Absence of evidence of transfusion transmission risk of Creutzfeldt-Jakob disease in the United States: Results froma 28-year lookback study.

BACKGROUND: For many years, there has been concern about the risk of transmission of classic forms of Creutzfeldt-Jakob disease (CJD) by blood transfusion, particularly after the recognition of such transmission of variant CJD (vCJD). We report on a 28-year lookback study of recipients of blood from donors who subsequently developed CJD. METHODS: Patients with diagnosed CJD and a history of blood donation were identified. Blood centers were asked to provide information about the distribution of the donations and consignees were requested to provide information about the recipients of the donations. Vital status of each available recipient was determined and, if deceased, the reported cause(s) of death were obtained primarily from the National Death Index. All recipients included in the study database contributed person-time up to the last recorded review of vital status. RESULTS: There were 84 eligible donors who gave 3284 transfusable components, and it was possible to evaluate 1245 recipients, totaling 6495 person-years of observation. The mean observation period per recipient was 5.5 years with a maximum of 51 years. No case of CJD or prion disease was reported among the recipient population. DISCUSSION: The study suggests that CJD may not be transfusion-transmissible, a position in agreement with similar findings from two similar European reports amounting to an overall observation period of 15,500 person-years. These studies have supported the conclusion that the risk, if any, of transmission of CJD by blood products is extremely small and remains theoretical.

Endodontic management of submerged roots following complicated traumatic dental injury (TDI) in children and adolescents: A systematic review.

INTRODUCTION: The International Association of Dental Traumatology (IADT) guidelines include the use of decoronation for the management of complex crown-root fractures but do not outline how this technique is best employed. The aim of this review is to reach a consensus in the management of the root canal system in decoronated permanent teeth undergoing root submergence and to determine whether this has an impact on the success and survival of the retained root. MATERIALS AND METHODS: Search included databases MEDLINE via Ebsco, EMBASE via Ovid, Web of Science via Clarivate, PubMed via PubMed.gov, the Cochrane Library via Wiley, cited reference searching and hand searching of relevant journals. Two independent reviewers performed study selection, data extraction and risk of bias assessment using Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS AND DISCUSSION: In total, 18 articles were included in qualitative analysis: 17 of these were case reports and one case series. A total of 37 teeth were treated with decoronation either using the Malmgren or an alternative protocol (root submergence following endodontic treatment with gutta-percha [GP] or a calcium silicate cement and vital root submergence). Limited evidence from this review suggests that immediate decoronation and vital root submergence are successful in apexogenesis and preserving alveolar bone. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: registration number CRD42022316266).

Trajectory and Demographic Correlates of Antibodies to SARS-CoV-2 Nucleocapsid in Recently Infected Blood Donors, United States.

We evaluated antibodies to the nucleocapsid protein of SARS-CoV-2 in a large cohort of blood donors in the United States who were recently infected with the virus. Antibodies to the nucleocapsid protein of SARS-CoV-2 indicate previous infection but are subject to waning, potentially affecting epidemiologic studies. We longitudinally evaluated a cohort of 19,323 blood donors who had evidence of recent infection by using a widely available serologic test to determine the dynamics of such waning. We analyzed overall signal-to-cutoff values for 48,330 donations (average 2.5 donations/person) that had an average observation period of 102 days. The observed peak signal-to-cutoff value varied widely, but the waning rate was consistent across the range, with a half-life of 122 days. Within the cohort, only 0.75% of persons became seronegative. Factors predictive of higher peak values and longer time to seroreversion included increasing age, male sex, higher body mass index, and non-Caucasian race.

Validity of donor-reported iron supplementation practices obtained at the time of donation.

BACKGROUND: Iron supplementation (IS) improves blood donors' iron stores and allows more frequent blood donation. Understanding the accuracy of self-reported IS is helpful for potential application of IS practices to donor eligibility or donation intervals. METHODS: Successful whole blood and red cell apheresis donors completed a survey at donation on the use of select dietary supplements. Respondents reporting use of either iron pills (IP) or multivitamins (MV) were invited by email to complete a similar follow-up survey 6-8 weeks later and to provide the quantitative iron content of IS by referring the donor to the pill bottle label. Consistency between baseline and follow-up responses was assessed overall and by pill type and demographic variables. RESULTS: Of 2444 donors answering the baseline survey, 40% (978) reported MV or IP at donation, 354 of whom completed the follow-up survey. A majority of survey respondents (56%-61%) reported taking iron across the two surveys, and 21%-24% took MV but were uncertain if their pills contained iron. Of 215 reporting IS at baseline, overall concordance at follow-up was 68% and was higher for donors who were female, ≥50-years old, and taking iron as an iron pill rather than in a multivitamin. CONCLUSION: Consistency of donor responses may be insufficient for use in guiding donor eligibility. Referring donors to their pill bottles was unsuccessful in improving the high frequency of uncertain responses. Incorporating IS into donor eligibility determinations is a complex endeavor that will benefit from careful planning and from post-implementation monitoring.

COVID-19 convalescent plasma donors: Unique motivations in unique times?

BACKGROUND: Early in the SARS-CoV-2 pandemic, many blood collection organizations (BCOs) were asked to collect and distribute COVID-19 convalescent plasma (CCP) as a potential treatment for this new virus and resulting disease. However, recruiting CCP donors presented unique challenges for BCOs, as there were few recovered patients at this time, and like the general population, most potential CCP donors had no blood donation experience. Thus, many CCP donors were new donors, and their donation motivations were unknown. MATERIALS AND METHODS: Donors who gave CCP at least once between April 27th and September 15th, 2020, were emailed a link to an online survey regarding their experience with COVID-19 and their motivations for donating CCP and blood. RESULTS: Of the 14,225 invitations sent, 3471 donors responded (24.4%). Most donors had never donated blood before (n = 1406), followed by lapsed donors (n = 1050), and recent donors (n = 951). There was a significant relationship between self-reported donation experience and fear of CCP donation (X2  = 119.2, p < .001). Motivations ranked "very important" by responding donors were wanting to help someone in need, a feeling of responsibility, and feeling a duty to donate. Donors with more severe disease were more likely to respond with feelings of a sense of duty to donate CCP (Χ2  = 8.078, p = .044) or altruism (Χ2  = 8.580, p = .035). CONCLUSIONS: Overwhelmingly, altruism and a sense of duty and responsibility were the reasons that CCP donors decided to donate. These insights can be useful for motivating donors for specialized donation programs or if wide scale CCP recruitment is needed in the future.

Low risk of human T-lymphotropic virus infection in U.S. blood donors; Is it time to consider a one-time selective testing approach?

BACKGROUND: U.S. blood donors are tested at each donation for human T-lymphotropic virus (HTLV) antibodies. Depending on donor incidence and other mitigation/removal technologies, a strategy of one-time selective donor testing should be considered. METHODS: Antibody seroprevalence was calculated for HTLV-confirmed-positive American Red Cross allogeneic blood donors from 2008 to 2021. Incidence was estimated for seven 2-year time periods using confirmed-positive repeat donors having seroconverted in 730 days. Leukoreduction failure rates were obtained from internal data from July 1, 2008-June 30, 2021. Residual risks were calculated using a 51-day window period. RESULTS: Between 2008 and 2021, >75 million donations (>18 million donors) yielded 1550 HTLV seropositives. HTLV seroprevalence was 2.05 antibody-positives per 100,000 donations (0.77 HTLV-1, 1.03 HTLV-2, 0.24 HTLV-1/2), and 10.32 per 100,000 among >13.9 million first-time donors. Seroprevalence differed significantly by virus type, sex, age, race/ethnicity, donor status, and U.S. census region. Over 14 years and 24.8 million person-years of observation, 57 incident donors were identified (25 HTLV-1, 23 HTLV-2, and 9 HTLV-1/2). Incidence decreased from 0.30 (13 cases) in 2008-2009 to 0.25 (7 cases) in 2020-2021. Female donors accounted for most incident cases (47 vs. 10 males). In the last 2-year reporting period, the residual risk was 1 per 2.8 million donations and 1 per 3.3 billion donations when coupled with successful leukoreduction (0.085% failure rate). CONCLUSIONS: HTLV donation seroprevalence for the years 2008-2021 varied by virus type and donor characteristics. Low HTLV residual risk and use of leukoreduction processes support the conclusion that a selective one-time donor testing strategy should be considered.

HIV risk behavior profiles among men who have sex with men interested in donating blood: Findings from the Assessing Donor Variability and New Concepts in Eligibility study.

BACKGROUND: Individual risk assessment allows donors to be evaluated based on their own behaviors. Study objectives were to assess human immunodeficiency virus (HIV) risk behaviors in men who have sex with men (MSM) and estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors. STUDY DESIGN AND METHODS: Cross-sectional survey and biomarker assessment were conducted in eight U.S. cities. Participants were sexually active MSM interested in blood donation aged 18-39 years, assigned male sex at birth. Participants completed surveys during two study visits to define eligibility, and self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, one of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Associations were assessed between HIV infection status or HIV PrEP use and behaviors, including sex partners, new partners, and anal sex. RESULTS: A total of 1566 MSM completed the visit 1 questionnaire and blood draw and 1197 completed the visit 2 questionnaire. Among 1562 persons without HIV, 789 (50.4%) were not taking PrEP. Of those not taking PrEP, 66.2% reported one sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. CONCLUSION: The study found that questions were able to identify sexually active, HIV-negative MSM who report lower risk sexual behaviors. About a quarter of enrolled study participants would be potentially eligible blood donors using individual risk assessment questions.

Is there evidence of a relationship between pre-eclampsia and periodontitis?

DATA SOURCES: The review searched several databases which included Medline (from 1950), Pubmed (from 1946), Embase (from 1949), Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov and Google Scholar (from 1990). STUDY SELECTION: Two of the authors (LD and HN) independently assessed the eligibility of studies by looking at the titles, abstracts and methods. If there was a disagreement, a third reviewer was consultant (QA) for a decision. DATA EXTRACTION AND SYNTHESIS: A data extraction form was created and used. Data collected included: the first author's name; publication year; study design; number of cases; number of controls, total sample size; country; national income group; mean age; the risk of estimates or data used to calculate the risk estimates; confidence intervals (CI) or data used to generate CI. For assessment of socioeconomic status and its role as a possible influential factor, the World Bank classification through Gross National Income per capita was used to determine which level (low-income, lower-middle-income, upper-middle-income, high-income) a country resided in. All authors cross-checked all data and discussions were had to resolve disagreements. Statistical software 'RevMan' was used to input data. Pooled odds ratios, mean difference, and 95% CI were calculated for the association between periodontitis and pre-eclampsia using a random-effects model. A significance level of 0.05 was used for pooled effect. Forest plots for primary analysis and subgroup analysis show the raw data, odds ratio and CIs, means and SDs for the chosen effect, heterogeneity statistic (I2), total number of participants per group, overall odds ratio and mean difference. Groups were divided for subgroup analysis by: study design (case-control and cohort); the studies' definition of periodontitis (defined by pocket depth [PD] and/or clinical attachment loss [CAL]); and national income (high-income or middle-income or low-income countries). Cochran's Q statistic and I2 statistic were used to determine heterogeneity and degree of heterogeneity, respectively. For publication bias, Egger's regression model and fail-safe number was used. RESULTS: Thirty articles and 9650 women were included in total. Six of the studies were cohort studies (2840 participants overall) and 24 were case-control studies. Pre-eclampsia was defined the same across all studies, whereas periodontitis differed. There was a significant association between periodontitis and pre-eclampsia (OR 3.18, 95% CI 2.26-4.48, p < 0.00001). In subgroup analysis of just cohort studies, the significance increased (OR 4.19, 95% CI 2.23-7.87, p < 0.00001). It further increased looking at lower-middle-income countries (OR 6.70, 95% CI 2.61-17.19, p < 0.0001). CONCLUSIONS: Periodontitis in pregnancy is a risk factor for pre-eclampsia. The data would suggest that this is more prominent in lower-middle-income subgroups. Further research could be undertaken to explore the possible mechanisms and also if prevention of adequate treatment can reduce the risk of pre-eclampsia, thereby improving maternal health outcomes.

International survey of strategies to mitigate transfusion-transmitted Trypanosoma cruzi in non-endemic countries, 2016-2018.

BACKGROUND AND OBJECTIVES: Chagas disease, caused by Trypanosoma cruzi, is endemic to Mexico, Central and South America. While initially limited to the Americas, emigration of infected persons triggered geographically broader blood safety challenges. To mitigate transfusion-transmitted Chagas (TTC), transfusion services implemented approaches including risk factor questions and serologic testing. We sought to understand and compare strategies in non-endemic countries. MATERIALS AND METHODS: Transfusion services in International Society of Blood Transfusion (ISBT)-affiliated organizations and members of the ISBT Working Party on Transfusion-Transmitted Infectious Diseases were invited to complete an online survey on T. cruzi mitigation strategies. The survey queried about cases of TTC, risk factors, testing methodology, educational materials, pathogen reduction, donor/product management, donor deferral and perceived public health concerns surrounding TTC. RESULTS: Responses were received from 27 institutions in 22 countries. Most countries (77.3%) reported no historical TTC cases, while 18.2% reported 1-5 cases and 4.5% reported 6-10 cases. Concern about Chagas among the general public and public health authorities was low, but 12 of 25 blood centres reported moderate/high concern. Overall, 17 countries mitigated for TTC: 15 used risk factor questions and 10tested for T. cruzi antibodies. Ten countries used pathogen reduction but not specifically to prevent TTC. CONCLUSION: While Chagas is rarely cited as a public health concern, blood centres in many non-endemic countries, including those outside the Americas, implemented measures to mitigate risk. Mitigation focussed on risk factors associated with Latin American immigrants and serologic testing. Thus, despite the rarity of TTC, many non-endemic countries continue to address it as an ongoing blood safety risk.

Is the oral health of visually impaired children and adolescents different compared to their sighted peers?

Data sources The review searched for articles via PubMed, Web of Science, Scopus, and Ovid. OpenGrey and the Brazilian Digital Library of Thesis and Dissertations (BDTD) were used to search for grey literature. As well as a manual searches of the reference lists from the included studies, a Google Scholar search was undertaken and the first 300 hits were screened. There was no restriction on date or language.Study selection Two authors screened initially 10% of the abstracts against the inclusion and exclusion criteria and then a calibration calculation was completed showing excellent agreement (kappa coefficient = 0.93). In phase one, abstracts were screened independently between the same two authors and discrepancies were discussed and resolved. In phase two, the full articles of those abstracts accepted were screened, as well as those whose abstracts were unavailable. Discrepancies were discussed with a third author for the final decision.Data extraction and synthesis Data extracted included: study characteristics (authors, year of publication, study design, country, sampling, the presence of a pilot study, aim, calibration and losses); population (age range and sex, sociodemographics and sample size); exposure (eligibility criteria and type and classification criteria of vision impairment); and outcome (prevalence and mean and standard deviation of oral health issues, such as dental plaque, gingivitis, calculus, periodontitis, oral hygiene [OH], dental caries and traumatic dental injuries [TDI]). Discrepancies were discussed with a third author for the final decision. In total, 15 studies were included in the systematic review and 12 in the meta-analysis. For the meta-analysis, heterogeneity was measured using I2 statistics.Results The meta-analysis found visually impaired children and adolescents had significantly higher levels of plaque (mean difference [MD] = 0.80; 95% confidence interval [CI] = 0.58-1.02; I2= 96%), gingival inflammation (MD = 0.69; 95% CI = 0.02-1.37; I2 = 100%), calculus (MD = 0.04; 95% CI = 0.03-0.06; I2 = 0%), OH indices (MD = 0.71; 95% CI = 0.24-1.18; I2 = 97%) and decayed missing filled surface (DMFS/dmfs) (MD = 0.90; 95% CI = 0.68-1.13; I2 = 26%) compared to sighted peers. TDI were statistically significantly higher (OR = 3.86; 95% CI = 2.63-5.68; I2 = 0%) in visually impaired children and adolescents. There was no significant difference in decayed missing filled teeth and DMFS/dmfs or caries.Conclusions Children and adolescents who are visually impaired are at greater risk of TDI and levels of dental plaque, gingival inflammation, calculus and DMFS and poorer OH. Furthermore, robust homogenous studies are required to strengthen any evidence of association between oral health outcomes and visual impairment in children and adolescents. Future research should also explore the directionality of these relationships.

Can teledentistry - in particular, photographs - be used to accurately diagnose caries and healthy teeth?

Aim To assess the use of teledenistry (TD) via photographs taken at home in identifying occlusal and vestibular caries by comparing the results with direct clinical assessment.Study design Cross-sectional pilot study.Methods In total, 43 dental students were recruited. The subjects were sent a protocol curated by the authors, outlining the required photographic views. Out of the ten photographs taken (five with flash, five without), the best five were selected for caries assessment by one clinician. The caries assessment was based on the International Caries Assessment System (ICDAS II). The students were then assessed in clinic by a second clinician and the results compared. Statistical analysis was then undertaken.Results A total of 430 photographs were sent in and 215 photographs were selected for analysis. In total, 1,201 teeth were analysed on 43 patients. Statistical tests showed TD to have a sensitivity of 74.0, specificity 99.1, a positive predictor value of 91.7 and a negative predictive value of 96.4. A Spearman correlation was undertaken for TD and caries detection, with a value of 0.816.Conclusions The results of this study showed that there is potential for reliably incorporating TD into routine caries diagnosis.

COVID-19 convalescent plasma donor characteristics, product disposition, and comparison with standard apheresis donors.

BACKGROUND: With coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) offering an early treatment option for COVID-19, blood collectors needed to quickly overcome obstacles to recruiting and qualifying eligible donors. We provide attributes of CCP donors and products and compare to standard donors and products. STUDY DESIGN AND METHODS: Information on CCP donors was gathered from the American Red Cross qualification website through product collection. Data from 2019 for standard plasma/platelet apheresis (SA) and whole blood (WB) donor demographics and SA donations including product disposition and reactions were used for comparison. RESULTS: Of almost 59 000 donors registering on the website, 75% reported an existing COVID-19 diagnostic polymerase chain reaction or an antibody test. The majority (56.2%) of 10 231 CCP donors were first-time donors in contrast to SA or WB donor populations, which were only 3.0% and 30.6%, respectively, first-time donors. The number of female donors was 12% higher than SA donors. Older (≥ 65 years) and younger (16-19 years) were comparatively underrepresented in CCP donors. Deferral (10.2%) and Quantity Not Sufficient rates (6.4%) for presenting CCP donations were higher than SA (8.2% and 1.1%, respectively). Human leukocyte antigen antibody reactivity was the highest cause of product loss for CCP donations vs SA donations (9.6% vs 1.3%). Acute adverse events also occurred at a higher rate among both first-time and repeat CCP donations compared to SA. CONCLUSIONS: CCP donors were more likely to be first-time and female donors than WB or SA donors. CCP donations had a higher rate of donor adverse reactions, deferrals, and product loss than SA donations.

Frequency of rare, serious donor reactions: International perspective.

BACKGROUND: Severe blood donor adverse events are rare, but due to their rarity studying them can be difficult. To get an accurate estimate of their frequency and rate in the donor population it may be necessary to combine donation data across countries. STUDY DESIGN AND METHODS: International blood collection organizations (BCOs) provided data on rare/severe donor reactions as well as denominator information for their donor populations from 2015 to 2017. Donor reactions were classified using standardized definitions. RESULTS: BCOs from six countries provided reaction data for more than 22 million donations. A total of 480 rare reactions were reported of which 76.7% were imputed as definite and 11% probable. Rates of rare reactions were higher in females and first-time donors. Systemic rare reactions were the most common reaction type, accounting for over three quarters of reactions reported. Of systemic reactions, vasovagal reactions with loss of consciousness and injury or off-site (n = 350) made up the majority and occurred 1.53 per 100,000 donations. For the 22.3% that were localized reactions, the majority of these were cellulitis (n = 71, 0.31 per 100,000 donations) followed by deep venous thrombosis (n = 21, 0.09 per 100,000 donations). CONCLUSION: Pulling together data from multiple BCOs across countries allows for a better understanding of rare reactions, such as vasovagal reaction with injury or cellulitis, and for generating a reliable incidence rate for air embolism or compartment syndrome. However, gaps remain due to missing elements such as unknown donor status or location of reaction.

Effectiveness of the post-donation instruction sheet in conveying information to repeat blood donors.

BACKGROUND AND OBJECTIVES: Written materials are commonly used for blood donor education. While pre-donation materials are largely standardized across US blood collectors, the post-donation instruction sheet (PDIS) is variable and few have been evaluated to assess their effectiveness in conveying information as reflected by donors' attention, understanding and recall. METHODS: An online survey was sent to two independent randomly selected samples of repeat donors, before and after implementation of the enhanced PDIS. RESULTS: A total of 12 935 blood donors responded (33·4% response rate). Most donors did not read the entire PDIS - 34·3% less than half and 18·1% none. Of the 10 593 donors who reported reading any of the PDIS, 97·8% recalled instructions about immediate post-donation care (e.g. extra fluids/no exercise) and 88·0% to call with questions/problems. However, only 50·1% remembered reading about what to do if you felt dizzy/faint and 32·4% about care for bruises. Recall rates in every area were similar before and after revision; except after revision, more donors remembered seeing information about maintaining iron and fewer that you should call the centre back with additional health information (P < 0·0001). DISCUSSION: Blood collectors rely heavily on written materials to convey instructions to donors. Most repeat donors do not read the entire PDIS, and many do not recall important information. More donors recalled seeing how to maintain iron with the enhanced PDIS, but recall deficits remained on how to care for adverse reactions. Written materials alone appear to be insufficient to educate some donors about new or updated topics.

Dental professionals' role in the fight against COVID-19: current evidence.

Data sources Five databases were used to search for articles: PubMed, Embase, Scopus, Web of Science and Cochrane.Study selection All articles with the relevant topics related to COVID-19 and limited to Italian and English Language (with available English abstract) were screened. Additionally, included articles were screened for relevant references.Date extraction and synthesis Two of the authors reviewed the titles and abstracts obtained from the search and screened for relevance. Databases were searched from January 2020 to the end of April 2020. Exclusion and inclusion criteria were detailed. No specific study type or design was mentioned.Results The overview covered the transmission pathway of COVID-19 in the dental setting. It detailed the protective mechanisms to reduce infection and transmission: airway protection; eye protection; triaging; antimicrobial agents; hand hygiene; reducing aerosol generation; and strict disinfection.Conclusion The overview supplied specific information for dental professionals, on both protection from COVID-19 and prevention of transmission of the virus. While a useful overview, with practical implications and advice for professionals, there is more emerging evidence post-publication as we learn more about the virus.

Management options of early childhood caries.

Data sources The review searched for articles via Medline up to March 2019 for English language papers only.Study selection Two authors screened the reviews initially against the inclusion and exclusion criteria. Discrepancies were discussed with all authors for the final decision. Due to a low number of higher-level studies on non-operative caries management (NOCM; excluding silver diamine fluoride [SDF]), studies other than randomised controlled trials, systematic reviews and meta-analyses were included to allow some collation of evidence for an overview to be gained.Data extraction and synthesis Data extracted included setting, participants, focused question, search results, comparators, main outcomes and conclusion. Data for SDF was collated separately to other NOCM due to the higher level of evidence and its use in cavitated lesions as well as non-cavitated carious lesions.Results Five systematic reviews investigated SDF use. All the reviews demonstrated SDF to be an effective management tool for arresting early caries. Ten studies looked at NOCM, which showed fluoride varnish has a moderate effect on arresting carious lesions, but the evidence was of low level. For restorative approaches, a low level of evidence showed resin restorations to have a higher failure rate than composite strip crowns, regardless of general anaesthesia, and more so than stainless steel or zirconia crowns.Conclusions SDF is an effective tool in the management of early childhood caries.

Use of a rapid electronic survey methodology to estimate blood donors' potential exposure to emerging infectious diseases: Application of a statistically representative sampling methodology to assess risk in US blood centers.

Risk assessments of transfusion-transmitted emerging infectious diseases (EIDs) are complicated by the fact that blood donors' demographics and behaviors can be different from the general population. Therefore, when assessing potential blood donor exposure to EIDs, the use of general population characteristics, such as U.S. travel statistics, may invoke uncertainties that result in inaccurate estimates of blood donor exposure. This may, in turn, lead to the creation of donor deferral policies that do not match actual risk. STUDY DESIGN AND METHODS: This article reports on the development of a system to rapidly assess EID risks for a nationally representative portion of the U.S. blood donor population. To assess the effectiveness of this system, a test survey was developed and deployed to a statistically representative sample frame of blood donors from five blood collecting organizations. Donors were directed to an online survey to ascertain their recent travel and potential exposure to Middle East respiratory syndrome coronavirus (MERS-CoV). RESULTS: A total of 7128 responses were received from 54 256 invitations. The age-adjusted estimated total number of blood donors potentially exposed to MERS-CoV was approximately 15 640 blood donors compared to a lower U.S. general population-based estimate of 9610 blood donors. CONCLUSION: The structured donor demographic sample-based data provided an assessment of blood donors' potential exposure to an emerging pathogen that was 63% larger than the U.S. population-based estimate. This illustrates the need for tailored blood donor-based EID risk assessments that provide more specific demographic risk intelligence and can inform appropriate regulatory decision making.

Transfusion-transmitted and community-acquired babesiosis in New York, 2004 to 2015.

BACKGROUND: Babesiosis is a potentially life-threatening zoonotic infection most frequently caused by the intraerythrocytic parasite Babesia microti. The pathogen is usually tickborne, but may also be transfusion or vertically transmitted. Healthy persons, including blood donors, may be asymptomatic and unaware they are infected. Immunocompromised patients are at increased risk for symptomatic disease. STUDY DESIGN AND METHODS: All reported community-acquired babesiosis cases in New York from 2004 to 2015 were evaluated, enumerated, and characterized. All potential transfusion-transmitted babesiosis (TTB) cases reported through one or more of three public health surveillance systems were investigated to determine the likelihood of transfusion transmission. In addition, host-seeking ticks were actively collected in public parks and other likely sites of human exposure to B. microti. RESULTS: From 2004 to 2015, a total of 3799 cases of babesiosis were found; 55 (1.4%) of these were linked to transfusion. The incidence of both community-acquired babesiosis and TTB increased significantly during the 12-year study period. The geographic range of both ticks and tickborne infections also expanded. Among TTB cases, 95% of recipients had at least one risk factor for symptomatic disease. Implicated donors resided in five states, including in 10 New York counties. More than half of implicated donors resided in counties known to be B. microti endemic. CONCLUSION: The increasing incidence of TTB correlated with increases in community-acquired babesiosis and infection of ticks with B. microti. Surveillance of ticks and community-acquired cases may aid identification of emerging areas at risk for Babesia transfusion transmission.

Creutzfeldt-Jakob disease lookback study: 21 years of surveillance for transfusion transmission risk.

BACKGROUND: Transfusion transmission of human prion diseases has been observed for variant Creutzfeldt-Jakob disease (vCJD), but not for the classic forms of prion disease (CJD: sporadic, genetic, and iatrogenic). Although the presence of prions or misfolded prion proteins in blood has been documented in some patients with the most common form of CJD, sporadic CJD, no transfusion-transmitted cases of CJD have been recognized. Since 1995, the American Red Cross has conducted a lookback study of the recipients of blood products from donors who develop CJD to assess the risk of blood-borne CJD transmission in the United States. STUDY DESIGN AND METHODS: Blood donors subsequently diagnosed with confirmed or probable CJD were enrolled and the consignees were asked to identify the recipients of their blood products. These donors' transfusion recipients are traced annually with the National Death Index to see if they subsequently die of CJD. RESULTS: To date, 65 CJD donors have been enrolled along with 826 of their blood recipients. These recipients have contributed 3934 person-years of follow-up and no transfusion-transmitted cases of CJD have been recognized. CONCLUSION: From this study, as well as other epidemiologic studies, there is no evidence of CJD transfusion transmission; this risk remains theoretical.

Prevalence, incidence, and risk factors of human immunodeficiency virus infection in blood donors in the Southeastern United States.

BACKGROUND: Human immunodeficiency virus (HIV)-positive blood donors pose a risk to blood safety. The Southeastern United States has the highest reported HIV infection rates. Here we calculate HIV prevalence, incidence, and residual risk in Southeastern US blood donors and report risk factors disclosed by incident donors in counseling sessions. STUDY DESIGN AND METHODS: American Red Cross donation and testing data from 2009 to 2014 for three Southeastern collection regions were used to calculate HIV prevalence, incidence, and residual risk. Incident donors had a previous HIV-negative donation within 730 days of their positive donation. Residual risk was defined as the window period multiplied by incidence. RESULTS: From 2009 to 2014, a total of 236 HIV-positive donors occurred in these regions for an overall prevalence of 8.3 per 100,000 donations. There were 56 incident donors over the 6-year period with incidence decreasing from 7.1 per 100,000 person-years (PYs) in the first two years (2009-2010) to 3.5 in the last two years (2013-2014). Residual risk decreased from 1 in 562,000 to 1 in 1,100,000. The most commonly reported risk factor behavior in male incident donors was men who have sex with men; females expressed no predominant risk factor. CONCLUSION: HIV prevalence and incidence among blood donors in the southeast are higher than other US regions, consistent with general public health surveillance. However, the overall residual risk estimates are low at less than 1 per million. Ongoing monitoring of the blood supply along with educational efforts to provide infected individuals with alternatives to donation remain important initiatives.