Managing the risk of transfusion-transmitted malaria from Australian blood donations: Recommendation of a new screening strategy.

BACKGROUND AND OBJECTIVES: To reduce the risk of transfusion-transmitted malaria (TTM) from transfusible components, Australia tests for malaria antibodies in both travellers returning from and former residents of malaria-endemic areas. The testing is performed a minimum of 120 days after last potential exposure. TTM is an extremely rare event and managing the risk adds considerable complexity. The objectives of this study were to analyse various testing and deferral strategies, considering the risk, donation numbers and operational complexities. MATERIALS AND METHODS: A residual risk model was developed to calculate the risk of TTM in five testing/deferral strategies. Australian blood donor data from 2020 and 2021 were used and incorporated the incidence of parasitaemia, Plasmodium species and the malaria enzyme immunoassay test's failure rate. Donor and donation loss or gain and an operational assessment were performed. RESULTS: The current model's estimated risk of TTM is 1 in 67.9 million transfused units. Testing residents with a 120-day plasma restriction for visitors without testing was found to have the same estimated risk, with an expected increase of 342 donations per year, significant cost savings and a 62% reduction in the number of donors requiring assessment. CONCLUSION: A strategy that involves testing residents of malaria areas only and a 120-day plasma travel restriction would not significantly increase the risk of TTM, is operationally simpler, costs less and results in a small increase in donations.

Optimal malarial screening strategy in Australian blood donors: A cost-effectiveness analysis.

BACKGROUND AND OBJECTIVES: The risk of transfusion-transmitted malaria (TTM) infections is extremely low in Australia, and the cost-effectiveness of the current screening strategy has not been assessed. This study aims to conduct a cost-effectiveness analysis of different malaria screening strategies in blood donors as part of the risk-based decision-making framework. MATERIALS AND METHODS: A decision tree model was developed to assess the cost-effectiveness of five alternative malaria screening strategies from a healthcare sector perspective. Screening strategies combining total or partial removal of malaria testing with different deferral periods were considered. The probabilities of developing severe and uncomplicated TTM were based on a literature review of cases in non-endemic areas since 2000. The health outcomes were quantified using disability-adjusted life years. The costs of non-returning donors due to deferral were also included. Deterministic and probabilistic sensitivity analyses were conducted to account for data uncertainty. RESULTS: The residual risks for all strategies were so low that the costs, mortality and morbidity associated with TTM are almost negligible. The overall costs were predominantly influenced by the costs of non-returning blood donors. As a result, removal of malaria testing and applying a 28-day deferral for at-risk donors were the least costly and most cost-effective of all the options considered. CONCLUSION: The current screening strategy for malaria in blood donors in Australia is not an efficient use of healthcare resources. Partial or total removal of malaria testing would bring significant cost savings without significantly compromising blood safety.

New tatt? We're ok with that! Relaxing the tattoo deferral for plasmapheresis donors maintains safety and increases donations.

BACKGROUND AND OBJECTIVES: Tattooing is one of the leading donor deferral reasons in Australia. Until September 2020, donors were deferred from all donation types for 4 months after a tattoo. At this time, our guideline changed such that donations of plasma for further manufacture were accepted immediately, provided the tattoo was administered in a licensed or regulated Australian establishment. We examined the effects of this change. MATERIALS AND METHODS: Donors with a tattoo deferral in the 2 years before or after the guideline change were identified and followed up until 3 November 2022. Between the two periods, we compared blood-borne virus (BBV) incidence, donor return, and the number of donors and donations regained after deferral. RESULTS: The incidence of BBV infection in donors after a tattoo deferral was zero in both periods. To exceed a residual risk of 1 in 1 million for hepatitis C virus, 190 donors would need to be infected yearly from a tattoo. Donors returned to donate significantly faster after the change (median return 85 days compared with 278 days). An extra 187 donations per 10,000 person-years of observation were gained, yielding a total of 44,674 additional plasma donations nationally 0-4 months after getting a tattoo. CONCLUSION: Allowing plasma donations immediately post-tattoo resulted in a substantial donation gain with no adverse safety effect. Lifeblood subsequently reduced the deferral for transfusible component donations to 7 days for tattoos in Australian licensed/regulated establishments.

Integrating Mobile and Fixed-Site Black Carbon Measurements to Bridge Spatiotemporal Gaps in Urban Air Quality.

Urban air pollution can vary sharply in space and time. However, few monitoring strategies can concurrently resolve spatial and temporal variation at fine scales. Here, we present a new measurement-driven spatiotemporal modeling approach that transcends the individual limitations of two complementary sampling paradigms: mobile monitoring and fixed-site sensor networks. We develop, validate, and apply this model to predict black carbon (BC) using data from an intensive, 100-day field study in West Oakland, CA. Our spatiotemporal model exploits coherent spatial patterns derived from a multipollutant mobile monitoring campaign to fill spatial gaps in time-complete BC data from a low-cost sensor network. Our model performs well in reconstructing patterns at fine spatial and temporal resolution (30 m, 15 min), demonstrating strong out-of-sample correlations for both mobile (Pearson's R ∼ 0.77) and fixed-site measurements (R ∼ 0.95) while revealing features that are not effectively captured by a single monitoring approach in isolation. The model reveals sharp concentration gradients near major emission sources while capturing their temporal variability, offering valuable insights into pollution sources and dynamics.

Corridor-Level Impacts of Battery-Electric Heavy-Duty Trucks and the Effects of Policy in the United States.

Electrifying freight trucks will be key to alleviating air pollution burdens on disadvantaged communities and mitigating climate change. The United States plans to pursue this aim by adding vehicle charging infrastructure along specific freight corridors. This study explores the coevolution of the electricity grid and freight trucking landscape using an integrated assessment framework to identify when each interstate and drayage corridor becomes advantageous to electrify from a climate and human health standpoint. Nearly all corridors achieve greenhouse gas emission reductions if electrified now. Most can reduce health impacts from air pollution if electrified by 2040 although some corridors in the Midwest, South, and Mid-Atlantic regions remain unfavorable to electrify from a human health standpoint, absent policy support. Recent policy, namely, the Inflation Reduction Act, accelerates this timeline to 2030 for most corridors and results in net human health benefits on all corridors by 2050, suggesting that near-term investments in truck electrification, particularly drayage corridors, can meaningfully reduce climate and health burdens.

Location-Specific Control of Precursor Emissions to Mitigate Photochemical Air Pollution.

The effects of precursor emission controls on air quality can vary greatly depending on where emission reductions occur. We use the adjoint of the Community Multiscale Air Quality (CMAQ) model to evaluate impacts of spatially targeted NOx emission reductions on odd oxygen (Ox = O3 + NO2). The air quality responses studied here include one population-weighted regionwide and three city-level receptors in Central California. We map high-priority locations for NOx control and their changes over decadal time scales. The desirability of NOx-focused emission control programs has increased between 2000 and 2022. We find for present-day conditions that reducing NOx emissions by 28% from targeted high-priority locations can achieve 60% of the air quality benefits of uniform NOx reductions at all locations. High-priority source locations are found to differ for individual city-level versus regionwide receptors of interest. While high-impact emission hotspots for improving city-level metrics are found within the city itself or closely adjacent, the spatial pattern of emission hotspots for improving regionwide air quality is more complex and requires comprehensive consideration of upwind sources. Results of this study can help to inform strategic decision-making at local and regional levels about where to prioritize emission control efforts.

Improved Spatial Resolution in Modeling of Nitrogen Oxide Concentrations in the Los Angeles Basin.

The extent to which emission control technologies and policies have reduced anthropogenic NOx emissions from motor vehicles is large but uncertain. We evaluate a fuel-based emission inventory for southern California during the June 2021 period, coinciding with the Re-Evaluating the Chemistry of Air Pollutants in CAlifornia (RECAP-CA) field campaign. A modified version of the Fuel-based Inventory of Vehicle Emissions (FIVE) is presented, incorporating 1.3 km resolution gridding and a new light-/medium-duty diesel vehicle category. NOx concentrations and weekday-weekend differences were predicted using the WRF-Chem model and evaluated using satellite and aircraft observations. Model performance was similar on weekdays and weekends, indicating appropriate day-of-week scaling of NOx emissions and a reasonable distribution of emissions by sector. Large observed weekend decreases in NOx are mainly due to changes in on-road vehicle emissions. The inventory presented in this study suggests that on-road vehicles were responsible for 55-72% of the NOx emissions in the South Coast Air Basin, compared to the corresponding fraction (43%) in the planning inventory from the South Coast Air Quality Management District. This fuel-based inventory suggests on-road NOx emissions that are 1.5 ± 0.4, 2.8 ± 0.6, and 1.3 ± 0.7 times the reference EMFAC model estimates for on-road gasoline, light- and medium-duty diesel, and heavy-duty diesel, respectively.

Responses of Photochemical Air Pollution in California's San Joaquin Valley to Spatially and Temporally Resolved Changes in Precursor Emissions.

Ground-level ozone adversely affects human health and ecosystems. The effectiveness of control programs depends on which precursor(s) are controlled, by how much, and where and when emission reductions occur. We use the adjoint of the Community Multiscale Air Quality model to investigate odd oxygen (Ox ≡ O3 + NO2) sensitivities in California's San Joaquin Valley (SJV) to precursor emissions from local and upwind sources. Sensitivities are mapped and disaggregated by hour and day. Taken together, impacts of precursor emissions in the San Francisco Bay area and Sacramento Valley are similar in magnitude to impacts of local SJV emissions. Same-day emission sensitivities are mostly attributable to local sources, with the most influential anthropogenic emissions of VOCs (volatile organic compounds) and NOx (nitrogen oxides) occurring in the morning (9-11 am) and early afternoon hours (1-3 pm), respectively. For the northernmost SJV receptor, the influence from Sacramento Valley emissions peaks 5-6 h later than Bay area emissions; this difference diminishes for SJV receptors located further downwind. Results show a shift toward more NOx-sensitive conditions in the afternoon with all but the southernmost receptor shifting from VOC- to NOx-sensitive conditions. We also evaluate opportunities to control pollution through shifts in precursor emission location and timing.

High-Resolution Modeling and Apportionment of Diesel-Related Contributions to Black Carbon Concentrations.

Exposure to diesel-related air pollution, which includes black carbon (BC) as a major component of the particulate matter emitted in engine exhaust, is a known human health hazard. The resulting health burden falls heavily on vulnerable communities located close to major sources including highways, rail yards, and ports. Determination of source contributions to the overall pollution burden is challenging due to collinearity in the exhaust composition profiles for relevant sources including heavy-duty diesel trucks, railroad locomotives, cargo-handling equipment, and marine engines. Additionally, the impact of each source depends not just on the magnitude of emissions but on its location relative to receptors as well as on meteorology. We modeled source-resolved BC concentrations in West Oakland, California, at a high (150 m) spatial resolution using the Weather Research and Forecasting model. The ability of the model to predict hourly and 24 h average BC concentrations is evaluated for a 100-day period in summer 2017 when BC was measured at 100 sites within the community. We find that a community monitoring site is representative of population-weighted average BC exposure in the community. Major contributing sources to BC in West Oakland include on-road diesel trucks (44 ± 5%) and three off-road diesel sources: ocean-going vessels (19 ± 1%), railroad locomotives (16 ± 2%), and harbor craft such as tugboats and ferries (11 ± 1%).

Evaluation of Nitrogen Oxide Emission Inventories and Trends for On-Road Gasoline and Diesel Vehicles.

On-road vehicles continue to be a major source of nitrogen oxide (NOx) emissions in the United States and in other countries around the world. The goal of this study is to compare and evaluate emission inventories and long-term trends in vehicular NOx emissions. Taxable fuel sales data and in-use measurements of emission factors are combined to generate fuel-based NOx emission inventories for California and the US over the period 1990-2020. While gasoline and diesel fuel sales increased over the last three decades, total on-road NOx emissions declined by approximately 70% since 1990, with a steeper rate of decrease after 2004 when heavy-duty diesel NOx emission controls finally started to gain traction. In California, additional steps have been taken to accelerate the introduction of new heavy-duty engines equipped with selective catalytic reduction systems, resulting in a 48% decrease in diesel NOx emissions in California compared to a 32% decrease nationally since 2010. California EMFAC model predictions are in good agreement with fuel-based inventory results for gasoline engines and are higher than fuel-based estimates for diesel engines prior to the mid-2010s. Similar to the findings of recent observational and modeling studies, there are discrepancies between the fuel-based inventory and national MOVES model estimates. MOVES predicts a steeper decrease in NOx emissions and predicts higher NOx emissions from gasoline engines over the entire period from 1990 to 2020.

No evidence for widespread Babesia microti transmission in Australia.

BACKGROUND: A fatal case of autochthonous Babesia microti infection was reported in Australia in 2012. This has implications for Australian public health and, given that babesiosis is transfusion transmissible, has possible implications for Australian blood transfusion recipients. We investigated the seroprevalence of antibodies to B. microti in Australian blood donors and in patients with clinically suspected babesiosis. STUDY DESIGN AND METHODS: Plasma samples (n = 7,000) from donors donating in at-risk areas and clinical specimens from patients with clinically suspected babesiosis (n = 29) were tested for B. microti IgG by immunofluorescence assay (IFA). IFA initially reactive samples were tested for B. microti IgG and IgM by immunoblot and B. microti DNA by polymerase chain reaction. RESULTS: Although five donors were initially reactive for B. microti IgG by IFA, none was confirmed for B. microti IgG (zero estimate; 95% confidence interval, 0%-0.05%) and all were negative for B. microti DNA. None of the patient samples had B. microti IgG, IgM, or DNA. CONCLUSIONS: This study does not provide evidence for widespread exposure to B. microti in Australian blood donors at local theoretical risk, nor does it provide evidence of B. microti infection in Australian patients with clinically suspected babesiosis. Given that confirmed evidence of previous exposure to B. microti was not seen, these data suggest that transmission of this pathogen is currently uncommon in Australia and unlikely to pose a risk to transfusion safety at present.

Tattoos, blood-borne viruses and blood donors: a blood donor cohort and risk assessment.

BACKGROUND AND OBJECTIVES: There is conflicting evidence in the literature as to whether there is a blood-borne virus (BBV) risk associated with tattoos in licensed premises. However, blood donors are currently deferred from blood donation in Australia for 4 months after any tattoo. We aimed to assess the incidence of BBVs in blood donors who declared tattoos and evaluate the risk to blood safety through risk modelling. MATERIALS AND METHODS: Donors from 2013 to 2016 with a tattoo deferral on their blood donor file with pre- and post-BBV testing were analysed to determine an incidence of BBVs using standard methods. This was compared to a 2014 cohort of whole blood donors with a deferral of 4 months due to travel to a malaria-endemic area. Using the incidence of tattoos and BBV risk, the total residual risk estimate of allowing tattooed donors to return without restriction was calculated. RESULTS: The incidence rate of BBVs in blood donors following tattoo deferral was 13·26 (95% CI 2·67-38·75) per 100 000 person-years (all were hepatitis C infections in males compared to 9·26 (95% CI 2·49-23·71) per 100 000 in blood donors following malaria deferral. If other risk factors were accounted for the risk in tattoo donors decreased to 4·4 per 100 000 person-years. The total residual risk calculation if donors with a tattoo were allowed to donate without restriction was estimated at 1 in 34 million. CONCLUSIONS: This residual risk indicates BBV deferral for donors post-tattoo in Australia is not required for blood safety.

Control Technology-Driven Changes to In-Use Heavy-Duty Diesel Truck Emissions of Nitrogenous Species and Related Environmental Impacts.

Emissions from thousands of in-use heavy-duty diesel trucks were sampled at a highway and an arterial street location in the San Francisco Bay Area, spanning a time period when use of diesel particle filters (DPFs) and selective catalytic reduction (SCR) increased rapidly. At the highway site where a diverse mix of trucks is observed, SCR systems on 2010 and newer engines reduce emitted nitrogen oxides (NOx) by 87 ± 5% relative to pre-2004 engines. SCR also mitigates DPF-related increases in nitrogen dioxide (NO2) emissions. However, a majority of trucks had in-use NOx emission rates that exceeded applicable emission standards. SCR systems increase emissions of nitrous oxide (N2O) and ammonia (NH3) from near-zero levels to 0.93 ± 0.13 and 0.18 ± 0.07 g kg-1, respectively. Emissions of all nitrogenous species and especially NH3 are skewed; 10% of trucks contribute 95% of the on-road fleet's total NH3 emissions. Similar emission changes are observed at the arterial street site where exclusively drayage trucks operate. The environmental effects of decreased black carbon, NOx, and carbon dioxide (CO2) emissions and increased N2O and NH3 emissions due to the rapid adoption of DPF and SCR systems by the California truck fleet are: (1) a 65% net decrease in the social cost of statewide exposure to diesel truck emissions (-3.3 billion 2018 US dollars per year), and (2) a 3% net decrease in the global warming potential-weighted emission factor (-27 g CO2-eq km-1).

Ross River virus in Australian blood donors: possible implications for blood transfusion safety.

BACKGROUND: Emerging transfusion-transmissible pathogens, including arboviruses such as West Nile, Zika, dengue, and Ross River viruses, are potential threats to transfusion safety. The most prevalent arbovirus in humans in Australia is Ross River virus (RRV); however, prevalence varies substantially around the country. Modeling estimated a yearly risk of 8 to 11 potentially RRV-viremic fresh blood components nationwide. This study aimed to measure the occurrence of RRV viremia among donors who donated at Australian collection centers located in areas with significant RRV transmission during one peak season. STUDY DESIGN AND METHODS: Plasma samples were collected from donors (n = 7500) who donated at the selected collection centers during one peak season. Viral RNA was extracted from individual samples, and quantitative reverse transcription-polymerase chain reaction was performed. RESULTS: Regions with the highest rates of RRV transmission were not areas where donor centers were located. We did not detect RRV RNA among 7500 donations collected at the selected centers, resulting in a zero risk estimate with a one-sided 95% confidence interval of 0 to 1 in 2019 donations. CONCLUSION: Our results suggest that the yearly risk of collecting a RRV-infected blood donation in Australia is low and is at the lower range of previous risk modeling. The majority of Australian donor centers were not in areas known to be at the highest risk for RRV transmission, which was not taken into account in previous models based on notification data. Therefore, we believe that the risk of RRV transfusion transmission in Australia is acceptably low and appropriately managed through existing risk management, including donation restrictions and recall policies.

In-Use Performance and Durability of Particle Filters on Heavy-Duty Diesel Trucks.

Diesel particle filters (DPFs) are standard equipment on heavy-duty diesel trucks with 2007 and newer engines in the U.S. This study evaluates the performance and durability of these filters. Black carbon (BC) emission rates from several thousand heavy-duty trucks were measured at the Port of Oakland and Caldecott Tunnel over multiple years as California regulations accelerated the adoption of DPFs. As DPF use increased, fleet-average BC emissions decreased, and emission factor distributions became more skewed. Relative to 2004-2006 engines without filters, DPFs reduced BC emission rates by 65-70% for 2007-2009 engines and by >90% for 2010+ engines. Average BC emission rates for 2007-2009 engines increased by 50-67% in 2015 relative to measurements made 1-2 years earlier. Some trucks in this cohort have become high-emitters, indicating that some DPFs are no longer working well. At the Port, where DPFs were universal in 2015, high-emitting 2007-2009 engines (defined here as emitting >1 g BC kg-1) comprised 7% of the fleet but were responsible for 65% of the total BC emitted. These observations raise concerns about DPF durability and the prospects for fully mitigating adverse effects of diesel particulate matter on human health and the environment.

Review of Urban Secondary Organic Aerosol Formation from Gasoline and Diesel Motor Vehicle Emissions.

Secondary organic aerosol (SOA) is formed from the atmospheric oxidation of gas-phase organic compounds leading to the formation of particle mass. Gasoline- and diesel-powered motor vehicles, both on/off-road, are important sources of SOA precursors. They emit complex mixtures of gas-phase organic compounds that vary in volatility and molecular structure-factors that influence their contributions to urban SOA. However, the relative importance of each vehicle type with respect to SOA formation remains unclear due to conflicting evidence from recent laboratory, field, and modeling studies. Both are likely important, with evolving contributions that vary with location and over short time scales. This review summarizes evidence, research needs, and discrepancies between top-down and bottom-up approaches used to estimate SOA from motor vehicles, focusing on inconsistencies between molecular-level understanding and regional observations. The effect of emission controls (e.g., exhaust aftertreatment technologies, fuel formulation) on SOA precursor emissions needs comprehensive evaluation, especially with international perspective given heterogeneity in regulations and technology penetration. Novel studies are needed to identify and quantify "missing" emissions that appear to contribute substantially to SOA production, especially in gasoline vehicles with the most advanced aftertreatment. Initial evidence suggests catalyzed diesel particulate filters greatly reduce emissions of SOA precursors along with primary aerosol.

Hepatitis E virus RNA in Australian blood donations.

BACKGROUND: Hepatitis E virus (HEV) poses a risk to transfusion safety. In Australia, locally acquired HEV is rare and cases are mainly reported in travelers returning from countries endemic for HEV. The risk posed by HEV to transfusion safety in Australia is unknown; therefore, we aimed to measure the rate of current HEV infection in Australian blood donations. STUDY DESIGN AND METHODS: A total of 14,799 blood donations were tested for HEV RNA by transcription-mediated amplification, with confirmatory testing by reverse transcription-polymerase chain reaction. Viral load quantification and phylogenetic analysis was performed on HEV RNA-positive samples. RESULTS: One (0.0068%; 95% confidence interval [CI], 0.0002%-0.0376%) sample was confirmed positive for HEV RNA, resulting in a risk of collecting a HEV-viremic donation of 1 in 14,799 (95% CI, 1 in 584,530 to 1 in 2,657). The viral load in this sample was approximately 15,000 IU/mL, and it was determined to be Genotype 3. DISCUSSION: Our finding of 1 in 14,799 Australian donations positive for HEV RNA is lower than that from many other developed countries; this is consistent with the relatively low seroprevalence in Australia. As this HEV RNA-positive sample was Genotype 3, it seems likely that this infection was acquired through zoonotic transmission, either within Australia or overseas in a developed nation. HEV has the potential to pose a risk to transfusion safety in Australia; however, additional, larger studies are required to quantify the magnitude of this risk.

Long-term trends in California mobile source emissions and ambient concentrations of black carbon and organic aerosol.

A fuel-based approach is used to assess long-term trends (1970-2010) in mobile source emissions of black carbon (BC) and organic aerosol (OA, including both primary emissions and secondary formation). The main focus of this analysis is the Los Angeles Basin, where a long record of measurements is available to infer trends in ambient concentrations of BC and organic carbon (OC), with OC used here as a proxy for OA. Mobile source emissions and ambient concentrations have decreased similarly, reflecting the importance of on- and off-road engines as sources of BC and OA in urban areas. In 1970, the on-road sector accounted for ∼90% of total mobile source emissions of BC and OA (primary + secondary). Over time, as on-road engine emissions have been controlled, the relative importance of off-road sources has grown. By 2010, off-road engines were estimated to account for 37 ± 20% and 45 ± 16% of total mobile source contributions to BC and OA, respectively, in the Los Angeles area. This study highlights both the success of efforts to control on-road emission sources, and the importance of considering off-road engine and other VOC source contributions when assessing long-term emission and ambient air quality trends.