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Background Adequate preparation and support for healthcare workers (HCWs) managing high-consequence infectious diseases (HCIDs) is critical to the overall clinical management of HCIDs. Qualitative studies examining how well prepared and supported HCWs feel are lacking despite their key role. This study investigated how prepared and supported front-line HCWs at an Australian tertiary hospital felt about managing HCIDs such as viral haemorrhagic fever (VHF). Methods A qualitative research approach was used to undertake interviews with 45 Royal Melbourne Hospital medical and nursing staff from emergency, intensive care and infectious diseases. Interview questions captured data on HCWs’ role, familiarity with using protocols, psychological attributes and training for scenarios related to VHF patient management. Interviews were recorded and transcribed. Categorical responses were analysed quantitatively and open-ended responses were analysed thematically. Results Ninety-eight percent of participants indicated feeling capable of undertaking their role in managing VHF patients; 77% felt supported through personnel/resources. However, 69% indicated barriers to managing these patients effectively; and 68% felt anxious at the prospect of managing VHF patients. Themes emerging from participants’ observations included concerns about training frequency, miscommunication, difficulty with uncertainty, feeling underprepared, and fear of transmitting infection to others. Conclusion Although the majority of HCWs feel confident about their ability to care for VHF patients, they also have a moderately-high degree of anxiety. Perceptions of interviewed staff have fed into recommendations to increase HCW preparedness and reduce anxiety, which include investigating support services, and exploring training options that create multi-departmental groups of highly specialised medical officers and nurses., Highlights • Participants felt capable to provide care for viral haemorrhagic fever patients. • Healthcare workers felt supported by personnel/resources to undertake their role. • The majority highlighted anxieties or concerns around managing these patients. • Specific reasons included difficulty with uncertainty and feeling underprepared. • Services to allay anxiety and enhanced training recommended to improve preparedness.

Background Passive immunisation is an important means of preventing hepatitis A in the most vulnerable populations in the event they are exposed. Trends in hepatitis A seroprevalence may impact on the production of effective immunoglobulin products for passive immunisation. Methods The seroprevalence of hepatitis A antibodies in blood donors in capital cities around Australia was measured using a commercial ELISA. Hepatitis A antibodies were quantified using the same commercial kit in a random sample of those who were seropositive. Results An estimated 51% (95% CI 48–54%) of Australian blood donors were seropositive for hepatitis A. Rates varied across the country and increased with age. The geometric mean titre (GMT) of those who were seropositive among our sample was 1246.8 mIU/mL (geometric standard deviation 11.8 mIU/mL) and increased with age. Conclusion Comparison with published data supported an increase in seroprevalence in younger age groups. The seeming increase in seroprevalence among donors is encouraging regarding Australia's ability to maintain immunoglobulin sufficiency. However, the overall GMT of hepatitis A antibodies in donations may be prone to decrease as current donor cohorts age.

Background and Objectives Hepatitis E virus (HEV) is a known transfusion-transmissible agent. HEV infection has increased in prevalence in many developed nations with RNA detection in donors as high as 1 in 600. A high proportion of HEV infections are asymptomatic and therefore not interdicted by donor exclusion criteria. To manage the HEV transfusion-transmission (TT) risk some developed nations have implemented HEV RNA screening. In Australia, HEV is rarely notified; although locally acquired infections have been reported, and the burden of disease is unknown. The purpose of this study was to determine the frequency of HEV infection in Australian donors and associated TT risk. Materials and Methods Plasma samples (n = 74 131) were collected from whole blood donors during 2016 and screened for HEV RNA by transcription-mediated amplification (TMA) in pools of six. Individual TMA reactive samples were confirmed by RT-PCR and, if positive, viral load determined. Prevalence data from the study were used to model the HEV-TT risk. Results One sample in 74 131 (95% CI: 1 in 1 481 781 to 1 in 15 031) was confirmed positive for HEV RNA, with an estimated viral load of 180 IU/ml, which is below that typically associated with TT. Using a transmission-risk model, we estimated the risk of an adverse outcome associated with TT-HEV of approximately 1 in 3·5 million components transfused. Conclusion Hepatitis E virus viremia is rare in Australia and lower than the published RNA prevalence estimates of other developed countries. The risk of TT-HEV adverse outcomes is negligible, and HEV RNA donor screening is not currently indicated.

BACKGROUND: Arboviruses, such as dengue viruses (DENV) and chikungunya virus (CHIKV), pose a risk to the safe transfusion of blood components, including plasma. Pathogen inactivation is an approach to manage this transfusion transmission risk, with a number of techniques being used worldwide for the treatment of plasma. In this study, the efficacy of the THERAFLEX MB-Plasma system to inactivate all DENV serotypes (DENV-1, DENV-2, DENV-3, DENV-4) or CHIKV in plasma, using methylene blue and light illumination at 630 nm, was investigated. STUDY DESIGN AND METHODS: Pooled plasma units were spiked with DENV-1, DENV-2, DENV-3 DENV-4, or CHIKV and treated with the THERAFLEX MB-Plasma system at four light illumination doses: 20, 40, 60, and 120 (standard dose) J/cm2. Pre- and posttreatment samples were collected and viral infectivity was determined. The reduction in viral infectivity was calculated for each dose. RESULTS: Treatment of plasma with the THERAFLEX MB-Plasma system resulted in at least a 4.46-log reduction in all DENV serotypes and CHIKV infectious virus. The residual infectivity for each was at the detection limit of the assay used at 60 J/cm2, with dose dependency also observed. CONCLUSIONS: Our study demonstrated the THERAFLEX MB-Plasma system can reduce the infectivity of all DENV serotypes and CHIKV spiked into plasma to the detection limit of the assay used at half of the standard illumination dose. This suggests this system has the capacity to be an effective option for managing the risk of DENV or CHIKV transfusion transmission in plasma. Refereed/Peer-reviewed

Dengue outbreaks have increased in size and frequency in Australia, and transfusion-transmitted dengue poses a risk to transfusion safety. Using whole blood samples collected during the large 2008-2009 dengue epidemic, we estimated the risk for a dengue-infectious blood donation as ≈1 in 7,146 (range 2,218-50,021).

Aim Australia has a low incidence of hepatitis A virus (HAV), with the majority of cases in travellers. Nonetheless, the sero-prevalence of antibodies against HAV among Victorians has increased over the last two decades, likely to be a result of vaccination and increased travel/immigration. This study measured the prevelance of HAV antibodies in blood donors from around Australia to determine if a similar rate exists in other states. Methods Samples were collected from donors between January and July 2011 from Australian capital cities. All samples ( n = 2109) were tested with a commercially available enzyme immunoassay for total anti-HAV antibody (levels ≥ 20IU/mL were considered sero-positive). Results Anti-HAV antibody was detected in 51.4% (95% CI 49.27-53.53%) of donors. Some variability was observed between cities; the highest rates were seen in Sydney donors (57.33%; 95% CI 51.74-62.93%), while the lowest in donors from Brisbane (43.67%; 95% CI 38.05-49.28%). Not surprisingly, sero-prevelance increased with increasing donor age. Conclusions This study demonstrated that over half of donors tested had anti-HAV antibodies, with relatively high rates in all capital cities. Given increased HAV vaccination rates, measuring naturally-acquired HAV infection in blood donors has become increasingly difficult and a serological test discriminating naturally-occurring from vaccine-induced immunity may be of interest.

Aim Insect-transmitted viral infections remain a significant public health concern in Australia. The positive predictive value (PPV) for detection of anti-viral antibodies in donors was assessed using commercially-available kits. Methods Blood samples collected from Australian blood donors were tested by ELISA for IgM or IgG specific for either Dengue virus (DENV), Ross River virus (RRV) or Barmah Forest virus (BFV). The PPV was determined by comparison with results from reference laboratories. Results For the commercially-available kits: anti-DENV IgG, 225 kit-positive, 213 confirmed, PPV 94.7%; anti-RRV IgG, 315 kit-positive, 239 confirmed, PPV 75.9%; anti-BFV IgG, 127 kit-positive, 47 confirmed, PPV 37.0%; anti-DENV IgM, 118 kit-positive, 7 confirmed, PPV 5.9%; anti-RRV IgM, 138 kit-positive, 45 confirmed, PPV 32.6%; anti-BFV IgM, 142 kit-positive, 71 confirmed, PPV 50.0%. Some potential sources of unexpected kit-positives were investigated, however, these contributed minimally to the unacceptable PPVs. Conclusions These kits are designed for diagnostic testing of symptomatic patients, however, it would be expected that reliability for investigation of sub-clinical infection would be equal. PPVs, with the exception of 94.7% for IgG anti-DENV, were less than 80%. To measure rates of subclinical infection an investigation algorithm including exploration of unexpected positives and reliable confirmatory testing is required.