Transfusion medicine
Transfusion transmitted disease
Zika virus

Editor-in-Chief: Debra Zynger, M.D.
Kyle Annen, D.O.

Topic Completed: 23 July 2019

Revised: 23 July 2019

Copyright: 2019, PathologyOutlines.com, Inc.

PubMed Search: Zika virus[TI] pathology[TIAB] full text[sb]

Kyle Annen, D.O.
Page views in 2019 to date: 130
Cite this page: Annen K. Zika virus. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/transfusionmedzika.html. Accessed October 18th, 2019.
Definition / general
Essential features
  • Zika virus is a mosquito borne infectious disease
  • It is also transmissible by transfusion, blood exposure and sexual intercourse
  • Most infected are asymptomatic; symptoms are a flu-like illness with conjunctivitis and maculopapular rash
  • Associated with severe birth defects such as microcephaly
  • Donors are tested via nucleic acid testing and if positive, are deferred for 120 days
Transmission
Symptoms
  • Most infected (80%) are asymptomatic or have mild symptoms lasting up to 1 week (Bull World Health Organ 2018;96:402)
  • Most common symptoms are fever, conjunctivitis, maculopapular rash, arthralgia, myalgia, headache
  • Usually self limiting
  • Neurologic manifestations, including Guillain-Barré syndrome, have been reported
  • Association of Zika infection during pregnancy and fetal malformations, microcephaly
Screening
  • ZIKV can be detected in serum or plasma for 1 - 2 weeks after infection (N Engl J Med 2017;379:1234)
  • Median value for ZIKV RNA persistence:
    • Serum / plasma: 11 - 17 days
    • Semen: 28 - 41 days
    • Urine: 6 - 10 days
    • Whole blood and red blood cells: up to 3 months
Blood donor screening
Blood donor testing
  • Only approved method is the individual donor nucleic acid test for Zika virus (Roche Molecular Systems)
  • Minipool nucleic acid testing (N Engl J Med 2018;378:1778)
    • A positive minipool nucleic acid test must be resolved using individual donor nucleic acid testing or pathogen reduction of blood components (only plasma and platelets are Food and Drug Administration approved at this time)
  • Individual donor nucleic acid testing is required for defined geographic collection areas at times of higher risk (i.e. suspected or documented Zika infection) as defined by positive ZIKV testing in a nearby blood center, Centers for Disease Control and Prevention or other surveillance notification
  • Converting to individual donor nucleic acid testing is required within 24 hours of notice
Donor deferral
  • Donor with confirmed positive ZIKV individual donor nucleic acid test is deferred for 120 days (U.S. Food and Drug Administration: Revised Recommendations for Reducing the Risk of Zika Virus Transmission by Blood and Blood Components [Accessed 11 June 2019])
  • Donor must be notified and counseled regarding the medical significance of the results
  • All in date blood products (including those of a prior donation) must be retrieved and quarantined
  • Physicians who transfused any components from the infected donor collected during a prior donation (120 days prior) should be encouraged to notify the transfusion recipient
  • Females of childbearing age should be advised that becoming pregnant is not recommended for 8 weeks from exposure
  • Males should be advised that Zika is transmitted in semen; unprotected sex should be avoided for 6 months from infection
Case reports
Board review question #1
Postinfectious disease screening is positive for a 42 year old male blood donor who donated 2 days ago. The testing is positive for Zika virus by individual donor nucleic acid testing. You call the donor to inform him that he is now deferred. Because the donor is male, it is important to inform him of which of the following?

  1. Zika virus can be sexually transmitted for 6 months in semen
  2. Zika virus can be transmitted through urine, so he should not use a public restroom for 10 days
  3. Zika virus is latent and he will never clear the infection
  4. Zika virus is not contagious outside of blood transfusion and mosquito bites
Board review answer #1
A. Zika virus is sexually transmitted and can cause fetal malformations in pregnancy. It is detectable in semen for 6 months.

Reference: Zika virus

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Board review question #2
You receive a letter from your blood provider, stating that a donor who last donated 8 weeks ago returned and the donor is now positive for Zika virus by individual donor nucleic acid testing. The donor was negative at the time of the transfusion. The blood donor is asymptomatic. A review of records reveals this unit was transfused to a 22 year old female postdelivery of a full term male infant. When you call the recipient to inform her of the exposure, she asks you what main risk of the disease is. You tell her

  1. She is at an increased risk of developing Guillain-Barré disease
  2. She may have a flu-like illness with fever, conjunctivitis, rash and headache
  3. There is no risk to her since the donor was negative for Zika at the time of donation
  4. This virus causes birth defects, so she should avoid pregnancy for at least 8 weeks
  5. This virus is transmissible through breast milk, so she should talk to her pediatrician
Board review answer #2
E. This virus is transmissible through breast milk, so she should talk to her pediatrician. The mother already delivered at the time of transfusion, so it should not have been transmitted to her infant perinatally. It is transmissible through breast milk, though in general, the benefits of breastfeeding are thought to outweigh the risk of Zika transmission in an otherwise healthy infant. She should discuss this with her pediatrician.

Reference: Zika virus

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