The Risk of Transfusion-Transmitted Viral Infections

doi:10.1056/NEJM199606273342601

Volume 334:1685-1690		June 27, 1996		Number 26

The Risk of Transfusion-Transmitted Viral Infections

George B. Schreiber, D.Sc., Michael P. Busch, M.D., Ph.D., Steven H. Kleinman, M.D., James J. Korelitz, Ph.D., for The Retrovirus Epidemiology Donor Study

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ABSTRACT

Background Accurate estimates of the risk of transfusion-transmittedinfectious disease are essential for monitoring the safety ofthe blood supply and evaluating the potential effect of newscreening tests. We estimated the risk of transmitting the humanimmunodeficiency virus (HIV), the human T-cell lymphotropicvirus (HTLV), the hepatitis C virus (HCV), and the hepatitisB virus (HBV) from screened blood units donated during the windowperiod following a recent, undetected infection.

Methods Using data on 586,507 persons who each donated bloodmore than once between 1991 and 1993 at five blood centers (fora total of 2,318,356 allogeneic blood donations), we calculatedthe incidence rates of seroconversion among those whose donationspassed all the screening tests used. We adjusted these ratesfor the estimated duration of the infectious window period foreach virus. We then estimated the further reductions in riskthat would result from the use of new and more sensitive viral-antigenor nucleic acid screening tests.

Results Among donors whose units passed all screening tests,the risks of giving blood during an infectious window periodwere estimated as follows: for HIV, 1 in 493,000 (95 percentconfidence interval, 202,000 to 2,778,000); for HTLV, 1 in 641,000(256,000 to 2,000,000); for HCV, 1 in 103,000 (28,000 to 288,000);and for HBV, 1 in 63,000 (31,000 to 147,000). HBV and HCV accountedfor 88 percent of the aggregate risk of 1 in 34,000. New screeningtests that shorten the window periods for the four viruses shouldreduce the risks by 27 to 72 percent.

Conclusions The risk of transmitting HIV, HTLV, HCV, or HBVinfection by the transfusion of screened blood is very small,and new screening tests will reduce the risk even further.

Source Information

From Westat, Inc., Rockville, Md. (G.B.S., J.J.K.); Irwin Memorial Blood Centers and the University of California, San Francisco (M.P.B.); and the UCLA Blood and Platelet Center, Los Angeles (S.H.K.).

Address reprint requests to Dr. Schreiber at Westat, Inc., 1650 Research Blvd., Rockville, MD 20850.

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N Engl J Med 1996; 335:1609-1610, Nov 21, 1996. Correspondence

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