Reporting incident HBV and HCV infections meeting CSTE acute case definition among repeat blood donors from blood collection centers to public health departments

Incident HBV and HCV infections identified during repeat blood donations (tested negative, then confirmed positive for NAT within 6 months, with any serologic profile), regardless of whether the donor is symptomatic, meet the 2012 CSTE acute HBV and HCV surveillance case definitions for public health reporting across the US. A modification to increase this period to 12 months is proposed for 2016.

However, routine reporting to public health departments has not typically included the documentation from blood collection centers of the recent past negative test results indicating that this is an acute infection, nor the context of past successful donations suggesting a lack of common risk factors, raising the possibility of healthcare-associated infection (HAI).

We hope to promote awareness among public health personnel about a new effort for direct reporting by blood collection centers of these incident HBV and HCV infections in repeat blood donors, now including this important epidemiologic information, to alert state or local public health personnel for prioritized investigation.

Recently acquired viral hepatitis infection among repeat blood donors who should not have more common risk factors can be a sentinel event signaling a possible HAI in the donor, especially in individuals who were test-negative at recent prior successful donations: at least six HAI outbreaks or transmissions (four described in Moorman et al, Transfusion 2015) have been detected since 2008 by public health investigation of such reports, in each instance from a single donor. Investigation of acute infections may yield important information for state and/or local public health departments in order to facilitate public health measures such as contact tracing and enhancement of infection control practices, and may enhance understanding of local hepatitis transmission patterns, regardless of transmission source.

Please note that the above reporting of potential HAI in blood donors is a separate process from that of routine reporting of HBV and HCV infections in blood donors.  Routine reporting will continue without change.  Following the time it takes for the blood centers to review their records and confirm the confirmatory status of the donor, confirm the repeat status of a donor and that the donor’s last negative donation occurred within 12 months of less of the confirmed-positive donation, and that the donor lacks common risk factors for infection, a second notification will be sent to the same contact information as the initial routine reports.  Since blood centers are only providing additional information on donors with recent infection and those who do not have common risk factors, the number of additional notifications will be a subset of the total that were initially reported.

Please note that, upon consultation, CDC can provide assistance to health departments during investigation and share best practices, based on many states’ previous experiences with issues such as: infection control breaches previously associated with transmissions in specific settings and observation recommendations, guidance for notification messages including specific populations to screen and guidance on laboratory testing and molecular genetic investigation ( http://www.cdc.gov/hepatitis/Outbreaks/ )