title: Dengue viremia in blood donors identified by RNA and detection of dengue transfusion transmission during the 2007 dengue outbreak in Puerto Rico.
abstract: BACKGROUND
  In 2007, a total of 10,508 suspected dengue cases were reported in Puerto Rico. Blood donations were tested for dengue virus (DENV) RNA and recipients of RNA-positive donations traced to assess transfusion transmission.
  
  
  METHODS
  Blood donation samples from 2007 were maintained in a repository and tested individually for DENV RNA by transcription-mediated amplification (TMA); a subset was further tested by an enhanced TMA (eTMA) assay. TMA-reactive samples were considered confirmed if TMA (including eTMA) was repeat reactive (RR). All TMA-RR samples were tested by quantitative, DENV type-specific reverse transcriptase-polymerase chain reaction (RT-PCR) and for anti-DENV immunoglobulin (Ig)M by enzyme-linked immunosorbent assay. Samples positive by RT-PCR were further tested for infectivity in mosquito cell culture. Patients receiving components from TMA-RR donations were followed.
  
  
  RESULTS
  Of 15,350 donation samples tested, 29 were TMA-RR for a prevalence of 1 per 529 (0.19%). DENV Types 1, 2, and 3 with viral titers of 10(5)  to 10(9)  copies/mL were detected by RT-PCR in 12 samples of which all were infectious in mosquito culture. Six TMA-RR samples were IgM positive. Three of the 29 recipients receiving TMA-RR donations were tested. One recipient in Puerto Rico transfused with red blood cells containing 10(8)  copies/mL DENV-2 became febrile 3 days posttransfusion and developed dengue hemorrhagic fever. The recipient was DENV-2 RNA positive by RT-PCR; both the donor and the recipient viruses had identical envelope sequences.
  
  
  CONCLUSIONS
  High rates of viremia were detected in blood donors in Puerto Rico coupled with the first documented transfusion transmission of severe dengue disease, suggesting that further research on interventions is needed.
authors.affiliation: Scientific Support Office, American Red Cross, Gaithersburg, Maryland 20877, USA. stramers@usa.redcross.org
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stramer
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Linnen
authors.forename: James M
authors.initials: JM
authors.lastname: Carrick
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Foster
authors.forename: David E
authors.initials: DE
authors.lastname: Krysztof
authors.forename: Shimian
authors.initials: S
authors.lastname: Zou
authors.forename: Roger Y
authors.initials: RY
authors.lastname: Dodd
authors.forename: Lourdes M
authors.initials: LM
authors.lastname: Tirado-Marrero
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hunsperger
authors.forename: Gilberto A
authors.initials: GA
authors.lastname: Santiago
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Muñoz-Jordan
authors.forename: Kay M
authors.initials: KM
authors.lastname: Tomashek
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000818:Animals; D001782:Blood Donors / Q000706:statistics & numerical data*; D009033:Culicidae / Q000821:virology; D003715:Dengue / Q000097:blood / Q000453:epidemiology / Q000635:transmission; D003716:Dengue Virus / Q000235:genetics* / Q000302:isolation & purification; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D010802:Phylogeny; D015995:Prevalence; D011647:Puerto Rico / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood*; D014766:Viremia / Q000097:blood / Q000453:epidemiology / Q000635:transmission
chemical_list: D012367:RNA, Viral