WNV in Blood, Ramifications for Blood Donations (2)

[1] and [2] are responses to my Aug 3 request for additional
information about a Jul 23 AP news story about Hira Nakhasi's July
22-23 2004 briefing to the FDA Blood Products advisory committee
(Nakhasi is director of FDA's Division of Emerging and Transfusion
Transmitted Diseases) and/or an American Red Cross study he spoke
about, indicating that WNV can linger in the blood up to 49 days. [3]
is summary of a research article and editorial appearing in the New
England Journal of Medicine, Sept 2003. -- LCL, WNV-L Moderator

[1]
From: rlampman@inhs.uiuc.edu
Date: August 3, 2004

Report from Am. Assoc. Blood Banks.  You need to log on to read full
text
Hira Nakhasi, PhD, director of the Department of Emerging and
Transfusion-Transmitted Diseases in the Office of Blood Research and
Review,  Center for Biologics Evaluation and Research, said the
agency's thinking was  based on unpublished data collected during the
2003 epidemic by the American  Red Cross and Blood Systems
Laboratories, which showed that West Nile viremia  sometimes lingers
for 49 days

Richard L. Lampman, PhD
  Research Scientist
  Center for Ecological Entomology
  Illinois Natural History Survey
  Medical Entomology Program

  217-333-1186 (general)
  217-244-5631 (office)
  217-333-2359 (fax)

---------------------

[2]
From: srossman@giveblood.org
Date: August 6, 2004

You have probably already heard that Nakashi spoke at a BPAC meeting.
The transcript will be on the FDA Dockets section of the FDA website in
a few weeks probably. The FDA often does not release the slides they
present at these meetings. He has spoken about WNV at many FDA
meetings before, and those are on the web.
I am not sure if the Red Cross info has been published, though I've
heard it from several sources.

Susan N. Rossmann, M.D., Ph.D.
Medical Director
Gulf Coast Regional Blood Center
1400 La Concha Lane
Houston TX 77054
Phone 713-791-6275
Fax 713-791-6603

----------

[3]
TRANSMISSION of WEST NILE VIRUS THROUGH BLOOD TRANSFUSION in the UNITED
STATES in 2002.
September 25, 2003. New England Journal of Medicine 349 (13):1236-1245.

Lisa N. Pealer, Ph.D., Anthony A. Marfin, M.D., M.P.H., Lyle R.
Petersen, M.D., M.P.H., Robert S. Lanciotti, Ph.D., Peter L. Page,
M.D., Susan L. Stramer, Ph.D., Mary Grace Stobierski, D.V.M., M.P.H.,
Kimberly Signs, D.V.M., Bruce Newman, M.D., Hema Kapoor, M.D., Jesse L.
Goodman, M.D., M.P.H., Mary E. Chamberland, M.D., M.P.H., for the West
Nile Virus Transmission Investigation Team

BACKGROUND: During the 2002 West Nile virus epidemic in the United
States, patients were identified whose West Nile virus illness was
temporally associated with the receipt of transfused blood and blood
components.

METHODS: Patients with laboratory evidence of recent West Nile virus
infection within four weeks after receipt of a blood component from a
donor with viremia were considered to have a confirmed
transfusion-related infection. We interviewed the donors of these
components, asking them whether they had had symptoms compatible with
the presence of a viral illness before or after their donation; blood
specimens retained from the time of donation and collected at follow-up
were tested for West Nile virus.

RESULTS: Twenty-three patients were confirmed to have acquired West
Nile virus through transfused leukoreduced and nonleukoreduced red
cells, platelets, or fresh-frozen plasma. Of the 23 recipients, 10 (43
percent) were immunocompromised owing to transplantation or cancer and
8 (35 percent) were at least 70 years of age. Immunocompromised
recipients tended to have longer incubation periods than
nonimmunocompromised recipients and infected persons in mosquito-borne
community outbreaks. Sixteen donors with evidence of viremia at
donation were linked to the 23 infected recipients; of these donors, 9
reported viral symptoms before or after donation, 5 were asymptomatic,
and 2 were lost to follow-up. Fever, new rash, and painful eyes were
independently associated with being an implicated donor with viremia
rather than a donor without viremia. All 16 donors were negative for
West Nile virus-specific IgM antibody at donation.

CONCLUSIONS: Transfused red cells, platelets, and fresh-frozen plasma
can transmit West Nile virus. Screening of potential donors with the
use of nucleic acid-based assays for West Nile virus may reduce this
risk.

SOURCES: From the Epidemic Intelligence Service, Division of Applied
Public Health Training, Epidemiology Program Office (L.N.P.), and the
Division of Viral and Rickettsial Diseases, National Center for
Infectious Diseases (M.E.C.), Centers for Disease Control and
Prevention (CDC), Atlanta; the Division of Vector-Borne Infectious
Diseases, National Center for Infectious Diseases, CDC, Fort Collins,
Colo. (A.A.M., L.R.P., R.S.L.); the American Red Cross Blood Services,
Biomedical Headquarters, Washington, D.C. (P.L.P.); the American Red
Cross Blood Services, Scientific Support Office, Gaithersburg, Md.
(S.L.S.); the Michigan Department of Community Health (M.G.S., K.S.)
and Bureau of Laboratories, Michigan Department of Community Health
(H.K.), Lansing; the American Red Cross Blood Services, Southeastern
Michigan, Detroit (B.N.); and the Food and Drug Administration, Center
for Biologics Evaluation and Research, Rockville, Md. (J.L.G.).

This article was published at www.nejm.org on September 18, 2003.

REPRINTS: Address reprint requests to Dr. Pealer at the Centers for
Disease Control and Prevention, 1600 Clifton Rd., D-18, Atlanta, GA
30333, or at lpealer@cdc.gov.

BLOOD TRANSFUSIONS

Perspective: Emerging Infections, Transfusion Safety, and Epidemiology.
  R.Y. Dodd
<http://content.nejm.org/cgi/content/short/349/13/1205?query=TOC>

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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Environmental Risk Analysis Program (ERAP)
Department of Communication
213 Rice Hall, Cornell University
Ithaca, New York USA 14853-5601

Phone: (607) 255-4765 Fax: (607) 255-0238
Email: LCL3@cornell.edu
Web: http://environmentalrisk.cornell.edu
Received on Fri Aug 6 13:01:57 2004