1 / 12

Parvovirus B19 Transmission in Transfusion Recipients as Assessed in a Prospective Study (TRIPS)

Parvovirus B19 Transmission in Transfusion Recipients as Assessed in a Prospective Study (TRIPS). Yu MW, 1 Virata-Theimer ML, 1 Geng Y, 1 Schechterly CA, 2 Colvin CA, 3 Busch MP, 4 Alter HJ, 2 Luban NLC 3 1 CBER/FDA; 2 CC/NIH; 3 CNMC; 4 BSRI SoGAT XX, Warsaw, Poland 12-13 June 2007.

deron
Download Presentation

Parvovirus B19 Transmission in Transfusion Recipients as Assessed in a Prospective Study (TRIPS)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Parvovirus B19 Transmission in Transfusion Recipients as Assessed in a Prospective Study (TRIPS) Yu MW,1 Virata-Theimer ML,1 Geng Y,1 Schechterly CA,2 Colvin CA,3 Busch MP,4 Alter HJ,2 Luban NLC3 1CBER/FDA; 2CC/NIH; 3CNMC; 4BSRI SoGAT XX, Warsaw, Poland 12-13 June 2007

  2. TRIPSTransfusion Related Infections Prospectively Studied • A prospective study to investigate the transfusion risk of HIV, HBV, HCV, CMV, HHV-8, EBV, and parvovirus B19 by using both NAT and serological methods for detection in a cohort of transfusion recipients participating in a linked donor-recipient study

  3. Sample Testing for B19 Markers • Plasma or blood samples from 742 transfused patients enrolled between Nov 2001 and Nov 2006 were tested for: • B19 DNA, generally 4 and 8-wk post-transfusion (post-trn) samples by an in-house nested PCR (B19 DNA levels determined by limiting dilution) • Anti-B19 IgG, 12 and 24-wk post-trn samples by EIA (Biotrin) • If B19 DNA positive, • B19 DNA/anti-B19 IgM/anti-B19 IgG, pre-trn, post-trn, and associated donors’ plasma samples • DNA sequencing and phylogenetic analysis for causality assessment

  4. Blood and Blood Products Transfused in TRIPS • Cryoprecipitate • Platelets • Red Blood Cells (RBC) • Fresh Frozen Plasma • Frozen Deglycerolized RBC • Liquid Plasma • Stem Cells

  5. B19 DNA and Anti-B19 IgG in Recipients Post-Transfusion* Testing # Pos/ # Recipients Tested (%) B19 DNA 14/742 (1.9) Anti-B19 IgG 385/632 (60.9) * B19 DNA testing generally performed on 4 and 8 wk samples and anti-B19 IgG testing on 12 and 24 wk samples

  6. 14 B19 DNA Positive Recipients • 11 (78.6%) recipients already pos for B19 DNA @ pre-trn • 6 + for low-level B19 DNA (≤ 63 IU/mL) and IgG • 3 + for DNA (≤ 2 x 107 IU/mL), IgM, and IgG • 1 + for DNA (> 2 x 1010 IU/mL) and IgM • 1 + for DNA only (63 IU/mL) • 1 recipient neg for all B19 markers @ pre- trn but pos for all @ post-trn • 1 recipient neg for all B19 markers @ pre-trn but had not seroconverted @ post-trn [the 4-wk DNA+ sample presumably false +] • 1 recipient with pending pre-trn testing

  7. A B19 Infected Recipient After Transfusion Plasma B19 DNA Anti-B19 Testing (IU/mL) IgG IgM Pre-trn Neg* Neg Neg Post-trn: 2 wk 6 x 106 Neg Equiv 4 wk 20 Neg Neg 8 wk 630 Pos Pos 12 wk 140 Pos Pos 24 wk Neg Pos Neg * <20 IU/mL of B19 DNA

  8. B19 Marker Testing of Donations Received by the B19 Infected Recipient Donor Trn B19 DNA Anti-B19 No. Date (IU/mL) IgG (IU/mL) IgM 1 Day 0a NTb NT NT 2 0 Neg Neg Neg 3 2 Neg Pos (15) Neg 4 2 5 x 109 Neg Neg 5 4 Neg Pos (79) Neg 6 4 Neg Pos (28) Neg a RBC from 2 donors were transfused every other day starting on Day 0; 6 RBC units were used. b Not tested; sample not available

  9. Summary(I) • 1.9% (14/742) of transfusion recipients were parvovirus B19 DNA positive. • Majority (78.6%) of them were already infected with B19 before transfusion. • Only one seronegative recipient (0.1%, 1/742) was infected with B19 via transfusion. • The transmission case was confirmed by causality assessment based upon sequencing and phylogenetic analysis of the linked donor-recipient samples. • Both the donor and the recipient were infected with genotype 1 of B19.

  10. Summary(II) • The recipient was infected by receiving 1 unit of RBC having 5 x 109 IUof B19 DNA/mL plasma along with another 1 RBC unit positive for anti-B19 IgG (15 IU/mL plasma) within the same day and 2 other RBC units positive for anti-B19 IgG (79, 28 IU/mL) 2 days afterward. • Total infectious dose: 5 x 1010 IU of B19 DNA in the presence of anti-B19 IgG (150 or 1220 IU; presumably containing some B19 neutralizing antibodies) • Assuming 10 mL of residual plasma per unit of RBC • Assuming the RBC unit with no available sample was negative for all B19 markers

  11. Summary(III) • Transfusion transmission of B19 from an acutely infected donor to a susceptible recipient may not be a rare event. • Such a transmission might not have been detected without a prospective study.

More Related