Duration of Dengue Viremia in Blood Donors and Relationships Between Donor Viremia, Infection Incidence and Clinical Case Reports During a Large Epidemic.
Dengue viruses (DENV-1-4) pose a transfusion-transmission risk. This study estimated the dengue RNA detection period in asymptomatic blood donors and relationships between donor viremia and dengue incidence during a large epidemic.



Donor samples from the 2012 dengue transmission season in Rio de Janeiro, Brazil, were tested for DENV RNA by a transcription-mediated amplification (TMA) assay, with DENV types and viral loads determined by polymerase chain reaction. Samples collected during the first and last weeks of enrollment were tested for DENV immunoglobulin (Ig) G and IgM to estimate incidence during the study period, which was analyzed relative to nucleic acid amplification technology (NAT) yield to estimate the duration of NAT-detectable viremia and compared with reported clinical dengue cases in Rio.



Samples from 16 241 donations were tested; 87 (0.54%) were confirmed as DENV-4 RNA positive. Dengue IgM-positive/IgG-positive reactivity increased from 2.8% to 8.8%, indicating a 6.2% incidence (95% confidence interval [CI], 3.2%-9.1%) during the study period. Based on these data, we estimated a 9.1-day period (95% CI, 4.4-13.9 days) of RNA detectable with TMA. With 100 475 reported cases of clinical dengue, 1 RNA-positive donation was identified per 800 DENV cases.



These parameters allow projections of dengue incidence from donor NAT yield data and vice versa, and suggest that viremic donations will be rare relative to clinical disease cases.
Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco.
Michael P
MP
Busch
Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo.
Ester C
EC
Sabino
RTI International, Rockville, Maryland.
Donald
D
Brambilla
Fundação Hemorio, Rio de Janeiro, Brazil.
Maria Esther
ME
Lopes
Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo.
Ligia
L
Capuani
RTI International, Rockville, Maryland.
Dhuly
D
Chowdhury
RTI International, Rockville, Maryland.
Christopher
C
McClure
Hologic, Inc, San Diego.
Jeffrey M
JM
Linnen
Focus Diagnostics, San Juan Capistrano, California.
Harry
H
Prince
Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco.
Graham
G
Simmons
Blood Systems Research Institute.
Tzong-Hae
TH
Lee
RTI International, Rockville, Maryland.
Steven
S
Kleinman
Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco.
Brian
B
Custer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood* / Q000276:immunology*; D001782:Blood Donors / Q000706:statistics & numerical data; D001803:Blood Transfusion; D001938:Brazil / Q000453:epidemiology; D009033:Culicidae / Q000821:virology; D003715:Dengue / Q000097:blood* / Q000453:epidemiology / Q000635:transmission*; D003716:Dengue Virus / Q000276:immunology*; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests; D014766:Viremia / Q000097:blood* / Q000453:epidemiology / Q000635:transmission
D000914:Antibodies, Viral
NAT; clinical symptoms; dengue; transfusion-transmission