title: Associations between West Nile virus infection and symptoms reported by blood donors identified through nucleic acid test screening.
abstract: BACKGROUND
  Blood collected in the United States and Canada is screened for West Nile virus (WNV) using nucleic acid testing (NAT). The role that donor-reported symptoms of infection disclosed at or shortly after donation may play in enhancing blood safety has been debated. Little data are available on subsequent manifestations of WNV-specific disease outcomes in viremic donors.
  
  
  METHODS
  Donors with initially reactive NAT results were informed by telephone and asked to complete symptom interviews. The questionnaires are focused on three time periods: the week before, the day of, and the 2 weeks after donation. Symptoms and risk factors were compared between confirmed-positive and false-positive donors (classified based on confirmatory NAT and serology). Additional analyses comparing confirmed-positive symptomatic and asymptomatic donors were conducted.
  
  
  RESULTS
  A total of 423 of 536 initially reactive donors were interviewed between 2003 and 2006: 292 confirmed-positive for WNV and 131 false-positive. Individual symptoms were not significant predictors of WNV infection, except skin rash in the week before donation (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.2-7.9) and body aches in the period after donation (OR, 2.8; 95% CI, 1.1-7.4). Specific combinations of symptoms were not good predictors of infection, but donors with three or more concurrent symptoms before donation were more likely to have WNV infection (OR, 2.5; 95% CI, 1.2-5.1). Demographic characteristics, predonation symptoms, and serology profiles in confirmed-positive donors did not predict postdonation symptom severity. Thirty-five confirmed-positive donors (12%) sought medical care for WNV infection, with two hospitalizations, but no cases of neuroinvasive disease.
  
  
  CONCLUSIONS
  The number rather than type of symptoms is associated with confirmed WNV infection, but the overall predictive value is low. Very few infected donors develop clinically significant disease.
authors.affiliation: Blood Systems Research Institute, University of California, San Francisco, USA. bcuster@bloodsystems.org
authors.forename: Brian
authors.initials: B
authors.lastname: Custer
authors.forename: Hany
authors.initials: H
authors.lastname: Kamel
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Kiely
authors.forename: Edward L
authors.initials: EL
authors.lastname: Murphy
authors.forename: Michael P
authors.initials: MP
authors.lastname: Busch
mesh_terms: D001782:Blood Donors; D005076:Exanthema / Q000821:virology; D005260:Female; D005843:Geography; D006261:Headache / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D009696:Nucleic Acids; D012367:RNA, Viral / Q000097:blood*; D011795:Surveys and Questionnaires; D014481:United States; D014901:West Nile Fever / Q000097:blood* / Q000175:diagnosis
chemical_list: D009696:Nucleic Acids; D012367:RNA, Viral