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Background and Objectives: On May 12, 2008, a severe earthquake hit Sichuan province in China. A post-earthquake survey was conducted to study the earthquake's effect on blood donor behaviour and stress at three blood centres at varying distances from the epicentre., Materials and Methods: A questionnaire was developed to assess donor post-traumatic stress disorders (PTSD) and attitudes toward giving blood. Responses were compared by centre and donor characteristics using multivariate logistic regression techniques., Results: Of all 17 456 donors, the overall prevalence of PTSD was 13.2%. Donors who knew someone killed or injured by the earthquake were 2.1 times more likely to have PTSD than others (95% CI: 1.8-2.4). 85.2% of donors cited the earthquake as their reason for donating. 16.1% of donors felt it acceptable to be less honest about one's health history in an emergency. After adjusting for PTSD, geographic and demographic characteristics, the donors knowing someone killed or injured by the earthquake were 1.4 times (95% CI: 1.2-1.7) more likely to cite the earthquake as reason for donating, and 1.8 times (95% CI: 1.5-2.1) more likely to accept being less honest about one's health history in case of national emergency., Conclusions: The psychological and behavioural impacts of the earthquake on blood donors extended far from the epicentre. After a disaster, it is important to emphasize that donors must be truthful on the donor questionnaire as some donors appear willing to be less than honest when they perceive an increased need for blood products.

Background: In the United States, African Americans donate at approximately half the rate of whites and therefore are underrepresented in the volunteer blood donor pool. The goal of this study was to identify motivators and barriers to African Americans donating blood., Study Design and Methods: A consortium of 15 predominantly African American churches of varying denominations in metropolitan Atlanta, Georgia, participated in an 81-item self-administered survey. The questionnaire was designed to assess participant's demographic background, blood donation frequency, motivators and barriers to donation, knowledge and beliefs regarding donation, and overall health status., Results: A total of 930 participants completed the survey: 72% female, 55% age 40 or older, 99% African American, and 58% college-educated. The most frequent reported motivators were donating to help save a life (96%) and donating because blood is needed (95%), while the most frequent barriers were that they rarely think about it and they were afraid, nervous, or anxious to give blood (35%). The association of barriers with donation status, age, gender, and education level was stronger than for motivators. Fear was more common in nondonors than lapsed and current donors, youngest compared to older adults, and women than men and less in those with higher income., Conclusion: Motivators and barriers to blood donation in African American church attendees differ depending on the respondents' demographics. To increase the effectiveness of church drives, donor recruitment should focus on addressing these barriers and motivators.

Background: Presenting blood donors are screened to ensure both their safety and that of the recipients of blood products. Donors with identified risks are deferred from donating blood either temporarily or permanently. Minorities are underrepresented as donors in the United States and this may in part be a result of increased donor deferral rates in minorities compared to white individuals., Study Design and Methods: Data consisted of deferred and successful blood donor presentations to the American Red Cross Southern Region in the metropolitan Atlanta area in 2004 to 2008. Bivariate and multivariate analyses were conducted by race/ethnicity, age group, and sex., Results: A total of 586,159 voluntary donor presentations occurred in 2004 to 2008, of which 79,214 (15.6%) resulted in deferral. In the age 16 to 69 years subset (98.3% of the presentations), deferred presentations were mostly women (78.2%). The most common reason for donor deferral was low hemoglobin (62.6%). The donor deferral rate varied by race/ethnicity, age, and sex: whites (11.1%), Hispanics (14.1%), and African Americans (17.9%); 16- to 19-year-olds (17.0%) and 50- to 59-year-olds (11.7%); and females (20.0%) and males (6.2%). Compared to whites and Hispanics, African American females had the highest deferral rate in each age group., Conclusions: Minorities are disproportionately impacted by blood donor deferrals. Methods to decrease blood donor deferral rates among African Americans are needed.

Background: An ongoing issue in transfusion medicine is whether newly identified or emerging pathogens can be transmitted by transfusion. One method to study this question is through the use of a contemporary linked donor-recipient repository., Study Design and Methods: The Retrovirus Epidemiology Donor Study Allogeneic Donor and Recipient (RADAR) repository was established between 2000 and 2003 by seven blood centers and eight collaborating hospitals. Specimens from consented donors were collected, components from their donations were routed to participating hospitals, and recipients of these units gave enrollment and follow-up specimens for long-term storage. The repository was designed to show that zero transmissions to enrolled recipients would indicate with 95 percent confidence that the transfusion transmission rate of an agent with prevalence of 0.05 to 1 percent was lower than 25 percent., Results: The repository contains pre- and posttransfusion specimens from 3,575 cardiac, vascular, and orthopedic surgery patients, linked to 13,201 donation specimens. The mean number of RADAR donation exposures per recipient is 3.85. The distribution of components transfused is 77 percent red cells, 13 percent whole blood-derived platelet concentrates, and 10 percent fresh frozen plasma. A supplementary unlinked donation repository containing 99,906 specimens from 84,339 donors was also established and can be used to evaluate the prevalence of an agent and validate assay(s) performance before accessing the donor-recipient-linked repository. Recipient testing conducted during the establishment of RADAR revealed no transmissions of human immunodeficiency virus, hepatitis C virus, or human T-lymphotropic virus., Conclusions: RADAR is a contemporary donor-recipient repository that can be accessed to study the transfusion transmissibility of emerging agents.

Background: Calculation of viral residual risk is dependent on estimating incidence, which is not easily obtainable by most blood centers. Prevalence, however, is readily available. Understanding whether prevalence reflects corresponding incidence may help blood centers monitor disease risks., Study Design and Methods: With data on 12 million allogeneic donations, prevalence and incidence of transfusion-transmitted viral infections (TTVIs) were calculated. Relationships between prevalence (in total, first-time, and repeat donations) and incidence were analyzed for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) relative to temporal and donor demographic stratifications, respectively., Results: Overall prevalence of HIV, HBV, and HCV did not consistently reflect corresponding incidence. The relationship between prevalence and incidence varied with time and donors' age and was virus-specific., Conclusion: Incidence of TTVIs cannot be easily predicted from overall prevalence. Accurate assessment of TTVI risk necessitates knowledge about donation histories and person-years at risk. Establishing comprehensive frameworks for monitoring blood donations and infectious disease markers remains a key to monitoring blood safety.

Background and Objectives: Converting first-time donors to become regular donors continues to be a challenge facing blood centres. We examined whether first-time donors with frequent return in the first 12 months were more likely to become regular donors., Subjects and Methods: The donation histories of 179 409 community whole-blood donors, whose first-time donation in 1991 was negative on donor screening tests, were evaluated. Donors were categorized by the number of donations made in the 12 months after (and including) their first donation. The donor return pattern in the subsequent 6 years, and its association with first-year donation frequency and demographics, was evaluated by using logistic regression analysis. A 'regular donor' was defined as one who returned to donate in at least 4 of the 6 years of follow-up., Results: First-year donation frequency was significantly correlated with long-term donor return (P < 0.0001). Among those giving 1, 2, 3, 4 and > or = 5 donations in the first year, 4%, 11%, 21%, 32% and 42%, respectively, became regular donors (P < 0.0001). Similar associations between donation pattern and donor return behaviour were observed after adjusting for demographic variables (P < 0.0001)., Conclusions: Strategies aimed at encouraging current donors to donate more frequently during the first year may help to establish a regular donation behaviour.

Background: Increasing concern about transfusion transmission of variant Creutzfeldt-Jakob disease has resulted in indefinite deferral of transfused donors in France and the UK. Little is known, however, about the impact of indefinite deferral of transfused donors on blood safety and availability in the US., Study Design and Methods: Data were collected on allogeneic donations at five US blood centers during 1991 through 2000. Donation characteristics, prevalence, and incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were compared between transfused and nontransfused donors. Unreported deferrable risk (UDR) and reasons to donate were evaluated with data from a mail survey., Results: Transfusion history was reported by 4.2 percent of donors. Prevalence and incidence of HIV and HBV were comparable between transfused and nontransfused donors. Although HCV incidence was similar in both groups, HCV prevalence was nearly three times higher in transfused than in nontransfused first-time donors. UDR and reasons to donate were similar in the two groups, except transfused donors were less likely to donate for screening test results (odds ratio, 0.5; 95% confidence interval, 0.3-0.8)., Conclusion: Transfused and nontransfused donors had similar viral incidence and comparable UDR, suggesting that indefinite deferral of transfused donors would unlikely improve blood safety. Until more is known about the prevalence and transfusion transmissibility of emerging agents, indefinite deferral of previously transfused donors in the US does not appear warranted.

Background: Blood donors with high-risk behaviors may not self-defer because they failed to read or understand the screening educational materials., Study Design and Methods: In 1993, a total of 34,726 allogeneic donors responded to an anonymous mail survey of 50,162 donors that inquired about demographics, donor status, amount of the donor educational materials read, new HIV knowledge gained, and donors' opinions on the length and difficulty of materials., Results: Although 78 percent reported reading all materials, only 32 percent indicated reading carefully; 34 percent learned new information about HIV and 95 percent perceived the materials as easy to understand. First-time donors were more likely to read carefully (OR, 7.9) and gain more HIV knowledge from the materials (OR, 1.9) than repeat donors. Minority, less educated, screening test-reactive, and HIV test-seeking donors reported reading the materials more carefully and learning more about HIV than their respective counterparts. Donors with less education, those with reactive screening tests, those seeking HIV test results, and those not reporting a risk behavior were more likely to find the materials difficult to understand., Conclusion: Most donors reported skimming and not having difficulty understanding the educational materials. Some donors may be aware that they should not donate or are failing to assimilate the information in the materials. Methods to present information more clearly and concisely are clearly needed. However, some high-risk donors may still continue donating no matter how improved the educational materials are.

Background: Understanding the donor base, infectious disease prevalence, and donation loss at various blood donation sites will help maximize blood collection efforts and blood availability., Study Design and Methods: Using donation data collected at five US blood centers, the prevalence of HIV, HTLV, HBsAg, and HCV in first-time whole-blood donations at 10 donation sites was evaluated: military, education, religious, professional, industry, services, community, health care, government, and fixed sites. Donation loss from screening test reactivity at each donation site was also evaluated., Results: During the study, 1.2 million first-time whole-blood donations were collected. Military and education sites had a low prevalence of all viral markers, except for HBsAg, which was highest at education sites. Variations in viral marker prevalence among donation sites were partially explained by donor demographic differences. Donation loss varied by donation site, ranging from 3.3 percent at education sites to 6.4 percent at industry sites, indicating differential efficiency of blood collection efforts., Conclusion: Different rates of positive viral test results and donation loss in first-time whole-blood donors were observed at various types of donation sites. This information may be useful in estimating the yield of usable units from specific blood drives and in allocating resources to meet blood center collection goals.

Background: Increased knowledge of HIV transmission and behavioral and test screening may encourage high-risk blood donors to self-defer., Study Design and Methods: Knowledge of HIV transmission and screening and the association with demographics, screening test reactivity, and unreported deferrable risks (UDRs) was assessed by a 1998 anonymous mail survey sent to 92,581 blood donors, of whom 57 percent responded. Groups were compared by using weighted chi-square tests and logistic regression analysis., Results: Four percent of the donors thought that it was very likely or somewhat likely for a person to contract HIV from donating blood, and 20 percent perceived a similar risk from blood transfusion. Only 60 percent of the donors knew that the available screening tests may not detect a recent infection. Thirty-seven percent either did not know or felt it was acceptable to donate blood to obtain HIV testing. Those most likely to answer knowledge questions incorrectly were more likely to have a higher prevalence of test reactivity or UDRs and to be

Context: Despite changes in eligibility policies, practical barriers limit blood donations from individuals with hemochromatosis. Increased knowledge of hemochromatosis donor characteristics may help foster further changes that will promote more donations., Objectives: To estimate the prevalence of donors diagnosed as having hemochromatosis and to compare rates of unreported deferrable risks for transfusion-transmissible viral infections (TTVIs), positive screening test results for TTVIs, and donation patterns between hemochromatosis patient donors and donors reporting no medical conditions necessitating phlebotomy (non-health-related donors)., Design: An anonymous mail survey conducted in 1998 as part of the ongoing Retrovirus Epidemiology Donor Study., Setting and Participants: Among a stratified probability sample of 92 581 blood donors from 8 geographically diverse US blood centers, 52 650 (57%) responded., Main Outcome Measures: Prevalence of hemochromatosis among blood donors; prevalence of unreported deferrable risks and positive screening test results for TTVIs among hemochromatosis patient donors vs non-health-related donors., Results: One hundred ninety-seven respondents (0.4%) identified themselves as hemochromatosis patients and 50 079 (95.1%) as non-health-related donors. An estimated 0.8% of all donations were from hemochromatosis patients, 45.8% of whom reported that they had donated blood to treat their illness. The proportion of repeat donors was higher in hemochromatosis patients than in non-health-related donors (83.5% vs 76.5%; P =.03). Among repeat donors, 68.7% of hemochromatosis patients reported donating at least 3 times in the past year compared with 49.1% of non-health-related donors (P<.001). The prevalence of unreported deferrable risks for TTVIs was similar in hemochromatosis patients (2.0%) and non-health-related donors(3.1%) as was the overall prevalence of positive screening test results (1.3% of hemochromatosis patients vs 1.6% of non-health-related donors)., Conclusions: Although significant numbers of hemochromatosis patients reported donating blood for therapeutic reasons, our findings suggest that this population does not present a greater risk to blood safety than other donors.

Background: Evaluating plateletpheresis (PPH) and repeat community whole-blood (RWB) donors' responses to donation incentive programs is essential for developing effective donor retention programs., Study Design and Methods: Using data from a 1998 anonymous questionnaire sent to 92,581 US blood donors, the prevalence of unreported deferrable risks, screening test reactivity, and response to incentives were compared in RWB and PPH donors by the use of weighted chi-square tests and logistic regression analyses., Results: From 52,650 respondents, 38,884 RWB and 2,028 PPH donors were identified. Levels of screening test reactivity (1%) and unreported deferrable risks (UDRs, 2-3%) were similar in RWB and PPH donors. RWB and PPH donors were strongly encouraged or discouraged by similar incentives. Of the incentives that would encourage a higher proportion of UDR-free RWB donors to return, cholesterol screening and earning a blood credit appealed to >50 percent. Similar results were obtained for cholesterol screening in PPH donors. Community service or education credits, premarital screening, and cash had limited appeal for PPH and RWB donors, respectively, and would be more likely to differentially encourage donors with a UDR to return., Conclusion: Incentives that were associated with the greatest donor appeal and that minimized the potential recruitment of more risky donors were identified.

Background: Incidence rates (IRs) for viral infections may vary with the frequency of donation among repeat, community, whole-blood (WB) donors, with IRs thought to be lower among donors with higher frequency of donation., Study Design and Methods: IRs for HIV, HTLV, HCV, and HBV infection were stratified by frequency of donation among 868,403 repeat WB donors who gave approximately 4 million donations at five United States blood centers from 1991 through 96. All donors had given at least 2 donations during those years, with the first donation being nonreactive on confirmatory testing. Frequency of donation was measured in three ways: by the number of donations per year; at the time of donation, by the number of donations given within the preceding 2-year period; and by the number of donations given from 1991 through 1993., Results: The IRs for HIV, HCV, and HBV infection did not appear to differ among donors with lower or higher numbers of donation per year. However, the IR for HTLV infection decreased as the number of donations per year increased (p = 0.0004). IRs for all viral markers remained stable, regardless of the number of donations given within the 2-year period before the donation. Although IRs for HIV, HTLV, and HCV infection did not vary by the number of donations given in 1991 through 1993, the IR for HBV infection appeared to be lower in donors who gave more donations in that period (p = 0.01)., Conclusion: These findings do not provide evidence of a lower IR for transfusion-transmissible viral infections among repeat WB donors who give more frequently. Abbreviated screening histories for frequent repeat donors might not be advisable.

Background: With changing demographics of the United States population and the continuous need to recruit new donors, it is important to monitor the demographic profile of first-time donors and to evaluate changes in the donor pool to improve recruitment targeting., Study Design and Methods: First-time whole blood (n = 901,862) donors at five United States blood centers between 1991 and 1996 were analyzed., Results: The total number of first-time donors appears to be decreasing. Over the 6-year period, there was an overall increase in the proportion of Hispanic and other minority first-time donors and a concurrent decrease in the proportion of white donors at Retrovirus Epidemiology Donor Study centers. Other variables, including age, sex, and education, did not show a consistent trend., Conclusion: The demographic profile of first-time donors is changing. These data highlight the importance for blood centers to continuously monitor the donor population. A better understanding of the donor population may help blood centers adjust their donor outreach, recruitment, and retention programs. New recruitment efforts appear needed to counter general apathy toward donating blood, and minority groups appear to be receptive to becoming blood donors.

Background: It is important to assess the potential efficacy and safety of offering donation incentives as part of recruitment and retention programs., Study Design and Methods: In 1995, 7489 allogeneic donors responded to an anonymous mail survey that inquired about demographics, donation history, infectious disease risks, and the potential appeal of incentives., Results: The projected net effect of offering blood credits and medical testing would be to motivate, respectively, 58 percent and 46 percent of donors to return, whereas offering an item of limited value would motivate 20 percent to do so. First-time and younger donors reported more frequently than repeat or older donors that incentives would appeal to them. Donors attracted by cash were 60 percent more likely to have a risk for transfusion-transmissible infections (p = 0.03). Although not statistically significant, the odds of being an at-risk donor were higher among individuals attracted by tickets to events (OR 1.5) and extra time off work (OR 1.2)., Conclusion: These findings suggest that offering blood credits and (though to a lesser extent) items of limited value could be safe and effective strategies for retaining donors. Although medical tests were found to have broad appeal, studies are needed to identify tests in which donors would be most interested.

Background: To evaluate whether the active recruitment of young donors of high school and college age could affect the safety of the blood supply, prevalence and incidence rates of infectious disease markers among donors aged 17 to 18 and 19 to 22 were compared to those in donors 23 years of age and older., Study Design and Methods: Over 15 percent of 4.97 million whole blood donations were collected from donors aged 17 to 18 and 19 to 22. Prevalence (per 100,000 first-time donors) and incidence (per 100,000 person-years) rates for confirmed infectious diseases were compared between age groups., Results: The prevalence estimates for HIV, HCV, HTLV-I and -II, and serologic tests for syphilis (STS) were significantly lower among first-time donors aged 17 to 18 and 19 to 22 than among those 23 to 44 years of age. HBsAg prevalence was higher in the first-time donors in the younger groups than in first-time donors in the older group because of higher prevalences among Asians and blacks. The incidence rates of HIV, HCV, and HTLV were similar in the younger groups and the older group. Donors 19 to 22 years of age had a higher incidence rate of estimated HBV than did donors aged 23 to 44 and 45+ (p<0.001), but the incidence rate of STS was lower in donors aged 17 to 18 and 19 to 22 than in donors 23 to 44 and 45+ years of age (p<0.001)., Conclusion: Aggressive recruitment of school-age donors should not result in an increased risk of transmission-transmitted infections, with the possible exception of HBV.

Context: Evaluating trends in blood donor infectious disease rates is essential for monitoring blood supply safety and donor screening effectiveness., Objective: To determine changes over time in blood donor population infection rates of human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), hepatitis C virus (HCV), and hepatitis B virus (HBV)., Design: Cross-sectional survey data from the National Heart, Lung, and Blood Institute-sponsored Retrovirus Epidemiology Donor Study., Setting: Five blood centers in different regions of the United States., Participants: A total of 1.9 million volunteer blood donors with 1 or more nonautologous donations from January 1991 to December 1996., Main Outcome Measures: Changes in rates of HIV, HTLV, HCV, and HBV infections were evaluated by comparing yearly prevalence estimates (per 100,000 donations) for first-time allogeneic donors and period-specific incidence rates (IRs) (per 100,000 person-years) for repeat allogeneic donors between 1991 and 1996 (for HCV, from about March 1992 to June 1996)., Results: Prevalence of HIV decreased in first-time donors from 0.030% to 0.015% (P=.006) and HCV prevalence decreased from 0.63% to 0.40% (P<.001). Trends were not statistically significant for the proportion of first-time donors with hepatitis B surface antigen (HBsAg) or HTLV. For repeat donors, IRs did not change significantly, indicating a stable but low level of seroconversion. The overall IRs (95% confidence intervals) per 100,000 person-years were 2.92 (2.26-3.70) for HIV, 1.59 (1.12-2.19) for HTLV, 3.25 (2.36-4.36) for HCV, and an estimated 10.43 (7.99-13. 37) for HBV (based on an HBsAg rate of 2.66 [2.04-3.41] with presumed false-positive results considered negative). The HBV IR estimate with presumed false-positive results considered positive (for comparability to previous analyses) was 17.83 (14.60-21.56)., Conclusion: The decrease in HIV and HCV prevalence rates, combined with the previously documented lower rates of infection in first-time donors compared with the general population, suggests the continued benefit of behavioral risk factor screening. JAMA. 2000;284:229-235

Context: The human T-lymphotropic viruses types 1 and 2 (HTLV-1 and HTLV-2) are highly prevalent among injection drug users in the United States. However, the clinical course of infection has not been well characterized., Objective: To understand HTLV-1-and HTLV-2-associated laboratory abnormalities, which may provide insights into their underlying pathophysiology., Design: Cohort study., Setting: Five US blood centers., Participants: A total of 133 HTLV-1-and 332 HTLV-2-seropositive former blood donors and 717 HTLV-seronegative donors followed up prospectively since 1991., Main Outcome Measures: Selected serum chemistry tests and complete blood cell counts were analyzed at enrollment and approximately 2 years later in participants. Repeated-measures analyses were conducted to evaluate the effect of HTLV infection on laboratory measures., Results: Compared with seronegative subjects, HTLV-1-seropositive subjects had 13% higher creatine kinase (P =.02) and slightly elevated lactate dehydrogenase (P =.03) levels at follow-up. The HTLV-2-seropositive participants had 11% higher absolute lymphocyte counts than seronegative subjects (P =.0001). Infection with HTLV-2 also appeared to be associated with slightly higher hemoglobin levels (P =.03) and hematocrit (P =.03) and with lower albumin levels (P =.01)., Conclusions: These results further our understanding of the biological mechanisms underlying HTLV and suggest that HTLV-associated laboratory changes are unlikely to alter clinical evaluation or counseling of otherwise healthy HTLV-infected subjects.

Injection drug use (IDU) is a known risk factor for hepatitis C virus (HCV) infection, but the strength of other parenteral and sexual risk factors is unclear. In 1997, we performed a case-control study of 2,316 HCV-seropositive blood donors and 2,316 seronegative donors matched on age, sex, race/ethnicity, blood center, and first-time versus repeat-donor status. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Questionnaires were returned by 758 (33%) HCV(+) and 1,039 (45%) control subjects (P =.001). The final multivariate model included only the following independent HCV risk factors: IDU (OR = 49.6; 95% CI: 20.3-121.1), blood transfusion in non-IDU (OR = 10.9; 95% CI: 6.5-18.2), sex with an IDU (OR = 6.3; 95% CI: 3.3-12.0), having been in jail more than 3 days (OR = 2.9; 95% CI: 1.3-6.6), religious scarification (OR = 2.8; 95% CI: 1.2-7. 0), having been stuck or cut with a bloody object (OR = 2.1; 95% CI: 1.1-4.1), pierced ears or body parts (OR = 2.0; 95% CI: 1.1-3.7), and immunoglobulin injection (OR = 1.6; 95% CI: 1.0-2.6). Although drug inhalation and a high number of lifetime sex partners were significantly more common among HCV seropositives, they were not associated with HCV after controlling for IDU and other risk factors. IDU, blood transfusion among non-IDU, and sex with an IDU are strong risk factors for HCV among United States blood donors. Weaker associations with incarceration, religious scarification, being stuck or cut with a bloody object, pierced ears or body parts, and immunoglobulin injection must be interpreted with caution.

Large lymphocytes with basophilic cytoplasm and cleaved/cerebriform nuclei called flower cells have been described in human T-lymphotrophic virus type I (HTLV-I) seropositive individuals and may be precursors of adult T-cell leukaemia (ATL). A cohort of 546 HTLV-seropositive former blood donors, 32 HTLV-positive sexual partners of these donors and 799 HTLV-seronegative controls has been followed as part of the Retrovirus Epidemiology Donor Study. A novel methodology was developed to systematically review peripheral blood slides from these subjects for HTLV-related lymphocyte abnormalities, using an algorithm based on morphologic features to objectively identify flower cells. The algorithm included: absence of azurophil granules; nuclear chromatin condensation; cell size >1.5 small lymphocytes; nuclear to cytoplasmic ratio >80%; and presence of nuclear folding/lobulation. Peripheral slides from subjects were screened by a medical technologist blinded to HTLV status. 6.8% of HTLV-I subjects (P = 0.0001 versus seronegatives), 0.9% of HTLV-II subjects and 1.1% of seronegatives were confirmed to have cells classified as flower cells by two haematologists using objective criteria, and blinded to serostatus. Despite the higher prevalence of flower cells in HTLV-I positives, no clinical correlations were found. Longitudinal follow-up may yield higher rates of cellular abnormalities as the sequelae of HTLV infection develop.

Background: Calculations of the incidence of hepatitis B virus (HBV) infections in the blood donor setting that are based solely on data for seroconversion to hepatitis B surface antigen (HBsAg) will underestimate the incidence due to the transient nature of antigenemia. Estimates based on antibody to hepatitis B core antigen will overestimate the incidence due to false-positive results caused by the nonspecificity of the test., Study Design and Methods: Serologic test results were obtained from multiple-time volunteer donors at five United States blood centers from January 1991 through December 1993. The observed HBsAg seroconversion rate was multiplied by an adjustment factor, derived from the weighted average probability of a positive HBsAg test for HBV-infected donors who become chronic carriers, for donors with a primary antibody response without detectable antigenemia, and for donors who develop transient antigenemia., Results: Among 586,507 multiple-time donors giving 2,318,356 donations and observed for 822,426 person-years, the HBsAg incidence rate was 4.01 per 100,000 person-years. On the basis of prior reports of the duration of HBsAg positivity and the observed distribution of interdonation intervals among the study group, there was an estimated 53-percent chance that an HBV-infected donor with transient antigenemia would have a positive HBsAg test result. If 70 percent of newly HBV-infected adults have transient antigenemia, 25 percent have a primary antibody response without primary antigenemia, and 5 percent become chronic carriers, the overall chance of being detected by the HBsAg test was 42 percent, for an adjustment factor of 2.38. The total HBV incidence rate, therefore, was estimated to be 9.54 per 100,000 person-years., Conclusion: The crude HBV incidence rate observed from HBsAg test results will underestimate the true rate. The adjusted HBV incidence rate should be used in applications such as estimations of residual HBV risk to the blood supply and projections of the benefits of screening for HBV DNA.

Objective: Individuals who do not respond accurately to questions about infectious disease risk factors at the time of blood donation represent a potential threat to the safety of the blood supply. This study was designed to estimate the prevalence of undetected behavioral and other risks in current blood donors., Design: Anonymous mail surveys to collect demographic, medical, and behavioral information were administered to individuals who had donated blood within the previous 2 months. Sampling weights were used in the analysis to adjust for differential sampling and response rates among demographic groups to provide prevalence estimates for the donor population., Setting: Five geographically and demographically diverse US blood centers., Participants: A stratified probability sample of 50,162 allogeneic blood donors., Main Outcome Measures: Estimated prevalence rates for risk behaviors that would have been a basis for deferral if reported at the time of the donor screening interview (deferrable risk)., Results: Completed questionnaires were received for 34,726 donors (69.2% of the sample). A total of 186 per 10,000 respondents (1.9%) reported a deferrable risk that was present at the time of their past donation, while 39 per 10,000 (0.4%) reported this behavior within the 3 months prior to donation. Rates (with 95% confidence intervals [CIs]) of deferrable risk behaviors were 1.4 (95% CI, 1.2-1.6) times higher for men than women, 1.6 (95% CI, 1.3-2.0) times higher for first-time vs repeat donors, 2.7 (95% CI, 2.0-3.6) times higher for donors with reactive screening tests, and 7.6 (95% CI, 3.6-15.8) times higher for donors who used the confidential unit exclusion option., Conclusions: Despite the high degree of transfusion safety in the United States today, a measurable percentage of active blood donors when assessed by anonymous survey report risks for human immunodeficiency virus and other infections not reported at the time of screening, suggesting the need for further refinements in the blood donor qualification process.

In the United States, blood donors have been routinely screened for human T-cell lymphotropic virus (HTLV) since 1988. HTLV-I and -II seropositive blood donors have been identified through confirmatory testing at five participating blood centers and frequency-matched seronegative controls provided information on potential HTLV sociodemographic, parenteral, and sexual risk factors during structured interviews. After adjustment, low educational attainment; accidental needlesticks or cuts; prior blood transfusion; > or = 7 sex partners; and a sex partner from an HTLV-I endemic area were significantly associated with both HTLV-I and -II. Gender did not modify the odds ratios (OR) in the final logistic regression models, despite apparent male-female differences in gender-specific bivariable analysis. Injection drug use (IDU) or having sex with an IDUs were significant risks for HTLV-II, but not for HTLV-I. The OR for donors who had IDU sex partners was 20.6 times higher than those who did not. For IDUs, the OR was increased 10.5 times over nonusers. Abortion was a significant HTLV-II risk factor for women. Our findings indicate that IDU and sex with IDUs are important risk factors for HTLV-II transmission, even among low-risk populations such as blood donors.

Objective: To measure demographic determinants of hepatitis C virus (HCV) seroprevalence among blood donors in the United States., Design: Cross-sectional epidemiological study., Setting: Five blood centers in different regions of the United States., Subjects: A total of 862,398 consecutive volunteer blood donors with one or more nonautologous donations from March 1992 through December 1993., Methods: Demographic data collection, serological screening with second-generation anti-HCV enzyme immunoassay, and confirmation with anti-HCV recombinant immunoblot., Results: There were 3126 donors with at least one blood donation confirmed HCV-seropositive, for a crude prevalence of 3.6 per 1000. Age-specific HCV seroprevalence rose from 0.5 per 1000 donors younger than 20 years to a maximum of 6.9 per 1000 in donors aged 30 to 39 years and declined in older age groups. There was interaction between age and educational attainment, with 30- to 49-year-olds with less than a high school diploma at highest risk of HCV infection (odds ratio [OR], 33.0; 95% confidence interval [CI], 23.0 to 47.2 compared with those younger than 30 years with a bachelor's degree or higher degree). Other independent risk factors for HCV seropositivity included male sex (OR, 1.9; 95% CI, 1.8 to 2.1), black race (OR, 1.7; 95% CI, 1.6 to 1.9), Hispanic ethnicity (OR, 1.3; 95% CI, 1.1 to 1.5), previous blood transfusion (OR, 2.8; 95% CI, 2.5 to 3.1), and first/only time donor status (OR, 4.2; 95% CI, 3.9 to 4.5 compared with repeat donors). Seropositivity for human T-lymphotropic virus types I and II, human immunodeficiency virus, or hepatitis B core antigen was highly associated with HCV seropositivity (OR, 10.4; 95% CI, 9.6 to 11.4 for one vs no marker)., Conclusions: Despite a low overall HCV prevalence in blood donors in the United States, there is a marked variation in HCV seroprevalence by demographic subgroup, even after controlling for prior blood transfusion, a recognized risk factor for HCV. Further study of the prevalence of other parenteral risk factors such as past injection drug use among blood donors is needed.

Background: Follow-up studies from the mid-1980s showed that 1 to 5 percent of blood donors testing reactive in anti-human immunodeficiency virus type 1 (HIV-1) enzyme immunoassay (EIA) and testing indeterminate in Western blot were infected with HIV-1 and were in the process of seroconverting. The present study was conducted to establish the rate of HIV infection among contemporary anti-HIV-1/HIV type 2 (HIV-2) EIA-reactive, Western blot-indeterminate donors., Study Design and Methods: Donations (n = 607) with indeterminate HIV supplemental test results were identified by screening 3,021,342 donations given from November 1990 through August 1993 at five participating blood centers. Consenting donors were enrolled and samples taken 4 to 8 weeks after donation. Follow-up sera were tested by EIA and Western blot for anti-HIV-1 seroconversion and by type-specific peptide assays for antibodies to HIV-2 and HIV-1 subtype O. Peripheral blood mononuclear cells and/or plasma from the follow-up samples were tested for HIV-1 DNA and/or RNA by polymerase chain reaction. The rate of HIV-1 infection among Western blot-indeterminate donors was also estimated by multiplying the incidence rate of HIV-1 seroconversion in this donor population by the estimated duration of the EIA-reactive and Western blot-indeterminate window during seroconversion (8.5 days)., Results: Supplemental test-indeterminate donors (n = 355) enrolled a median of 38 days after donation; 265 (75%) of these donors were identified as indeterminate after an anti-HIV-1/2 EIA-reactive donation. Enrolled and non-enrolled donors had similar distributions of demographic characteristics and band patterns. Follow-up samples from all 355 donors tested negative for HIV-1 in polymerase chain reaction. Follow-up sera tested Western blot-negative in 54 cases (15%) and Western blot-indeterminate in 299 (84%). Two follow-up sera (0.6%) were interpreted, according to manufacturer's package insert criteria, as Western blot positive with p24 and gp41 bands and/or gp120/160 bands; however, paired testing of index and follow-up sera from these two cases showed identical Western blot and EIA reactivity, and polymerase chain reaction was negative for HIV RNA and DNA, which ruled out HIV infection. The absence of HIV infection in 355 Western blot-indeterminate donors was consistent with our incidence-based model analysis, which yielded an estimate of one HIV-1 infection for every 215 Western blot-indeterminate donations (95% CI, 1/39-1/8333)., Conclusion: Contemporary blood donors classified as indeterminate in supplemental HIV testing are infrequently infected with HIV. Donors whose follow-up samples test negative in anti-HIV-1/2 EIAs and negative or persistently indeterminate in Western blots should be considered eligible for reinstatement.

Background: Since the mid-1980s, blood banks in the United States have screened donors for elevated alanine aminotransferase (ALT) in an effort to prevent posttransfusion hepatitis. The present study was designed to quantitate the residual value of ALT screening following the implementation of hepatitis C virus (HCV) assays., Study Design and Methods: Two approaches were used. First, a database of 2.3 million donations made by 586,507 volunteer blood donors between 1991 and 1993 was used to compare the incidence of seroconversion to hepatitis B virus (HBV) and HCV marker positivity in donors with elevated ALT values and with normal ALT values. Second, the duration of ALT elevation prior to HBV and HCV seroconversion was determined from 34 well-documented cases of posttransfusion HBV and HCV; elevated-ALT window periods were multiplied by rates of HBV and HCV incidence in donors to project the yield of ALT screening. Predictive value and cost-effectiveness analyses were also performed to compare the value of ALT screening before and after HCV screening was implemented., Results: Both approaches indicate that ALT testing does not detect HBV in the window phase but does currently identify approximately 3 HCV window-phase donations per 1 million donations; this contrasts with ALT detection of approximately 1800 HCV-infectious units per 1 million donations prior to anti-HCV screening. Currently, only 8 in 10,000 donated units with elevated ALT (negative anti-HCV) are infected with HCV. The cost of continued ALT screening was estimated at $7,931,000 per quality-adjusted year of life saved., Conclusion: The yield, predictive value, and cost-effectiveness of ALT screening of blood donors have declined dramatically with the implementation of progressively improved anti-HCV assays. ALT screening of volunteer blood donors should be discontinued.

Calculation of viral residual risk is dependent on estimating incidence, which is not easily obtainable by most blood centers. Prevalence, however, is readily available. Understanding whether prevalence reflects corresponding incidence may help blood centers monitor disease risks. With data on 12 million allogeneic donations, prevalence and incidence of transfusion-transmitted viral infections (TTVIs) were calculated. Relationships between prevalence (in total, first-time, and repeat donations) and incidence were analyzed for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) relative to temporal and donor demographic stratifications, respectively. Overall prevalence of HIV, HBV, and HCV did not consistently reflect corresponding incidence. The relationship between prevalence and incidence varied with time and donors’ age and was virus-specific. Incidence of TTVIs cannot be easily predicted from overall prevalence. Accurate assessment of TTVI risk necessitates knowledge about donation histories and person-years at risk. Establishing comprehensive frameworks for monitoring blood donations and infectious disease markers remains a key to monitoring blood safety. [ABSTRACT FROM AUTHOR]