Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Childhood immunizations in the United States wikipedia , lookup
Globalization and disease wikipedia , lookup
Human cytomegalovirus wikipedia , lookup
Neonatal infection wikipedia , lookup
Infection control wikipedia , lookup
Hospital-acquired infection wikipedia , lookup
Diagnosis of HIV/AIDS wikipedia , lookup
Lookback study for transfusionrelated HBV infection in Japan Tokyo Metropolitan Red Cross Blood Center Masahiro Satake Lookback study in Japan • Aliquots from all donations have been stored since 1997. • When necessary, each aliquot was investigated using individual donation-NAT (ID-NAT). • Subjects for the study : converters for HBs-Ag, HBc-Ab, HCV-Ab, HIV-Ab, screening NAT for HBV, HCV or HIV during April 1999 and February 2005 ID-NAT results in repository tubes from seroconverted or NAT-converted donors No. of ID-NAT performed No. of positive tubes Positivity rate (%) HBV 20,033 261 1.30 HCV 4,371 2 0.05 HIV 1,673 1 0.06 total 26,077 264 1.01 (‘99 April ~ ’05 February) No. of HBV ID-NAT positive but pool-NAT negative donors estimated by lookback study Conversion / year ID-NAT positive No. of ID-NAT positive donors HBV-pool NAT 80 3.75% 3.0 HBs-Ag 124 3.7% 4.6 HBc-Ab 3269 1.0% 32.6 total 3473 1.16% 40.2 These donations do not directly relate to infectivity. The infectivity of HBV-ID-NAT positive components No. of ID-NAT positive donation No. of components released transfused・・・・・・・・・・・ discarded・・・・・・・・・・・ unknown・・・・・・・・・・・ 267 321 293 16 12 Outcome of transfused patients(191 reports available ) HBs-Ag conversion 6 HBV-DNA conversion 2 HBs-Ab conversion 3 positive, but no information before transfusion 7 markers not changed 60 dead 99 discharged etc. 14 The infectivity of HBV-ID NAT-positive components HBV infected 11 Undetermined 7 No change 60 others 115 Infectious risk when transfused with ID-NAT positive blood 11/78~18 /78 6~10 HBV infections per year Infectivity of HBV ID-NAT positive components Component Infected No change Window period 10 21 31 32% (10/31) 1 39 40 2.5% (1/40) total infectivity (HBcAb -) Chronic carrier (HBcAb +) Infectivity of W.P. component is 13 times as high as that from chronic carrier. Implicated components component RBC FFP Platelet From window From chronic period carrier 5 / 10 (50%) 0 / 19 3 / 10 1 / 18 (30%) (6%) 2/4 (50%) 0/1 Established cases for HBV infection Disorders of patients hematologic malignancy gastric cancer dissecting aortic aneurysm shock due to multiple trauma rheumatoid arthritis unknown 2 2 1 1 1 4 ID-NAT in repository tubes --- voluntarily reported HBV cases --100 4 virus (+) virus (-) 4 unknown 5 6 75 4 57 31 36 1999 2000 42 0 2001 2002 2003 The risk of HBV infection under current screening algorism including 50p-NAT system Sources HBV-infection Lookback investigation 6~10 Voluntary report of infection 5 total 11~15 cases/year Lookback study for HCV and HIV No. of ID-NAT performed HCV 4,371 HIV 1,673 No. of positive tubes 2 (1 donation before NAT implementation) 1 (Established infected case) Seroconversion possibly due to nonspecific reaction was also subjected to lookback study. Estimates for the Occurrence of TransfusionTransmitted Viral Diseases in Japan • HBV HBV+ donation detectable only by ID-NAT : 1 / 150,000 11~15 infection cases per year (1 infection / 3.6~5.4 x 105 components) • HCV (difficult to estimate) HCV+ donation detectable only by ID-NAT : 1 / 24 million (1 component / 4 years) • HIV (difficult to estimate) HIV+ donation detectable only by ID-NAT : 1 / 12 million (1 component / 2 years)