Ross River virus (RRV)

Status: 
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Record number: 
1709
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
This is the first case reported. Frequency is estimated as very rare. Ross River virus (RRV) is only found in Australia (primarily) and Papua New Guinea. The EUFRAT model estimated the risk of infection in donors as one in 95 039 (one in 311 328 to one in 32 399) to one in 14 943 (one in 48 593 to one in 5094). The point estimate for collecting a RRV viraemic donation varied from one in 166 486 (one in 659 078 to one in 49 158) (annualized national risk) to one in 26 117 (one in 103 628 to one in 7729) (area of high transmission). The modelling predicted 8-11 RRV-infected labile blood components issued in Australia during a 1-year period.
Time to detection: 
The donor developed symptoms of infection 2 days after blood donation in March 2014. The RRV infection was diagnosed serologically 10 days after donation. Blood centre was informed by a donor approximately 2 months after the donation.
Alerting signals, symptoms, evidence of occurrence: 
The donor had developed fatigue and arthralgia 2 days after giving blood. The recipient was having regular blood transfusions due to myelodysplastic syndrome which was associated with chronic fatigue and joint pains. The recipient reported worsening symptoms in the months after the transfusion of the infected blood; however, there was not a clear exacerbation of these symptoms consistent with the incubation period of RRV.
Demonstration of imputability or root cause: 
The donor developed an illness clinically compatible with RRV infection 2 days after donating blood and was shown to have a serological profile consistent with acute RRV infection 10 days after donating. The donated blood was subsequently shown to contain RRV RNA by two in-house RT-PCR tests, and this was confirmed by sequencing. While the exacerbation of the chronically ill recipient’s fatigue and muscle and joint pains was not clearly consistent with the incubation period of RRV subsequent to the transfusion, the results of RRV serological tests performed about 2 months after transfusion were consistent with infection within this 2-month period. There were no stored blood specimens collected from the recipient shortly after receiving the blood donation, and hence it was not possible to compare sequences with the donor virus to confirm transmission. Surveillance by the WA Department of Health showed that the recipient was the only person for whom RRV infection was reported between 1 July 2013 and 30 June 2014 from the local government area in which she resided. The recipient also spent most of her time indoors and could not recall being bitten by mosquitoes. Taken together, these lines of evidence strongly support the likelihood that the recipient’s RRV infection was transmitted by transfusion.
Imputability grade: 
2 Probable
Suggest new keywords: 
Ross River Virus
Reference attachment: 
Suggest references: 
First reported case of transfusion-transmitted Ross River virus infection. Hoad VC et al. Med J Aust. 2015 Mar 16;202(5):267-70. Seed CR, Hoad VC, Faddy HM, Kiely P, Keller AJ, Pink J. Re-evaluating the residual risk of transfusion-transmitted Ross River virus infection. Vox Sang. 2016 May;110(4):317-23. doi: 10.1111/vox.12372. Epub 2016 Jan 8. PMID: 26748600.
Expert comments for publication: 
The case of transfusion transmission of RRV no longer appears to be only a theoretical risk. However, with the relatively low number of RRV notifications per year in the general population of Australia transfusion transmission of RRV is likely to remain a rare event.