A probable case of West Nile virus transfusion transmission
2017
BACKGROUND Transfusion-transmitted
West Nile virus(WNV) infection is infrequent as a result of minipool (MP) and individual-
donation(ID)
nucleic acid testing(
NAT) of
blood donations. ID-
NATis triggered on the basis of local WNV activity identified by MP-
NAT. STUDY DESIGN AND METHODS A 78-year-old male patient who was treated for cardiac disease received 14 blood components from 30 donors in August 2016. He was discharged 7 days after aortic valve replacement and coronary bypass surgery, but was re-admitted on Day 12 with symptoms of viral infection, and eventually was diagnosed with
aseptic meningitis. The patent died on Day 51. RESULTS The patient was positive for WNV-
immunoglobulin M(IgM) antibodies in his cerebrospinal fluid on Day 14 and was positive for WNV-IgM (on Days 14 and 16) and WNV-IgG antibodies (on Day 16) in his serum. All associated
donationswere nonreactive by MP-
NATor ID-
NAT. However, one MP-
NATwas noted to have an elevated (but negative) signal-to-cutoff ratio, and one donor from that MP was subsequently found positive for WNV-IgM and IgG antibodies; the donor was diagnosed with a WNV-like viral syndrome that had an onset 3 to 5 days postdonation. The donor's plasma was transfused 12 days before the patient's onset of WNV-
meningoencephalitis. Conversion to ID-
NATwas triggered for the region 7 days after the implicated
donation, which was associated with the region's first human WNV case. CONCLUSION Despite the possibility of mosquito-borne transmission, this was considered to be a case of transfusion-transmitted WNV infection from an MP-
NAT–nonreactive
donationcollected just before triggering conversion to ID-
NAT; a rare event recognized once in 84 million
donations.
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