DENGUE Is it important to require Blood Donation screening for this Arboviruses?

Spring, 2010

Dengue Fever Camilla Polk for Ph D., EpidemiologyWalden UniversityEnvironmental Health (PUBH - 8165 - 2)Instructor: Dr. Jalal Ghaemghami

Stakeholders

Blood Product Recipients and their families

Medical StaffPublic Health

RepresentativesHospitals

Blood BanksAssay/Screening

Test ManufacturersGovernment

Agencies (CDC; NIH; Agencies for Health in various countries); etc)

Objectives of this Presentation

Provide understanding of Dengue Fever.

Emphasize why Dengue is important.

Discuss the costs of Dengue.

Explore how the latest technologies and global trends impact Dengue’s current state and future potential.

Dengue Fever is not a familiar disease in the United States.

However, it is a common occurrence in Tropical and Sub-Tropical locations. It has overcome Malaria in prevalence and is gaining attention as it begins moving into new areas.

For this reason, decisions of whether to test blood donations must be considered.

Dengue Fever

Dengue Fever is caused by Dengue Virus (DENV), a Flavivirus.The vector of transmission is mosquitoes.There are four sub-types of Dengue that produce Dengue Fever in Humans: DENV 1, DENV2, DENV3, and DENV4Dengue can be asymptomatic in patients but can also progress into more severe forms of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).

Etiology and Epidemiology

Believed to have originated in monkeys, but jumped to humans between 100-800 years ago.

(CDC, 2009)

In China during the Jin dynasty (ad 265–420)In Cairo and Batavia (Jakarta) in 1779.

(“Dengue”, 2010)

Historical Dengue

Reasons why Dengue is a threat:There are four reasons provided by Wilder-

Smith, Chen, Massad, and Wilson (2009):

“[1] Dengue is of major international public health concern because of the increasing range of its carriers. [2] Increased frequency of epidemics. [3] Co-circulation of multiple virus serotypes, and [and 4] Emergence of dengue hemorrhagic fever in new areas.”

Quick Facts about Dengue

40% of the Global Population are at risk.

50-100 million annual infections.

500,000 cases of DHF.22,000 deaths, mostly

among children.- (CDC, 2009)

Difficulty eradicating carriers as they radiate into new geographical locations.

Traveler exposure

Potential Transmission through exposure to Blood Products.

Statistical Data on Dengue. Concerns associated with Dengue.

Statistical Data on Dengue.

Countries involved:

Northern Australia, Northern Argentina, Barbados, Bolivia, Brazil, Cambodia, Costa Rica, Dominican Republic, Guyana, Honduras, India, Indonesia, Jamaica, Malaysia, Mexico, Pakistan, Panama, Paraguay, Philippines, Puerto Rico, Samoa, Saudi Arabia, Singapore, Sri Lanka, Suriname, Taiwan, Thailand, Trinidad, Venezuela, and Vietnam.

- (CDC, 2010)

• 40% of the Global Population are at risk.

(WHO, 2009)

• 50-100 million annual infections.• 500,000 cases of DHF.• 22,000 deaths, mostly among

children.(CDC, 2009)

Concerns associated with Dengue.

Aedes mosquitoes are found in both urban and rural areas (unlike Malaria carriers)

Aedes is often active during daytime.

Difficulty eradicating carriers as they radiate into new geographical locations.

(CDC, 2009)

Global TradeTraveler exposurePotential Transmission through

exposure to Blood Products.

Mosquitoes

Both species feed on humans, hence to concern for the spread of Dengue. However, A. albopictus also feeds on animals and has raised alarm over the invasive nature of this insect.

Difficulty eradicating carriers as they radiate into new geographical locations.A. aegypti can be found is 16 states

within the US, as well as tropical and sub-tropical regions throughout the world. However, it is sensitive to cooler climates but prefers urban areas for residence.

(Knowlton, Solomon, Rotkin-Ellman, 2009)

Mosquitoes

A. albopictus was first discovered in the US in Texas but has quickly moved into other areas of the country – it tolerates cooler climates and prefers rural or suburban areas.

(Knowlton, Solomon, Rotkin-Ellman, 2009)

Global Trade and Travel

Both species of mosquitoes are believed to have arrived in America through trade goods. In the example of A. albopictus – tires from Asia were thought to have shielded the insect in transit and still provide breeding areas within the states.

Travelers to endemic areas number over 120 million per year. For every case of illness reported, there are believed to be thousands that go un-reported.

“It is the responsibility of hospitals, Blood collection centers, and Blood storage facilities to protect the health of those donating Blood and to assure the safety of the Blood supply in general. Therefore, tests will be performed and a donor’s general health evaluated at the time of every donation” (Blood Donor Requirements, n.d.).

Blood Donations

The costs in lives – an approx. mortality rate 22,000 deaths per year.

Monetary costs – “The aggregate annual economic costs of dengue … were I$587 million [with] a preliminary adjustment for under-reporting [that] could raise to $1.8 billion” (Suaya, Shepard, Siquiera, Martelli, Lum, Tan, Kongsin, Jiamton, Garrido, Montoya, Armien, Huy, Castillo, Caram, Sah,, Tyo, & Halstead, 2009).

Costs of Dengue

Cost breakdown

The calculations derived by Suaya, et al (2009) were based on costs defined as:

direct medical costsmedical expenses of

healthcare and prevention.

direct non-medical costsout-of-pocket expenses,

transportation, food, and lodging

AbsenteeismLoss of pay from workLoss of school days“Other days lost by either

the patients or any other household member who provided care to the patient during an illness episode” (Suaya, et all, 2009)

Direct Costs Indirect Costs

The Future of Dengue

Global Warming encourages mosquito spread.

Travelers’ exposure risks

Exploding population and increasing urbanization.

There is a great need for improved data collection associated with Dengue – so that the disease can be better understood and better public health choices can be made.

Diagnostic technology is continuous being improved. This is important in early detection of the disease.

Increase in Disease seems likely:

Tracking and Diagnostic Technology

There are numerous factors that make Dengue a great concern for society in general. However, with the increasing demands of treatment in our healthcare systems the impact on transfusion and blood products usage is being emphasized. Therefore Blood Banking Industry members must decide if Dengue warrants an individual screening test.

Should donor screening for Dengue be made mandatory?

References

“Blood Donor Requirements” (n.d.) Retrieved on April 19, 2010 from http://www.bloodbook.com/donr-requir.html

US Centers for Disease Control and Prevention (CDC). (2009). Epidemiology. Retrieved on April 16, 2010 from http://www.cdc.gov/dengue/epidemiology/index.html

US Centers for Disease Control and Prevention (CDC). (2005). Information on Arboviral Encephalitides. Retrieved on April 16, 2010 from http://www.cdc.gov/ncidod/dvbid/arbor/arbet.htm

US Centers for Disease Control and Prevention (CDC). (2007). Mosquito-Borne Diseases. Retrieved on April 16, 2010 from http://www.cdc.gov/ncidod/diseases/list_mosquitoborne.htm

References

US Centers for Disease Control and Prevention (CDC). (2009). Other Infectious Diseases Related to Travel – Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). Retrieved on April 23, 2010 from http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx

US Centers for Disease Control and Prevention (CDC). (2010). Outbreak Notice Update: Dengue, Tropical and Subtropical Regions. Retrieved on April 25, 2010 from http://wwwnc.cdc.gov/travel/content/outbreak-notice/dengue-tropical-sub-tropical.aspx

Council of State and Territorial Epidemiologists. (2008). Add Dengue Virus Infections to the Nationally Notifiable Conditions List. Retrieved on April 23, 2010 from http://www.cste.org/ps2009/09-id-19.pdf

Dengue. (2010) Encyclopædia Britannica. 2010. Encyclopædia Britannica Online. Retrieved on April 24, 2010 from http://www.britannica.com/EBchecked/topic/157664/dengue

Knowlton, K., Solomon, G.,& Rotkin-Ellman, M. (2009). Mosquito-Borne Dengue Fever Threat Spreading in the Americas. Natural Resources Defense Council (NRDC) Issue Paper, July 2009.

  

References

Mohammed, H., Linnen, J.M., Muñoz-Jordán, J.L., Tomashek, K., Foster, G., Broulik, A.S., Petersen, L., & Stramer, S.L. (2008). Dengue virus in blood donations, Puerto Rico, 2005. Transfusion, 48, 1348-1354. DOI: 10.1111/j.1537-2995.2008.01771.x

Platelia Dengue NS1 AG. (2008). Bio-Rad Package Insert for Qualitative or Semi-Qualitative Detection of Dengue Virus NS1 Antigen in Human Serum or Plasma by Enzyme Immunoassay.

Suaya, J., Shepard, D.S., & Beatty, M.E., (2006). Dengue: Burden of Disease and Costs of Illness. Scientific Working Group on Dengue Research. Retrieved on April 23, 2010 from http://www.tropika.net

Suaya, J., Shepard, D.S., Siquiera, J.B., Martelli, C.T., Lum, L.C.S., Tan, L.H., Kongsin, S., Jiamton, S., Garrido, F., Montoya, R., Armien, B., Huy, R., Castillo, L., Caram, M., Sah, B.K., Tyo, K.R., & Halstead, S.B. (2009) Cost of Dengue in Eight Countries in the Americas and Asia: A Prospective Study. American Journal of Tropical Medicine and Hygiene, 80(5), 846-855.

References

Wichman, Gascon, Schunk, Puente, Siikamaki, Gjørup, Lopez-Velez, Clerinx, Peyerl-Hoffman, Sundøy, Genton, Kern, Calleri, Górgolas, Mühlberger, & Jelinek. (2007). Severe Dengue Virus Infection in Travelers: Risk Factors and Laboratory Indicators. Journal of Infectious Diseases,195, 1089-1096. DOI: 10.1086/512680.

Wilder-Smith A, Chen LH, Massad E, Wilson ME. (2009) Threat of dengue to blood safety in dengue-Endemic countries. Emerging Infectious Disease, 2009 Jan. DOI: 10.3201/eid1501.071097. Retrieved on April 19, 2010 from http://www.cdc.gov/eid/content/15/1/pdfs/07-1097.pdf

World Health Organization (WHO). (2009). Dengue and dengue hemorrhagic fever – Fact Sheet 117. Retrieved on April 24, 2010 from http://www.who.int/mediacentre/factsheets/fs117/en/

Additional Readings

US Centers for Disease Control and Prevention (CDC). (2005) Information on Aedes albopictus. Retrieved on May 9, 2010 from http://www.cdc.gov/ncidod/dvbid/arbor/albopic_new.htm

The Role of Laboratories and Blood Banks in Disaster Situations (2002). Pan American Health Organization – Regional Office of the World Health Organization. ISBN 92 75 12380 2 Retrieved on April 19, 2010 from http://www.paho.org/english/ad/ths/ev/LAB_laboratories.pdf

Dengue fever. (2010, April 21). In Wikipedia, The Free Encyclopedia. Retrieved on April 25, 2010, from http://en.wikipedia.org/w/index.php?title=Dengue_fever&oldid=357344461

Health Sciences Authority of Singapore. (n.d.) Retrieved on April 19, 2010 from http://www.hsa.gov.sg