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Adverse Occurrence type:
Ninety-three cases of transfusion-transmitted malaria were reported from 1963 through 1999 by 28 states: 33 (35%) were due to P. falciparum, 25 (27%) were due to P. vivax, 25 (27%) were due to P. malariae, 5 (5%) were due to P. ovale, 3 (3%) were mixed infections, and 2 (2%) were due to unidentified species. Ten of the 93 patients (11%) died.
Time to detection:
1 - 180 days (median, 10)
Alerting signals, symptoms, evidence of occurrence:
Retrospective review of all cases of transfusion-transmitted malaria reported to the Centers for Disease Control and Prevention (CDC) from 1963 (the first year that complete records were available) through 1999. Information about the patients was obtained from reports of cases of malaria sent to the National Malaria Surveillance System at the CDC, which include information on demographic characteristics, date of the onset of illness, species responsible for the infection, history of travel or blood transfusion, type of antimalarial therapy, and outcome of the illness.
Demonstration of imputability or root cause:
There were a presumed 91 infective donors for the 93 patients. In 67 of the 91 episodes (74%), an infective donor could be identified: 48 of the 67 implicated donors were identified by serologic tests (72%), 7 by blood smear (10%), 10 by both serologic tests and blood smear (15%), and 2 by the sole-donor criterion (3%). Among the 70 patients for whom information was available, the infective component was whole blood in 63%, packed red cells in 31%, and platelets (which can transmit malaria because of contamination with residual red cells) in 6%.
Mungai, M., Tegtmeier, G., Chamberland, M. and Parise, M. (2001). Transfusion-transmitted malaria in the United States from 1963 through 1999. N Engl J Med 344(26): 1973-8.
Add the voice Blood/Type not specified to the MPHO taxonomy (Evi)
Expert comments for publication:
The examination of blood films is still the basis for diagnosing acute malaria, but this is not sufficiently sensitive for blood bank screening. In non-endemic countries, strategies to reduce risk of transmission include donor history in combination with discretionary testing for antimalarial immunoglobulin. In endemic countries, more specific donor questioning, consideration of seasonal variation and geographical distribution may help to identify the population of donors who are most likely to be infected.