What is the prevalence of viral infections transmitted by transfusion?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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In countries with a high human development index (HDI) (based on life expectancy, education, and per capita income), transfusion of blood products is now very safe with respect to viral transfusion-transmissible infections. This is due to the increased sensitivity of pathogen testing, which reduces infectious window periods. Risk is significantly increased in countries with a low HDI because of high seroprevalence and inadequate pathogen testing and transfusion standards. The risk frequencies noted in this and the subsequent sections pertaining to transfusion-transmissible infections are likely to have wide confidence intervals, which accounts in part for differences in reporting.

The incidence of hepatitis A is 1 case per 2 million RBC units transfused (1:2 million). [38] The risk of transmission of hepatitis B virus per unit of component is 1:7.5 million. [39] Acute disease develops in one third of patients infected with hepatitis B, but chronic infections develop in fewer than 10% of those infected. The risk of transmission of hepatitis C virus per unit of component is 1:13 million. [39] In contrast to hepatitis B, greater than 80% of hepatitis C infections become chronic, with significant subsequent mortality attributed to cirrhosis and hepatocellular carcinoma.

The risk of transmission of human immunodeficiency virus (HIV) per unit of component is 1:21 million. [39]

The risk of transmission of human T-cell leukemia virus type I (HTLV-I) and human T-cell leukemia virus type II (HTLV-II) per unit of component is 1:7.6 million. [39]  

Cytomegalovirus (CMV) is the most common virus transmitted through transfusion, with an incidence ranging from 1:10 to 1:30. Because of its prevalence, transmission carries little risk to the general population. Patients at risk for developing disseminated CMV infection include neonates weighing less than 1200 g, seronegative pregnant women, recipients of seronegative allogeneic transplants, patients with advanced HIV infection, patients with lymphoma, and patients receiving chemotherapy.

Epstein-Barr virus (EBV) is also commonly transmitted due to its seroprevalence. The incidence of transmission is 1:200.

The risk of transmission of West Nile virus is < 1:1 million. [39]

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