Reducing the Risk of Transfusion Transmission of Zika

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Table of Contents

Introduction
Main part
Conclusion
References

Introduction

Nowadays, it became a commonplace trend among healthcare practitioners and biologists to refer to the explosive spread of Zika virus (ZIKV) that has taken place throughout the last decade; as such that represents an acute epidemiological threat to humanity. The reason for this apparent – as time goes on, there is being gathered more and more circumstantial evidence as to this virus’s capacity to trigger the development of physical deformities in human fetuses (microcephaly).

Moreover, ever since 2013, ZIKV has been increasingly reported in conjunction with people being diagnosed with Guillain-Barré syndrome – something that presupposes Zika’s ability to have a neurotropic effect on the functioning of one’s brain. What adds to the issue’s severity even more is that, as of today, there are no vaccines or antivirals specifically designed to inhibit Zika’s self-replication within the cells of a human body.

Partially, this can be explained by the fact that even today, many subtleties of the virus’ pathogenesis remain undiscovered – not the least because of Zika’s phylogenetic similarity with other flaviviruses, which makes its positive identification rather challenging (Paixao, Barreto, Teixeira, Costa, & Rodrigues, 2016). To complicate things even further, there is the apparent lack of Zika-related academic publications, which certainly does make sense, given the epidemic’s sheer recentness.

The latter observation, however, presupposes that at this stage of the ongoing research on Zika, it is thoroughly possible to derive a number of qualitative insights into the concerned subject matter by reviewing the available literature of relevance. This research paper aims to accomplish just that. In particular, the emphasis will be placed on outlining the possible strategies for reducing the risk of Zika being transmitted via blood transfusion, as elaborated upon by different authors. Readers will also be able to learn the main historical/epidemiological facts about the virus, as well as to find out what are the main obstacles on the way of health authorities from different countries trying to work out an effective approach for tackling the scope of potential dangers, posed by Zika.

Main part

Historical excurse

Zika is a virus, named after the Zika forest in Uganda, where it was documented for the first time in 1947. It has much in common with other flaviviruses, such as Dengue and Yellow Fever. People infected with Zika experience some general weakness and occasionally – a skin rash. The virus is spread by a certain kind of tropical mosquitoes, known as Aedes. Ever since it was discovered, Zika has been circulating around some parts of Africa and Asia, but it did not appear to be doing much damage to the exposed populations. Up to 80% of all infected individuals showed no symptoms, whatsoever (Gould & Solomon, 2008).

In the year 2007, the virus began to move eastwards – the development that caused the outbreak of Zika epidemic on the island of Yap in the Philippine Sea. However, not even a single instance of hospitalization was reported. In November of 2015, health officials in Brazil began to raise the alarm about a worrying trend – the dramatic increase in the number of children born with the condition of microcephaly (extremely small heads) in the country’s areas with the largest percentage of the registered Zika-cases.

Whereas, prior to the year 2015, there used to be no more than 400 microcephaly-birth cases reported in this country on an annual basis, by now the number of such cases has reached a staggering 5079 (Barton & Salvadori, 2016). Initially, there were only a few reasons for healthcare specialists in Brazil to suspect Zika of having been the actual culprit, in this respect. However, it did not take too long for Zika’s RNA to be found in the blood of women pregnant with defective babies.

As of today, it still remains unclear whether the Zika virus had anything to do with the dramatic upsurge of microcephaly in Brazil. However, as time goes on, more and more physicians throughout the world come to conclude that the virus and the incapacitating condition of microcephaly in children are indeed interrelated. On April 13, 2016, The Center for Disease Control and Prevention (CDC) officially declared Zika to be responsible for causing birth-defects (Baden, Petersen, Jamieson, Powers, & Honein, 2016).

As of now, there is still no vaccine in existence for this specific virus. Therefore, most recommendations as to how avoid being infected are concerned with encouraging people to exercise vigilance. Pregnant women are advised to refrain from visiting Zika-active countries in South America and Asia. Those already living there are instructed to avoid mosquito bites.

As of today, researchers are working to clear up many things about Zika that continue to remain a mystery. In this regard, the most crucial challenge is to find out whether this specific virus is capable of affecting the prenatal development of a fetus. Simultaneously, scientists continue to apply much effort into working out an effective strategy for keeping the virus well contained and preventing it from being able to gain any more ground. So far, there have been no significant breakthroughs, in this respect. One of the reason for this is that, as it moves across the planet, Zika continues to mutate – something that causes physicians a great deal of worry.

After all, it is not only that the virus appears fully capable of adapting to the unfamiliar climatic conditions, but it also exhibits a tendency to affect the workings of the infected people’s psyche. Therefore, the importance of studying Zika and its spatial characteristics cannot be overestimated.

Risk-reducing strategies

As it was mentioned earlier, Zika is a vector-borne virus, which implies that most people become infected due to being bitten by Aedes mosquitoes. Nevertheless, such a transmittance-route presupposes that there is also a certain possibility for this virus to find its way into a person’s body by the mean of a sexual intercourse and blood transfusion. The scenario’s plausibility can be illustrated, regarding the fact that the first incidence of Zika’s sexual transmission (in French Polynesia) was confirmed as far back, as in 2007, and also the fact throughout the year 2015, there were at least four confirmed episodes of Zika’s transfusion transmission having taken place in Brazil (Barjas-Castro et al., 2016).

Therefore, it does not come as a particular surprise that, as of today, many scientists/healthcare workers are concerned with trying to conceptualize the strategies for reducing the risk of transfusion transmission of Zika. Even though such their quest is still through its early phases, it is already possible to outline the would-be deployed approaches to addressing the task in question.

Probably the most logical/easily implementable of them is educating people about the potential danger of traveling to the areas where Zika has been known to proliferate (Ahmad, Amin, & Ustianowski, 2016). Although this particular suggestion does not seem to be directly related to the objective of reducing the likelihood for the virus to be transmitted to patients by physicians (during the blood transfusion procedure), this is far from being the actual case. The statement’s validity can be illustrated, with respect to the recorded (in 2015) instance of five tourists from Netherlands having been infected with the virus in Suriname, which they ended up carrying along back to Europe.

One of these tourists has been known as an active blood donor for most of his life (Goorhuis et al., 2016). Given the fact that the virus’s incubation period in the Netherlands proved to be as long as 28 days (in the tropical regions, this period rarely lasts for longer than 14 days), there is a good probability that, after having returned from the trip, the concerned individual did ‘succeed’ in passing the virus to more than one person.

The soundness of the educational approach to reducing the transfusion-related risk of Zika’s transmission will become particularly apparent in light of the earlier mentioned fact that due to the pandemic’s recentness, there still remains much uncertainty as to its etiology. Moreover, many people continue to disregard the prospect of being infected with Zika, because of their belief that the dangers posed by this particular virus are deliberately exaggerated by those who act on behalf of the pharmaceutical industry in the West (Martins, Dye, & Bavari, 2016).

Another strategy that is being commonly proposed for deployment, within the context of how physicians strive to diminish the discussed risk, has to do with the idea that donors should be screened for the presence of ZIKV RNA in their blood – especially if they reside in the areas with tropical/subtropical climate. What will come in particularly handy, in this respect, is that on March 30, 2016, Roche Molecular Systems introduced the first Zika NAT (nucleic acid test) assay for identifying the virus’s presence in donor blood (Lanteri et al., 2016).

It is understood, of course, that it will not be overnight that this assay becomes available in the Third World countries, affected by the pandemic the most. However, there can be only a few doubts that the development in question will contribute rather substantially towards ‘empowering’ humanity in its confrontation with Zika. Meanwhile, the World Health Organization (WHO) encourages donors to report whether they have had any Zika-like symptoms within the period of 14 days, prior to donating blood.

The main challenge, in this regard, is that there is very little specificity to the symptoms of one being infected with Zika – something that will inevitably undermine the effectiveness of self-reporting, on the part of donors (Basarab, Bowman, Aarons, & Cropley, 2016).

The latter consideration prompted the WHO to insist that the collection of donor blood should only be allowed to take place in the areas that have never been affected by the pandemic of Zika. Moreover, the organization’s representatives also call to enact the bylaw that would disqualify from being able to donate blood even those individuals who have stayed in the Zika-‘rich’ parts of the world for as little, as one day (Sikka et al., 2016).

The enactment of such a bylaw should come hand in hand with the application of a continual effort into helping people to increase their awareness of what may account for the possible consequences of one’s infestation with Zika, and what represent the most effective risk-avoidance strategies, in this respect. Because Zika has been confirmed sexually transmittable, the WHO suggests that no blood should be taken from those donors who are known to pursue a sexual relationship with active travelers to the Zika-infested areas for the duration of at least 28 days, after the last time that both parties have had sex (Kindhauser, Allen, Frank, Santhana, & Dye, 2016).

While scientists continue to study the virus so that it could be spatially contained, physicians are advised to resort to keeping blood components in quarantine, as yet another method of reducing the risk for patients to end up infected with Zika ‘by a needle’. The method’s practical implementation is concerned with freezing the would-be transfused blood materials and keeping them quarantined for a duration of at least 14-20 days – the timespan required for the symptoms of Zika to manifest in donors (Doshi, 2016).

Despite this method’s apparent simplicity, it has proven effective in the past. For example, it is now commonly assumed that one of the reasons why health authorities were able to put an end to the rapid spread of the West Nile virus during the nineties, is that they were quick enough to decide to quarantine donor blood in the affected areas. Given the pathogenic similarity between this particular virus and Zika, there can be very little doubt that the quarantining of blood components is indeed fully appropriate, as the instrument of preventing the latter from being transfusion-transmitted.

Unfortunately, there could be more obstacles on the way of implementing the earlier mentioned risk-reduction strategy than one may expect. The reason for this is that there is a high demand for donor blood all over the world. In most Western countries, the task of addressing this demand is largely delegated to the so-called ‘blood banks’ – the institutions that are being unofficially curated by the International Committee of the Red Cross (ICRC), which in turn has close ties with the Catholic Church.

This Church’s officials, however, have always been known for their strongly arrogant attitudes towards the prospect of relying on science, within the context of how a particular virus-triggered epidemic is being dealt with – the activities of Mother Theresa, who used to insist that there is no need to sterilize blood-transfusing needles, illustrate the validity of this statement (Hitchens, 2004). Because of this particular consideration, it will only be logical to assume that the initiative to quarantine blood components, as the mean of lowering the risk of Zika’s transmittance, will not prove very popular with health authorities – especially given the sheer power of the Catholic Church in the affected areas.

As it appears from the academic publications of relevance, there are also a few truly innovative techniques being developed to contain the spread of Zika by ensuring that this virus will not compromise the safety of blood transfusions. Probably the most notable of them is concerned with the idea of exposing frozen plasma and platelet concentrates to UVA (ultraviolet) light, in order to disable the virus’s function of self-replication. According to the empirically obtained findings of the 2016 study by Aubry, Richard, Green, Broult, and Musso, this idea is indeed thoroughly viable.

The reason for this is that while conducting their study, the authors were able to confirm that in the aftermath of having been treated with UVA, the infected (with Zika) substances had ceased indicating the presence of the targeted viral RNA. Given the fact that throughout the last few years the spread of Zika has gained nothing short of an exponential momentum, there can be only a few doubts as to the sheer importance of this study’s findings.

After all, once the proposed technique is being perfected, it will be possible to substantially reduce the risk of contracting the virus due to blood transfusion and even to eliminate it altogether. What is especially valuable about the solution in question, is that it is rather inexpensive, which makes it thoroughly suitable to be deployed in the Third World countries. At the same time, however, it is much too early to assume that the treatment of donor blood with ultraviolet light will prove 100% effective, as the virus-deactivating measure.

Conclusion

The main discursive insights of this research paper can be formulated as follows:

There is a good reason to believe that the pandemic spread of the Zika virus does have a strong effect on the epidemiological situation in the world. In its turn, this implies that a number of pro-active steps should be taken to minimize the affiliated threats.
The likelihood of Zika’s transmittance via blood transfusion can be reduced by taking advantage of quite a few time-tested strategies that have been designed to lessen the severity of viral hazards, faced by humanity. Among the best known of them, can be named: selective screening of blood donors, educating people about the dangers of Zika, delegitimizing the collection of donor blood from those who reside in the affected regions, quarantining blood materials, and deactivating Zika’s self-replicating code.
There are both: advantages and disadvantages to each of the outlined strategies for reducing the risk of Zika’s transmittance. In its turn, this implies that the practical deployment of these strategies should be circumstantially appropriate.
Along with the purely technical aspects to the question of what should be done to ensure that blood transfusions remain ‘Zika-free’, there are some societal ones, as well.

It would be intellectually dishonest to claim that this research paper contains many of the previously unexplored acumens into the discussed subject matter. However, there is a good rationale to believe that will prove useful to those interested in finding out more about Zika, in general, and about what can be done to make sure that blood transfusions do not result in the virus’s transmittance, in particular. Because of the paper’s size-wise format, its findings cannot be deemed exhaustive. Therefore, it can be recommended that while conducting research on the same/similar topic in the future, researchers should focus on identifying the link between the spatial features of Zika’s pandemic, on one hand, and the discursive essence of social dynamics in the affected areas, on the other.

References

Ahmad, S., Amin, T., & Ustianowski, A. (2016). Zika virus: Management of infection and risk. BMJ : British Medical Journal, 352, 1-5.

Aubry, M., Richard, V., Green, J., Broult, J., & Musso, D. (2016). Inactivation of Zika virus in plasma with amotosalen and ultraviolet A illumination. Transfusion, 56(1), 33-40.

Baden, L., Petersen, L., Jamieson, D., Powers, A., & Honein, M. (2016). Zika virus. The New England Journal of Medicine, 374(16), 1552-1563.

Barjas-Castro, M., Angerami, R., Cunha, M., Suzuki, A., Nogueira, J., Rocco, I., &… Addas-Carvalho, M. (2016). Probable transfusion-transmitted Zika virus in Brazil. Transfusion, 56(7), 1684-1688.

Barton, M. & Salvadori, M. (2016). Zika virus and microcephaly. Canadian Medical Association Journal, 188(7), E118-E119.

Basarab, M., Bowman, C., Aarons, E., & Cropley, I. (2016). Zika virus. BMJ : British Medical Journal, 352, 1-7.

Doshi, P. (2016). Convicting zika. BMJ: British Medical Journal, 353, 1-3. Goorhuis, A., von Eije, K., Douma, R., Rijnberg, N., van Vugt, M., Stijnis, C., &

Grobusch, M. (2016). Zika virus and the risk of imported infection in returned travelers: Implications for clinical care. Travel Medicine and Infectious Disease, 14(1), 13-15.

Gould, E., & Solomon, T. (2008). Pathogenic flaviviruses. The Lancet, 371(9611), 500-509.

Hitchens, C. (2004). Less than Miraculous. Free Inquiry, 24(2), 14-18.

Kindhauser, M., Allen, T., Frank, V., Santhana, R., & Dye, C. (2016). Zika: The origin and spread of a mosquito-borne virus. World Health Organization: Bulletin of the World Health Organization, 94(9), 675-686.

Lanteri, M., Kleinman, S., Glynn, S., Musso, D., Hoots, W., Custer, B., &… Busch, M. (2016). Zika virus: A new threat to the safety of the blood supply with worldwide impact and implications. Transfusion, 56(7), 1907-1914.

Martins, K., Dye, J., & Bavari, S. (2016). Considerations for the development of Zika virus vaccines. Vaccine, 34(33), 3711-3712.

Paixao, E., Barreto, F., Teixeira, M., Costa, M., & Rodrigues, L. (2016). History, epidemiology, and clinical manifestations of Zika: A systematic review. American Journal of Public Health, 106(4), 606-612.

Sikka, V., Chattu, V., Popli, R., Galwankar, S., Kelkar, D., Sawicki, S.,… Papadimos, T. (2016). The emergence of Zika virus as a global health security threat: A review and a consensus statement of the INDUSEM joint working group (JWG). Journal of Global Infectious Diseases, 8(1), 3-15.

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