title: West Nile virus blood transfusion-related infection despite nucleic acid testing.
abstract: BACKGROUND
  A case of West Nile virus (WNV) encephalitis associated with transfusion of blood that did not react when tested for WNV by minipool (MP) nucleic acid testing (NAT) is described. A Nebraska man developed clinical encephalitis 13 days after surgery and transfusion of 26 blood components. Antibody testing confirmed WNV infection. An investigation was initiated to determine the source of this infection.
  
  
  METHODS
  The patient's family members were interviewed to identify risk factors for WNV infection. Residual samples were retested for WNV RNA using transcription-mediated amplification (TMA) assay and two polymerase chain reaction (PCR) assays. Blood donors' follow-up serum samples were collected. All samples were tested for WNV-specific immunoglobulin M antibodies.
  
  
  RESULTS
  The patient's family denied recent mosquito exposure. The 20 blood components collected after July 2003 did not react when tested for WNV in a six-member MP-NAT at the time of donation. Retrospective individual testing identified one sample as WNV-reactive by the TMA assay and one of the PCR assays. Seroconversion was demonstrated in the donor associated with this sample.
  
  
  CONCLUSIONS
  WNV RNA detection by individual donation NAT demonstrates viremic blood escaping MP-NAT and supports transfusion-related WNV transmission. MP-NAT may not detect all WNV-infected blood donors, allowing WNV transmission to continue at low levels. WNV NAT assays might vary in sensitivity and pooling donations could further impact test performance. Understanding MP NAT limitations can improve strategies to maintain safety of the blood supply in the United States.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Macedo de Oliveira
authors.forename: Brady D
authors.initials: BD
authors.lastname: Beecham
authors.forename: Susan P
authors.initials: SP
authors.lastname: Montgomery
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lanciotti
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Linnen
authors.forename: Cristina
authors.initials: C
authors.lastname: Giachetti
authors.forename: Larry A
authors.initials: LA
authors.lastname: Pietrelli
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stramer
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Safranek
mesh_terms: D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001782:Blood Donors; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D012367:RNA, Viral / Q000097:blood*; D065227:Transfusion Reaction; D014901:West Nile Fever / Q000209:etiology*; D014902:West Nile virus / Q000235:genetics*
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D012367:RNA, Viral