Zika virus infection blood donation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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Zika virus may be detected in blood for a short period of time. Although rare, reports of Zika virus transmission via blood transfusions have been described. The risk of Zika virus infection in the continental USA due to blood transfusion is extremely low. The U.S. Food and Drug Administration (FDA), the Red Cross, and the British National Health Service Blood and Transplant Agency announced that individuals who traveled to Zika-affected regions would be ineligible to donate blood for at least 28 days. The Canadian Blood Agency announced that individuals who traveled to Zika-affected regions would be ineligible to donate blood for at least 3 weeks (21 days).

## Blood Donation

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* Zika virus may be detected in blood for a short period of time. Although rare, reports of Zika virus transmission via blood transfusions have been described.
* The risk of Zika virus infection in the continental USA due to blood transfusion is extremely low.

### ZIKV blood screening

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Blood screening of ZIKV includes:

* Questionnaire (includes travel history, Zika endemic areas etc)
* Laboratory test

* Individual donor nucleic acid test (ID-NAT)
* Pathogen reduction technology (PRT)

* Blood donations that test positive for Zika virus are removed from the blood supply.

### U.S. Food and Drug Administration (FDA) (28 Days)

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* The U.S. Food and Drug Administration (FDA) issued a new guidance (August 26, 2016) recommending universal testing of donated blood and blood components for Zika virus in all states and U.S. territories.[2]
* ZIKV is considered as transfusion-transmitted infection.
* FDA is recommending that blood establishments defer blood donations from individuals in accordance with the following guidance:

* In areas without active Zika virus transmission, the FDA recommends that donors at risk for Zika virus infection be deferred for four weeks.
* Individuals considered to be at risk include:

* Those who have had symptoms suggestive of Zika virus infection during the past four weeks
* Those who have had sexual contact with a person who has traveled to, or resided in, an area with active Zika virus transmission during the prior three months
* Those who have traveled to areas with active transmission of Zika virus during the past four weeks

* In areas with active Zika virus transmission, the FDA recommends that Whole Blood and blood components for transfusion be obtained from areas of the U.S. without active transmission.
* Blood establishments may continue collecting and preparing platelets and plasma if an FDA-approved, pathogen-reduction device is used.

* The guidance also recommends blood establishments update donor education materials with information about Zika virus signs and symptoms and ask potentially affected donors to refrain from giving blood.

### Red Cross (28 Days)

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* The Red Cross announced that individuals who traveled to Zika-affected regions would be ineligible to donate blood for at least 28 days.[3]
* If an individual donates blood and develops symptoms of Zika virus within 14 days of donation, he/she is asked to notify thet Red Cross immediately.

### British National Health Service Blood and Transplant Agency (28 Days)

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* The British National Health Service Blood and Transplant Agency announced that individuals who traveled to Zika-affected regions would be ineligible to donate blood for at least 28 days.[4]

### Canadian Blood Agency (21 Days)

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* The Canadian Blood Agency announced that individuals who traveled to Zika-affected regions would be ineligible to donate blood for at least 3 weeks (21 days).[5]

### Methods of Processing of Blood

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ZIKV can be cleared by viral inactivation and removal methods, which are currently used to in the processing of plasma-derived products. The methods used in viral clearance include:[1][2][3]

* Heat
* Solvent/detergent (S/D) treatment
* Incubation at low pH

These methods are not generally used in treatment of blood and blood products intended for transfusion. However, solvent/detergent method is FDA approved for the treatment of pooled plasma products.

Pathogen reduction technology (PRT)

Amotosalen combined with UV illumination is the FDA approved pathogen reduction device used for plasma and platelets treatment for viruses, including flaviviruses, such as dengue, West Nile and ZIKV.[4][5]

## References

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1. ↑ Dichtelmüller HO, Flechsig E, Sananes F, Kretschmar M, Dougherty CJ (2012). "Effective virus inactivation and removal by steps of Biotest Pharmaceuticals IGIV production process". Results Immunol. 2: 19–24. doi:10.1016/j.rinim.2012.01.002. PMC 3862342. PMID 24371563.CS1 maint: Multiple names: authors list (link)
2. ↑ Xie YW, Chan PK, Szeto CK, Kwok SY, Chu IM, Chu SS; et al. (2008). "Clearance of dengue virus in the plasma-derived therapeutic proteins". Transfusion. 48 (7): 1342–7. doi:10.1111/j.1537-2995.2008.01647.x. PMID 18315529.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
3. ↑ Leydold SM, Farcet MR, Kindermann J, Modrof J, Pölsler G, Berting A; et al. (2012). "Chikungunya virus and the safety of plasma products". Transfusion. 52 (10): 2122–30. doi:10.1111/j.1537-2995.2012.03565.x. PMID 22339168.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ Pathogen reduction system http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm427500.htm (2014) Accessed on September 27, 2016
5. ↑ Aubry M, Richard V, Green J, Broult J, Musso D (2016). "Inactivation of Zika virus in plasma with amotosalen and ultraviolet A illumination". Transfusion. 56 (1): 33–40. doi:10.1111/trf.13271. PMID 26283013.CS1 maint: Multiple names: authors list (link)