Table 4.

Options for minimizing dengue risk in the blood supply

Strategies	Endemic countries	Non-endemic countries
No specific measures taken for dengue	Risk of transfusion-transmitted dengue increased, dependent on prevalence in donor population and proportion of donors with asymptomatic infection	Risk of transfusion-transmitted dengue low, dependent on proportion of donor population who may recently be exposed to dengue infection through travel
	No direct cost to blood service, but indirect cost from patient morbidity from transfusion-transmitted infection and loss of confidence in blood supply safety	No direct cost to blood service, but indirect cost from loss of confidence in blood supply safety in event of a transfusion-transmitted infection occurring
Donor qualification – deferral of at-risk donors, e.g. symptoms of fever, travel history, exposure to dengue patients, etc.	Deferral based on exposure not feasible when disease is endemic, unable to exclude early and asymptomatic infection	Deferral based on exposure feasible, able to reduce risk of accepting donations from early and asymptomatic infected donors
	Nonspecific, leads to high donor loss	Low donor loss, dependent on proportion of donor population likely to travel to endemic countries
	Low cost-effectiveness	Cost-effective
NAT testing of donations for dengue	Able to detect asymptomatic infection	Able to detect asymptomatic infection
	Donor loss dependent on specificity of test system	Donor loss dependent on specificity of test system
	Expensive	Expensive
	Cost-effectiveness depends on prevalence of asymptomatic infected donors	Low cost-effectiveness
Pathogen reduction	Able to reduce transmission risks	Able to reduce transmission risks
	Expensive and only available for platelets and plasma currently. May result in reduced product yields	Expensive and only available for platelets and plasma currently. May result in reduced product yields
	Low cost-effectiveness for dengue alone	Low cost-effectiveness for dengue alone
	Increased cost-effectiveness depends on ability to reduce risks of other transfusion-transmitted diseases as well	Increased cost-effectiveness depends on ability to reduce risks of other transfusion-transmitted diseases as well