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The intense investigation following the outbreak of microcephaly associated with Zika virus (ZIKV) in Brazil led to the recognition that many cases of ZIKV are asymptomatic, that ZIKV RNA could be found in blood samples, and that ZIKV infection could be transmitted via blood transfusion. Given these findings, in 2016 the U.S. Food and Drug Administration recommended individual-unit nucleic acid testing for ZIKV. The American Red Cross (in conjunction with the testing manufacturer) now reports on the results and costs of this screening approach between June 2016 and September 2017.
Among 4,325,889 screened donations, 9 were positive. Two of the donors had acquired ZIKV in Florida, six had traveled to ZIKV-active areas, and one had received an experimental ZIKV vaccine. The overall cost of the screening program was about $42 million; for the 8 identified mosquito-borne ZIKV infected individuals, the cost estimate was $5.3 million per person.
Saá P et al. Investigational testing for Zika virus among U.S. blood donors. N Engl J Med 2018 May 10; 378:1778. (https://doi.org/10.1056/NEJMoa1714977)
Comment
The terrible consequences of congenital ZIKV infection seen in Brazil and the rapid spread of Zika in the Americas in 2016 certainly justified the intense efforts to protect our blood supply. The current findings, coupled with the falling incidence of ZIKV infection across the western hemisphere in the last 2 years, suggest that alternative testing approaches, such as performing initial screening of 16-donor minipools, may now be more cost-effective for the country.