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Predictive model for Zika virus RNA minipool nucleic acid testing in outbreak scenarios
Author(s) -
Yogurtcu Osman N.,
Yang Hong,
Chancey Caren,
Forshee Richard A.,
Eder Anne F.
Publication year - 2019
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.15296
Subject(s) - nat , zika virus , outbreak , virology , nucleic acid test , medicine , biology , statistics , virus , infectious disease (medical specialty) , mathematics , covid-19 , disease
BACKGROUND Zika virus (ZIKV), a mosquito‐borne flavivirus, causes asymptomatic infections in blood donors and can be transmitted by transfusion. During the 2016 US outbreak, universal individual‐donation nucleic acid testing (ID‐NAT) was used to screen the blood supply for ZIKV. Testing pooled samples from multiple donations with minipool (MP)‐NAT is less sensitive than ID‐NAT, which raised questions about its utility in ZIKV outbreaks. STUDY DESIGN AND METHODS A mathematical model and computer simulation determined the risk of missing ID‐NAT–reactive and immunoglobulin (Ig) M–negative donations in a ZIKV outbreak if MP‐NAT is used initially instead of ID‐NAT. The model calculated the time required for ZIKV RNA to replicate to a concentration detectable by testing donations individually or in pools of 6 (MP6) or 16 (MP16). A computer simulation then randomly selected infection times to determine the probability of detection by the candidate tests. RESULTS The probability of detecting the first ID‐NAT–reactive unit in an outbreak is 92% (2.5th‐97.5th percentile, 79%‐99%) by MP6 and 85% (2.5th‐97.5th percentile, 67%‐99%) by MP16. When one donation is detected by MP‐NAT, the model predicts that the chance of having missed one or more ID‐NAT–reactive donations is 8% to 15%. The probability of missing a unit by MP‐NAT is constant over the course of the outbreak (8% by MP6, 15% by MP16). CONCLUSION The model predicts that the probability that a candidate MP‐NAT will detect the first ID‐NAT–reactive unit in a ZIKV outbreak is 85% to 92% and remains constant over time.