Current incidence and estimated residual risk of transfusion-transmitted infections in donations made to Canadian Blood Services.
BACKGROUND
New testing methods such as nucleic acid amplification testing (NAT) and chemiluminescent serologic assays have been introduced, more precise estimates for infectious window periods are available, and a new method for estimating the residual risk (RR) of transfusion-transmitted infections (TTIs) has been developed. Thus, available RR estimates for Canada need to be updated.


METHODS
Incidence rates for known TTI markers were determined for all allogeneic whole-blood donations made to Canadian Blood Services between 2001 and 2005; they were derived from NAT conversions or seroconversions of repeat donors with at least two donations in a 3-year period. RR estimates for human immunodeficiency virus (HIV)-1 and hepatitis C virus (HCV) derived from the classical incidence/window-period model were compared to those obtained by the new method that estimates incidence from NAT-positive, antibody-negative donations (NAT-yield cases) from all donors divided by person-years.


RESULTS
With the classical method, the RR of HIV (1 per 7.8 million donations) and HCV (1 per 2.3 million) were low; HBV RR was higher (1 per 153,000). HCV RR was significantly lower when estimated with the new method (1 per 13 million). Eleven HCV NAT-yield cases were predicted by applying the classical method to our seroconversion data but only 2 were observed (p = 0.011). Observed HIV-1 NAT-yield cases (n = 1) matched those predicted (n = 0.7).


CONCLUSIONS
New tests have reduced an already low risk of TTI in Canada. HCV RR estimates by two different methods differed but both were low.
O'Brien
Sheila F
SF
Canadian Blood Services, and the Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. sheila.o'brien@bloodservices.ca
Yi
Qi-Long
QL
Fan
Wenli
W
Scalia
Vito
V
Kleinman
Steven H
SH
Vamvakas
Eleftherios C
EC
D001771:Blood Banks / Q000706:statistics & numerical data*; D001782:Blood Donors; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology / Q000635:transmission; D006679:HIV Seropositivity; D015497:HIV-1; D015498:HIV-2; D015490:HTLV-I Infections / Q000097:blood / Q000453:epidemiology / Q000635:transmission; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology / Q000635:transmission; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D065227:Transfusion Reaction; D014777:Virus Diseases / Q000097:blood / Q000453:epidemiology* / Q000635:transmission*