West Nile virus blood transfusion‐related infection despite nucleic acid testing
- 2 December 2004
- journal article
- Published by Wiley in Transfusion
- Vol. 44 (12), 1695-1699
- https://doi.org/10.1111/j.0041-1132.2004.04130.x
Abstract
BACKGROUND: A case of West Nile virus (WNV) encephalitis associated with transfusion of blood that did not react when tested for WNV by minipool (MP) nucleic acid testing (NAT) is described. A Nebraska man developed clinical encephalitis 13 days after surgery and transfusion of 26 blood components. Antibody testing confirmed WNV infection. An investigation was initiated to determine the source of this infection. STUDY DESIGN AND METHODS: The patient's family members were interviewed to identify risk factors for WNV infection. Residual samples were retested for WNV RNA using transcription-mediated amplification (TMA) assay and two polymerase chain reaction (PCR) assays. Blood donors’ follow-up serum samples were collected. All samples were tested for WNV-specific immunoglobulin M antibodies. RESULTS: The patient's family denied recent mosquito exposure. The 20 blood components collected after July 2003 did not react when tested for WNV in a six-member MP-NAT at the time of donation. Retrospective individual testing identified one sample as WNV-reactive by the TMA assay and one of the PCR assays. Seroconversion was demonstrated in the donor associated with this sample. CONCLUSION: WNV RNA detection by individual donation NAT demonstrates viremic blood escaping MP-NAT and supports transfusion-related WNV transmission. MP-NAT may not detect all WNV-infected blood donors, allowing WNV transmission to continue at low levels. WNV NAT assays might vary in sensitivity and pooling donations could further impact test performance. Understanding MP NAT limitations can improve strategies to maintain safety of the blood supply in the United States.Keywords
This publication has 16 references indexed in Scilit:
- Transmission of West Nile Virus through Blood Transfusion in the United States in 2002New England Journal of Medicine, 2003
- West Nile virus infection transmitted by blood transfusionTransfusion, 2003
- The cost‐effectiveness of NAT for HIV, HCV, and HBV in whole‐blood donationsTransfusion, 2003
- US NAT yield: where are we after 2 years?Transfusion Medicine, 2002
- Emerging Infectious Agents: Do They Pose a Risk to the Safety of Transfused Blood and Blood Products?Clinical Infectious Diseases, 2002
- Clinical Findings of West Nile Virus Infection in Hospitalized Patients, New York and New Jersey, 2000Emerging Infectious Diseases, 2001
- Clinical Characteristics of the West Nile Fever Outbreak, Israel, 2000Emerging Infectious Diseases, 2001
- Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological surveyThe Lancet, 2001
- The Outbreak of West Nile Virus Infection in the New York City Area in 1999New England Journal of Medicine, 2001
- The Risk of Transfusion-Transmitted Viral InfectionsNew England Journal of Medicine, 1996