Status:
Ready to upload
Record number:
2313
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Half of the general population has been infected by late adolescence, with 70%–80% infected by adult life. Annual incidence in women of childbearing age is 1%–1.5% (may be higher in periodic outbreaks). The prevalence of B19V in blood donor populations ranges from 6% to 79.1% for IgG (92% in donors older than 61 years), from 0.72% to 7.53% for IgM, from 0.01% to 15.3% for IgM + IgG, and from 0% to 1.3% for B19V DNA (studies published between 1995 and 2014).
The transmission of the virus through blood transfusion is possible but rare, with only a few reported cases of TT B19V infection. The virus may have been transmitted more frequently, but the disease did not develop due to the presence of neutralising antibodies in transfusion recipients or a low viral load in the blood component. Only a few countries implemented universal screening of blood donations for B19V.
There are more reports of B19V transmission through plasma-derived medicinal products, since the virus is highly resistant to all commonly used inactivation methods, including heat and solvent/detergent (S/D) treatment, and is also difficult to remove by filtration because of its small size. Therefore, for the prevention of B19V transmission through PDMPs, each plasma for fractionation is routinely screened for NAT in single donations and mini-pools and multiple steps of viral inactivation and removal are incorporated into the fractionation process.
applied.
Time to detection:
Ranges from 11 days to one month after transfusion.
Alerting signals, symptoms, evidence of occurrence:
Alerting signals, symptoms, evidence of occurrence: Signs and symptoms developed between five days to three months after transfusion. Fever was the most commonly described symptom, occurring in four of the six cases described in detail in the three articles included in this entry. Skin manifestations -- either as a systemic eruption or disseminated erythema -- were also described. Other findings include red blood cell aplasia and pancytopenia. Seroconversion also occurred in seven of the ten cases described across the three articles, ranging from occurring 22 days to four months after transfusion. Parvovirus B19 DNA has been detected in all ten cases after transfusion.
Demonstration of imputability or root cause:
Donor blood products were tested for presence of Parvovirus B19 DNA through use of polymerase chain reaction (PCR) as well as testing for IgG and IgM. Seven of the 10 cases described in the three articles had sequencing performed on both donor and recipient specimen that revealed matching sequences, which proved transmission.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Fever of unknown origin
pancytopenia
red blood cell aplasia
fever of unknown origin, pancytopenia, red blood cell aplasia
Reference attachment:
Suggest references:
1) Symptomatic parvovirus B19 infection caused by blood component transfusion. Masahiro Satake, et al. TRANSFUSION 2011;51:1887-1895
2) Nagaharu K, et al. Persistent symptomatic parvovirus B19 infection with severe thrombocytopenia transmitted by red blood cell transfusion containing low parvovirus B19 DNA levels. Transfusion. 2017
Jun;57(6):1414-1418.
3) Yu M-yW, Alter HJ, Virata-Theimer MLA, Geng Y, Ma L, Schechterly CA, Colvin CA, Luban NLC. (2010). Parvovirus B19 infection transmitted by transfusion of red blood cells confirmed by molecular analysis of linked donor and recipient samples. Transfusion 50:1712-21.
Note:
MG: Record 1444 - we should add information from these papers to 1444; please open to editing and when we finish, we'll ask for this record to be removed/merged. NOTE: The Satake paper only has access to the abstract, the link to the PDF is not functional.
Record 1444 has ben opened for editing; Satake paper pdf has been attached (EP)
RNK - Please consider adding Platelets under MHO, as the case series does include a recipient of platelet transfusion. Please combine with entry 1444, as I have included the paper of 1444 in my analysis. (Done_EP)
Expert comments for publication:
The cases are presented from Japan and the United States, which, respectively, do and do not screen routinely for Parvovirus B19 in donor blood products. In Japan, donor blood was screened from 1998-2007 via receptor-mediated hemagglutination (RHA) assay for Parvovirus B19, before transitioning to chemiluminescence enzyme immunoassay–based screening assay in 2008. While using RHA testing, 300-400 donations were excluded per year due to the detection of Parvovirus B19. The United States does not screen donor blood, hence the frequency detected in the included study is much higher than that of Japan.
The reported cases of TT B19V suggest that NAT screening could reduce the transmission rate, but the extent of clinical disease is uncertain and potentially small. Thus, the benefits of screening are uncertain. However, outcomes of TT B19V could be severe in specific populations of transfused patients, who might benefit from B19V-screened components.