Epidemiology of Transfusion Transmitted Disease Sharyn Orton, MT(ASCP)SBB, M.S.P.H, Ph.D. candidate Project Leader, Tran

1. Epidemiology of Transfusion Transmitted Disease Sharyn Orton, MT(ASCP)SBB, M.S.P.H, Ph.D. candidate Project Leader, Transmissible Diseases Department American Red Cross Jerome H. Holland Laboratory Rockville, MD.

2. After 20+ years as a Medical Technologist in the field of Blood Banking, I returned to graduate school to pursue a Master’s degree and Ph.D in Epidemiology. This decision was a result of my interests in both the burgeoning field of new/emerging potentially transfusion transmitted diseases and conditions as well as blood donor behavior and modification. In order to be competent to design and perform studies in these areas, further education was needed. In addition, there are very few formally trained Epidemiologists in this field. My current position as Project Leader in the Transmissible Diseases Department has allowed me to develop and coordinate research projects in the Blood Banking arena. Some new areas of research include (1) transfusion potential for infectious causes of chronic diseases and cancer, (2) validation of donor history questions, (3) donor motivations and (4) application of new molecular techniques for use in detection of transfusion transmitted conditions. These are interesting and exciting new areas of work.

3. Each year: - 8 million donors donate - 14 million units of blood make - 23 million blood components to - 4 million patients

4. Safety measures: - Volunteer blood supply - Predonation educational material - Donor history exam and questionnaire

5. - Serological testing - Confidential Unit Exclusion - Callback

6. Tests performed on blood: - ABO, Rh and antibody screen - HBsAg - Anti-HBc - Anti-HCV

7. - Anti-HTLV I/II - STS - Anti-HIV 1/2 - HIV p24 Antigen - ALT

8. - Anti-CMV (selectively) - HCV RNA (new in 1999) - HIV RNA (new in 1999)

9. Types of donations: - Allogeneic - Directed - Autologous - Apheresis

10. Calculation of residual risk of transfusion associated infection uses: - seroconverting donors to calculate incidence - the duration of the window period

11. Incidence in blood donors: - HCV 4.32 - HIV 1/2 3.37 - HBV 9.8 - HTLV I/II 1.12

12. Current window period (in days): HCV 23 HIV 11 HBV 59 HTLV 51

13. Residual risk of transfusion transmitted infection: - HCV 2.72/million donations - HIV 1.01/million donations - HBV 6.65/million donations - HTLV 1.56/million donations

14. Epidemiology of Hepatitis C -variation in genotype prevalences worldwide -prior to screening the blood supply caused hepatitis in 5- 10% of transfusion recipients

15. - today causes hepatitis in ~ 0.1% of transfusion recipients

16. Methods to Reduce Transfusion Transmitted Infection - microbial inactivation - plasma hold - leuko-reduction

17. - minimizing exposure: use of autologous blood using strict transfusion criteria, transfuse fewer products treat patient with drugs

18. - minimizing exposure, con’d: recombinant plasma products

19. Potential parasitic infections - malaria - babesiosis - toxoplasmosis - Chagas’disease - leishmaniasis

20. Emerging viruses in transfusion: - HGV - TTV - prions: CJD

21. - KS associated HHV-8 - MS putatively associated retrovirus

22. Seroprevalence in blood donors: - HGV RNA 1 - 3% - HGV E2 antibody 10% - TT virus ?? - CJD ??

23. - HHV-8 1 - 20% - MS associated retrovirus ??

24. Additional thoughts - Clerical errors as a source of transfusion transmission - New/emerging agents and methods of surveillance - Blood alternatives

25. Comparative safety of transfusion: Your risk of : violence or poisoning 1: 3000 auto accident 1: 8000 developing leukemia 1: 12,000 homicide 1: 100,000