Profile of blood donors with serologic tests reactive for the presence of syphilis in São Paulo, Brazil

BACKGROUND: Syphilis screening of blood donors is a common practice worldwide, but very little is known about the meaning of a positive serologic test for syphilis in blood donors and the risk profile of these donors. The aim of this study was to determine the demographic characteristics and risk behaviors of blood donors with recent and past syphilis and their implications for blood bank testing and deferral strategies.
STUDY DESIGN AND METHODS: Demographic characteristics, category of donation, number of previous donations, sexual behavior, and history of sexually transmitted diseases were reviewed comparing blood donors with recent and past syphilis from January 1, 1999, to December 31, 2003.
RESULTS: A total of 2439 interviews were reviewed, including 2161 (88.6%) donors with past and 278 (11.4%) with recent syphilis infection. Factors associated with recent infection included younger age (≤20 years odds ratio [OR], 36.5; 95% confidence interval [CI], 15.8-84.1), two previous donations (OR, 2.7; 95% CI, 1.9-3.9), male-male sex (homosexual OR, 8.2; 95% CI, 3.2-20.8; and bisexual OR, 11.4; 95% CI, 3.6-36.3), two or more partners in the past 12 months (OR, 2.3; 95% CI, 1.3-4.0), symptoms for syphilis (OR, 4.5; 95% CI, 2.8-7.1), and human immunodeficiency virus (HIV) seropositivity (OR, 39.6; 95% CI, 4.6-339.8). Community donors were also associated with recent syphilis infection (OR, 1.5; 95% CI, 1.2-1.9) compared to replacement donors.
CONCLUSION: Sexual history, including male-male sex and multiple partners, were strongly associated with recent syphilis infection, which in turn was strongly associated with HIV. Continuous and vigilant surveillance that includes assessing sexual history and other factors associated with syphilis are needed to guide blood safety policies.     

Interdonation intervals and patterns of return among blood donors in Brazil

BACKGROUND: In Brazil, most donations come from repeat donors, but there are little data on return behavior of donors. STUDY DESIGN AND METHODS: Donors who made at least one whole blood donation in 2007 were followed for 2 years using a large multicenter research database. Donation frequency, interdonation intervals, and their association with donor demographics, status, and type of donation were examined among three large blood centers in Brazil, two in the southeast and one in the northeast. RESULTS: In 2007, of 306,770 allogeneic donations, 38.9% came from 95,127 first‐time donors and 61.1% from 149,664 repeat donors. Through December 31, 2009, a total of 28.1% of first‐time donors and 56.5% of repeat donors had donated again. Overall, the median interdonation interval was approximately 6 months. Among men it was 182 and 171 days for first‐time and repeat donors, and among women, 212 and 200 days. Predictors of return behavior among first‐time donors were male sex (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.13‐1.20), community donation (OR, 2.26; 95% CI, 2.20‐2.33), and age 24 years or less (OR, 0.62‐0.89 for donors ≥25 years). Among repeat donors predictors were male sex (OR, 1.35; 95% CI, 1.32‐1.39), age 35 years or more (OR, 1.08‐1.18 vs. ≤24 years), and community donation (OR, 2.39; 95% CI, 2.33‐2.44). Differences in return by geographic region were evident with higher return rates in the northeast of Brazil. CONCLUSION: These data highlight the need to develop improved communication strategies for first‐time and replacement donors to convert them into repeat community donors.     

Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers

BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi‐square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T‐lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First‐time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in São Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in São Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2‐1.5), especially HIV (AOR, 1.9‐4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.     

The relative safety of automated two-unit red blood cell procedures and manual whole-blood collection in young donors

BACKGROUND: Automated red blood cell (RBC) apheresis offers the advantage of collecting 2 units of RBCs (2RBC) from one donation, but may expose donors to procedure-related risks. This study evaluated the relative safety of 2RBC compared to whole-blood (WB) donation with a focus on young donors.
STUDY DESIGN AND METHODS: Adverse reactions recorded at the collection site or requiring outside medical care were compared after 4,348,686 WB and 206,570 2RBC donations in 26 regional blood centers.
RESULTS: 2RBC donors were more likely than WB donors to be male (91.6% vs. 50.3%) and repeat donors (84.0% vs. 81.0%). The overall complication rate was higher for 2RBC than WB collections (627.9 vs. 435.1 per 10,000; odds ratio [OR], 1.44; 95% confidence interval [CI], 1.41-1.47), but more than 96% of all reactions were minor in severity. For donors younger than 20 years, adverse events were equally or less common after 2RBC than after WB donation, but were more common after 2RBC for donors 20 years or older. The rate of major systemic complications was significantly lower for 2RBC than WB donations in all age groups (10.2 vs. 14.3 per 10,000 collections; OR, 0.71; 95% CI, 0.62-0.82). Overall, the need for outside medical care was similar for 2RBC and WB collections (3.4 vs. 4.2 per 10,000 donations, respectively), but significantly less likely after 2RBC donation for donors less than 20 years old (3.8 vs. 7.0. per 10,000 donations; OR, 0.53; 95% CI, 0.32-0.89).
CONCLUSION: 2RBC collection procedures, as currently performed in the American Red Cross, are associated with fewer immediate adverse reactions in young donors and have a comparable safety profile in older donors. These data support the collection of 2RBC from young donors.     

Improved safety for young whole blood donors with new selection criteria for total estimated blood volume

BACKGROUND: Young age, first‐time donation status, and estimated blood volume (EBV) are leading determinants of syncopal complications after whole blood donation. We evaluated a multifaceted safety initiative and more restrictive selection criteria for whole blood donation by individuals younger than 19 years. STUDY DESIGN AND METHODS: Measures introduced over 2 years addressed donor education, drive environment and supervision, and new eligibility criteria for EBV of 3.5 L or more based on height, weight, and sex for individuals younger than 19 years. Presyncopal and syncopal reactions after whole blood donation during the school year in the baseline, transitional (2008), and full implementation (2009) periods were evaluated. RESULTS: Young donors (16‐ to 18‐years‐olds) gave 754,402 and 710,922 whole blood donations in the 2008 and 2009 school years accounting for 16% of the total collections in both 9‐month study periods. The new selection criteria were associated with a significant reduction in the reaction rates among 16‐ to 18‐year‐olds. Sixteen‐year‐old donors had the greatest decrease in 2009 compared to baseline for presyncopal reactions (10.5% vs. 7.3%; odds ratio [OR], 0.67; 95% confidence interval [CI], 0.65‐0.69) and syncope (43.1 vs. 37.1 per 10,000 donations; OR, 0.86; 95% CI, 0.77‐0.96). Donor subgroup analysis by sex, age, and donation status demonstrated that age‐related differences in reaction rates were eliminated in 2009. CONCLUSION: The safety initiative with new selection criteria for EBV led to decreased complications among donors 16 to 18 years old, such that the risk for 16‐year‐olds was no longer different from that observed for 19‐year‐olds in the analysis stratified by age, sex, and donation status.     

Prevalence of posterior subcapsular cataracts in volunteer cytapheresis donors

BACKGROUND: Granulocyte donors routinely receive dexamethasone orally before donation. Steroids may increase the risk of posterior subcapsular cataract (PSC) formation. STUDY DESIGN AND METHODS: We recruited 100 granulocyte donors (four or more granulocyte donations; any number of platelet [PLT] donations) and 100 age‐ and sex‐matched PLT donors (zero to three granulocyte donations, any number of PLT donations) to examine the risk of PSC. PSC was assessed by a masked ophthalmologist and reading center lens photograph gradings or medical record documentation of PSC as the reason for cataract extraction. RESULTS: Fourteen eyes of 10 granulocyte donors and five eyes of four PLT donors had PSCs (odds ratio [OR], 2.82; 95% confidence interval [CI], 0.83‐9.61; p = 0.10). Risk of PSC increased with number of granulocyte donations: compared to zero to three donations (4.0%), the risk for four to nine, 10 to 19, and 20 or more donations was 8.6% (OR, 2.25; 95% CI, 0.31‐13.99; p = 0.30), 9.5% (OR, 2.53; 95% CI, 0.44‐14.20; p = 0.21), and 13.0% (OR, 3.60; 95% CI, 0.48‐22.81; p = 0.11), respectively (p = 0.06 for trend). CONCLUSION: We did not demonstrate a statistically significant increased risk of PSC associated with granulocyte donation. However, although this makes a large risk unlikely, we cannot rule out a small to moderate risk and there is biologic plausibility that the steroid administration associated with granulocyte donation could be associated with PSC formation. Transfusion medicine professionals should advise granulocyte apheresis donors to maintain an appropriate frequency of eye examinations.     

The effectiveness of the confidential unit exclusion option

BACKGROUND: The confidential unit exclusion (CUE) option is intended to reduce human immunodeficiency virus (HIV) transmission by excluding donors newly infected with HIV who have not yet developed HIV antibody (window-period donors); however, its efficacy in excluding window- period donors has not been evaluated. STUDY DESIGN AND METHODS: The use of the CUE option was studied among the donors of 3.7 million units at 18 American Red Cross blood services regions during 1991 and 1992 and among 322 previously HIV-1-seronegative donors who subsequently donated a seropositive unit between 1987 and 1990 at 40 United States blood centers. These seroconverting donors had previously been shown to be highly likely to donate during their window period. RESULTS: On the basis of data from these two populations, it was estimated that only 3 to 5 percent of units donated by window-period donors were not transfused because of the CUE option, that 0.4 percent of all donations were from donors who confidentially excluded their blood from transfusion, and that donors who confidentially excluded their blood were 21 times more likely to be HIV antibody-positive than donors who did not use the CUE option. It is estimated that, if all US blood centers used the CUE option, a total of 2 to 17 otherwise acceptable units donated by window-period donors would not be transfused annually. CONCLUSION: Although donors who confidentially exclude their blood from transfusion are 21 times more likely to have HIV antibody, the rarity of window-period donors and the infrequency of confidential exclusion by window-period donors cause the CUE option to have minimal impact on transfusion safety.     

Adverse reactions and other factors that impact subsequent blood donation visits

BACKGROUND: The importance of adverse reactions in terms of donor safety recently has received significant attention, but their role in subsequent donation behavior has not been thoroughly investigated. STUDY DESIGN AND METHODS: Six REDS‐II blood centers provided data for this analysis. Summary minor and major adverse reaction categories were created. The influence of adverse reactions on donation was examined in two ways: Kaplan‐Meier curves were generated to determine the cumulative pattern of first return, and adjusted odds ratios (AORs) for demographic and other factors positively and negatively associated with return were estimated using multivariable logistic regression. RESULTS: Donors who had major reactions had longer times to return than donors with minor or no reactions. The AOR of returning for donors with major reactions was 0.32 (95% confidence interval [CI], 0.28‐0.37) and with minor reactions 0.59 (95% CI, 0.56‐0.62) when compared to donors who did not have reactions. Conversely, the most important factors positively associated with return were the number of donations in the previous year and increasing age. Subsequent return, whether a major, minor, or no reaction occurred, varied by blood center. Factors that are associated with the risk of having adverse reactions were not substantial influences on the return after adverse reactions. CONCLUSION: Having an adverse reaction leads to significantly lower odds of subsequent donation irrespective of previous donation history. Factors that have been associated with a greater risk of adverse reactions were not important positive or negative predictors of return after a reaction.     

Epidemiologic and laboratory findings from 3 years of testing United States blood donors for Trypanosoma cruzi

BACKGROUND: At most blood centers in the United States routine testing of donations for Trypanosoma cruzi using an enzyme‐linked immunosorbent assay (ELISA) is followed by supplemental testing by radioimmunoprecipitation assay (RIPA). The objective of this study was to report the results of routine testing and risk factor data from allogeneic blood donors. STUDY DESIGN AND METHODS: T. cruzi testing data from January 2007 through December 2009 were analyzed, and risk factor interviews and follow‐up studies were conducted on seroreactive donors. Prevalences of confirmed infection and risk factors associated with infection were assessed using logistic and multivariable logistic regression. RESULTS: Of 2,940,491 allogeneic donations from 1,183,076 donors, 305 (0.01% per donation tested and 0.026% per blood donor) were repeat reactive (RR) and 89 of those were confirmed positive by RIPA, yielding an overall seroprevalence of 1 per 33,039 donations and 1 per 13,292 donors. Country of birth and US blood center location differences in the seroprevalence of T. cruzi were evident. The odds of confirmed infection were highest if the donor reported having been bitten by the reduviid (kissing) bug (odds ratio [OR], 76.1; 95% confidence interval [CI], 11.1‐3173) followed by having lived in a rural area of Latin America (OR, 38.6; 95% CI, 15.1‐102.5). In multivariable analyses, having spent 3 months or more in Mexico or Central and/or South America was associated with the highest odds of RIPA‐confirmed infection (OR, 8.5; 95% CI, 2.7‐26.5). Polymerase chain reaction (PCR) testing of ELISA RR donors exhibited low sensitivity (1/22 [4%] RIPA‐confirmed donors was PCR positive). CONCLUSION: Risk factors for confirmed infection in US blood donors are consistent with the known epidemiology of Chagas disease. Blood donors or transfusions do not substantially contribute to the burden of T. cruzi infection in the United States.     

The increasing prevalence of serologic markers for syphilis among Chinese blood donors in 2008 through 2010 during a syphilis epidemic

BACKGROUND: In China, the growing syphilis epidemic parallels the spread of human immunodeficiency virus (HIV) in the general population. This study evaluated the prevalence and incidence of serologic markers for syphilis among donors at five Chinese blood centers. STUDY DESIGN AND METHODS: We examined whole blood and apheresis donations collected from January 2008 through December 2010. Postdonation testing of syphilis was conducted using two different Treponema pallidum antibody enzyme‐linked immunosorbent assay kits. The prevalence of serologic markers for syphilis (%), and the rate of coinfection with HIV‐1/2, hepatitis B virus (HBV), and hepatitis C virus (HCV) were calculated. A multivariable logistic regression analysis was conducted examining donor characteristics associated with positive syphilis serology. Seroconversion rate and syphilis incidence were estimated. RESULTS: Of 801,511 donations, 60% were from first‐time donors and 40% were from repeat donors. There was a significant increase in syphilis serologic markers among first‐time donors with 0.41, 0.45, and 0.57% positivity over 3 years (p < 0.001). Approximately 2.8, 0.8, and 0.5% of HIV‐1/2–, HBV‐, and HCV‐positive donations also tested reactive for syphilis. Logistic regression results suggest that first‐time donors were nine times more likely to be syphilis positive than repeat donors. Higher syphilis positivity was associated with donors older than 25 years and with less education. Estimated incidence among repeat donations was 33 (95% confidence interval, 29‐39) per 100,000 person‐years. CONCLUSION: The increase in syphilis serologic prevalence reflected the syphilis epidemic in the general population. Without screening, most of these syphilis‐positive donations would get into the blood supply. Thus, during a syphilis epidemic, continued syphilis screening of blood donations may be important to maintain blood safety and public health.     

The potential impact of selective donor deferrals based on estimated blood volume on vasovagal reactions and donor deferral rates

BACKGROUND: Whole blood donation in the United States is restricted in volume to 10.5 mL/kg or less in an effort to prevent hypovolemic reactions, but still may exceed more than 15% of a donor's estimated blood volume (EBV). We analyzed the association of EBV with prefaint and systemic vasovagal reactions (SVRs) among whole blood donors and the potential impact of an EBV‐based deferral policy. STUDY DESIGN AND METHODS: Independent predictors for prefaint reactions and SVRs were assessed by multivariate logistic regression analysis on 591,177 unique donors participating in the Retrovirus Epidemiology Donor Study‐II study. RESULTS: Young age (16 years old odds ratio [OR], 3.70; 95% confidence interval [CI], 2.78‐4.94), low EBV (<3.5 L OR, 3.30; 95% CI, 2.57‐4.23), and first‐time donation status (OR, 2.33; 95% CI, 2.03‐2.67) were the strongest predictors for SVRs, with similar trends seen for prefaint reactions. Sex, height, race, blood center, and donation site were weakly associated predictors. A total of 5.6% of all donors had an EBV of less than 3.5 L and experienced 12.5% of all prefaint reactions and 14.5% of SVRs. The highest reaction rates were seen in donors less than 23 years old with an EBV of less than 3.5 L who comprised 2.7% of all donors, who were mostly female (99.9%), and who experienced 8.8% of prefaint reactions and 11.0% of SVRs. CONCLUSION: Young age, low EBV, and first‐time donation status are the major correlates of prefaint reactions and SVRs, suggesting that high school and college donors are at particular risk. Deferral of donors with low EBV who are less than 23 years old may offer a rational approach to protecting donors at greater risk of reactions without jeopardizing the adequacy of the blood supply.     

The microbiologic safety of umbilical cord blood transfusion for children with severe anemia in Mombasa, Kenya

BACKGROUND: Severe anemia requiring blood transfusion is common in hospitalized young children in sub‐Saharan Africa but blood is often in short supply. Umbilical cord blood may be a useful source of blood if microbiologic safety concerns can be addressed. STUDY DESIGN AND METHODS: Cord blood, donated on the labor ward at the provincial hospital in Mombasa, was cultured soon after collection (screening culture) and after a period of storage (poststorage culture). Conventional blood transfused to children at the hospital was cultured only at the time of issue (poststorage culture). Maternal sera (cord blood) and conventional blood donations were also screened for transfusion‐transmitted infection. RESULTS: At poststorage culture, the overall contamination rate of cord blood was one‐third that of conventional blood (13/449 vs. 38/434; odds ratio [OR], 0.31; 95% confidence interval [CI], 0.15‐0.61) and for bacteria of high pathogenic potential it was half that of conventional blood (4/449 vs. 7/434; OR, 0.55; 95% CI, 0.12‐2.18). Screening cultures were positive in 50% (2/4) of cord blood packs where an organism of high pathogenic potential was isolated at poststorage culture. Cord blood donors had a lower seroreactivity than conventional donors for human immunodeficiency virus (OR, 0.63; 95% CI, 0.29‐1.18), hepatitis B virus (OR, 0.32; 95% CI, 0.16‐0.59), and hepatitis C virus (OR, 0.20; 95% CI, 0.24‐0.76). For syphilis, initial seroreactivity in cord blood donors was 3.8% compared to 1.8% in conventional blood donors (OR, 2.10; 95% CI, 1.15‐3.60) but was 0.5% after retesting. CONCLUSION: With respect to bacterial contamination and seroreactivity for transfusion‐transmitted infection, the safety of cord blood in Mombasa compares favorably with conventional blood. Clinical trials of cord blood transfusion are justified.     

Healthy donor effect: its magnitude in health research among blood donors

BACKGROUND: The healthy donor effect has been mentioned as a methodologic problem in blood donor health research. The aim of this study was to investigate different elements of the healthy donor effect. STUDY DESIGN AND METHODS: First, recent donors (<4 years registered as a donor) were compared with the general population. Second, active and lapsed donors were compared. Third, short‐career donors (<14 donations) were compared with long‐career donors (>37 donations). Various health and lifestyle indicators were used as outcome measures. RESULTS: Compared to the general population, recent donors had a better self‐rated health (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.27‐1.61), visited the general practitioner (GP) less often (OR, 0.66; 95% CI, 0.60‐0.72), and were less often treated by a specialist (OR, 0.83; 95% CI, 0.75‐0.93). Recent donors also exhibited a healthier lifestyle compared to the general population. When examining active versus lapsed donors, similar results were found in favor of active donors. With respect to donation career, long‐career donors were healthier than short‐career donors, but effects were less strong; the ORs were 1.33 (95% CI, 1.15‐1.54) for self‐rated health, 0.85 (95% CI, 0.76‐0.94) for GP visit, and 0.83 (95% CI, 0.68‐1.00) for specialist treatment. When comparing long‐ and short‐career donors on lifestyle indicators, there were barely any significant differences. CONCLUSIONS: The findings strongly point to the presence of a healthy donor effect when comparing donors with the general population and active versus lapsed donors. The healthy donor effect was less pronounced within active donors, when comparing long‐ and short‐career donors. Therefore, health research should primarily be carried out within active donors.     

Predictive value of past and current screening tests for syphilis in blood donors: changing from a rapid plasma reagin test to an automated specific treponemal test for screening

BACKGROUND: This study evaluated the change from a rapid plasma reagin (RPR) test to an automated specific treponemal test (PK-TP) in screening for syphilis in blood donors. STUDY DESIGN AND METHODS: A cross-sectional seroprevalence analysis was performed on 4,878,215 allogeneic blood donations from 19 American Red Cross Blood Services regions from May 1993 through September 1995. Positive predictive values relative to the confirmatory fluorescent treponemal antibody absorption test (FTA-ABS) were calculated. Differences in seroprevalence were compared in RPR and PK-TP tests for 1) unconfirmed and confirmed tests, 2) first-time and repeat donors, and 3) "recent" versus "past" infections. Donation data from three additional Red Cross regions were evaluated for repeat donation patterns of blood donors who had a donation that was positive in a serologic screening test for syphilis. The value of RPR and PK-TP tests as surrogate markers for HIV infection was compared. RESULTS: Reactive rates were lower but the positive predictive values was higher for the PK-TP test than for the RPR test. Initially, donors screened by PK-TP were more likely to be confirmed as positive than were donors screened by RPR, but these rates became comparable. It is estimated that a single HIV window-period donation was removed by serologic testing for syphilis each year of this study period. CONCLUSIONS: The change to the PK-TP test resulted in a lower repeatedly reactive rate, better prediction that a confirmed-positive test for syphilis would occur in testing in the FTA-ABS, fewer donations lost, and comparable deferral rates. Because of the high rate of reactivity to serologic testing for syphilis among donors previously confirmed positive for syphilis, indefinite deferral after a confirmed-positive index donation may be warranted. Serologic testing for syphilis is ineffective as a marker of HIV-infectious window-period donations.     

A case‐control study of factors associated with resolution of hepatitis C viremia in former blood donors (CME)

BACKGROUND: Nucleic acid testing (NAT) is performed on blood collected in the United States allowing for the classification of hepatitis C virus (HCV) antibody–positive donors into resolved and chronic hepatitis C infections. We report a case‐control study of factors associated with HCV resolution. STUDY DESIGN AND METHODS: Blood donors with resolved (HCV antibody positive, RNA negative defined as “cases”) or chronic (HCV antibody positive, RNA positive defined as “controls”) based on their index donation HCV test results were enrolled. Participants completed a risk factor, symptoms, and treatment questionnaire followed by HCV antibody, HCV RNA, and liver biochemical testing. RESULTS: We enrolled 100 cases and 202 controls. In a multivariate logistic regression model, significant independent effects for spontaneous viral clearance were observed for African American (inverse; odds ratio [OR], 0.11; 95% confidence interval [CI], 0.01‐0.87), autologous blood donation (OR, 4.70; 95% CI, 2.02‐10.94), alcohol intake (OR, 2.39; 95% CI, 1.13‐5.03), and transfusion before May 1990 (inverse; OR, 0.36; 95% CI, 0.14‐0.91). Cases admitting injection drug use had shorter time since first injection than did controls. Forty‐nine index RNA positive controls received antiviral therapy and 25 (51%) were RNA negative at enrollment; surprisingly several RNA‐negative cases received liver biopsies and/or antiviral treatment. CONCLUSIONS: We document the role donor screening plays in the identification, subsequent medical evaluation, and treatment among individuals who presumably did not know that they were at risk for HCV infection. Additionally, we confirmed race/ethnicity as a determinant of clearance and suggest infectious dose and route of infection may play a role in clearance.     

Human immunodeficiency virus prevalence, incidence, and residual risk of transmission by transfusions at Retrovirus Epidemiology Donor Study-II blood centers in Brazil

BACKGROUND: In Brazil nationally representative donor data are limited on human immunodeficiency virus (HIV) prevalence, incidence, and residual transfusion risk. The objective of this study was to analyze HIV data obtained over 24 months by the Retrovirus Epidemiology Donor Study‐II program in Brazil. STUDY DESIGN AND METHODS: Donations reactive to third‐ and fourth‐generation immunoassays (IAs) were further confirmed by a less‐sensitive (LS) IA algorithm and Western blot (WB). Incidence was calculated for first‐time (FT) donors using the LS‐EIA results and for repeat donors with a model developed to include all donors with a previous negative donation. Residual risk was projected by multiplying composite FT and repeat donor incidence rates by HIV marker–negative infectious window periods. RESULTS: HIV prevalence among FT donors was 92.2/10⁵ donations. FT and repeat donor and composite incidences were 38.5 (95% confidence interval [CI], 25.6‐51.4), 22.5 (95% CI, 17.6‐28.0), and 27.5 (95% CI, 22.0‐33.0) per 100,000 person‐years, respectively. Male and community donors had higher prevalence and incidence rates than female and replacement donors. The estimated residual risk of HIV transfusion transmission was 11.3 per 10⁶ donations (95% CI, 8.4‐14.2), which could be reduced to 4.2 per 10⁶ donations (95% CI, 3.2‐5.2) by use of individual‐donation nucleic acid testing (NAT). CONCLUSION: The incidence and residual transfusion risk of HIV infection are relatively high in Brazil. Implementation of NAT will not be sufficient to decrease transmission rates to levels seen in the United States or Europe; therefore, other measures focused on decreasing donations by at‐risk individuals are also necessary.     

The influence of adverse reactions,subjective distress,and anxiety on retention of first‐time blood donors

BACKGROUND: This study investigated the effects of adverse events (i.e., needle reactions, fatigue, and vasovagal reactions) and feelings of distress and anxiety on retention of first‐time blood donors. All effects were explored separately for men and women. STUDY DESIGN AND METHODS: First‐time blood donors (n = 2438) received a questionnaire, asking them about their experience of adverse events, subjective distress, and anxiety at their first donation. Provision of a second donation was checked approximately 18 months later. After exclusion of nonresponders and donors who did not experience an adverse event, 1278 first‐time donors were included in the logistic regression analyses. RESULTS: Nine percent of donors who experienced an adverse event at their first donation did not return for a second donation. Vasovagal reactions decreased retention in both males and females (men—odds ratio [OR], 0.45; 95% CI, 0.23‐0.89; women—OR, 0.71; 95% CI, 0.51‐0.98). Fatigue decreased retention in males only (OR, 0.62; 95% CI, 0.42‐0.91), and subjective distress decreased retention in females only (OR, 0.77; 95% CI, 0.65‐0.92). CONCLUSION: In addition to decreasing vasovagal reactions, retention interventions could productively target coping with fatigue and reducing subjective distress after adverse reactions.     

Prevalence of serologic markers for hepatitis B and C viruses in Brazilian blood donors and incidence and residual risk of transfusion transmission of hepatitis C virus

BACKGROUND: We evaluate the current prevalence of serologic markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors and estimated HCV incidence and residual transfusion‐transmitted risk at three large Brazilian blood centers. STUDY DESIGN AND METHODS: Data on whole blood and platelet donations were collected from January through December 2007, analyzed by center; donor type; age; sex; donation status; and serologic results for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti‐HBc), and anti‐HCV. HBV and HCV prevalence rates were calculated for all first‐time donations. HCV incidence was derived including interdonation intervals that preceded first repeat donations given during the study, and HCV residual risk was estimated for transfusions derived from repeat donors. RESULTS: There were 307,354 donations in 2007. Overall prevalence of concordant HBsAg and anti‐HBc reactivity was 289 per 100,000 donations and of anti‐HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% confidence interval, 0.77‐7.03) per 100,000 person‐years, and residual risk of HCV window‐phase infections was estimated at 5.0 per million units transfused. CONCLUSION: Improvement in donor selection, socioeconomic conditions, and preventive measures, implemented over time, may have helped to decrease prevalence of HBV and HCV, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of HBV and HCV markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening, and counseling strategies.     

Regional variation in the modeling of donation frequency: the case of Héma‐Québec,Canada

BACKGROUND: Many studies on factors that can affect the frequency of blood donation have shown the influence of several individual characteristics. However, few studies have analyzed regional variations in blood donation frequency. The objective of this article is to verify to what extent individual and geographic variables influence blood donation in the Province of Québec, Canada. STUDY DESIGN AND METHODS: This article used a database provided by Héma‐Québec (the organization in charge of blood collection in Québec), which included 426,247 donors, who made 1.4 million donations over a period of 5 years. Using the donors' residential postal codes and those of the blood collection sites, we created two geographic variables: the distance between the donor's place of residence and his or her collection site and each donor's region of residence. We subsequently modeled the frequency of blood donation and the different donor categories (based on the number of blood donations) using both a negative binomial regression model and an ordinal logistic regression model. RESULTS: The results indicate that, once the individual characteristics have been taken into account, the geographic variables, including proximity to the collection site, have a significant impact on the frequency of blood donation. Likewise, according to the results of the negative binomial model, among the 17 regions in the Province of Québec, there are five regions where blood donation incidence rate ratios (IRRs) are very high, that is, Abitibi‐Témiscamingue (IRR, 1.77; 95% confidence interval [CI], 1.61‐1.95); Bas‐Saint‐Laurent (IRR, 1.75; 95% CI, 1.59‐1.93); Saguenay‐Lac‐Saint‐Jean (IRR, 1.68; 95% CI, 1.53‐1.84); Centre‐du‐Québec (IRR, 1.66; 95% CI, 1.51‐1.83); and Chaudière‐Appalaches (IRR, 1.62; 95% CI, 1.48‐1.78). CONCLUSION: Such knowledge of the geography of blood donations makes it possible to better target certain regions when planning new blood drives, to ensure a constant blood supply.