Dengue virus in blood donations, Puerto Rico, 2005.
BACKGROUND
A single instance of transfusion-transmitted dengue infection has been reported. The high incidence of dengue in endemic countries, the high proportion of asymptomatic infection, and the median 5-day viremia, however, suggest that transfusion-associated dengue transmission may be more widespread than documented.


METHODS
The prevalence of dengue virus (DENV) RNA was determined in all blood donations to the American Red Cross in Puerto Rico from September 20 to December 4, 2005, using a specific type of nucleic acid amplification test called transcription-mediated amplification (TMA). TMA-positive donations were defined as those having two repeatedly reactive TMA results. TMA-positive donations were tested by enzyme-linked immunosorbent assay for immunoglobulin M (IgM) antibodies, by reverse transcription-polymerase chain reaction (RT-PCR), and by viral culture.


RESULTS
Twelve (0.07%) of 16,521 blood donations tested were TMA-positive. Four were positive by RT-PCR (DENV serotypes 2 and 3). Virus was cultured from 3 of 4 RT-PCR-positive donations. One of the 12 TMA-positive donations was IgM-positive. Only 5 donations remained TMA-positive when diluted 1:16, as is done for routine minipool screening for other transfusion-transmissible viral infections (hepatitis C, human immunodeficiency, West Nile viruses [WNVs]).


CONCLUSIONS
Nearly 1 in 1000 blood donations contained DENV RNA, and virus could be cultured from TMA-positive donations, suggesting a transfusion transmission risk similar to that which existed in the United States for WNV before universal donation screening. Similar to WNV, IgM antibody screening is likely to be ineffective, and some potentially infectious donations will be missed by minipool screening. Transfusion transmission should be considered in patients with dengue after blood transfusion.
Mohammed
Hamish
H
Dengue Branch, Division of Vector-Borne Infectious Disease, Centers for Disease Control and Prevention, San Juan, Puerto Rico. hmohammed@cdc.gov
Linnen
Jeffrey M
JM
Muñoz-Jordán
Jorge L
JL
Tomashek
Kay
K
Foster
Gregory
G
Broulik
Amy S
AS
Petersen
Lyle
L
Stramer
Susan L
SL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001771:Blood Banks; D001782:Blood Donors; D003715:Dengue / Q000453:epidemiology / Q000821:virology*; D003716:Dengue Virus / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D011647:Puerto Rico / Q000453:epidemiology; D012011:Red Cross; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014481:United States