Use of Blood Donor Screening Data to Estimate Zika Virus Incidence, Puerto Rico, April-August 2016.

Puerto Rico has been heavily impacted by Zika virus, a mosquitoborne flavivirus that emerged in the Americas during 2015. Although most persons with Zika virus show no symptoms, the virus can cause neurologic and other complications, including fetal microcephaly. Local Zika virus transmission in Puerto Rico has been reported since December 2015. To prevent transfusion-associated transmission, local blood collection ceased in March 2016 but resumed in April 2016 after Zika virus screening of blood donations became available. Using data from screening of blood donations collected by the 2 largest blood centers in Puerto Rico during April 3-August 12, 2016, and assuming a 9.9-day duration of viremia, we estimated that 469,321 persons in Puerto Rico were infected during this period, for an estimated cumulative incidence of 12.9%. Results from blood donation screening during arboviral outbreaks can supplement routine clinical and surveillance data for improved targeting of prevention efforts.

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 aegypti mosquitoes 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.

Prevalence of steroid receptors and HER 2/neu in breast cancer biopsies of women living in Puerto Rico.

OBJECTIVE: The purpose of this study is to determine the prevalence rate of estrogen and progesterone receptors and HER 2/neu in the breast cancer biopsies analyzed in the Laboratory of Immunohistochemistry of the University of Puerto Rico School of Medicine in the year 2000. This data may serve as a reference point for future studies of the epidemiological aspects of breast cancer among women living in Puerto Rico. BACKGROUND: Determination of estrogen receptor (ER) and progesterone receptor (PR) on biopsy specimens of breast carcinoma prior to treatment is standard practice in the management of breast carcinoma. ER and PR are used to identify patients who are likely to respond to endocrine therapy. The prevalence of ER, PR and Her2/neu among USA women is 77%, 55% and 10-34%, respectively. One of the major clinical roles for testing HER 2/neu expression is to determine eligibility for treatment with Trastuzumab. METHODS: Retrospective analysis of 309 breast cancer biopsies was done. Paraffin embedded blocks of breast cancer tissue biopsies were received from different hospitals and Pathology Laboratories located throughout the island specifically for routine analysis of steroid receptor (ER/PR) and/or HER 2/neu expression. Immunostaining was performed in a Ventana Medical Systems automated instrument. RESULTS: Positive nuclear staining for ER and PR were seen in 65.9% (203/308) and 51.8% (159/307), respectively. In the HER2/neu test, 27.8% (46/165) gave a strong and complete membranous staining (score 3+). CONCLUSIONS: There is a lower prevalence of estrogen receptor in the breast cancer biopsies of women living in Puerto Rico than their USA counterparts, but similar prevalence of progesterone receptor status and HER 2/neu protein over expression.

Immediate transfusion reactions

Immediate transfusion reactions were characterized in recipients of 15,990 RBCs, 18,013 platelets, 409 single donor platelets, 3,451 FFP and 1,507 units of cryoprecipitate. The overall incidence of immediate reactions was 0.2. Allergic reactions occurred in 40 patients, febrile non-hemolytic in 36 patients, bacterial contamination in 2 patients, circulatory overload in 3 patients and mechanical hemolysis in one patient. Three patients had nonspecific reactions. The incidence of immediate transfusion reactions was low when compared with similar studies. Possible causes are under-reporting transfusion reactions and the use of leukoreduced components.

Evaluation of serologic markers for transfusion trasmitted infectious diseases for allogeneic blood donors in Puerto Rico

The purpose of this project is to assess the prevalence of serologic markers for transfusion transmitted infectious disease in allogeneic blood donors of the American Red Cross Blood Services (ARCBS) in Puerto Rico. Four hundred records were randomly selected from a population of 7718 first time volunteer donors from the ARCBS in P.R. covering the period from Jan. 1st to Jun. 30th, 1991. Variables obtained were: age, sex, presence of hepatitis B surface antigen (HBsAg), hepatitis B anti-core antibody (anti-HBc), hepatitis C virus antibody (anti-HCV), HIV 1/2 antibody, HTLV I/II antibody, RPR reactivity and ALT. The prevalence of serologic markers in our study is consistently higher than that found in similar studies in the U.S. population, except for HBsAg and HCV. This could be explained with the use of data from only first time volunteer donors since the prevalence is higher in this group than in repeat donors. None of the donors in this sample were positive for HBsAg probably due to the small sample. The prevalence of anti-HCV in this study is within the values found for the U.S. population.