Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission

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Abstract

In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.

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World Health Organization Estimates of the Global and Regional Disease Burden of 11 Foodborne Parasitic Diseases, 2010: A Data Synthesis

Paul Torgerson, Brecht Devleesschauwer, Nicolas Praet … (2015)

Background Foodborne diseases are globally important, resulting in considerable morbidity and mortality. Parasitic diseases often result in high burdens of disease in low and middle income countries and are frequently transmitted to humans via contaminated food. This study presents the first estimates of the global and regional human disease burden of 10 helminth diseases and toxoplasmosis that may be attributed to contaminated food. Methods and Findings Data were abstracted from 16 systematic reviews or similar studies published between 2010 and 2015; from 5 disease data bases accessed in 2015; and from 79 reports, 73 of which have been published since 2000, 4 published between 1995 and 2000 and 2 published in 1986 and 1981. These included reports from national surveillance systems, journal articles, and national estimates of foodborne diseases. These data were used to estimate the number of infections, sequelae, deaths, and Disability Adjusted Life Years (DALYs), by age and region for 2010. These parasitic diseases, resulted in 48.4 million cases (95% Uncertainty intervals [UI] of 43.4–79.0 million) and 59,724 (95% UI 48,017–83,616) deaths annually resulting in 8.78 million (95% UI 7.62–12.51 million) DALYs. We estimated that 48% (95% UI 38%-56%) of cases of these parasitic diseases were foodborne, resulting in 76% (95% UI 65%-81%) of the DALYs attributable to these diseases. Overall, foodborne parasitic disease, excluding enteric protozoa, caused an estimated 23.2 million (95% UI 18.2–38.1 million) cases and 45,927 (95% UI 34,763–59,933) deaths annually resulting in an estimated 6.64 million (95% UI 5.61–8.41 million) DALYs. Foodborne Ascaris infection (12.3 million cases, 95% UI 8.29–22.0 million) and foodborne toxoplasmosis (10.3 million cases, 95% UI 7.40–14.9 million) were the most common foodborne parasitic diseases. Human cysticercosis with 2.78 million DALYs (95% UI 2.14–3.61 million), foodborne trematodosis with 2.02 million DALYs (95% UI 1.65–2.48 million) and foodborne toxoplasmosis with 825,000 DALYs (95% UI 561,000–1.26 million) resulted in the highest burdens in terms of DALYs, mainly due to years lived with disability. Foodborne enteric protozoa, reported elsewhere, resulted in an additional 67.2 million illnesses or 492,000 DALYs. Major limitations of our study include often substantial data gaps that had to be filled by imputation and suffer from the uncertainties that surround such models. Due to resource limitations it was also not possible to consider all potentially foodborne parasites (for example Trypanosoma cruzi). Conclusions Parasites are frequently transmitted to humans through contaminated food. These estimates represent an important step forward in understanding the impact of foodborne diseases globally and regionally. The disease burden due to most foodborne parasites is highly focal and results in significant morbidity and mortality among vulnerable populations.

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Human antibody responses after dengue virus infection are highly cross-reactive to Zika virus.

Lalita Priyamvada, Kendra Quicke, William Hudson … (2016)

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus of significant public health concern. ZIKV shares a high degree of sequence and structural homology compared with other flaviviruses, including dengue virus (DENV), resulting in immunological cross-reactivity. Improving our current understanding of the extent and characteristics of this immunological cross-reactivity is important, as ZIKV is presently circulating in areas that are highly endemic for dengue. To assess the magnitude and functional quality of cross-reactive immune responses between these closely related viruses, we tested acute and convalescent sera from nine Thai patients with PCR-confirmed DENV infection against ZIKV. All of the sera tested were cross-reactive with ZIKV, both in binding and in neutralization. To deconstruct the observed serum cross-reactivity in depth, we also characterized a panel of DENV-specific plasmablast-derived monoclonal antibodies (mAbs) for activity against ZIKV. Nearly half of the 47 DENV-reactive mAbs studied bound to both whole ZIKV virion and ZIKV lysate, of which a subset also neutralized ZIKV. In addition, both sera and mAbs from the dengue-infected patients enhanced ZIKV infection of Fc gamma receptor (FcγR)-bearing cells in vitro. Taken together, these findings suggest that preexisting immunity to DENV may impact protective immune responses against ZIKV. In addition, the extensive cross-reactivity may have implications for ZIKV virulence and disease severity in DENV-experienced populations.

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Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.

Lorraine Peddada, Steven Kleinman, Lal B. Rawal … (2003)

The characterization of primary HIV infection by the analysis of serial plasma samples from newly infected persons using multiple standard viral assays. A retrospective study involving two sets of archived samples from HIV-infected plasma donors. (A) 435 samples from 51 donors detected by anti-HIV enzyme immunoassays donated during 1984-1994; (B) 145 specimens from 44 donors detected by p24 antigen screening donated during 1996-1998. Two US plasma products companies. The timepoints of appearance of HIV-1 markers and viral load concentrations during primary HIV infection. The pattern of sequential emergence of viral markers in the 'A' panels was highly consistent, allowing the definition and estimation of the duration of six sequential stages. From the 'B' panels, the viral load at p24 antigen seroconversion was estimated by regression analysis at 10 000 copies/ml (95% CI 2000-93 000) and the HIV replication rate at 0.35 log copies/ml/day, corresponding to a doubling time in the preseroconversion phase of 20.5 h (95% CI 18.2-23.4 h). Consequently, an RNA test with 50 copies/ml sensitivity would detect HIV infection approximately 7 days before a p24 antigen test, and 12 days before a sensitive anti-HIV test. The sequential emergence of assay reactivity allows the classification of primary HIV-1 infection into distinct laboratory stages, which may facilitate the diagnosis of recent infection and stratification of patients enrolled in clinical trials. Quantitative analysis of preseroconversion replication rates of HIV is useful for projecting the yield and predictive value of assays targeting primary HIV infection.

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Author and article information

Journal

Journal ID (nlm-ta): Transplant Direct

Journal ID (iso-abbrev): Transplant Direct

Journal ID (publisher-id): TXD

Title: Transplantation Direct

Publisher: Lippincott Williams & Wilkins

ISSN (Electronic): 2373-8731

Publication date Collection: January 2019

Publication date (Electronic): 20 December 2018

Volume: 5

Issue: 1

Electronic Location Identifier: e416

Affiliations

[1 ] Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia.

[2 ] Serology and Virology Division, NSW Health Pathology Prince of Wales Hospital, Sydney, Australia.

[3 ] Women's and Children's Health and Biotechnology and Biomolecular Sciences, University of New South Wales Schools of Medicine, Sydney, Australia.

[4 ] Departments of Infectious Diseases and Microbiology, Fiona Stanley Hospital, Perth, Australia.

[5 ] PathWest Laboratory Medicine, Perth, Australia.

[6 ] Communicable Diseases Network Australia, New South Wales Health, Sydney, Australia.

[7 ] Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.

[8 ] Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.

[9 ] Sydney School of Public Health, The University of Sydney, Sydney, Australia.

[10 ] Austin Health, Melbourne, Australia.

[11 ] The Organ and Tissue Authority, Australian Government, Canberra, Australia.

[12 ] Kirby Institute, University of New South Wales, Sydney, Australia.

[13 ] Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.

[14 ] Transplantation Services, Royal Prince Alfred Hospital, Sydney, Australia.

[15 ] Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia.

[16 ] Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, Australia.

[17 ] Department of Nephrology, Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand.

[18 ] Department of Nephrology, Fiona Stanley Hospital, Perth, Australia.

[19 ] Faculty of Health and Medical Sciences, UWA Medical School, The University of Western Australia, Crawley, Australia.

[20 ] Renal and Transplantation, Royal Adelaide Hospital, Adelaide, Australia.

[21 ] Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.

[22 ] Renal Transplantation, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.

[23 ] Lung Transplant, Alfred Health, Melbourne, Victoria, Australia.

[24 ] Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.

[25 ] Department of Cardiology, St Vincent's Hospital, Sydney, Australia.

[26 ] St Vincent's Hospital Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia.

[27 ] Kidney Disorders, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand.

[28 ] Woolcock Institute of Medical Research, Sydney, Australia.

[29 ] School of Medical and Molecular Biosciences, University of Technology, Sydney, Australia.

[30 ] Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL.

Author notes

[*]Correspondence: Sarah Louise White, PhD, Level 2 West 66, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia. ( sarah.white@ 123456sydney.edu.au ).

Article

Publisher ID: TXD50325 Accession ID: 00001

DOI: 10.1097/TXD.0000000000000852

PMC ID: 6324914

PubMed ID: 30656214

SO-VID: 3d7e5c5b-efbb-44a5-b8b4-236d3b553028

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Date received : 13 August 2018

Date accepted : 15 August 2018

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Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission

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Zika Virus

Most cited references 385

World Health Organization Estimates of the Global and Regional Disease Burden of 11 Foodborne Parasitic Diseases, 2010: A Data Synthesis

Human antibody responses after dengue virus infection are highly cross-reactive to Zika virus.

Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.

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