Transfusion‐transmitted babesiosis: one state's experience

Abstract

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.

Characteristics of transfusion‐transmitted Babesia microti, American Red Cross 2010‐2017

“…Although the possibility of transfusion‐transmitted infection is very low, the blood supply remains at risk of contamination with known and emerging pathogens. B. microti is currently the most common, if not the only endemic parasite transmitted by blood transfusion in the United States, and the 77 cases discussed in this article add to more than 200 already reported . Both the number of reported TTB cases and naturally‐acquired babesiosis infections have increased in the last two decades, and contributing factors include the geographic expansion of the primary tick vector, and the increased awareness and recognition of the disease in endemic areas …”

Detection and Transstadial Passage of Babesia Species and Borrelia burgdorferi Sensu Lato in Ticks Collected from Avian and Mammalian Hosts in Canada

“…Pathologically, this piroplasm lives and multiples in erythrocytes, and is typically transmitted by ixodid ticks. Alternately, this intraerythrocytic hemoparasite can also be transmitted by blood transfusion [101][102][103][104] and transplacental passage [105][106][107][108]. When sporozoites invade red blood cells, symptoms range from a silent, subclinical infection to a fulminant, malaria-like disease that can result in death [6,57,[60][61][62]95,96].…”

Emerging Human Babesiosis with “Ground Zero” in North America

“…The fourth factor is transfusion transmission. From 2009 to 2016 in Massachusetts alone 45 of 2578 (1.7%) were transmitted by transfusion [82]. The last, but not least, factor is vertical transmission from an infected mother to her offspring [83].…”