We need to talk more about transfusion-transmitted malaria in Plasmodium vivax endemic areas

Alternative transmission routes in the malaria elimination era: an overview of transfusion-transmitted malaria in the Americas

“…International policies recommend that blood for transfusion should be screened for TT infections, including malaria [ 45 ], however these practices vary considerably between countries and regions. Furthermore, there has been a paucity of information concerning the distribution and potential role of different Plasmodium species in transfusion-related malaria cases, and the clinical impact of parasitaemic blood amongst patients with co-morbidities, which most of blood transfusion recipients present [ 19 ]. This analysis shows that malaria screening in blood services in the American continent is mainly based on the epidemiological history of the donor.…”

“…The wide variation in malaria prevalence in candidate donors from dissimilar endemic areas means that epidemiological and laboratorial screening policies need to be adapted locally. In Brazil, epidemiological screening is based on annual parasite index (API), an indicator not uniform throughout a spatial unit and with considerable changes over time [ 19 ]. Strikingly, this screening strategy does not consider that asymptomatic P. vivax or P. ovale relapses may occur even several months after the primary episode [ 46 ].…”

“…Cryptic P. malariae and P. falciparum infections [ 47 – 50 ] are also clearly related to TT malaria in non-endemic areas from asymptomatic individuals returning years after visiting or living in active transmission settings, as shown here for the Americas and previously in a review of TT P. falciparum infections in non-endemic countries in Europe and the Americas (Canada and the USA) [ 51 ]. In Latin America, malaria is becoming a disease of peri-urban areas, potentially leading to more donations from Plasmodium carriers [ 19 ].…”

“…Furthermore, as most malaria-infected blood donors are asymptomatic, both the use of clinical and epidemiological criteria as well as microscopy and rapid diagnostic tests (RDTs) are potentially insufficient for malaria screening. These asymptomatic infections characterized by low parasite densities require more sensitive methods for detection [ 19 ]. Although cases of TT malaria are assumed based on different criteria, transmission can only be proven definitely by genotyping.…”

Transmission of Plasmodium falciparum by red blood cell transfusions in the management of sickle cell disease patients in Mali

“…The potential use of Pf -infected blood units in malaria-endemic areas for SCD-affected patients raises an ethical issue which needs to be addressed by the scientific community. In a 2014 report from Brazil, only four cases of malaria transmission by transfusions were identified since 2002 (Lacerda et al, 2014).…”