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Alerting signals, symptoms, evidence of occurrence:
Barjas-Castro et al describe a case of a 54 year old male, repeat blood donor (Sao Paulo state, Brazil, 2015) reported febrile illness (fever, malaise and headaches) 3 days post donation. Serum sample collected 6 days post donation was negative for dengue IgM (MAC-EIA) and flavivirus haemmuglutination-inhibition (HI) antibodies, as well as RT-PCR. The archive donation was positive for ZKV by PCR. RBC and FFP had not been issued by the time of the notification, but platelet had been used to make a platelet pool which had been transfused intra-operatively to a liver transplant recipient. Recipient was evaluated on day +4 post-transplant, when their serum sample was negative for dengue IgM by EIA and positive for ZKV by PCR and virus isolation; haemagglutination inhibiton for flavivirus antibody was also positive. During the surgical procedure, the liver recipient had also received 12 FFP units, 1 RBC unit, and 1 bottle of20% human albumin. No symptomatology or laboratory alterations were described for this recipient. The second paper by Motta et describes an apheresis platelet donation, used to manufacture 2 units of leukodepleted and irradiated (25 Gy) platelets. Five days post donation, the donor reported a 2 days illness of cutaneous rash, retro-orbital pain, and pain in both knees. Two samples that were obtained from the donor before and after donation were negative for chikungunya virus (CHIKV) and dengue virus (DENV) by RT-PCR, but the index plasma and urine samples 14 days later were positive for ZIKV. Serologic analysis by means of point-of-care testing, in-house indirect immunofluorescence assay (IFA), and plaque-reduction neutralization testing (PRNT) confirmed the presence of acute ZIKV infection in the donor. The first recipient (Patient 1) was a 54-year-old woman with the primary myelofibrosis syndrome. The second recipient (Patient 2) was a 14-year-old girl with acute myeloid leukemia who had undergone haploidentical bone marrow transplantation; neither had any symptoms of ZIKV and the authors did not describe any laboratory results.
Demonstration of imputability or root cause:
Ten partial nucleotide sequences from the donor’s ZIKV strain, with lengths ranging from173 to 427 base pairs for each fragment, were aligned with the complete genome of the recipient’s strain. These analyses revealed 99.8% homology in the aligned regions of the two strains. The authors do not describe if the retrospective analysis included all 12 FFP and 1 RBC units transfused to the recipient. They conclude that the high degree of sequence homology is consistent with the likelihood of transfusion-associated transmission of ZIKV, because there was no ongoing transmission of ZIKV in the region where the donor lived and where the transfusion ocurred. The origin of the donor’s infection was not explored. The second report involved two recipients from a common donor; two samples obtained from the donor before and after donation were negative for chikungunya virus (CHIKV) and dengue virus (DENV) by RT-PCR, but the index plasma and urine samples 14 days later were positive for ZIKV. Serologic analysis by means of point-of-care testing, in-house indirect immunofluorescence assay (IFA), and plaque-reduction neutralization testing (PRNT) confirmed the presence of acute ZIKV infection in the donor. Routine pretransfusion samples from the two patients were negative on PCR assay for CHIKV, DENV, and ZIKV, but samples collected 6 days after platelet transfusion in Patient 1 and 23 to 51 days after platelet transfusion in Patient 2 were positive for ZIKV on PCR assay. Molecular sequencing and phylogenetic analysis of ZIKV RNA revealed nucleotide changes in the envelope gene (codons 11 and 186) shared only by the donor and platelet recipients when compared to all available isolates from Brazil (GenBank accession numbers, KX173840, KX173841, KX173842, and KX173844). Against a backdrop of a high degree of conservation (>99% nucleotide identity) of ZIKV isolates in the Western Hemisphere, the possibility of a single spatiotemporal cluster of mosquito-acquired cases was further undermined by the fact that Patient 2 lived 200 km away from Rio de Janeiro, where blood was collected and transfused.
Suggest new keywords:
plaque-reduction neutralization testing
acute myeloid leukemia
1) Probable transfusion-transmitted Zika virus in Brazil. Maria L. Barjas-Castro et al. TRANSFUSION 2016;00;00–00 2) Evidence for Transmission of Zika Virus by Platelet Transfusion. Motta IJ, Spencer BR, Cordeiro da Silva SG, Arruda MB et al. N Engl J Med. 2016 Aug 17.
add zika in the virus list: Harm to a Recipient => Infection => Viral => Zika virus (ZIKV) (EP)
Expert comments for publication:
These cases emphasize the importance of postdonation information and its utility, particularly when collecting blood donations in areas with active transmission of a potential transfusion-transmissible pathogen. Critical analysis of sequence data, with inclusion of unrelated background sequences is very important in the interpretation of sequence relatedness, particularly when looking for molecular evidence of transmission events. Regardless of source of infection, these two papers describe Zika infection in 3 patients with varying degrees of immunocompromise and absence of increased morbidity. It is not possible to infer from the limited available data so far, the frequency of these transmission events and the effect of ZIKV infection in this group of patients.