Estimating the residual risk for HIV, HCV and HBV in different types of platelet concentrates in Germany.

BACKGROUND AND OBJECTIVES: We estimated and compared the residual risks due to window-period donations for pooled and apheresis platelets in Germany using a modification of a previously described statistical model. This model directly utilizes the reported interdonation intervals before a positive donation and reflects in this aspect the look-back procedures used in haemovigilance. MATERIALS AND METHODS: Data from the German National Blood Donor Surveillance System for the years 2006-2012, including reports about donations from repeat donors with confirmed positive test results for HIV, HCV and HBV, were used to estimate the risk of undetected infectious units for both pooled and apheresis platelets. RESULTS: Demographics of whole-blood and apheresis donors differed in age, gender, catchment area and interdonation interval. These differences impact on the prevalence and incidence of transfusion relevant infections and consequently the residual risk. The estimates for the residual risks for pooled and apheresis platelets were comparable. For HIV, there was no significant difference, for HCV apheresis platelets had a lower residual risk, whereas pooled platelets had a lower risk for undetected HBV infections. CONCLUSION: These findings do not support calls for a shift to an apheresis platelets-only policy in Germany.

Sexual risk behaviour and donor deferral in Europe.

One of the most controversial policies in blood transfusion worldwide is the permanent deferral from donating blood of men with sexual contacts to other men (MSM). This policy was implemented for safety reasons as sex between men is known to be a high risk factor for acquiring severe infectious diseases transmissible by blood transfusion. Sexual contacts among heterosexual persons may hold similar risks but a clear-cut discrimination between different individual risks is impossible. Nevertheless, the current blood donor deferral periods defined by European Union (EU) legislation depend on a distinction of different grades of risk with respect to sexual behaviour. Under the aegis of the Steering Committee on Blood Transfusion (CD-P-TS) of the Council of Europe (CoE), an international working group evaluated epidemiological and behavioural data, modelling studies on residual risk and spread of infections, and studies on adherence to donor selection criteria. The aim was to distinguish sexual behaviour of different risk categories. It was concluded, that existing data confirm that MSM and commercial sex workers (CSW) are groups at high risk. Any further grading lacks a scientific data base. Modelling studies indicate that adherence to deferral policies is of major relevance suggesting that good donor adherence may outweigh the small negative effects on blood safety postulated for changing from permanent to temporary deferral periods for high risk sexual behaviours. The fact that a considerable percentage of donors are MSM - despite the permanent deferral policy - demonstrates the need to increase donor understanding and adherence.

[HIV, HCV, HBV and syphilis surveillance among blood donors in Germany 2008-2010]. / HIV-, HCV-, HBV- und Syphilissurveillance unter Blutspendern in Deutschland 2008-2010.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to article 22 of the Transfusion Act. This report includes data from all blood donation services in Germany for 2008-2010. The prevalence for HIV ranged from 6.6-7.0/100,000, for HCV from 68.9-81.6/100,000, for HBV from 116.2-136.6/100,000 and for syphilis from 31.0-42.1/100,000 donations. The proportion of incident infections per 100,000 donations ranged from 0.8-0.9 for HIV, 0.8-1.0 for HCV, 0.3-0.5 for HBV and 1.4-1.6 for syphilis. Since 2001 the prevalence and incidence of HBV and HCV among blood has declined whereas incident HIV infections reached a peak in 2008 and 2010 and show an increasing trend. Also, the proportion of syphilis infections among first time donors was highest in 2010. Significant differences in infection prevalence and incidence were found between the sexes, different age groups and different donation types. In order to optimise donor selection a validated donor questionnaire should be used and confidentiality in all steps of donation should be assured. The possibility of a confidential self-exclusion should be explicitly pointed out to donors.

[Demography and donation frequencies of blood and plasma donor populations in Germany. Update 2010 and 5-year comparison]. / Demografie und Spendeaktivität von Blut- und Plasmaspendern in Deutschland. Update 2010 und 5-Jahres-Vergleich.

The Robert Koch Institute collects and evaluates nationwide data on the incidence and prevalence of transfusion-relevant infections among blood and plasma donors in Germany. Since 2006 data not only on the number of donations tested but also on the number of the respective donors have become available. The demographic profile and donation frequencies of German whole blood, plasma and platelet donors in 2010 and the percentages among the general population are described and compared to data from 2006. Although the general population eligible to donate blood is on the decline since 2003, with a loss of 2% between 2006 and 2010, this has not led to a decrease in the number of blood donors and donations. Instead, the number of new and repeat whole blood donors increased by 8% and 7%, respectively. At the same time, the number of new plasma donors grew by 23%, that of repeat plasma donors by 41%. In 2010 more than 4.3% of the population aged 18-68 years was active as repeat whole blood donors; 0.4% repeatedly donated plasma or platelets. Since 2006 the percentage of donors among the general population increased significantly, especially among the youngest age group (18-24 years). Donation frequency varied depending on donor age and sex, with an average of 1.9 per year for whole blood donations, 12.5 for plasmapheresis and 5.0 for plateletpheresis. While the donation frequency for whole blood remained unchanged since 2006, the frequency of apheresis donations increased, especially among older donors. By recruiting more new donors and retaining and reactivating existing ones more effectively, the number of whole blood and apheresis donations was augmented.

[Epidemiological data on infections among blood donors in Germany 2007]. / Infektionsepidemiologische Daten von Blutspendern in Deutschland 2007.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV), and syphilis infections among blood and plasma donors in Germany according to §22 of the Transfusion Act ("Transfusiongesetz"). The surveillance data permit an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2007. Due to the revision of the Transfusion Act in 2005, not only the number of donations but also the number of donors is now available for analysis. Nearly 550,000 donations or blood samples from new donors and more than 6.24 million donations collected from approximately 2.43 million repeat donors were tested for transfusion-relevant infections in 2007. The prevalence for HIV was 8.0/100,000, for HCV 70.0/100,000, for HBV 132.5/100,000, and for syphilis 36.8/100,000 donations. The proportion of seroconversions/100,000 donations was 0.6 for HIV, 1.1 for HCV, 0.6 for HBV, and 1.7 for syphilis. The analysis showed a very low incidence of HIV, HBV, and syphilis with marginal changes compared to previous years. The prevalence and incidence of HCV among blood donors was once again declining.

Mitogenic activity of high molecular polysaccharide fractions isolated from the cuppressaceae Thuja occidentalis L. enhanced cytokine-production by thyapolysaccharide, g-fraction (TPSg).

Thuja polysaccharide g fraction (TPSg) was shown to be an inducer of the CD4+ fraction of the human peripheral blood T-cell subset (1,2). Furthermore, it could be demonstrated that TPSg is a potent inhibitor of the expression of HIV-1-specific antigens and of the HIV-1-specific reverse transcriptase (3). This report deals with the cytokine pattern induced by TPSg in human peripheral blood lymphocyte (PBL) and purified monocyte/macrophage cultures. In addition, a further characterization of the CD4+ T-cell fraction stimulated by TPSg was performed by FACS analysis. TPSg is induces IL-1 beta, IL-2, IL-3, IL-6, gamma-IFN, G-CSF, GM-CSF, and TNF-beta production in PBL cultures; and IL-1 beta and IL-6 in monocyte/macrophage cultures. Enzyme-linked immunosorbent assays (ELISAs) demonstrated that no IL-4 was produced by PBL cultures under TPSg influence.

Human immunodeficiency virus, hepatitis C and hepatitis B infections among blood donors in Germany 2000-2002: risk of virus transmission and the impact of nucleic acid amplification testing.

Blood and plasma donations in Germany are collected by several institutions, namely the German Red Cross, community and hospital-based blood services, private blood centres, commercial plasma donation sites and transfusion services of the army. All blood donation centres are required to report quarterly data on infection markers to the Robert Koch Institute, thus providing current and accurate epidemiological data. The prevalence and incidence of relevant viral infections are low in the blood donor population in Germany, with a decreasing trend for hepatitis C infections in new and repeat donors since 1997. The implementation of mandatory nucleic acid amplification technique (NAT) testing for hepatitis C virus (HCV) in 1999 has markedly improved transfusion safety. HIV-NAT became mandatory in 2004 but was done voluntarily by the majority of the blood donation services before then. The potential benefit of hepatitis B virus (HBV) minipool NAT is not as clear because chronic HBV carriers with very low virus levels might donate unidentified. The residual risk of an infectious window period donation inadvertently entering the blood supply can be estimated using a mathematic model which multiplies the incidence rate by the number of days during which an infection may be present but not detectable, i.e. the length of the window period. The risk of an undetected infection without NAT testing was estimated to be 1 in 2,770,000 for HIV, 1 in 670,000 for HCV and 1 in 230,000 for HBV in 2001/2002. This contrasts with 1 in 5,540,000 for HIV, 1 in 4,400,000 for HCV and 1 in 620,000 for HBV with minipool NAT testing. This demonstrates that NAT testing can further reduce the already very small risk of infectious donations entering the blood supply.

[HIV, HCV, HBV and syphilis infections among blood donors in Germany 2006. Report from the Robert Koch Institute in accordance with Article 22 of the Transfusion Act]. / Infektionsepidemiologische Daten von Blutspendern 2006 : Bericht des Robert Koch-Instituts zu den Meldungen nach section sign 22 Transfusionsgesetz.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to Article 22 of the Transfusion Act. The surveillance data permit an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2006. Due to the revision of the Transfusion Act in 2005 not only the number of donations but also the number of donors has become available for analysis. More than 500,000 donations or blood samples from new donors and about 6 million donations collected from ca. 2.3 million repeat donors were screened in 2006. The prevalence for HIV was 6.2/100,000, for HCV 76.2/100,000, for HBV 150.2/100,000 and for syphilis 34.4/100,000 donations. The rate of seroconversions/100,000 donations was 0.8 for HIV, 1.1 for HCV, 0.7 for HBV and 1.6 for syphilis. The analysis showed a very low incidence of HIV, HBV und syphilis with marginal changes compared to previous years. The prevalence and incidence of HCV among blood donors was once again declining.

[Demography and donation frequencies of blood and plasma donor populations in Germany]. / Blutspenderpopulationen in Deutschland: Demographie und Spendeaktivität : Ergänzung zum Bericht des Robert Koch-Instituts zu den Meldungen nach section sign 22 Transfusionsgesetz.

According to Article 22 of the Transfusion Act, the Robert Koch Institute collects and evaluates nationwide data on the prevalence and incidence of transfusion-relevant infections among blood and plasma donors in Germany. Due to revision of the Transfusion Act in 2005 not only the number of donations but also the number of donors has become available for analysis. Here we give a detailed account on the demographic profile and donation frequencies of German whole blood, plasma and platelet donors in 2006. Overall, 4 % of the German population eligible to donate were active as repeat whole blood donors in 2006; 0.3 % repeatedly donated plasma or platelets. Irrespective of the type of donation, the percentage of donors among the general population was highest among the youngest age group (18 to 24 years). While the age distribution of whole blood repeat donors roughly resembled that of the general population, with the greatest number among those aged 35 to 44, younger age groups were overrepresented among repeat plasma donors. Donation frequency varied depending on donor age and sex, with an average of 1.9 per year for whole blood donations, 11.9 for plasmapheresis and 4.0 for plateletpheresis. With the exception of the latter, men donated more frequently than women. For both sexes, donation frequency increased with age. Detailed knowledge of the demographic profile and changes in the composition of donor populations are essential for planning adequate blood supply. The data presented may serve as reference for assessing the consequences of measures that affect the number of donors and/or donations (for example changing deferral criteria) in Germany.

[HIV, HCV, HBV and syphilis infections among blood donors in Germany 2005. Report from the Robert Koch Institute in accordance with Article 22 of the Transfusion Act]. / Infektionsepidemiologische Daten von Blutspendern 2005. Bericht des Robert Koch-Instituts zu den Meldungen nach Paragraph 22 Transfusionsgesetz.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to article 22 of the Transfusion Act. The surveillance data permit an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2005. In total, 6.26 million donations or blood samples from prospective donors were screened. The prevalence of the relevant infections was 6.1/100,000 for HIV, 81.2/100,000 for HCV, 143.9/100,000 for HBV and 35.6/100,000 donations for syphilis. The rate of seroconversions/100,000 donations was 0.9 for HIV, 1.4 for HCV, 0.9 for HBV and 2.3 for syphilis. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections among first time donors and an increase in incident HIV and syphilis infections since 1999. The latter has to be monitored carefully and possible causes need to be evaluated.

[Infection epidemiological data among blood donors in Germany 2003-2004. Report of the Robert Koch Institute in accordance with Article 22 of the Transfusion Act]. / Infektionsepidemiologische Daten von Blutspendern 2003-2004. Bericht des Robert Koch-Instituts zu den Meldungen nach [section sign] 22 Transfusionsgesetz.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany in accordance with Article 22 of the Transfusion Act. This surveillance permits an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2003 and 2004. Altogether 7.09 million and 6.37 million donations or blood samples from prospective donors were screened in 2003 and 2004, respectively. In 2003 the prevalence rates of the relevant infections (per 100,000 donations) were 8.2 for HIV, 99.3 for HCV, 158.9 for HBV and 34.4 for syphilis. In 2003 the rates of seroconversion (per 100,000 donations) were 0.8 for HIV, 1.2 for HCV, 1.0 for HBV and 1.5 for syphilis in 2003. In 2004 the prevalence rates (per 100,000 donations) were 4.8 for HIV, 85.3 for HCV, 156.3 for HBV and 36.8 for syphilis. In 2004 the rates of seroconversion (per 100,000 donations) were 0.9 for HIV, 1.3 for HCV, 0.6 for HBV and 2.0 for syphilis. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections and an increase in HIV and syphilis infections. The latter needs to be monitored carefully and possible causes evaluated. The quality of the reported data has improved compared to previous years. Still, some problems remain with the differentiation of the data according to sex, age and interdonation interval as well as reporting by individual blood donation centres as required by the Transfusion Act.

[Report of the Robert Koch Institute according to Article 22 of the Transfusion Act for the years 2001 and 2002]. / Bericht des Robert Koch-Instituts zu den Meldungen nach (section sign) 22 Transfusionsgesetz für die Jahre 2001 und 2002.

The Robert Koch Institute collects and evaluates data on the prevalence and incidence of HIV, hepatitis C (HCV), hepatitis B (HBV) and syphilis infections among blood and plasma donors in Germany according to Article 22 of the Transfusion Act. The surveillance permits an assessment of the occurrence of infections in the blood donor population and consequently the safety of the collected donations. This report includes data from all blood donation services in Germany for 2001 and 2002. Altogether 5.71 million and 6.63 million donations or blood samples from prospective donors were screened in 2001 and 2002, respectively. The analysis showed a very low incidence of infections with a decreasing trend for HCV infections since 1997 but a slight increase in HIV infections in 2001-2002 compared to 1999-2000. The prevalence of the relevant infections/100,000 donations was 4.7 for HIV, 94.7 for HCV, 159.0 for HBV and 33.4 for syphilis in 2001. The rate of seroconversions/100,000 donations was 0.5 for HIV, 1.6 for HCV, 1.4 for HBV and 1.6 for syphilis in 2001. In 2002 the prevalence/100,000 donations was 7.5 for HIV, 97.4 for HCV, 164.1 for HBV and 31.9 for syphilis. The rate of sero-conversions/100,000 donations in that year was 0.7 for HIV, 1.5 for HCV, 1.2 for HBV and 1.9 for syphilis. The quality of the reported data has improved significantly compared to previous years. Still, some problems remained with the differentiation of the data according to sex, age and interval between donations and the reporting by individual blood donation centres as required by the Transfusion Act.

Maternal and fetal hepatitis C virus exposure by intrauterine transfusion.

We report a case of accidental exposure to hepatitis C virus by an intrauterine transfusion that resulted in infection of the mother but not the child.

[Do polymorphisms of the SDF1 and CCR2b genes modify the course of hepatitis C or HIV/HCV co-infection?]. / Beeinflussen Polymorphismen des SDF1- und CCR2b-Gens den Verlauf der Hepatitis C und der HIV/HCV-Koinfektion?

BACKGROUND AND OBJECTIVE: Complementary to the CCR5-Delta32 mutation polymorphisms in the genes of CCR2b (CCR2b-V64 I) and stromal derived factor (SDF)-1 (SDF-1 3'A) affect the course of the human immunodeficiency virus (HIV) infection. While the CCR5-Delta32 mutation is also increased in chronic hepatitis C virus (HCV) infection it is unclear, whether the CCR2b-V64 I and the SDF-1 3'A polymorphisms also are associated with chronic HCV infection. METHODS: We analyzed the frequencies of the CCR2b-V64I and SDF1 - 3'A mutation in patients with HIV/HCV coinfection (n = 130), HIV infection (n = 105), HCV infection (n = 153) and 112 healthy blood donors. We stratified each group into homozygous mutations, heterozygous mutations and homozygous wild types, respectively. The resulting subsets were compared with respect to HIV and HCV loads, CD4 and CD8 cell counts. RESULTS: The mutant SDF1 - 3'A allele was found at 20.3 % frequency in patients with HCV infection and at 20.4 % frequency in patients with HIV/HCV coinfection, respectively. It was present in 27.1 % of the patients with HIV infection and 27.9 % of the healthy controls (not significant). The number of SDF-1 3) A homozygous patients was highest in patients with HIV/HCV coinfection and significantly different compared to the Hardy-Weinberg equilibrium (p = 0.010, chi (2) = 9.15). However, CD4- and CD8-cell counts or viral loads were not affected by this mutation. The frequency of the CCR2b-V64 I allele was similar in all patient groups. However, CCR2b-V64 I heterozygous patients showed HIV loads that were threefold lower than in CCR2b wildtype patients (22.9 x 103 vs. 6.4 x 103 copies/ml, not significant). Furthermore, hepatitis C viral loads were reduced roughly by 30 %. CONCLUSION: These results suggest that the SDF1 - 3'A and CCR2b-V64I mutations do not affect the course of HCV and HIV/HCV infection in the same manner as does the CCR5-Delta32 mutation.