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  1. Article ; Online: Evaluating the risk of transfusion and transplant-transmitted monkeypox infections.

    Harvala, Heli / Simmonds, Peter

    Transfusion medicine (Oxford, England)

    2022  Volume 32, Issue 6, Page(s) 460–466

    Abstract: The recent emergence of monkeypox virus (MPXV) in the UK and elsewhere is of urgent public health concern. Several aspects of MPXV epidemiology and pathogenesis, including its systemic spread and viraemia during acute infection, furthermore represent an ... ...

    Abstract The recent emergence of monkeypox virus (MPXV) in the UK and elsewhere is of urgent public health concern. Several aspects of MPXV epidemiology and pathogenesis, including its systemic spread and viraemia during acute infection, furthermore represent an important potential threat to the safety of blood transfusion and organ transplantation. Reported infections in the UK have been exponentially increasing over the last 2 months, with 1552 reported cases in the UK by 7th July 2022. This is likely to be considerable underestimate given current limitations in diagnostic capacity and clinical diagnoses hampered by its similar disease presentations to other causes of rash and genitourinary disease. While MPXV infections are currently most widespread in gay, bisexual or other men who have sex with men, wider spread of MPXV outside defined risk groups for infection may prevent identification of infection risk in donors. While typically mild disease outcomes have been reported in UK cases, case fatality rates ranging from 1% to over 10% are reported for different MPXV strains in its source area in sub-Saharan Africa. Recipients of blood components and organs transplant, especially those who are immunosuppressed, may reproduce the greater systemic spread and morbidity of those infected through percutaneous routes. There is a potential risk of MPXV transmission and severe disease outcomes in blood and transplant recipients. In addition to current risk assessments performed in the UK and exclusion of donors with recent MPXV exposure, determining viraemia frequencies in donors and directly evaluating transmission risk would be of considerable value in assessing whether MPXV nucleic acid screening should be implemented.
    MeSH term(s) Male ; Humans ; Mpox (monkeypox)/diagnosis ; Viremia ; Homosexuality, Male ; Sexual and Gender Minorities ; Monkeypox virus ; Blood Transfusion
    Language English
    Publishing date 2022-09-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1067989-3
    ISSN 1365-3148 ; 0958-7578
    ISSN (online) 1365-3148
    ISSN 0958-7578
    DOI 10.1111/tme.12918
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Biomarkers of transfusion transmitted occult hepatitis B virus infection: Where are we and what next?

    Fu, Michael X / Simmonds, Peter / Andersson, Monique / Harvala, Heli

    Reviews in medical virology

    2024  Volume 34, Issue 2, Page(s) e2525

    Abstract: Blood transfusion is a vital procedure, where transfusion-transmitted infection of hepatitis B virus (HBV) remains an important issue, especially from blood donors with occult hepatitis B virus infection (OBI). Occult hepatitis B virus infection is a ... ...

    Abstract Blood transfusion is a vital procedure, where transfusion-transmitted infection of hepatitis B virus (HBV) remains an important issue, especially from blood donors with occult hepatitis B virus infection (OBI). Occult hepatitis B virus infection is a complex entity to detect using surrogate blood biomarkers for intrahepatic viral transcriptional activity, requiring a continually refined battery of tests utilised for screening. This review aims to critically evaluate the latest advances in the current blood biomarkers to guide the identification of OBI donors and discuss novel HBV markers that could be introduced in future diagnostic practice. Challenges in detecting low HBV surface antigen levels, mutants, and complexes necessitate ultrasensitive multivalent dissociation assays, whilst HBV DNA testing requires improved sensitivity but worsens inaccessibility. Anti-core antibody assays defer almost all potentially infectious donations but have low specificity, and titres of anti-surface antibodies that prevent infectivity are poorly defined with suboptimal sensitivity. The challenges associated with these traditional blood HBV markers create an urgent need for alternative biomarkers that would help us better understand the OBI. Emerging viral biomarkers, such as pre-genomic RNA and HBV core-related antigen, immunological HBV biomarkers of T-cell reactivity and cytokine levels, and host biomarkers of microRNA and human leucocyte antigen molecules, present potential advances to gauge intrahepatic activity more accurately. Further studies on these markers may uncover an optimal diagnostic algorithm for OBI using quantification of various novel and traditional blood HBV markers. Addressing critical knowledge gaps identified in this review would decrease the residual risk of transfusion-transmitted HBV infection without compromising the sustainability of blood supplies.
    MeSH term(s) Humans ; Hepatitis B virus/genetics ; Hepatitis B Antibodies ; Hepatitis B ; Hepatitis B, Chronic ; Blood Transfusion ; Hepatitis B Core Antigens ; Blood Donors ; Biomarkers ; DNA, Viral
    Chemical Substances Hepatitis B Antibodies ; Hepatitis B Core Antigens ; Biomarkers ; DNA, Viral
    Language English
    Publishing date 2024-02-20
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1086043-5
    ISSN 1099-1654 ; 1052-9276
    ISSN (online) 1099-1654
    ISSN 1052-9276
    DOI 10.1002/rmv.2525
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Parechovirus A Circulation and Testing Capacities in Europe, 2015-2021.

    Bubba, Laura / Broberg, Eeva K / Fischer, Thea K / Simmonds, Peter / Harvala, Heli

    Emerging infectious diseases

    2024  Volume 30, Issue 2, Page(s) 234–244

    Abstract: Parechovirus infections usually affect neonates and young children; manifestations vary from asymptomatic to life-threatening. We describe laboratory capacity in Europe for assessing parechovirus circulation, seasonality, and epidemiology. We used ... ...

    Abstract Parechovirus infections usually affect neonates and young children; manifestations vary from asymptomatic to life-threatening. We describe laboratory capacity in Europe for assessing parechovirus circulation, seasonality, and epidemiology. We used retrospective anonymized data collected from parechovirus infection case-patients identified in Europe during January 2015-December 2021. Of 21 laboratories from 18 countries that participated in the study, 16 (76%) laboratories with parechovirus detection capacity reported 1,845 positive samples; 12/16 (75%) with typing capability successfully identified 517 samples. Parechovirus A3 was the most common type (n = 278), followed by A1 (153), A6 (50), A4 (13), A5 (22), and A14 (1). Clinical data from 1,269 participants highlighted correlation of types A3, A4, and A5 with severe disease in neonates. We observed a wide capacity in Europe to detect, type, and analyze parechovirus data. To enhance surveillance and response for PeV outbreaks, sharing typing protocols and data on parechovirus-positive cases should be encouraged.
    MeSH term(s) Child ; Infant, Newborn ; Humans ; Child, Preschool ; Parechovirus/genetics ; Retrospective Studies ; Europe/epidemiology ; Disease Outbreaks ; Laboratories
    Language English
    Publishing date 2024-01-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1380686-5
    ISSN 1080-6059 ; 1080-6040
    ISSN (online) 1080-6059
    ISSN 1080-6040
    DOI 10.3201/eid3002.230647
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Virological safety of the UK blood supply in the era of individual risk assessments and HIV PrEP.

    Maddox, Victoria / Vallely, Pamela / Brailsford, Susan R / Harvala, Heli

    Transfusion medicine (Oxford, England)

    2023  Volume 33, Issue 5, Page(s) 372–378

    Abstract: A more individualised donor selection policy was implemented in the UK in 2021, which replaced the previous 3-month deferral for men who have sex with men (MSM). Other blood services have a variety of policies in place to ensure the virological safety of ...

    Abstract A more individualised donor selection policy was implemented in the UK in 2021, which replaced the previous 3-month deferral for men who have sex with men (MSM). Other blood services have a variety of policies in place to ensure the virological safety of blood components, ranging from an indefinite ban on MSM, to a defined period of exclusion, or to an individualised risk assessment that is not based on gender or sexual orientation. Justification of these policies should be based on scientific evidence including assessment of lengths of virological window periods, infectious disease epidemiology within donor populations and donation screening assay sensitivities. Developments in molecular technology and assays which can detect both antibodies and antigens in the very early stages of infection have significantly reduced the risk in most developed countries. However, the increasing usage of pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV infection after possible high-risk sexual contact within the UK blood donor population has been recently noted. It has brought with it new diagnostic challenges within blood screening, notably possible non-detection of HIV RNA and serological markers following PrEP use despite potential infectivity. The use of other testing strategies such as detection of HIV DNA and screening for non-declared PrEP usage should be investigated further.
    MeSH term(s) Female ; Humans ; Male ; Blood Donors ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/virology ; Homosexuality, Male ; Risk Assessment ; Sexual and Gender Minorities ; United Kingdom/epidemiology ; Safety Management/standards ; Blood Donation/standards ; HIV/isolation & purification ; Pre-Exposure Prophylaxis ; Antiviral Agents/administration & dosage ; Antiviral Agents/therapeutic use
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2023-09-05
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1067989-3
    ISSN 1365-3148 ; 0958-7578
    ISSN (online) 1365-3148
    ISSN 0958-7578
    DOI 10.1111/tme.12993
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: HTLV-1 screening of blood donations: We are systematically missing opportunities.

    Rosadas, Carolina / Harvala, Heli / Davison, Katy / Taylor, Graham P

    British journal of haematology

    2023  Volume 202, Issue 6, Page(s) 1220–1223

    MeSH term(s) Humans ; Human T-lymphotropic virus 1 ; Blood Donation ; HTLV-I Infections/diagnosis ; Human T-lymphotropic virus 2 ; Blood Donors ; Prevalence ; Mass Screening
    Language English
    Publishing date 2023-07-24
    Publishing country England
    Document type Letter
    ZDB-ID 80077-6
    ISSN 1365-2141 ; 0007-1048
    ISSN (online) 1365-2141
    ISSN 0007-1048
    DOI 10.1111/bjh.18988
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Fulminant Transfusion-Associated Hepatitis E Virus Infection Despite Screening, England, 2016-2020.

    Harvala, Heli / Reynolds, Claire / Brailsford, Su / Davison, Katy

    Emerging infectious diseases

    2022  Volume 28, Issue 9, Page(s) 1805–1813

    Abstract: In England, all blood donations are screened in pools of 24 by nucleic acid test (NAT) for hepatitis E virus (HEV) RNA. During 2016-2020, this screening successfully identified and intercepted 1,727 RNA-positive donations. However, review of previous ... ...

    Abstract In England, all blood donations are screened in pools of 24 by nucleic acid test (NAT) for hepatitis E virus (HEV) RNA. During 2016-2020, this screening successfully identified and intercepted 1,727 RNA-positive donations. However, review of previous donations from infected platelet donors identified 9 donations in which HEV RNA detection was missed, of which 2 resulted in confirmed transmission: 1 infection resolved with ribavirin treatment, and 1 proceeded to fatal multiorgan failure within a month from infection. Residual risk calculations predict that over the 5-year study period, HEV RNA detection was missed by minipool NAT in 12-23 platelet and 177-354 whole-blood donations, but transmission risk remains undetermined. Although screening has been able to largely eliminate infectious HEV from the blood supply in England, missed detection of low levels of HEV RNA in donated blood can lead to a severe, even fulminant, infection in recipients and could be prevented by more sensitive screening.
    MeSH term(s) Blood Donors ; Blood Transfusion ; Hepatitis E/diagnosis ; Hepatitis E/epidemiology ; Hepatitis E virus/genetics ; Humans ; Mass Screening/methods ; RNA, Viral/genetics
    Chemical Substances RNA, Viral
    Language English
    Publishing date 2022-09-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1380686-5
    ISSN 1080-6059 ; 1080-6040
    ISSN (online) 1080-6059
    ISSN 1080-6040
    DOI 10.3201/eid2809.220487
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Detection frequencies and viral load distribution of parvovirus B19 DNA in blood and plasma donations in England.

    Williams, Sarah / Ratcliff, Jeremy / Nguyen, Dung / Simmonds, Peter / Harvala, Heli

    Transfusion medicine (Oxford, England)

    2022  Volume 32, Issue 5, Page(s) 402–409

    Abstract: Background and objectives: Infections with human parvovirus B19 (B19V) are transmissible by blood components and plasma-derived medicines. The European Pharmacopoeia regulates maximum levels of virus allowed in manufacturers' plasma pools. To evaluate ... ...

    Abstract Background and objectives: Infections with human parvovirus B19 (B19V) are transmissible by blood components and plasma-derived medicines. The European Pharmacopoeia regulates maximum levels of virus allowed in manufacturers' plasma pools. To evaluate contamination risk prior to re-introduction of UK-sourced plasma for manufacturing, we investigated viraemia frequencies of B19V in plasma samples collected from blood donors before and during COVID-enforced lockdown.
    Materials and methods: Quantitative PCR for B19V DNA was used to screen pools of 96 anonymised plasma samples collected in England from 2017 (n = 29 505), 2020 (n = 3360) and 2021 (n = 43 200). Selected positive pools were resolved into individual samples. Data on donor notifications and related lookback investigations were collected from European countries by on-line survey in 2020.
    Results: Screening of 76 065 donations identified 80 B19V-positive pools. While most positive samples had low viral loads (<10
    Conclusion: Information on seroprevalence, incidence and viral loads of B19V viraemia is contributory the evaluation of alternative operational screening strategies for plasma testing.
    MeSH term(s) Antibodies, Viral ; Blood Donors ; COVID-19 ; Communicable Disease Control ; DNA, Viral ; Humans ; Immunoglobulin G ; Parvoviridae Infections/epidemiology ; Parvovirus B19, Human/genetics ; Seroepidemiologic Studies ; Viral Load ; Viremia/epidemiology
    Chemical Substances Antibodies, Viral ; DNA, Viral ; Immunoglobulin G
    Language English
    Publishing date 2022-06-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 1067989-3
    ISSN 1365-3148 ; 0958-7578
    ISSN (online) 1365-3148
    ISSN 0958-7578
    DOI 10.1111/tme.12893
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Blood donor notification of variant Creutzfeldt-Jakob disease risk: Lessons in communicating donor deferral and risk.

    Reynolds, Claire A / Yawitch, Tali / Hewitt, Patricia E / Harvala, Heli

    Transfusion medicine (Oxford, England)

    2022  Volume 33, Issue 1, Page(s) 75–80

    Abstract: Background: In 2005, the blood service in England notified 101 donors by letter that they may be at risk of variant Creutzfeldt-Jakob disease (vCJD) because a recipient of their blood later developed vCJD. Donor experience of the notification was ... ...

    Abstract Background: In 2005, the blood service in England notified 101 donors by letter that they may be at risk of variant Creutzfeldt-Jakob disease (vCJD) because a recipient of their blood later developed vCJD. Donor experience of the notification was studied in a 2009 survey.
    Methods: Fifteen questions focused on satisfaction, emotional response and understanding of the notification letter. An average Likert score was calculated: 1 and 2 = dissatisfied, 3 = equivocal and 4 and 5 = satisfied; the per cent satisfied and dissatisfied were calculated and characteristics compared using the Fisher and Chi-squared tests.
    Results: The questionnaire was completed by 56 of 90 notified donors, mostly repeat, U.K.-born donors over 45 years of age. Four years after notification, many individuals still felt surprise (44%), upset (44%) or worry (50%) about the letter, with 10 feeling depressed. Thirty per cent were uncertain if they had vCJD or not. For future notifications, 57% would still favour a detailed letter and 36% would prefer a discussion in person.
    Discussion: It was notable how many individuals, 4 years later, still felt continuing anxiety about the vCJD notification letter, not noted in earlier interviews. This highlights a need for on-going support required in donor notifications where outcome for the individual is highly uncertain.
    MeSH term(s) Humans ; Creutzfeldt-Jakob Syndrome ; Blood Donors ; England ; Surveys and Questionnaires
    Language English
    Publishing date 2022-06-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 1067989-3
    ISSN 1365-3148 ; 0958-7578
    ISSN (online) 1365-3148
    ISSN 0958-7578
    DOI 10.1111/tme.12891
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Investigating Blood Donors With Postdonation Respiratory Tract Symptoms During the Wild-Type, Delta, and Omicron Waves of the Coronavirus Disease 2019 Pandemic in England.

    Gates, Shannah / Ijaz, Samreen / Baklan, Hatice / Washington, Charlotte / Brailsford, Su / Zambon, Maria / Harvala, Heli

    Open forum infectious diseases

    2023  Volume 10, Issue 10, Page(s) ofad499

    Abstract: Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been shown to be detectable in blood from infected individuals. Though RNAemia frequencies are typically low, the presence of potentially infectious virus potentially ...

    Abstract Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been shown to be detectable in blood from infected individuals. Though RNAemia frequencies are typically low, the presence of potentially infectious virus potentially poses a transmission risk during blood transfusion.
    Methods: Archived plasma samples were collected from blood donors who later reported possible SARS-CoV-2 infection with the wild-type strain, Delta variant, or Omicron variant. This was based on either symptom onset or a positive test within 2 weeks from their donation. Donations were tested for SARS-CoV-2 RNA, and information on symptoms and testing results were gathered during postdonation interview.
    Results: Of 518 archived plasma samples tested, 19 (3.7%) were found to have detectable levels of SARS-CoV-2 RNA. SARS-CoV-2 RNA was detected in donors who donated during the Delta (10/141 [7.1%]) and Omicron (9/162 [5.6%]) waves. SARS-CoV-2 RNA was not detected in donors who donated during the wild-type wave (0/215). Seventeen of 19 RNAemic donors reported symptom onset or a positive test within 2 days of donating. SARS-CoV-2 RNA was detected in asymptomatic or presymptomatic blood donors.
    Conclusions: Despite RNAemia being correlated with SARS-CoV-2 disease severity, RNAemia was detected in asymptomatic or presymptomatic blood donors.
    Language English
    Publishing date 2023-10-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofad499
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The importance of enterovirus surveillance in a post-polio world.

    Fischer, Thea K / Simmonds, Peter / Harvala, Heli

    The Lancet. Infectious diseases

    2021  Volume 22, Issue 1, Page(s) e35–e40

    Abstract: Poliovirus is known to most people in the world as the cause of polio, a devastating paralytic disease from the past. Success in polio eradication has understandably translated into stricter containment plans for poliovirus, coordinated by WHO. In this ... ...

    Abstract Poliovirus is known to most people in the world as the cause of polio, a devastating paralytic disease from the past. Success in polio eradication has understandably translated into stricter containment plans for poliovirus, coordinated by WHO. In this Personal View, we discuss the impact of recent biosafety level 3+ guidelines for handling potential poliovirus-containing diagnostic specimens, which has resulted in closure of many national WHO poliovirus reference laboratories. This reduction in laboratory capacity has a knock-on effect of capability to detect and characterise non-polio enteroviruses in samples obtained from patients with neurological symptoms. The development is of concern given the widespread circulation of non-polio enteroviruses, their role as the most common cause of meningitis worldwide, and their involvement in other severe neurological conditions, such as acute flaccid myelitis and encephalitis. These disease presentations have increased substantially in the past decade, and have been associated with major outbreaks of enterovirus D68 and enterovirus A71, leaving many who survived with lasting paralysis and disabilities. To address this growing gap in diagnostic and surveillance capability, we have established the European Non-Poliovirus Enterovirus Network (also known as ENPEN) as a supra-national, non-commercial, core reference consortium. Our consortium will develop, test, and implement generic surveillance platforms for non-polio enteroviruses and other emerging viral diseases.
    MeSH term(s) Central Nervous System Viral Diseases ; Disease Outbreaks ; Enterovirus/pathogenicity ; Enterovirus Infections/complications ; Enterovirus Infections/epidemiology ; Epidemiological Monitoring ; Feces/virology ; Humans ; Myelitis ; Neuromuscular Diseases ; Paralysis/virology ; Poliomyelitis/epidemiology ; Poliovirus/pathogenicity ; Research
    Language English
    Publishing date 2021-07-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2061641-7
    ISSN 1474-4457 ; 1473-3099
    ISSN (online) 1474-4457
    ISSN 1473-3099
    DOI 10.1016/S1473-3099(20)30852-5
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