Should screening for
dengue be mandatory before blood transfusion?
I recently came across a
story in The Muscat Daily (Jan. 23, 2019) which said “the Ministry of Health (MoH) and the Department of Blood Banks
Services in Oman have announced on their Twitter accounts that “those affected
by dengue virus will not be allowed to donate blood for six months”. Dengue
cases are being reported in the country. The latest figures by the Ministry of
Health revealed that until January 22, there were 52 recorded cases of dengue
fever. In a statement, MoH said, “As a precautionary measure to prevent the
spread of the infection, residents and citizens of the dengue-affected areas
will also not be allowed to donate blood for 28 days.” According to the
Ministry, this is being put in place to help “prevent others from contracting
the disease”.
Travel is a risk factor
for spread of any infectious disease. With increasing travel, there is a chance
of the disease appearing in another part of the country or the globe, where it
did not occur previously. Consequently, the prevalence of dengue has increased
several-folds across the world.
The dengue virus was
recognized as a transfusion-transmitted pathogen in 2008 (World J Virol. 2015; 4(2):113-23). Chikungunya virus is also a
transfusion-transmissible infection, as per the World Health Organization
(WHO).
Since then, there has
been concern about the risk of transmission of dengue via blood transfusion.
Dengue virus becomes a blood-borne pathogen during the period of viremia, which
coincides with the febrile period (World
J Virol. 2015; 4(2):113-23).
“In 2009, the
American Association of Blood Banks placed dengue virus in the highest category
of emerging infectious agents for their potential impact on transfusion
recipient safety for the next years in North America” (World J Virol. 2015; 4(2):113-23).
Although rare, cases of
transfusion-transmitted dengue fever have been reported. So far, five cases of
transfusion-transmitted dengue, including one case of dengue hemorrhagic fever,
have been formerly documented (World J
Virol. 2015; 4(2):113-23).
Blood donors have been
recognized as likely vehicles for transmission of the infection in endemic
areas.
Dengue has become
endemic in India, particularly in Delhi, where it has become a perennial
infection.
In a study conducted to
determine the prevalence of dengue virus infection in blood donors in a
tertiary care centre, high seroprevalence (58%) of dengue infection in healthy
asymptomatic blood donors was found; but, no active viremia was detected (J Clin Diagn Res. 2016;10(10):
DC08–DC10).
Seroprevalence
is still a risk to blood safety and is a potential source for
transfusion-transmitted infections.
NACO National Blood
Transfusion Council “Guidelines for
Blood donor selection and Blood Donor Referral 2017” recommend that
blood donation should be deferred for 6 months following full recovery
in case of history of dengue or Chikungunya. A person who has visited a Dengue
and/or Chikungunya endemic area is deferred for 4 weeks following return from
the endemic area if no febrile illness is noted.
In its 2012 “Guidelines on Assessing Donor Suitability
for Blood Donation”, the WHO also recommends that individuals with a
history of dengue or chikungunya virus in endemic areas should defer for 6
months following full recovery from infection. It further says that individuals
who have visited an area endemic for dengue or chikungunya should defer for 28
days following return. And, those who have suffered a febrile illness during or
following return from an endemic region should defer for 6 months following
full recovery from infection
Dr NK Bhatia, Medical
Director, Mission Jan Jagriti Blood Bank is a renowned name in blood banking
with more than three decades of experience the field. According to Dr NK
Bhatia, “Dengue patients are not
allowed to donate blood for one year after treatment. If there is a history of blood/blood products
transfusion, the same deferral period applies. This is also true for
Chikungunya patients. Any person who has a ‘normal’ viral fever is not allowed
to donate blood for 7 days after the active phase is over. Some extend this
duration to one year.”
Hence, a medical history
becomes very important when assessing eligibility of a prospective blood donor.
Always ask a history of
dengue/Chikungunya, history of blood/blood product transfusion and history of
any viral fever.
Dengue patients should
defer blood donation for up to 6-12 months post-infection.
But, a question then
arises “Should screening for dengue be mandatory before blood transfusion as is
for hepatitis B virus, hepatitis C virus, HIV, syphilis, malaria” as many
dengue patients go undetected in acute febrile illness?
Dr KK
Aggarwal
Padma
Shri Awardee
President
Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Past
National President IMA
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