Transusion Transmitted Infections Flashcards
When did we introduce hepatitis E testing?
Testing introduced in January 2016
What is Hepatitis E
A small, nonenveloped, single-stranded RNA virus of the family Hepeviridae, a Hepevirus
There are 4 main strains HEV1-4
Talk about the four different strains of hepatitis E virus
HEV1 and HEV 2 infections in developing countries -> waterborn infection
HEV3 and 4 infections endemic in the developing world - zoonotic infections, under reported, many cases subclinical
Talk about the prevalence of HEV
Prevalence of 1:5000 donors approximately
HEV1 and 2 causes 3.4 million sympotomatic cases nicluding 70,000 deaths and 3, 000 stillbirths
Significant proportion of symptomatic cases are misdiagnosed or unrecognised especially with HEV3 and HEV4
What was originally thought about hep e
it was thought to originally be due to alcoholism i.e. alcoholic cirhhosis
What is the main zoonotic source of Hepatitis E
Pigs
What are some HEV1 and 2 endemic areas
China
India
Rural Malasia
What are the main sources of hepatitis E
Human hosts, certain animal species including pigs and wild boar
There is evidence of zoonotic transmission via the food-borne route
Consumption of uncooked meat including pig, wild-boar, deer etc
Elevated seroprevalence in pig farmers, abattoir workers and veterinarians
Who do we see chronic hepatitis E infections in?
Immuno-compromised patients
Solid-organ transplant recipients
Patients with haematological disease
HIV infection with low CD4 cell counts <100/mm^3
How does hepatitis E manifest in the immuno-compromised?
Rapid progression of liver fibrosis, chronic hepatitis after 15 months, cirrhosis E after 3 years
Extra-hepatic manifestations including neurological complications
When did we become concerned with hepatitis E
We didnt think it was an infectious virus so we didnt really bother with it
We only started after two studies carried out in the UK and US revealed that between 3 and 13% of suspected drug-induced liver injury was in fact HEV3 infection
After this Ireland was quick to develop an assay for HEV -> we have a large pork industry and large prevalence so we didnt want to be cought with this as we had been HCV
What is HTLV 1 and 2
Oncogenic viruses causative of adult T-Cell leukaemia and lymphoma (in chronic)
They may also cause a tropical spastic paraparesis
What is tropical spastic paraparesis?
A progressive degeneration of spinal cord neurones
How is HTLV transmissed
HTLV1 is transmitted by cellular blood components but not by cell free
Both 1 and 2 are transmitted by sexual contact, needles and breast milk
NB: blood storage decreases risk
What is the incubation period and seroprevalence of HTLV 1 and 2
30-90 days incubation
Seroconversion and possible disease up to 40 years after infection
IgM first produced then IgG
20 million people are infected worldwide, 3-8 million are in Africa
In the US prevalence of 0.016 percent of donors have it
Remains in the body for life, once in your system it can reactivate whenever immunosuppressed etc
When did we start screening for HTLV
Screening donors since 1996
But weve only had 4 HTLV donors in 22 years
What is cytomegalovirus
Herpes virus 5
It usually causes an asymptomatic infection which resolves on its own and is replaced by anti-CMV antibody
thus the Ab is a marker for infection
Many donors and patients are therefore exposed to the virus and only the immunosuppressed are of concern
Talk about the seroprevalence of CMV
26% of Irish donors - low compared to other -> can be up to 90% in certain countries
-> 29% in females, 24% in males
Seroconversion rate was 1.55% -> i.e. donors tat were previously neg that are now pos
Prevalence is highest in over 60s
Talk abou CMV in the immunocompromised
Immunosuppressed or neonates get CMV- blood
Its a common cause of fatality in HIV
-> causes hepatitis like infection
-> terrible encephalitis and eventually death
-> historic cause of death though
antiviral medications may stop the replication of the virus but will not destroy it
What problems are associated with CMV
Virus can remain latent in healthy donors - donors arent excluded from donating
reactivation of virus upon transfusion in immunocompromised
Cellular blood components are the potential transmitters
Window period of 6-8 weeks
CMV DNA is present weeks to months before the antibody appears
Why do we still use CMV+ units?
This is because immunecompetent people cannot get CMV from LD blood -> it is considered CMV safe to give to healthy people
Who should be given CMV negative blood?
Intra-uterine foetuses
Exchange transfusion infants
Neonates up to 1 year
Bone marrow recipients
PBSC recipients
Other organ transplants
Seronegative pregnant mothers
HIV patients, not yet infected
Patients immunosuppressed in general
What is West Nile Virus, how is it transmitted
A mosqiuto botn virus carried by birds
Lipid enveloped RNA virus
Its not that dangerous but 1% of people get encephalitis
Transmitted from humans then to birds and from birds to other parts of america etc
Talk about the initial outbreak of WNV
Initial outbreak in USA in 1999
It used to be unheard of until the early 2000s where we had our first cases
There was first an outbreak in a NY blood bank
Transplanted organs gave 4 recipients WNV
>30 cases of transplant/transfusion cases
Incidence of 1.5 cases per 10000 donors are positive