Prevention of transfusion‐transmitted cytomegalovirus (CMV) infection: Standards of care

Lieberman, Lani; Devine, Dana V.; Reesink, H. W.; Panzer, Simon; Wong, Jenny K. Y.; Raison, T.; Benson, Simon; Pink, Joanne; Leitner, Gerda; Horvath, Michaela; Compernolle, Veerle; Scuracchio, Patrícia; Wendel, Sarah K.; Delage, Gilles; Nahirniak, Susan; Dongfu, X.; Krusius, Tom; Juvonen, Eeva; Sainio, Susanna; Cazenave, J.‐P.; Guntz, Philippe; Kientz, Daniel; Andreu, G.; Morel, Penelope A.; Seifried, Erhard; Hourfar, Kai; Lin, C. K.; O’Riordan, Joan; Raspollini, E.; Villa, Stefania; Rebulla, Paolo; Flanagan, P.; Teo, Diana; Lam, Sally; Ang, Ai Leen; Lozano, Miguel; Sauleda, Sílvia; Cid, Joan; Pereira, Arturo; Ekermo, Bengt; Niederhauser, Christoph; Waldvogel, Sophie; Fontana, Stefano; Desborough, Michael; Pawson, Rachel; Li, M.; Kamel, Hossam; Busch, MP; Qu, Lirong; Triulzi, Darrell J.

doi:10.1111/vox.12103

Cited by 14 publications

(15 citation statements)

References 13 publications

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“…Internationally, there is wide variation in both testing and leucodepletion practices to manage HTLV risk for donated blood. Table uses several sources to summarize current strategies (to the best of our knowledge) .…”

Section: Introductionmentioning

confidence: 99%

“…HTLV testing ceased altogether in 2007 because no positive donors had been identified since 2000 . Finland abandoned new‐donor testing in 2008 based on a risk assessment noting the low prevalence and incidence of HTLV infections in Finland and the risk reduction capability of leucodepletion . In the Netherlands, cost‐effectiveness analysis found that new‐donor testing was significantly more cost‐effective than universal testing, preventing 85% of related morbidity in recipients, at 5% of the cost ; testing was reduced from universal to new‐donor testing in July 2013 .…”

Section: Introductionmentioning

confidence: 99%

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Reconsideration of blood donation testing strategy for human T‐cell lymphotropic virus in Australia

et al. 2017

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Transfusion-transmission of HTLV is a minimal risk in Australia even without testing. However, any revision of testing strategy must consider not only risk and cost-effectiveness, but also stakeholder, ethical and regulatory perspectives. Considering all relevant criteria, new-donor testing is judged the optimal strategy because it is able to achieve almost the same outcomes as universal testing, at a fraction of the cost.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconsideration of blood donation testing strategy for human T‐cell lymphotropic virus in Australia

et al. 2017

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“…The transfusion of CMV-seronegative blood products is a reasonable approach to avoid the transfusion of blood products from donors with latent infections or late-phase primary infections, but it could involve the risk of transfusion of blood products from donors with primary CMV infections (window-period donations), since IgG antibodies after primary CMV infection do not occur until 6 to 8 weeks after infection (11). A published report of CMV breakthrough cases after transfusion of CMV-seronegative blood products (21) suggested a role for window-period donations, but further studies are required to assess the incidence of window-period donations (12,22). Indeed, the infectivity of these window-period donations needs to be elucidated, and even seronegative donors in the window period may present a low risk regarding TT-CMV infection (23).…”

Section: Discussionmentioning

confidence: 99%

Systematic Evaluation of Different Nucleic Acid Amplification Assays for Cytomegalovirus Detection: Feasibility of Blood Donor Screening

2015

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Acute primary cytomegalovirus (CMV) infections, which commonly occur asymptomatically among blood donors, represent a significant risk for serious morbidity in immunocompromised patients (a major group of transfusion recipients). We implemented a routine CMV pool screening procedure for plasma for the identification of CMV DNA-positive donors, and we evaluated the sensitivities and performance of different CMV DNA amplification systems. Minipools (MPs) of samples from 18,405 individual donors (54,451 donations) were screened for CMV DNA using the RealStar CMV PCR assay (Altona Diagnostic Technologies), with a minimum detection limit of 11.14 IU/ml. DNA was extracted with a high-volume protocol (4.8 ml, Chemagic Viral 5K kit; PerkinElmer) for blood donor pool screening (MP-nucleic acid testing [NAT]) and with the Nuclisens easyMAG system (0. H uman cytomegalovirus (CMV) is a ubiquitous viral pathogen that causes mostly asymptomatic disease in immunocompetent individuals. In immunocompromised patients, however, CMV infection represents a significant risk for serious morbidity, e.g., due to interstitial pneumonia or hepatitis (1-3). Immunocompromised patients, such as patients undergoing hematopoietic stem cell transplantation (HSCT), solid-organ transplant recipients, infants with low birth weights, fetuses, pregnant woman, HIV patients, and patients being treated for hematological malignancies, belong to the major groups of transfusion recipients, and CMV-seronegative individuals were considered high-risk patients for transfusion-transmitted (TT)-CMV infections (4-6). The introduction of leukodepletion of blood products and provision of CMV-seronegative blood products reduced the incidence of TT-CMV infections in at-risk populations by 92%. However, TT-CMV breakthrough infections occur in 1 to 3% of high-risk patients who receive transfusions (4-6), possibly due to windowphase donations during acute primary CMV infections.The seroprevalence rates of CMV antibodies among blood donors show geographic differences, ranging from 45.8% in Germany to 96.5% in Brazil (3, 7). Primary CMV infections in blood donors occur in all age groups, with prevalence rates between 0.2 and 1.2% (3,6,8,9). The disease presentation is mostly asymptomatic, frequently with a prolonged course (10, 11). Mononucleosis-like symptoms are rare, whereas nonspecific viral disease symptoms occur often but not at significantly increased rates, compared to matched control groups (3,5).Determination of the prevalence of primary CMV infections among blood donors represents an important parameter for the effective prevention of 12). The aim of the present study was implementation of routine CMV DNA screening according to the setup used for our standard viral nucleic acid MATERIALS AND METHODSBlood donors. A total of 54,451 allogeneic blood donations from 18,405 individual German blood donors were routinely screened for the presence of CMV DNA by the Uni.Blutspendedienst OWL between March and June 2013. Master pools of 96 donations were set up by combin...

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“…42,43 Because LR also decreases the incidence of febrile nonhemolytic transfusion reactions and human leukocyte antigen alloimmunization, nowadays, the vast majority of blood products are leukoreduced, and universal LR of blood products has been implemented in many countries. 44,45 …”

Section: Strategies For the Reduction Of Tt-cmv Infectionmentioning

confidence: 99%

“…42,46 This potential risk has led to proposals that LR-only blood products be collected from donors who have been seropositive for at least 1 year or that the donors also be screened for CMV by PCR. 34,45,47 However, it remains to be determined whether the latter would be a cost-effective way to further decrease the risk of TT-CMV infection. For example, a recent study detected CMV DNA in the plasma of only 0.03% of blood donors.…”

Section: Harmon and Coolingmentioning

confidence: 99%

Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

Harmon¹,

Cooling²

2017

IJCTM

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Cytomegalovirus (CMV) is a pervasive DNA virus that infects a significant portion of individuals worldwide, and may be transmitted through the transfusion of blood products. Although CMV infection is of little consequence in immunocompetent individuals, patients with an impaired immune system are at risk of significant morbidity and mortality. Unlike other blood-borne infectious agents, it is impractical to defer all CMV-positive individuals from blood donation as this would exclude a substantial number of otherwise eligible donors. Other methods such as transfusion of CMV-seronegative and leukoreduced blood products must be employed to prevent the transmission of CMV to at-risk patients. In this study, the widespread use of current strategies for the prevention of transfusion-transmitted CMV (TT-CMV) infection and the evidence to support these methods in various at-risk groups were reviewed. In addition, emerging pathogen inactivation technologies that have the potential to eliminate TT-CMV were also discussed.

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Prevention of transfusion‐transmitted cytomegalovirus (CMV) infection: Standards of care

Abstract: a Refers to cases when mother is CMV negative. b Refers to cases when recipient and donor are CMV negative.

Cited by 14 publications

References 13 publications

Reconsideration of blood donation testing strategy for human T‐cell lymphotropic virus in Australia

Reconsideration of blood donation testing strategy for human T‐cell lymphotropic virus in Australia

Systematic Evaluation of Different Nucleic Acid Amplification Assays for Cytomegalovirus Detection: Feasibility of Blood Donor Screening

Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

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