title: Modelling the risk of transfusion transmission from travelling donors.
abstract: BACKGROUND
  The EUFRAT (European Up-Front Risk Assessment Tool) was developed as an online risk assessment tool ( http://eufrattool.ecdc.europa.eu ) to help decision-makers assess the transmission risk of emerging infectious diseases (EID) through blood transfusion. The aim of this study is to extend the methodology developed in the EUFRAT project to quantify the transfusion transmission (TT) risk from travelling donors.
  
  
  METHODS
  A generic model for estimating the TT risk from a group of travelling donors that visited an EID risk area was developed. In addition, the new model distinguishes projected future transmissions from those that have already occurred. As an illustration the model was applied to the outbreaks of chikungunya in Italy in 2007 and Q fever in the Netherlands in 2007-2009.
  
  
  RESULTS
  Formulas for calculating the travelling donors' TT risk were derived. For the chikungunya outbreak in Italy an early intervention (at the end of week 7 after the start of the outbreak, so after only 19% of all cases) would have been required to prevent only 41% of all expected transmissions at that time. For Q fever, in which the transmission of chronic Q fever is considered, even at the end of the third annual outbreak's peak 47% of all (chronic) Q fever transmissions could still be prevented.
  
  
  CONCLUSIONS
  The updated model allows estimation of the infection transmission risk from travelling donors. In combination with the distinction between past and future transmissions, these estimates provide valuable information to support decisions concerning communication with the public and/or the implementation of safety interventions.
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|National Blood Service Zimbabwe, Harare, Zimbabwe.
authors.forename: Tonderai
authors.initials: T
authors.lastname: Mapako
authors.affiliation: Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands. w.oei@umcutrecht.nl.|Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. w.oei@umcutrecht.nl.
authors.forename: Welling
authors.initials: W
authors.lastname: Oei
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands.
authors.forename: Marinus
authors.initials: M
authors.lastname: van Hulst
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.|National Institute for Public Health and the Environment, Bilthoven, The Netherlands.|Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Mirjam E
authors.initials: ME
authors.lastname: Kretzschmar
authors.affiliation: Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Mart P
authors.initials: MP
authors.lastname: Janssen
mesh_terms: D001803:Blood Transfusion; D065632:Chikungunya Fever / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D021821:Communicable Diseases, Emerging / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D004196:Disease Outbreaks; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008962:Models, Theoretical; D009426:Netherlands / Q000453:epidemiology; D011778:Q Fever / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D018570:Risk Assessment; D014195:Travel
keywords: Blood transfusion; Emerging infectious diseases; Transmission risk; Travellers’ risk