What is the best strategy for the prevention of transfusion-transmitted malaria in sub-Saharan African countries where malaria is endemic?

Abstract

The transmission of malaria by blood transfusion was one of the first recorded incidents of transfusion-transmitted infections (TTIs). Although the World Health Organization (WHO) recommends that blood for transfusion should be screened for TTIs, malaria screening is not performed in most malaria-endemic countries in sub-Saharan Africa (SSA). The transfusion of infected red blood cells may lead to severe post-transfusion clinical manifestations of malaria, which could be rapidly fatal. Ensuring that blood supply in endemic countries is free from malaria is highly problematical, as most of the donors may potentially harbour low levels of malaria parasites. Pre-transfusion screening within endemic settings has been identified as a cost-effective option for prevention of transfusion-transmitted malaria (TTM). But currently, there is no screening method that is practical, affordable and suitably sensitive for use by blood banks in SSA. Even if this method was available, rejection of malaria-positive donors would considerably jeopardize the blood supply and increase morbidity and mortality, especially among pregnant women and children who top the scale of blood transfusion users in SSA. In this context, the systematic prophylaxis of recipients with anti-malarials could constitute a good alternative, as it prevents any deferral of donor units as well as the occurrence of TTM. With the on-going programme, namely the Affordable Medicine Facility - Malaria, there is an increase in the availability of low-priced artemisinin-based combination therapy that can be used for systematic prophylaxis. It appears nonetheless an urgent need to conduct cost-benefit studies in order to evaluate each of the TTM preventive methods. This approach could permit the design and implementation of an evidence-based measure of TTM prevention in SSA, advocating thereby its widespread use in the region.

Residual risk of transfusion-transmitted malaria infection in a malaria endemic sub-Saharan African setting

“…Which of the 1st or the 2nd strategies is the most cost-effective to lessen the risk of TTM in sub-Saharan Africa? Some possible answers are presented in the review by Nansseu et al [62]. In either case, there is an urgent need to conduct cost-benefit studies to evaluate each of these two TTM preventive methods.…”

Blood donors screening for malaria in non-endemic area in the Kingdom of Saudi Arabia: Is it necessary to introduce immunological testing?

“…Cases of TTM with negative microscopic examination and positive high antibody titer have been recorded in the literature (23–27). Although there has been some debate over the most effective strategy for the prevention of TTM, donor deferral plus malarial antibody screening provides the most effective strategy in non-endemic countries (28–30). In our study, we used a large sample size of 180,000 from healthy blood donors in the central area of KSA.…”

Towards a safe and sufficient blood supply in Sub‐Saharan Africa

“…Unfortunately, at present, there is no screening test that is suitably sensitive, practical and affordable for use in healthy donors in endemic regions (reviewed [30]). Also, the use of malaria prophylaxis following blood transfusion has not been widely adopted, perhaps because of cost and other practical considerations but also because of concerns about the development of drug resistance and the lack of an evidencebase upon which to base decisions [29,30]. Bacterial testing of whole blood or blood components is not performed in most SSA countries, not even for quality control of production processes.…”