Dengue Fever and Blood Transfusion


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In this presentation we provide the evidence that dengue fever is transmissible through blood transfusions. A discussion can be found at The Brazilian Blood Journal.

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Dengue Fever and Blood Transfusion

  1. 1. Global Warming Dengue Fever & Blood Transfusion E s t a c i o F e r r e i r a R a m o s, M.D. e s t a c i o . r a m o s @ g m a i l . c o m © Copyright, 2007, 2009
  2. 2. E s t a c i o F e r r e i r a R a m o s, M.D. e s t a c i o . r a m o s @ g m a i l . c o m © Copyright, 2007, 2009 Global Warming Population Growth Dengue Fever & Blood Transfusion
  3. 3. South American Population & Distribution
  4. 4. <ul><li>Urban Viral Disease </li></ul><ul><li>Arthropod-Borne </li></ul><ul><li>Epidemic, Pandemic </li></ul><ul><li>Tropical & Subtropical World </li></ul><ul><li>Potentially Fatal </li></ul><ul><li>No Vaccine Available </li></ul>Dengue Essentials
  5. 5. <ul><li>Dengue Virus </li></ul><ul><li> </li></ul><ul><li>RNA Virus </li></ul><ul><li>flaviviridae family </li></ul><ul><li>4 strains </li></ul><ul><li>Den1, Den2, Den3, Den4 </li></ul>
  6. 6. <ul><li>Vectors: </li></ul><ul><li> </li></ul><ul><li>aedes aegypti </li></ul><ul><li>aedes albopictus </li></ul><ul><li>Active Domestic Breeders </li></ul><ul><li>Tenacious Urban Hunters </li></ul>
  7. 7. Dengue in World 100 million infections year 250 thousand hemorrhagic fever 25 thousand deaths. 2.7 billion people at risk Incidence has quadrupled since 1985 - WHO, 2006 Murray et al. (2002) Medical Microbiology. 4th edition. St. Louis: Mosby. Pages 561-564 ■ DENGUE ■ VECTORS ONLY
  8. 10. Dengue Cases Reported World Health Organization 1955 – 2005 Ave. annual no. cases
  9. 11. Vectors –The Americas 1970 2006
  10. 12. August 12th, 2007 posted by Kelly Burkholder-Allen August 12, 2007 @ 9:55 am According to the CDC, the Rio Grande Valley is at risk for dengue fever CDC warns of increased risk of dengue fever in RGV By MELISSA McEVER - The Brownsville Herald Catching dengue fever is a real risk… local health officials should be on the lookout for its symptoms, according to a new report from the CDC. The region is seeing more cases of dengue and hemorrhagic fever, a life-threatening complication of the mosquito-borne virus, than in past. In 2005, Officials reported a large-scale dengue outbreak that included 223 cases of hemorrhagic fever, and that same year 24 dengue cases were reported in Cameron County – including a Brownsville woman who became seriously ill. In an outbreak investigation, the CDC and officials from the Texas Health Services found that the woman and two other Cameron County residents, had contracted dengue fever locally rather than in Mexico. That finding was surprising, because most dengue cases are imported from other countries, officials said . “These were the first cases that were locally acquired,” said Dr. Brian Smith, regional director for the Texas Health Services’ Region 11, which includes the Valley. The findings suggest that dengue’s reach is growing beyond its usual borders…
  11. 14. <ul><li>Faster Reproduction </li></ul><ul><li>Better Adaptation </li></ul><ul><li>Resistant to Pesticides </li></ul><ul><li>Invading New Urban Areas </li></ul><ul><li>Victimizing New Populations </li></ul><ul><li>More Efficient Virus Spread </li></ul>Vectors & Global Warm ing
  12. 15. <ul><li>Shorter Cycles in Vectors </li></ul><ul><li>Faster Adaptation </li></ul><ul><li>Carriers: Travelers & Migrants </li></ul><ul><li>Increasing Virulence </li></ul><ul><li>More Outbreaks </li></ul><ul><li>Hyperepidemics, Pandemics </li></ul>Virus & Global Warm ing
  13. 16. <ul><li>Blood Transfusion </li></ul><ul><li>Needlestick </li></ul><ul><li>Intrapartum </li></ul><ul><li>Bone Marrow Transplantation </li></ul><ul><li>Mucosal Exposure to Blood </li></ul> Non-Vector Dengue Infection
  14. 17. First Documented Case Transfusion Transmitted Dengue Virus Infection. Rapid Detection and Typing of Dengue Virus from Clinical Samples by RNA-PCR. Lanciotti RS, Calisher CH, Gubler DJ, Chang GJ and Vorndam AD. JCM 1992; 30: 545-51 C. K. Lin – Hong Kong St. Mary Hospital Red Cross Blood Transfusion Service, 1992
  15. 18. Estimated risk of transmission of dengue virus through blood transfusion in Puerto Rico. Beatty ME, Biggerstaff B, Rigau J, Petersen L. (#126). At 5th International Conference on Emerging Infectious Diseases. Atlanta, GA. March 19-22, 2006.
  16. 19. Dengue Infection Through Blood Transfusion <ul><li>Danger – It Happens </li></ul><ul><li>Growing Problem </li></ul><ul><li>Near Future Major Concern </li></ul><ul><li>Not Monitored </li></ul><ul><li>Prevention Needed Now </li></ul>
  17. 20. Dengue Infection by Blood Transfusion Real Risk: 1:1000 Risk will vary worldwide depending on endemicity (Brazil, 2.4 million blood collections/year)
  18. 21. Approach: All Donated Blood at Dengue Endemic Regions Must be Tested for Dengue NS1 Antigen.
  19. 22. <ul><li>“ primo non nocere” </li></ul>Hipocrates (430 – 370 A.C.)
  20. 23. <ul><li>Patients & Families </li></ul><ul><li>The Environment </li></ul><ul><li>Healthcare Workers </li></ul><ul><li>Blood Banks & Hospitals </li></ul><ul><li>Healthcare Systems </li></ul><ul><li>Communities (surveillance) </li></ul>To Protect
  21. 24. Web to Goal: Information <ul><li>International Task Group </li></ul><ul><li>World Health Organization </li></ul><ul><li>Blood Transfusion Societies </li></ul><ul><li>Promote Medical Education </li></ul><ul><li>Inform Communities </li></ul><ul><li>Reach Governments & Politicians </li></ul>
  22. 25. NS1 Antigen EIA Screening <ul><li>Low Cost </li></ul><ul><li>Easy to Perform </li></ul><ul><li>Automation Compatible </li></ul><ul><li>Technology Already in Blood Banks Worldwide </li></ul><ul><li>Cost-Effective vs NAT 2 </li></ul><ul><li> Nucleic Acid Testing - Dengue RNA RT-PCR 2 </li></ul>
  23. 26. NS1 Antigen EIA Screening <ul><li>Integrates to Blood Banks Laboratory Routines </li></ul><ul><li>Specificity: 100% (or close) </li></ul><ul><li>Highly Sensitive </li></ul><ul><li>Detects Potential Risk </li></ul><ul><li>Almost Closes Infectivity </li></ul><ul><li>Window </li></ul>
  24. 27. <ul><li>Blood Donors must be oriented to inform febrile states occurring up to two weeks after donation. </li></ul><ul><li>NS1 Antigen and/or RT-PCR for Dengue Virus RNA must be performed on all blood donors at endemic regions. </li></ul><ul><li>Medical Education Programs must address the possibility of Transfusion Transmitted Dengue Virus. </li></ul>
  25. 28. Estacio Ferreira Ramos, M.D. Blood Banker, Hematologist Pathologist Carlos Carl Ehrich Medical Research Salvador, Bahia - Brazil [email_address] Skype: esfera2k Mobile: +55(71) 9956-0635 Hospital Portugues Blood Bank +55(71)3203-5555 Scientific Director UMA – Universidade da Mata Atlântica Representative in Brazil, Worldwatch Institute
  26. 29. References Gubler DJ. The global emergence/resurgence of arboviral diseases as public health problems. Arch Med Res. 2002;33:330-42. Pan American Health Organization. 2005: Number of reported cases of dengue & dengue hemorrhagic fever (DHF), Region of the Americas (by country And subregion). cases-2005.htm Kouri GP, Guzman MG, Bravo JR, Triana C. Dengue haemorrhagic fever/dengue shock syndrome: lessons from the Cuban epidemic, 1981. Bull World Health Organ. 1989;67:375-80. Pan American Health Organization. Dengue hemorrhagic fever in Venezuela Epidemiol Bull. 1990;11:7-9. CDC. Dengue–Texas. MMWR Morbid Mortal Wkly Rep. 1980;29:451. Lacayo M, Taylor R, Duran H, Abell A, et al. Outbreak investigation of dengue. Texas, 2005 (Late-breaker). 54th Annual Meeting: American Society of Tropical Medicine and Hygiene. Washington, DC, December, 2005.
  27. 30. <ul><li>CDC. Travel-associated dengue —United States, 2005. MMWR Morbid Mortal </li></ul><ul><li>Wkly Rep. 2006;55:22:700-2. </li></ul><ul><li>Trofa AF, DeFraites RF, Smoak BL, Kanesathasan N, King AD, Burrous JM, et al. </li></ul><ul><li>Dengue fever in US military personnel in Haiti. JAMA. 1997;277:1546-8. </li></ul><ul><li>Smith CE, Tom Tammy, Sasaki J, Ayers T, Effler PV. Dengue risk among visitors to </li></ul><ul><li>Hawaii during an outbreak. Emerg. Infect. Dis. 2005;11:750-66. </li></ul><ul><li>Rigau-Pérez JG, Clark GC, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV. Dengue </li></ul><ul><li>and dengue haemorrhagic fever. Lancet. 1998;352:971-7. </li></ul><ul><li>Fernandez R, Rodriguez T, Borbonet F, Vasquez S, Guzman M, Kouri G. Estudio de </li></ul><ul><li>la relacion dengue-embarazo en un grupo de madres cubanas. Rev Cubana Med </li></ul><ul><li>Trop. 1994;46:76–8. </li></ul><ul><li>Beatty ME, Biggerstaff B, Rigau J, Petersen L. Estimated risk of transmission of dengue virus through blood transfusion in Puerto Rico (#126). At 5th International Conference on Emerging Infectious Diseases. Atlanta, GA. March 19-22, 2006. </li></ul>