Use of a NAT-based assay to improve the surveillance system and prevent transfusion-transmitted malaria in blood banks
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Malaria Journal Open Access
RESEARCH
Use of a NAT‑based assay to improve the surveillance system and prevent transfusion‑transmitted malaria in blood banks Daniele Rocha3,5, Gisely Cardoso de Melo1,2, José Marcelo Hipólito Carneiro6, Marisa Ribeiro3,5, Sthefanie Ribeiro3, Daniela Tupy de Godoy3, Anne Cristine Gomes de Almeida1, Elisabete Ferreira de Andrade3,5, Cláudia Maria de Moura Abrahim6, Nelson Abrahim Fraiji6, Antonio Gomes Pinto Ferreira3, Wuelton Marcelo Monteiro1,2, Rodrigo Brindeiro5, Amilcar Tanuri5, Marcus Vinicius Guimarães de Lacerda1,2,4 and Patrícia Alvarez3*
Abstract Background: Malaria can be transmitted by blood transfusion through donations collected from asymptomatic donors. Transfusion-transmitted malaria (TTM) poses a great risk to blood services worldwide. A good screening tool for Plasmodium spp. detection in blood banks must have a high sensitivity for prevention of TTM. However, in Brazilian blood banks, screening for malaria still relies on microscopy. Methods: In Brazil, screening for human immunodeficiency virus type 1 (HIV), RNA/DNA for hepatitis C (HCV) and hepatitis B (HBV) viruses is mandatory for every blood donation and uses nucleic acid amplification testing (NAT). The aim of this study was to evaluate the inclusion of an assay for malaria to identify Plasmodium sp. from total nucleic acid (TNA; DNA/RNA) by targeting the 18S rRNA gene of the parasite. Results: Considering the limitations of microscopy and the wide availability of the Brazilian NAT platform in the screening of blood units for HIV, HCV, and HBV, a molecular diagnostic tool was validated for detection of Plasmodium sp. in blood banks; a pilot study showed that using this novel NAT assay could reduce the risk of TTM. Conclusion: The prototype HIV/HCV/HBV/malaria NAT assay was effective in detecting infected candidate donors and has good prospects to be applied in routine screening for preventing TTM. Keywords: Malaria, Plasmodium, Molecular diagnostic, Blood transfusion, Transfusion-transmitted malaria, Hemovigilance, Nucleic acid testing Background Malaria is an acute public health problem with annual estimates of 228 million new cases and 405,000 deaths worldwide [1]. Plasmodium vivax is the predominant parasite in the Americas, representing 75% of malaria *Correspondence: [email protected] 3 Institute of Technology in Immunobiology Bio‑Manguinhos, Oswaldo Cruz Foundation/Fiocruz, Avenida Brasil 4365, Rio de Janeiro, Brazil Full list of author information is available at the end of the article
cases [1]. In Brazil, P. vivax is also the most common infecting parasite, accounting for 84% of all reported malaria cases [2]. Vector control is the main way to prevent and reduce malaria transmission. Early diagnosis and treatment of malaria reduces disease and prevents deaths and also contributes to reducing malaria transmission [1]. Microscopy is the conventional ‘gold standard’ method for the diagnosis of malaria and allows the differentiation of Plasmodium species and the determination of parasite
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