Emerging Infectious Disease and Transfusion Medicine: Time
to take Action with Proactive Measures
*Ángel Luis Pajares Herraiz
Centro Regional de Transfusión Toledo-Guadalajara & Servicio de Transfusión Complejo Hospitalario de Toledo, Spain
Received: June 27, 2017; Published: July 03, 2017
Corresponding author: Ángel Luis Pajares Herraiz, Director Centro Regional de Transfusión Toledo-Guadalajara & Servicio de Transfusión Complejo
Hospitalario de Toledo, Avenida Barber 30, TOLEDO, España
One of the concerns throughout the history of transfusion
medicine has been the transmission of infectious diseases through
the transfusion of allogeneic blood. Since the identification of
post transfusion hepatitis in the 1940s [1], the AIDS epidemic in
the 1980s [2], the discovery of hepatitis C in 1989 and its role in
blood donation and transmission of HCV [3], and most recently
-between 1980 and 1996 the delivery of the variant of Creutzfeldt-
Jakob disease by blood transfusion [4,5], transfusion medicine had
to implement stronger and more secure measures in the selection
of blood donors and in the diagnosis of Transfusion-transmissible
diseases (TTD) in order to avoid post-transfusion transmission of
infectious agents, mainly HBV, HCV and VIH.
A new scenario has arisen in recent years with the increase of
emerging infectious agents (EIA), being possible by several factors
[6,7]:
i. Ecological factors: climate change, droughts and floods,
local zoology, etc.
Characteristics of the pathogen: Viruses, protozoan, bacteria,
etc.
ii. Vector characteristics: migration, increase, competition
between vectors and changes in its behavior, etc.
iii. Characteristics of the host: native population, immune
suppression, increase of the susceptible population, etc.
iv. Human factors affecting the environment: modification
of the local geography, rise in the migratory pressure, changes in
the hygienic-alimentary and / or sexual habits and others factors
like wars and terrorism.
Emerging pathogens can be defined as new, reemerging,
migratory or drug resistant infectious agents whose incidence have
increased over the past two decades or threaten to increase in the
near future. Climate change and globalization has created favorable
conditions to the increased incidence of EAI, with different
epidemics in different areas of the planet. Therefore, Europe
through the ECDC has listed a range of 11 pathogens with potential risk to the population and blood support (West Nile virus, Dengue,
Leishmaniasis, Chikungunya fever, Malaria, Tick-borne encephalitis,
Lyme disease, Crimean-congo hemorrhage fever, Usutu virus fever,
Babesiosis and Chagas) [8].
Measures to avoid post-transfusion transmission of infectious
agents include the adequate selection of donors based on
international or local guidelines [9-11], distinguishing those who
are in high risk, as well as the screening and testing of donated
blood by serology and molecular biology for the TTE pathogens
required by law [10] or in specific circumstances as epidemics.
The increase of the TTE tests has augmented the cost of donated
blood analysis [12], and it will increase even more in the future to
the point of becoming a pressing problem for the different health
services. With these strategies, it can take several months or years
since the moment the transmission of a disease is known to occur
via blood transfusion to the discovery of the causal agent and the
development of adequate screening tests, possibly allowing it to
spread without control. Therefore, it is necessary to take proactive
measures. In fact, in the consensus conference of Toronto in 2007
[13] the emergence and risk of new emerging pathogens was
recognized, concluding that this situation could undermine the
trust of the safety of the blood supplied and determining the urgent
need to take proactive measures, such as inactivation.
Methods of Pathogen Inactivation aim to prevent TTD by means
of disruption of his DNA/RNA, making the infectious agent inactive
or unable to replicate in the different components obtained from
blood donation, avoiding its post-transfusion transmission. To date
there are different methods approved to inactivate pathogens [14]:
i. Plasma: detergent solvent (approved in 1998 for UK, in
2009 for EU, and in 2013 for USA), methylene blue (TheraflexR)
(2001 in EU), amotosalen plus ultraviolet A (InterceptR) (2002 in
EU, 2014 in USA) and riboflavin and ultraviolet B (MirasolR) (2008
in EU);
ii. Platelets: Intercept (2002 in EU, 2014 in USA) and Mirasol
(2007 in EU)
Inactivation with Intercept and Mirasol is underway for
red blood cells concentrates and whole blood, respectively.
Inactivation has demonstrated its effectiveness for plasma
and platelets over the years [14-18], leading to a new stage in
transfusion safety. Inactivation may have an impact in terms of cost
reduction despite the expensive technology required [19].
In conclusion, based on the current situation of the EAI and
since new epidemics of pathogens are emerging every year, it is
imperative that governments establish an effective exchange of
information on epidemiological alerts; that they establish protocols
for vaccination of the susceptible populations and they need to
prevent the EAI in travelers, assessing the risk of a traveler who
donates blood with appropriate guidelines for selection of blood
donors. In the other hand, it is necessary to implement more
proactive measures to avoid the huge amount of analytical tests for
the TTE diagnosis, with Pathogen Inactivation showing up as a new
paradigm that could become the “solution” to get safer blood.
ISSN: 2574 -1241
