Table. Blood donors’ characteristics, virological data and follow up of HAV infected blood products, France, 2015–2017 (n = 18 HAV-RNA-positive donations).
| HAV molecular investigations | Blood products | ||||
|---|---|---|---|---|---|
| Case number | Year of donation | Sex and age group in years | Clinical symptoms (time before or after donation) |
Viral load (log IU/mL) Genotype (strain) |
Transfused blood products (time after donation) [Discarded blood products] |
| 1 | 2015 | Female 49–58 |
Hospitalised for fever and acute abdominal syndrome (Day + 10) | 4.00 IA (NN) |
Red blood cell concentrate (Day + 11) [Fresh frozen plasma] |
| 2 | 2015 | Male 39–48 |
Asthenia during 1 week (Day - 14) | Not available IA (NN) |
Pooled platelet concentrate (Day + 2) Red blood cell concentrate (Day + 9) [Fresh frozen plasma] |
| 3 | 2016 | Female 39–48 |
Icterus and vomiting (Day + 12) | 2.48 IA (NN) |
[Red blood cell concentrate and fresh frozen plasma] |
| 4 | 2016 | Male 39–48 |
Asymptomatic (NA) | 2.90 IA (NN) |
Pooled platelet concentrate (Day + 4) [Red blood cell concentrate and fresh frozen plasma] |
| 5 | 2016 | Female 39–48 |
Asthenia, headache, dark urine, urticaria (Day + 2) | 8.40 IA (NN) |
[Fresh frozen plasma] |
| 6 | 2017 | Male 18–28 |
Influenza-like syndrome (Day + 4) Hospitalised for acute hepatitis (Day + 10) |
3.33 IIIA (NN) |
[Red blood cell concentrate and fresh frozen plasma] |
| 7 | 2017 | Female 39–48 |
Febrile gastroenteritis (Day + 3) Gynaecologic pains and lumbago (Day + 8) Icterus (Day + 11) |
3.94 IA (VDR_521_2016) |
[Red blood cell concentrate and fresh frozen plasma] |
| 8 | 2017 | Male 18–28 |
Diarrhoea, influenza-like syndrome, mild conjunctival icterus (around Day - 60) | 2.19 IA (RIVM HAV16–090) |
[Fresh frozen plasma] |
| 9 | 2017 | Male 18–28 |
Clay-coloured stools, dark urine, digestive signs, icterus (Day + 3) | 3.80 IA (VDR_521_2016) |
Apheresis platelet concentrate (Day + 3) |
| 10 | 2017 | Male 39–48 |
Asthenia, mild fever (NN) | 4.13 IA (VDR_521_2016) |
Apheresis platelet concentrate (Day + 3) [Fresh frozen plasma] |
| 11 | 2017 | Female 29–38 |
Abdominal pains, asthenia, fever (Day + 7) | 2.92 IA (RIVM HAV16–090) |
Pooled platelet concentrate (Day + 2) [Red blood cell concentrate and fresh frozen plasma] |
| 12a | 2017a | Male 39–48 |
Acute hepatitis A (Day + 31) | 1.2 IA (RIVM HAV16–090) |
[Fresh frozen plasma] |
| 13 | 2017 | Male 59–70 |
Digestive signs, fever, nausea (Day + 10) | 3.45 IA (RIVM HAV16–090) |
Pooled platelet concentrate (Day + 2) [Red blood cell concentrate and fresh frozen plasma] |
| 14 | 2017 | Male 49–58 |
Asymptomatic (NA) | 2.29 IA (VDR_521_2016) |
[Red blood cell concentrate and fresh frozen plasma] |
| 15 | 2017 | Male 39–48 |
Asthenia, fever, nausea (Day + 11) | 8.59 IA (VDR_521_2016) |
Red blood cell concentrate (Day + 13) Pooled platelet concentrate (Day + 4) [Fresh frozen plasma] |
| 16 | 2017 | Male 18–28 |
Asthenia, influenza-like syndrome (NN) | 5.25 IA (RIVM HAV16–090) |
[Fresh frozen plasma] |
| 17 | 2017 | Male 49–58 |
Asthenia, dark urine, icterus, nausea (Day + 12) | 4.12 IA (RIVM HAV16–090) |
Pooled platelet concentrate (Day + 4) [Red blood cell concentrate and fresh frozen plasma] |
| 18 | 2017 | Male 29–38 |
Hospitalised for acute hepatitis A (Day + 8) | 7.63 IA (RIVM HAV16–090) |
Pooled platelet concentrate (Day + 3) [Red blood cell concentrate and fresh frozen plasma] |
HAV: hepatitis A virus; NA: not applicable; NN: not known.
Viral strains were characterised as previously published [20]. Viral load in individual samples was assessed with the RealStar HAV RT-PCR Kit (Altona Diagnostics, Hamburg, Germany) with serial dilutions of the World Health Organization International Standard sample for HAV-RNA nucleic acid testing assays (NIBSC, Hertfordshire, United Kingdom) as quantification curve. Lower quantification limit was estimated at 10 IU/mL. Delay between donation date and date of identification of HAV-RNA positive donation varied but did not exceed 30 days. Upon HAV positivity detection in a pooled sample, Etablissement Français du Sang (EFS) procedure calls for a rapid identification of the HAV-infected donor.
a This donor did not initially test HAV-RNA positive in pool screening, but after this person reported clinical symptoms one month post-donation, repeat testing of the individual sample found it positive. Initial negative NAT screening (pool of 96) result may be explained by a viral load (1.2 log10 IU/mL) under the 95% limit of detection (estimated for pool of 96 at around 2 log10 IU/mL).