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Screening of Blood Donations for Zika Virus Infection — Puerto Rico April 3–June 11 2016 MMWR

MMWR Early Release Vol. 65, Early Release June 17, 2016

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Screening of Blood Donations for Zika Virus Infection — Puerto Rico, April 3–June 11, 2016

Transfusion-transmitted infections have been documented for several arboviruses, including West Nile and dengue viruses (1). Zika virus, a flavivirus transmitted primarily by Aedes aegyptimosquitoes that has been identified as a cause of congenital microcephaly and other serious brain defects (2), became recognized as a potential threat to blood safety after reports from a 2013–2014 outbreak in French Polynesia. Blood safety concerns were based on very high infection incidence in the population at large during epidemics, the high percentage of persons with asymptomatic infection, the high proportion of blood donations with evidence of Zika virus nucleic acid upon retrospective testing, and an estimated 7–10-day period of viremia (3). At least one instance of transfusion transmission of Zika virus has been documented in Brazil after the virus emerged there, likely in 2014 (4). Rapid epidemic spread has followed to other areas of the Americas, including Puerto Rico.

In February 2016, the Food and Drug Administration (FDA) issued recommendations for donor screening, donor deferral, and product management to reduce the risk for transfusion-transmitted Zika virus in the United States and its territories (5). In addition to behavioral- and health-risk questionnaires for blood donors in all areas, FDA recommends deferrals for donors in unaffected areas who recently lived in or visited an area with active mosquito-borne transmission of Zika virus. For establishments collecting blood in areas with active, local mosquito-borne transmission, such as Puerto Rico and other U.S. territories, the recommendations include discontinuing local blood collections and importing blood units from unaffected areas of the continental United States unless one of the following is implemented: 1) Zika virus screening of locally collected blood donations or 2) treatment of locally collected units with pathogen-reduction technology (FDA-approved only for plasma and apheresis platelets). In Puerto Rico, interventions initially were limited to importation of blood units from unaffected U.S. areas and to treatment of plasma and apheresis platelets with pathogen-reduction technology; no Zika virus screening test was available. On April 3, 2016, Zika virus screening of locally collected blood donations was implemented using a newly developed nucleic acid test (NAT) (cobas Zika, Roche Molecular Systems, Inc., Pleasanton, California) authorized by FDA under an investigational new drug application (IND) (6). As part of the IND, plasma samples from blood donors are screened individually, and specimens with reactive results are subjected to additional testing including an alternate NAT and immunoglobulin M serology. A blood donation with an initial reactive result by NAT is regarded as a presumptive viremic donor, indicating an infected donor, and is interdicted and removed from the blood supply.

During April 3–June 11, 2016, a total of 68 (0.5%) presumptive viremic donors were identified from 12,777 donations tested. The highest weekly incidence was 1.1% for the latest week of reporting, June 5–June 11, and incidence has been increasing over time (Figure).

Although the blood donor population of Puerto Rico is not intended to be statistically representative of the general population, the increasing prevalence of Zika virus nucleic acid among blood donors likely reflects an overall increase in infection incidence in the population at large. Based on data from previous outbreaks caused by arboviruses transmitted by Aedes aegypti, the high incidence often associated with these outbreaks can result in a substantial proportion of the population becoming infected. For example, chikungunya virus was introduced into Puerto Rico in 2014. Retrospective screening for chikungunya virus nucleic acid was performed on blood donations collected during June–December 2014, and the estimated detectable viremia was 0.65%, with a peak of 2.1% in October. Testing for chikungunya virus immunoglobulin M antibody of retained individual blood donation samples obtained during March 1–9, 2015, suggested that nearly 25% of the Puerto Rico population became infected during the previous year’s epidemic (7). Because viremia is only present days after acute infection, immunoglobulin M antibody can provide a more precise estimate of the burden of recent infection. The 2014–2015 chikungunya virus data suggest that detection of viremia in a relatively small proportion of blood donors each week can reflect a substantial proportion of the general population becoming infected during the course of an epidemic season.

Currently, no medication or vaccine is available to treat or prevent Zika virus disease. Prevention relies on avoidance of mosquito bites, elimination of mosquito breeding sites, community mosquito control, and taking measures to prevent sexual transmission. Screening of the U.S. blood supply using nucleic acid tests has markedly reduced the risk for transfusion transmission for multiple pathogens, including for West Nile virus after it was associated with arboviral epidemics in the United States. Measures to protect the blood supply from Zika virus, including donor deferrals, laboratory screening, and pathogen reduction technology, are expected to similarly reduce the risk for transfusion transmission.

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Corresponding author: Matthew J. Kuehnert, eocevent281@cdc.gov, 800-232-4636.

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1Zika virus response blood safety team, CDC; 2Roche Molecular Systems, Inc., Pleasanton, California; 3Creative Testing Solutions, Tempe, Arizona; 4Blood Systems Research Institute, San Francisco, California; 5Banco de Sangre de Servicios Mutuos, San Juan, Puerto Rico; 6Banco de Sangre de Puerto Rico; 7Food and Drug Administration, Silver Spring, Maryland; 8Puerto Rico Department of Health.

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References

1. Petersen LR, Busch MP. Transfusion-transmitted arboviruses. Vox Sang 2010;98:495–503. CrossRef PubMed
2. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med 2016;374:1981–7. CrossRef PubMed
3. Lanteri MC, Kleinman SH, Glynn SA, et al. Zika virus: a new threat to the safety of the blood supply with worldwide impact and implications. Transfusion 2016. Epub June 9, 2016. CrossRefPubMed
4. Barjas-Castro ML, Angerami R, Cunha M, et al. Probable transfusion-transmitted Zika virus in Brazil. Transfusion 2016. In press.
5. Food and Drug Administration. Recommendations for donor screening, deferral, and product management to reduce the risk of transfusion-transmission of Zika virus. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2016.http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM486360.pdf
6. Food and Drug Administration. FDA allows use of investigational test to screen blood donations for Zika virus. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2016. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm493081.htm
7. Simmons G, Brès V, Lu K, et al. High incidence of chikungunya virus frequency of viremic blood donations during epidemic, Puerto Rico, USA, 2014. Emerg Infect Dis 2016;22:1221–8. Epub April 2016. CrossRef PubMed

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FIGURE. Proportion of screened blood donations reactive for Zika virus infection, by week of testing — Puerto Rico, April 3–June 11, 2016

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Suggested citation for this article: Kuehnert MJ, Basavaraju SV, Moseley RR, et al. Screening of Blood Donations for Zika Virus Infection — Puerto Rico, April 3–June 11, 2016. MMWR Morb Mortal Wkly Rep. ePub: 17 June 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm6524e2.

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Week 11

• This week our growing Baby Prisbrey is over two inches long! It is so crazy to think that week 9 the baby was just one, and now it is two! So much happens so quickly and it is mind boggling to think about how amazing the gift of life is!

• This weekend was conference weekend and so we watched it on Saturday from home and then Sunday we went over and made breakfast with Kileys family and some of her friends and watched it at Kelli and Keltons house while they were in SLC at conference! We hung out all day and had lots of fun!

• Sunday night was the Academy of country Music awards! Mmmm I love me some country music! Baby and I listen to Blake Sheltons new CD everyday and so we were excited to watch him host! Daddy thought we were crazy because I sat directly in front of the TV all night!

• This week is teacher appreciation week and I have been so loved and appreciated! I have received so many goodies and treats all week! It is so fun being a teacher! (most days ha ha ha)

• My belly is starting to get big! I definitely notice a change each and every day! Even Kason has noticed a rather LARGE change this week!

• I have been craving bagels with cream cheese! This week I had no problems eating and so I am up two pounds! ...oops!

• This has been a fun week for Kason and I. Our anniversary is Sunday and so I think we both have felt so blessed and loved all week. We remember those feelings we get this exact week before the wedding a year ago and its brought so much fun and joy to think back on it! On the 10th it was my one year anniversary of being endowed and I have had the most amazing year spending time in the Lords beautiful Temple! It is by far one of my most favorite things to do!

• I ordered some cute ruffle lace bloomers and hair bows and they arrived this week! I am not so sure I think its a girl.. But I guess we will cross our fingers April 29th will tell us! :)

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