Global WarmingDengue Fever& Blood Transfusion

E s t a c i o F e r r e i r a R a m o s, M.D.e s t a c i o . r a m o s @ g m a i l . c o m

© Copyright, 2007, 2009

E s t a c i o F e r r e i r a R a m o s, M.D.e s t a c i o . r a m o s @ g m a i l . c o m

© Copyright, 2007, 2009

Global WarmingPopulation GrowthDengue Fever& Blood Transfusion

South American Population & Distribution

Urban Viral Disease Arthropod-Borne Epidemic, Pandemic Tropical & Subtropical World Potentially Fatal No Vaccine Available

Dengue Essentials

Dengue Virus RNA Virusflaviviridae family4 strains

Den1, Den2, Den3, Den4

Vectors:

aedes aegyptiaedes albopictus

Active Domestic BreedersTenacious Urban Hunters

Dengue in World

100 million infections year250 thousand hemorrhagic fever

25 thousand deaths.2.7 billion people at risk

Incidence has quadrupled since 1985 - WHO, 2006

Murray et al. (2002) Medical Microbiology. 4th edition. St. Louis: Mosby. Pages 561-564

■ DENGUE

■ VECTORS ONLY

Dengue Cases ReportedWorld Health Organization

1955 – 2005

0

200000

400000

600000

800000

1000000

1955-1959

1960-1969

1970-1979

1980-1989

1990-1999

2000-2005

Ave.annual

no. cases

Vectors –The Americas

1970 2006

August 12th, 2007 posted by Kelly Burkholder-Allen August 12, 2007 @ 9:55 am According to the CDC, the Rio Grande Valley is at risk for dengue feverCDC warns of increased risk of dengue fever in RGV

By MELISSA McEVER - The Brownsville Herald

Catching dengue fever is a real risk… local health officials should be on the lookout for its symptoms, according to a new report from the CDC. The region is seeing more cases of dengue and hemorrhagic fever, a life-threatening complication of the mosquito-borne virus, than in past. In 2005, Officials reported a large-scale dengue outbreak that included 223 cases of hemorrhagic fever, and that same year 24 dengue cases were reported in Cameron County – including a Brownsville woman who

became seriously ill. In an outbreak investigation, the CDC and officials from the Texas Health Services found that the woman and two other Cameron County residents, had contracted dengue fever locally rather than in Mexico. That finding was surprising, because most dengue cases

are imported from other countries, officials said. “These were the first cases that were locally acquired,” said Dr. Brian Smith, regional director for the Texas Health Services’ Region 11, which includes the Valley. The findings suggest that dengue’s reach is growing beyond its usual borders…

Faster ReproductionBetter AdaptationResistant to PesticidesInvading New Urban AreasVictimizing New PopulationsMore Efficient Virus Spread

Vectors & Global Warming

Shorter Cycles in VectorsFaster AdaptationCarriers: Travelers & MigrantsIncreasing VirulenceMore OutbreaksHyperepidemics, Pandemics

Virus & Global Warming

Blood Transfusion Needlestick Intrapartum Bone Marrow Transplantation Mucosal Exposure to Blood http://www.searo.who.int/LinkFiles/Dengue_Bulletins_Volumes_29_(2005)_CHAPTER03.pdf

Non-Vector Dengue Infection

First Documented Case Transfusion Transmitted Dengue Virus Infection.

Rapid Detection and Typing of Dengue Virus from Clinical Samples

by RNA-PCR. Lanciotti RS, Calisher CH, Gubler DJ,

Chang GJ and Vorndam AD. JCM 1992; 30: 545-

51

C. K. Lin – Hong Kong St. Mary HospitalRed Cross Blood TransfusionService, 1992

Estimated risk of transmission of dengue virus through blood transfusion in Puerto Rico.Beatty ME, Biggerstaff B, Rigau J, Petersen L. (#126). At 5th International Conference on Emerging Infectious Diseases. Atlanta, GA. March 19-22, 2006.

Dengue Infection Through Blood TransfusionDanger – It Happens

Growing ProblemNear Future Major ConcernNot MonitoredPrevention Needed Now

Dengue Infection by Blood Transfusion

Real Risk: 1:1000

Risk will vary worldwide depending on endemicity(Brazil, 2.4 million blood collections/year)

Approach:

All Donated Blood at Dengue Endemic RegionsMust be Tested for Dengue NS1 Antigen.

“primo non nocere”

Hipocrates (430 – 370 A.C.)

Patients & FamiliesThe EnvironmentHealthcare WorkersBlood Banks & HospitalsHealthcare SystemsCommunities (surveillance)

To Protect

Web to Goal: InformationInternational Task GroupWorld Health Organization Blood Transfusion Societies Promote Medical Education Inform Communities Reach Governments & Politicians

NS1 Antigen EIA ScreeningLow CostEasy to PerformAutomation Compatible Technology Already in Blood Banks WorldwideCost-Effective vs NAT 2

Nucleic Acid Testing - Dengue RNA RT-PCR 2

NS1 Antigen EIA ScreeningIntegrates to Blood Banks Laboratory RoutinesSpecificity: 100% (or close)Highly SensitiveDetects Potential RiskAlmost Closes Infectivity Window

Blood Donors must be oriented to inform febrile states occurring up to two weeks after donation.NS1 Antigen and/or RT-PCR for Dengue Virus RNA must be performed on all blood donors at endemic regions.Medical Education Programs must address the possibility of Transfusion Transmitted Dengue Virus.

Estacio Ferreira Ramos, M.D.Blood Banker, Hematologist

Pathologist

Carlos Carl Ehrich Medical ResearchSalvador, Bahia - Brazilestacio.ramos@gmail.com

Skype: esfera2kMobile: +55(71) 9956-0635

Hospital PortuguesBlood Bank

+55(71)3203-5555

Scientific DirectorUMA – Universidade da Mata

AtlânticaRepresentative in Brazil,

Worldwatch Institutewww.wwiuma.org.br

ReferencesGubler DJ. The global emergence/resurgence of arboviral

diseases as public health problems. Arch Med Res. 2002;33:330-42.

Pan American Health Organization. 2005: Number of reported cases of

dengue & dengue hemorrhagic fever (DHF), Region of the Americas (by country

And subregion). http://www.paho.org/English/AD/DPC/CD/dengue-cases-2005.htm

Kouri GP, Guzman MG, Bravo JR, Triana C. Dengue haemorrhagic fever/dengue

shock syndrome: lessons from the Cuban epidemic, 1981. Bull World Health

Organ. 1989;67:375-80.

Pan American Health Organization. Dengue hemorrhagic fever in Venezuela

Epidemiol Bull. 1990;11:7-9.

CDC. Dengue–Texas. MMWR Morbid Mortal Wkly Rep. 1980;29:451.

Lacayo M, Taylor R, Duran H, Abell A, et al. Outbreak investigation of dengue.

Texas, 2005 (Late-breaker). 54th Annual Meeting: American Society of Tropical

Medicine and Hygiene. Washington, DC, December, 2005.

CDC. Travel-associated dengue —United States, 2005. MMWR Morbid Mortal

Wkly Rep. 2006;55:22:700-2.

Trofa AF, DeFraites RF, Smoak BL, Kanesathasan N, King AD, Burrous JM, et al.

Dengue fever in US military personnel in Haiti. JAMA. 1997;277:1546-8.

Smith CE, Tom Tammy, Sasaki J, Ayers T, Effler PV. Dengue risk among visitors to

Hawaii during an outbreak. Emerg. Infect. Dis. 2005;11:750-66.

Rigau-Pérez JG, Clark GC, Gubler DJ, Reiter P, Sanders EJ, Vorndam AV. Dengue

and dengue haemorrhagic fever. Lancet. 1998;352:971-7.

Fernandez R, Rodriguez T, Borbonet F, Vasquez S, Guzman M, Kouri G. Estudio de

la relacion dengue-embarazo en un grupo de madres cubanas. Rev Cubana Med

Trop. 1994;46:76–8.

Beatty ME, Biggerstaff B, Rigau J, Petersen L. Estimated risk of transmission of dengue virus through blood transfusion in Puerto Rico (#126). At 5th International Conference on Emerging Infectious Diseases. Atlanta, GA. March 19-22, 2006.