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Geographic exposure risk of variant Creutzfeldt‐Jakob disease in US blood donors: a risk‐ranking model to evaluate alternative donor‐deferral policies
Author(s) -
Yang Hong,
Huang Yin,
Gregori Luisa,
Asher David M.,
Bui Travis,
Forshee Richard A.,
Anderson Steven A.
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13971
Subject(s) - deferral , medicine , bovine spongiform encephalopathy , limiting , risk assessment , environmental health , blood transfusion , food and drug administration , disease , surgery , business , prion protein , mechanical engineering , computer security , accounting , computer science , engineering
BACKGROUND Variant Creutzfeldt‐Jakob disease (vCJD) has been transmitted by blood transfusion (TTvCJD). The US Food and Drug Administration (FDA) recommends deferring blood donors who resided in or traveled to 30 European countries where they may have been exposed to bovine spongiform encephalopathy (BSE) through beef consumption. Those recommendations warrant re‐evaluation, because new cases of BSE and vCJD have markedly abated. STUDY DESIGN AND METHODS The FDA developed a risk‐ranking model to calculate the geographic vCJD risk using country‐specific case rates and person‐years of exposure of US blood donors. We used the reported country vCJD case rates, when available, or imputed vCJD case rates from reported BSE and UK beef exports during the risk period. We estimated the risk reduction and donor loss should the deferral be restricted to a few high‐risk countries. We also estimated additional risk reduction by leukocyte reduction (LR) of red blood cells (RBCs). RESULTS The United Kingdom, Ireland, and France had the greatest vCJD risk, contributing approximately 95% of the total risk. The model estimated that deferring US donors who spent extended periods of time in these three countries, combined with currently voluntary LR (95% of RBC units), would reduce the vCJD risk by 89.3%, a reduction similar to that achieved under the current policy (89.8%). Limiting deferrals to exposure in these three countries would potentially allow donations from an additional 100,000 donors who are currently deferred. CONCLUSION Our analysis suggests that a deferral option focusing on the three highest risk countries would achieve a level of blood safety similar to that achieved by the current policy.