Transfusion risk from emerging pathogens in the Asia–Pacific region

Helen Faddy; E Viennet; Robert L P Flower

doi:10.1111/voxs.12247

Background: An emerging infectious disease (EID) refers to a disease that has recently appeared in a population or one that has rapidly increased in incidence or geographic range. Examples of EIDs include Ebola, HIV/AIDS, hepatitis E and the vector‐borne diseases caused by Zika and dengue virus. EIDs pose a risk to transfusion safety, which can be direct, if the agent can be transmitted through blood transfusion, or indirect, where outbreaks reduce the pool of available donors. Although examples of both have been observed, the former will be the focus of this review. Many transfusion risks have become global due to globalization and increased international travel; however, unique region‐specific concerns exist. The Asia–Pacific region varies in size depending on context, but for the purposes of this review will be defined as South‐East Asia, East Asia and Oceania. This region is a hotspot for genetic diversity, as well as the emergence of a number of infectious diseases. The Asia–Pacific region is also geographically, culturally, socio‐economically and climatically diverse. Moreover, the level of sophistication in blood operators within this region varies, from a national supplier based on voluntary blood donors as is seen in Australia to hospital‐based services relying on replacement donors, which is seen in many nations across the Pacific. Aims: To review current EID risks to blood transfusion safety in the Asia–Pacific region. Methods: Review of available public health reports and literature for the occurrence of EIDs in the Asia–Pacific region that pose a transfusion risk. Results: EIDs that pose a transfusion risk occur across the Asia–Pacific region, with differing levels of endemicity between and within countries. Reports of hepatitis E virus (HEV) sero‐positivity vary from 2·2% in Fiji to 15·2% in Papua New Guinea. As a result of high HEV prevalence in the Hokkaido region of Japan, HEV nucleic acid amplification testing (NAT) has been implemented for screening blood donations. Dengue infection is widespread across the Asia–Pacific, with major outbreaks occurring in 2014 in Fiji, Malaysia, the Philippines and Thailand. In Australia, dengue is episodic in the north‐east, resulting in donation restrictions in affected areas. Zika virus emerged in the Asia–Pacific in early 2007 and outbreaks have spread across the Pacific, with epidemics in French Polynesia, the Cook Islands, Easter Island and New Caledonia. Due to the theoretical transfusion risk, several preventative procedures were implemented in French Polynesia during an outbreak in 2013, including NAT. Summary/conclusions: EIDs pose a transfusion risk globally, and in the Asia–Pacific region. A number of EIDs that can be transmitted through blood transfusion are endemic to the Asia–Pacific, with countries managing the transfusion risk depending on the level of endemicity of the agent in question, and the maturity of blood operations in each county. Climate change is predicted to increase the distribution and density of a range of disease vectors, which is likely to increase the transmission of a number of vector‐borne diseases, representing a significant threat to the maintenance of a safe blood supply in the future.

Transfusion risk from emerging pathogens in the Asia–Pacific region

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