Dengue Fever and Blood Transfusion
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Transcript of Dengue Fever and Blood Transfusion
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Global WarmingDengue 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
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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 WarmingPopulation GrowthDengue Fever& Blood Transfusion
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South American Population & Distribution
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Urban Viral Disease Arthropod-Borne Epidemic, Pandemic Tropical & Subtropical World Potentially Fatal No Vaccine Available
Dengue Essentials
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Dengue Virus RNA Virusflaviviridae family4 strains
Den1, Den2, Den3, Den4
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Vectors:
aedes aegyptiaedes albopictus
Active Domestic BreedersTenacious Urban Hunters
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Dengue in World
100 million infections year250 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
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Dengue Cases ReportedWorld Health Organization
1955 – 2005
0
200000
400000
600000
800000
1000000
1955-1959
1960-1969
1970-1979
1980-1989
1990-1999
2000-2005
Ave.annual
no. cases
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Vectors –The Americas
1970 2006
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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 feverCDC 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…
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Faster ReproductionBetter AdaptationResistant to PesticidesInvading New Urban AreasVictimizing New PopulationsMore Efficient Virus Spread
Vectors & Global Warming
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Shorter Cycles in VectorsFaster AdaptationCarriers: Travelers & MigrantsIncreasing VirulenceMore OutbreaksHyperepidemics, Pandemics
Virus & Global Warming
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Blood Transfusion Needlestick Intrapartum Bone Marrow Transplantation Mucosal Exposure to Blood http://www.searo.who.int/LinkFiles/Dengue_Bulletins_Volumes_29_(2005)_CHAPTER03.pdf
Non-Vector Dengue Infection
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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 HospitalRed Cross Blood TransfusionService, 1992
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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.
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Dengue Infection Through Blood TransfusionDanger – It Happens
Growing ProblemNear Future Major ConcernNot MonitoredPrevention Needed Now
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Dengue Infection by Blood Transfusion
Real Risk: 1:1000
Risk will vary worldwide depending on endemicity(Brazil, 2.4 million blood collections/year)
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Approach:
All Donated Blood at Dengue Endemic RegionsMust be Tested for Dengue NS1 Antigen.
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“primo non nocere”
Hipocrates (430 – 370 A.C.)
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Patients & FamiliesThe EnvironmentHealthcare WorkersBlood Banks & HospitalsHealthcare SystemsCommunities (surveillance)
To Protect
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Web to Goal: InformationInternational Task GroupWorld Health Organization Blood Transfusion Societies Promote Medical Education Inform Communities Reach Governments & Politicians
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NS1 Antigen EIA ScreeningLow CostEasy to PerformAutomation Compatible Technology Already in Blood Banks WorldwideCost-Effective vs NAT 2
Nucleic Acid Testing - Dengue RNA RT-PCR 2
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NS1 Antigen EIA ScreeningIntegrates to Blood Banks Laboratory RoutinesSpecificity: 100% (or close)Highly SensitiveDetects Potential RiskAlmost Closes Infectivity Window
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Blood Donors must be oriented to inform febrile states occurring up to two weeks after donation.NS1 Antigen and/or RT-PCR for Dengue Virus RNA must be performed on all blood donors at endemic regions.Medical Education Programs must address the possibility of Transfusion Transmitted Dengue Virus.
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Estacio Ferreira Ramos, M.D.Blood Banker, Hematologist
Pathologist
Carlos Carl Ehrich Medical ResearchSalvador, Bahia - [email protected]
Skype: esfera2kMobile: +55(71) 9956-0635
Hospital PortuguesBlood Bank
+55(71)3203-5555
Scientific DirectorUMA – Universidade da Mata
AtlânticaRepresentative in Brazil,
Worldwatch Institutewww.wwiuma.org.br
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ReferencesGubler 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). http://www.paho.org/English/AD/DPC/CD/dengue-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.
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CDC. Travel-associated dengue —United States, 2005. MMWR Morbid Mortal
Wkly Rep. 2006;55:22:700-2.
Trofa AF, DeFraites RF, Smoak BL, Kanesathasan N, King AD, Burrous JM, et al.
Dengue fever in US military personnel in Haiti. JAMA. 1997;277:1546-8.
Smith CE, Tom Tammy, Sasaki J, Ayers T, Effler PV. Dengue risk among visitors to
Hawaii during an outbreak. Emerg. Infect. Dis. 2005;11:750-66.
Rigau-Pérez JG, Clark GC, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV. Dengue
and dengue haemorrhagic fever. Lancet. 1998;352:971-7.
Fernandez R, Rodriguez T, Borbonet F, Vasquez S, Guzman M, Kouri G. Estudio de
la relacion dengue-embarazo en un grupo de madres cubanas. Rev Cubana Med
Trop. 1994;46:76–8.
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.