ISBT XXXIst International Congress Berlin. Infekcijos

Transcription

1 ISBT XXXIst International Congress Berlin Infekcijos

2 Apie tai, kas svarbiausia.. Bendra epidemiologija Slapta HBV infekcija. HBV mutantai Mp-NAT vs ID-NAT? B19 virusinė infekcija Seni patogenai naujoje erdvėje (arbovirusinės infekcijos) Bakterijų sukeltos TTI

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4 Experience of German Red Cross blood donor services with nucleic acid testing: results of screening more than 30 million blood donations for human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus Michael K. Hourfar, Christine Jork, Volkmar Schottstedt, Marijke Weber-Schehl, Veronika Brixner,* Michael P. Busch,* Geert Geusendam,* Knut Gubbe,* Christina Mahnhardt,* Uschi Mayr-Wohlfart,* Lutz Pichl,* W. Kurt Roth,* Michael Schmidt,* Erhard Seifried,* and David J. Wright* for the German Red Cross NAT Study Group

5 Residual Risk = (Window period) x (Incidence rate).

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8 HBV paplitimas Š.Europa 0,91-8,7 P.Europa 7,5-13,9 JAV 3,6-8,5 Kanada Australija Hong kong 0, >2 bilijonai teigiamų HBV 1/3 aktyvus HBV

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10 Ag/Ak/fazė HBs Ag HBe Ag Anti HBs Anti HBc (IgM) Anti HBc (bendras) Anti HBe Interpretacija Teig. Teig. Neig. Neig. Neig. Neig. Ankstyva ūmi infekcija Teig. Neig. Neig. Teig. Teig. Teig. Serokonversija Neig. Neig. Neig. Teig. Teig. Teig. Ūm.periodo konvalescencija Teig. Teig. Neig. Neig. Teig. Teig. Aktyvi lėtinė infekcija (tikėtinas kepenų pakenkimas) Teig. Neig. Neig. Neig. Teig. Teig. Lėtinė infekcija, kepenų pažeidimas mažai tikėtinas Nešiotojas Neig. Neig. Teig. Neig. Teig. Teig. Pasveikmas Natūralus imunitetas Neig. Neig. Teig. Neig. Neig. Neig. Imunitetas po vakcinacijos Neig. Neig. Neig. Neig. Neig. Neig. Infekcijos nėra Inkubacijos periodas

11 Lack of correlation between HBsAg and HBV DNA levels in blood donors who test positive for HBsAg and anti-hbc: implications for future HBV screening policy Mary C. Kuhns, Steven H. Kleinman, Anne L. McNamara, Bhupat Rawal, Simone Glynn, and Michael P. BuschFrom Abbott Laboratories, Abbott Park, Illinois; Westat, Rockville, Maryland; and Blood Systems Research Institute, San Francisco, California BACKGROUND:Studies showing a significant correlation between hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels have focused on the HBV seroconversion window period. STUDY DESIGN AND METHODS:HBsAg levels relative to HBV DNA results in 200 HBsAg-positive, anti-hepatitis B core antigen (HBc) reactive blood donations were analyzed using quantitative polymerase chain reaction (PCR) (detection limit 400 copies/ml), two research PCR assays with increasing sensitivities (65 copies/ml and 1.3 copies/ml, respectively), and a quantitative HBsAg assay;hbsag and HBV DNA levels were correlated with HBVserologic profiles; and the potential for replacing HBsAg screening with nucleic acid testing (NAT) was analyzed. RESULTS:Serologic profiles for over 90 percent of the donor samples were consistent with chronic HBV infection. Correlation between HBsAg and HBV DNA concentrations was weak (correlation coefficient =0.33). Thirty six percent (72/200) of donor samples had DNA levels under 400 copies per ml. Retesting of the 72 samples by more sensitive PCR assays showed that 60 out of 200 (30%) were positive by PCR with sensitivity of 65 copies per ml, whereas 6 out of 200 (3%) required PCR sensitivity of 1.3 copies per ml for positivity. Three percent (6/200) were negative by all three NAT assays. CONCLUSIONS: HBV DNA levels in HBsAg-positive,anti-HBc reactive blood donations can be extremely low. About 6 percent of donations would be negative by current minipool HBV NAT methods. About 3 percent of donations would remain undetected by sensitive single donor NAT. These results indicate caution in any consideration of dropping HBsAg screening. TRANSFUSION Volume 44, September 2004

12 HBV TTI Ankstyva fazė Serologija neigiama Cirkuliuojantys virionai HBV mutant Buvusi infekcija OBI HbsAg - HBV viremija plazmoje +/- (<100 IU/ml) Sero + OBI Sero - OBI Anti Hbc Kiti faktoriai: Viruso koncentracija, biologinės savybės Donoro infekcijos fazė Recipiento imuninės sistemos būklė

13 Pasveikimo periodas, DNR titras l.mažas Lėtinis HBV nešiotojas anti HBc, anti HBe + HBV mutantų sukelta infekcija su mažu DNR titru. HBV DNA + HBs Ag Anti HBc + ir/ar anti HBs

14 Italija m. ištirta 7,436,996 kraujo vnt. 383 NAT teig. 20 (1: ) Ūmi infekcija 363 (1:20 000) OBI

15 Japonijos Raudonasis Kryžius OBI donacijos (su mažu anti-hbc titru) 10 k. mažesnė infekcijos perdavimo rizika nei lango periodu. OBI donorai su anti-hbs mažiau infekuotesni, nei donorai be anti-hbs

16 Pre core/core regiono mutacijos Dažniausia - pre-core regiono 1896 nukleotido pozicijos mutacija.ši mutacija keičia TGG į TAG stop kodoną, kuris nulemia transkripcijos pabaigą šioje srityje taip sustabdydamas HBeAg sintezę. Mutacijos dažnis Afrikoje, Azijoje, P.Europoje % nešiotojų HBsAg + HBV DNA + HBeAg

17 S Mutantai Hidrofilinio HBs Ag regiono, svarbaus kontaktui su humoraliniu imunitetu, mutacija. HBs Ag - HBV variantai įgyja didesnę išlikimo galimybę Dažniausios Azijoje (2% to 3% of vakcinuotųjų) 95% + Anti-HBC HBV-DNA HBeAg

18 NAT 1990 m. PGR paremta metodika donorų atrankai Daugelyje šalių In-house sistema Šiuo metu egzistuoja trys sertifikuotos pilnai automatizuotos NAT sistemos Švedija nuo 2008 m. neatlieka NAT Vokietija ir Austrija dėl mažo HBV, HCV, ŽIV-1 paplitimo, atlieka MP-NAT (iki 96 mėginių)

19 NAT technologijos Transkripcijos medijuota amplifikacija (TMA) Real time-pgr technologija Procesas: 1. Mėginio ekstrakcija 2. Amplifikacija 3. Detekcija

20 PGR TMA PGR

21 Testuojami patogenai Dažniausiai testuojami patogenai: HBV, HCV, ŽIV 1 Testuojami tik tam tikrose šalyse ir tam tikrų situacijų metu (WNV, HAV, B19, Chikungunya, ŽIV 2) Testuojami patogenai, kurių perdavimo rizika su kraujo komponentais mažai žinoma (SARS CoV, Influenza, H1N1) Bakterijų paieška kraujo komponentuose?

22 Tikslas - sutrumpinti lango periodą: ŽIV (doubling time 17 h) nuo 22(16d.) iki 8-9 d. (MP) ir 5-6 d. (ID) HCV (doubling time 11 h) - nuo d.iki 6-7 d (MP) ir 4-5 d (ID). HBV (doubling time 2,56 d) nuo 32 d. iki 20 d.

23 NAT problemos ID-NAT vs MP-NAT? HIV-1, HCV pranašumas abejotinas HBV - reikalingas l.didelis analitinis jautrumas Virusų mutacijos primer/ probe regionuose. Diegiamos paralelinės nors dviejų konservatyvių regionų amplifikacijos Maža viruso koncentracija, nepasiekianti analitinio metodo jautrumo.

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25 B19 DNR virusas neturintis apvalkalo Didelės koncentracijos (10/14 IU/ml) net asimptominėje būklėje Jungiasi prie eritrocitų pirmatakų P antigeno, sukeldamas apoptozę Rezultatas: aplastinė krizė 60 % 30 m. aptinkami neutralizuojantys antikūnai, liudijantys apie buvusią infekciją. Aprašyti tik keli su transfuzija susiję atvejai (dažniau su plazmos derivatais)

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27 Exposure of hematologic patients to parvovirus B19 as a contaminant of blood cell preparations and blood products. Plentz A, Hahn J, Knöll A, Holler E, Jilg W, Modrow S. Institute of Medical Microbiology and Hygiene and the Department of Haematology and Oncology, University of Regensburg, Germany. annelie.plentz@klinik.uni-regensburg.de RESULTS: Twenty-one (1%) of 2123 blood products tested positive for the presence of B19 DNA (2% of pooled products, 0.7% of single-donor products, and 17.6% of allogeneic peripheral blood progenitor cells), the median viral load was 700 genome equivalents per ml. During the study period, 114 patients were treated on the ward, and 14 (12%) of them received B19 DNA-positive blood components. None of them developed symptoms of an acute B19 infection, although one had a short low-level viremia. CONCLUSIONS: Although B19 DNA was detected in 1 percent of blood products given to hematologic patients, the exposure of 12 percent of patients did not result in symptomatic infections.

28 A linked donor-recipient study to evaluate parvovirus B19 transmission by blood component transfusion Steven H. Kleinman,1,2 Simone A. Glynn,3 Tzong-Hae Lee,4 Leslie H. Tobler,4 Karen S. Schlumpf,1 Deborah S. Todd,1 Hannah Qiao,1 Mei-ying W. Yu,5 and Michael P. Busch,4,6 for the National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study-II (NHLBI REDS-II) 1Westat Inc, Rockville, MD; 2Department of Pathology, University of British Columbia, Vancouver, BC; 3National Heart, Lung, and Blood Institute, Rockville, MD; 4Blood Systems Research Institute, San Francisco, CA; 5Division of Hematology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, MD; and 6Department of Laboratory Medicine, University of California, San Francisco We used a linked donor and recipient repository and a sensitive, quantitative B19V DNA polymerase chain reaction (PCR) assay to assess such transmissionin B19V-susceptible (ie, anti-b19v immunoglobulin G [IgG] negative) recipients We found no transmission to 24 susceptible recipients from transfusion of components with B19V DNA at concentrations less than 10/6 IU/mL (upper 95% confidence interval, 11.7%). We found an anamnestic IgG response in one pretransfusion seropositive recipient transfused with a component containing greater than 10/10 IU/mL B19V DNA. We assessed 112 B19V DNA positive components from 105 donors (of tested donations) transfuse into a population of surgical patients with a pretransfusion B19V IgG seroprevalence of 78%. These findings show either that transmission from components with less than 10/6 IU/mL does not occur, or, if it does, it is an uncommon event. These data do not support the need to routinely screen blood donations with a sensitive B19V DNA nucleic acid assay. (Blood. 2009;114: )

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