title: Triggers for switching from minipool testing by nucleic acid technology to individual-donation nucleic acid testing for West Nile virus: analysis of 2003 data to inform 2004 decision making.
abstract: BACKGROUND
  Concern about West Nile virus (WNV) transfusion-transmitted infections missed by minipool (MP) nucleic acid testing (NAT) has prompted consideration of the use of individual-donation (ID) NAT. Strategies were investigated for the application of limited ID-NAT capacity in 2004.
  
  
  METHODS
  Patterns of WNV MP-NAT-reactive donations tested by the Blood Systems Laboratory each week for 79 blood centers from June 29 to November 23, 2003 (196 MP-NAT repeat-reactive [RR] donations among 801,697 units), were analyzed. ID-NAT initiation strategies were developed consisting of counts of RR donations and/or weekly RR rates, together with three ID-NAT discontinuation strategies, and ID testing burden was assessed based on these combined start and stop strategies.
  
  
  RESULTS
  The effectiveness, reported as the percentage of MP-RR donations that would trigger ID-NAT based on each initiation strategy, ranged from 57 to 100 percent. The addition of a 1- or 2-week no-yield requirement for ID discontinuation substantially increased testing burden. Combined strategies resulted in projected ID-NAT of between 10 and 50 percent of donations for a 10- to 20-week period. For this organization, the most feasible ID-NAT initiation strategy was 2 MP-reactive donations and a weekly rate of 1 in 1000, which had an effectiveness of 81 percent and led to peak weekly ID-NAT of 20 to 25 percent of donations depending on the discontinuation rule.
  
  
  CONCLUSIONS
  This new approach of targeted ID-NAT based on ongoing monitoring of MP-NAT yield may prove to be a rational policy for agents like WNV that cause seasonal and regional epidemics.
authors.affiliation: Blood Systems Research Institute, San Francisco, California 94118, USA. bcuster@bloodsystems.org
authors.forename: Brian
authors.initials: B
authors.lastname: Custer
authors.forename: Peter A
authors.initials: PA
authors.lastname: Tomasulo
authors.forename: Edward L
authors.initials: EL
authors.lastname: Murphy
authors.forename: Sally
authors.initials: S
authors.lastname: Caglioti
authors.forename: Dennis
authors.initials: D
authors.lastname: Harpool
authors.forename: Patrick
authors.initials: P
authors.lastname: McEvoy
authors.forename: Michael P
authors.initials: MP
authors.lastname: Busch
mesh_terms: D001771:Blood Banks / Q000706:statistics & numerical data; D001782:Blood Donors; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D006801:Humans; D012367:RNA, Viral / Q000097:blood*; D012621:Seasons; D012680:Sensitivity and Specificity; D065227:Transfusion Reaction; D014766:Viremia; D014901:West Nile Fever / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D014902:West Nile virus / Q000235:genetics*
chemical_list: D012367:RNA, Viral