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

Linden, Jeanne V.; Prusinski, Melissa A; Crowder, Lauren A.; Tonnetti, Laura; Stramer, Susan L.; Kessler, Debra; White, Jennifer L.; Shaz, Beth H.; Olkowská, D

doi:10.1111/trf.14476

Cited by 39 publications

(47 citation statements)

References 30 publications

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“…We describe a marked overall increase in babesiosis cases in Massachusetts over time. This trend is consistent with recent findings from New York State . In addition to identification of this trend in public health surveillance data, a recent study among Medicare recipients indicated that the rate of babesiosis in Massachusetts elderly (45 per 100,000 population) was second only to Connecticut (46 per 100,000) as the highest in the United States .…”

Section: Discussionsupporting

confidence: 87%

Transfusion‐transmitted babesiosis: one state's experience

et al. 2018

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BACKGROUND The risk for tickborne exposure to Babesia microti infection exists statewide in Massachusetts. Broad exposure complicates investigations of transfusion‐transmitted babesiosis (TTB). We summarize 8 years of the epidemiology of TTB and highlight the role of public health in prevention and control. STUDY DESIGN AND METHODS Cases of babesiosis are routinely reported to the Massachusetts Department of Public Health. These are investigated to determine whether they meet the surveillance case definition and to identify whether they were potentially transfusion transmitted. Frequencies from 2009 to 2016 are described and incidence rates calculated using population denominators from the US census. Changes over time were analyzed using simple linear regression. RESULTS From 2009 to 2016, there were 2578 cases of babesiosis reported; of these, 45 (1.7%) were transfusion transmitted. Of the 45 cases of TTB, 15 (33%) received blood products from two or more suppliers. In 11 TTB cases, the Department of Public Health was notified first, who in turn notified the appropriate blood provider. In 2009, the crude rate of reported babesiosis was 1.2 per 100,000 population and increased significantly through 2016 to 7.8 per 100,000 population (p = 0.006). The number of blood donors reported with laboratory evidence of B. microti infection increased from 19 in 2012 to 78 in 2016; at the same time, the number of TTB cases decreased from six to three. CONCLUSION TTB remains a major challenge, and blood donor screening strategies are currently in the process of implementation. While population and environmental changes facilitate increases in babesiosis, donor screening has the potential to eliminate TTB.

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Section: Discussionsupporting

confidence: 87%

Transfusion‐transmitted babesiosis: one state's experience

et al. 2018

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“…It also concluded that blood donation screening for antibodies to and DNA from B. microti was associated with an absence of TTB. In addition, the frequency of donations from donors in the antibody‐negative window period and associated infectivity, as well as the expanding range of Babesia as determined by infected ticks, community‐acquired cases, and TTB cases have been recently reported …”

Section: Assessing the Risk And Risk Management Options (Rbdm Stage 4)mentioning

confidence: 99%

“…While this option lowers the cost of testing because it results in fewer units tested, the difficulty in identifying all patients at risk for severe disease is of concern; those at highest risk usually can be identified but most transfusion services prefer a uniform strategy. Ethical concern was raised with “underselecting” at‐risk patients to receive screened units.…”

Section: Evaluation Of Options a Through E (Category 1: Mitigate Tranmentioning

confidence: 99%

Assessing the risk of Babesia to the United States blood supply using a risk‐based decision‐making approach: Report of AABB's Ad Hoc Babesia Policy Working Group (original report)

2018

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Recognizing the increasing threat of transfusion-transmitted babesiosis to the US blood supply, the AABB Board of Directors tasked an Ad Hoc Babesia Policy Working Group (the Working Group) to use the Alliance of Blood Operators' risk-based decision-making (RBDM) framework to assess the risks and benefits of introducing Babesia donation testing in the United States. The regional nature of the Babesia microti risk added complexity to the RBDM assessment because of the unique operational and financial considerations for operators and hospitals located in endemic states. Therefore, the assessment considered safety, product availability, sector sustainability, and technology availability. After assessing safety risk, economic and operational impact, reimbursement equity, ethical considerations, and stakeholder feedback from two consultations, the Working Group concluded that a regional approach to donor screening in endemic states was appropriate because it applied the intervention where the risk was highest and appropriately allocated cost to the risk. Nucleic acid testing using a ribosomal RNA template was the recommended intervention because it was the most cost-effective, resulted in no wasted units, and captured similar numbers of infections as antibody plus DNA-based polymerase chain reaction. The current model for blood reimbursement was maintained but AABB was encouraged to facilitate collection of data to identify threats to sector sustainability in endemic states. Babesia expansion was acknowledged with a mechanism to regularly reevaluate what are "endemic states." Finally, given that public awareness of the Babesia threat is the first line of defense, AABB should work with appropriate agencies for general education about the health risk from B. microti.

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“…The Babesia Report, taken in conjunction with the FDA Draft Guidance, highlights the lack of consensus around which states should be treated as Babesia ‐endemic or as Babesia ‐risk states . The known map of B. microti incidence is expanding . Clinical babesiosis cases have been reported in 49 states and transfusion‐transmitted babesiosis (TTB) cases in 22 states to date .…”

Section: Babesia Rbdm Reportmentioning

confidence: 99%

“…Clinical babesiosis cases have been reported in 49 states and transfusion‐transmitted babesiosis (TTB) cases in 22 states to date . Ticks carrying B. microti have been detected in states currently considered nonendemic, such as Alabama, Arkansas, Indiana, and Mississippi, and there is a correlation between tick and human disease . The states identified in the Babesia Report and FDA Draft Guidance are different.…”

Section: Babesia Rbdm Reportmentioning

confidence: 99%