA Seroprevalence: 1996-98

  10. Increasing Rate of Seropositivity? • EIA + donors deferred • regardless of RIPA test result • significant increase in rate each year • significant increase in at-risk donors each year • enhanced minority recruitment efforts • bottom line: more seropositive donors!

  11. Seroprevalence: Donation Type Donation No. No. Yes (%) Confirmed Rate Type Donations Responses Positive Allogeneic 991,017 74,326 (7.5) 138 1/7,200 Apheresis 93,116 2,421 (2.6) 1 1/93,000 Directed 18,974 1,935 (10.2) 8 1/2,400

  12. Lookback: 0 for 19? • transmission by transfusion does occur! • 13 – 49% in South America • 33 of 52 (63%) seropositive donors parasitemic • parasitemia intermittent = not all units infective • products received: • 11 red cells • 3 FFP • 2 cryoprecipitate • 3 platelets

  13. Are Platelets to Blame? • at least 5 of 6 reported tx cases in U.S./Canada included platelets • platelet recipients more likely to be immunocompromised • T. cruzi may separate with platelets during whole blood centrifugation • survival in blood components: • whole unit < 3 weeks • platelets < 4 days • red cells < 4 days • plasma none

  14. Nationwide Risk 13.2 million donations/year 8.25 million donors 206,250 at-risk donors 330 seropositive donors 528 seropositive donations/year 618 potentially infectious components/year (1/1.6) (2.5%) (1/625) (1.6) (1.17)

  15. Interventions? • question strategies • designed to identify at-risk donors for deferral or testing • lack sensitivity • blood screening • lack of licensed tests • potential strategies • added value of NAT testing minimal • one-time testing • logistically difficult, not cost effective? • universal testing

  16. Chagas’/T. cruzi Summary • seropositive donors nationwide • levels vary based on at-risk population • no reliable risk factors • infections are: • asymptomatic, chronic & untreatable • congenitally transmitted • infectious donors demonstrable • universal screening • ongoing blood safety issue

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