Original article
European strategies against the parasite transfusion riskRisque parasitaire, quelles stratégies en Europe ?

https://doi.org/10.1016/j.tracli.2004.12.001Get rights and content

Abstract

Protozoal infections are endemic in mainly tropical low income countries, affecting millions of people. Malaria, American trypanosomiasis (Trypanosoma cruzi/Chagas disease) and protozoal tickborne diseases (e.g. Babesia) can be efficiently transmitted by transfusion of cellular blood components. In non-endemic areas like Europe malaria, Chagas disease and Babesia are imported diseases resulting of travelling to endemic areas and migration of autochthons from these endemic areas. A recent International Forum showed that in Europe, as well as the USA, prevention of transfusion-associated protozoal infections depend mainly on selection of donors using questionnaires. Most countries divide donors at risk for malaria in two groups: individuals who have lived in the first 5 years of their life in malaria endemic areas and those who are borne and residing in non-endemic areas and visited the endemic area(s). The first category of donors is rejected for 3 years after their last visit to the endemic area, and in one country such donors are permanently rejected. In some countries such donors are accepted after 4 months–3 years, provided a test for malaria is non-reactive. Persons from non-endemic areas, who visited the malaria endemic area, are rejected for 4–12 months. Some countries reject these donors for 3 years or permanently when they resided for more than 6 months in the endemic area. The rejection rate of donors for malaria risk in the various countries was 0.003–0.43% of all donations. Over the last decade only a few cases of TT-malaria were reported in the various countries. In several countries donors are questioned for risk of T. cruzi infection. In some countries donors are excluded when they (or their mothers) were born in South or Central America, if they received a blood transfusion in these areas and if they lived in rural areas in these endemic countries for more than 4 weeks. In none of the countries donors are asked if they had Babesia or Leishmania. At present implemented measures to prevent TT-malaria in the European countries are probably highly effective. More research is needed to establish the theoretical risk of TT-T. cruzi and TT-Leishmania infection in Europe, before preventive measures may be considered.

Résumé

Les infections parasitaires sont endémiques dans la plupart des pays aux faibles revenus. Elles affectent des millions des gens. Le paludisme, la trypanosomiase américaine (Trypanosoma cruzi/maladie de Carlos Chagas) et les infections dues aux protozoaires dont les vecteurs sont des tiques peuvent être effectivement transmis lors de la transfusion de composants sanguins. Dans les régions non-endémiques comme l'Europe, le paludisme, la maladie de Chagas et la babesiose sont importés à la suite des voyages en zone endémique et des migrations des populations originaires de ces zones endémiques. Un récent Forum International a montré qu'en Europe, aussi bien qu'aux États-Unis, la prévention des infections parasitaires liées à la transfusion dépendent en grande partie de la sélection des donneurs à partir de questionnaires. La plupart des pays classe les donneurs risquant de développer un paludisme en deux groupes : les personnes ayant vécu dans une zone endémique de paludisme pendant cinq ans, et ceux qui sont nés et ont résidé dans les zones non-endémiques mais qui ont voyagé en zone endémique. La première catégorie des donneurs est refusée pendant les trois ans qui suivant leur dernier séjour en zone endémique, et un pays les refuse définitivement. Dans quelques pays, ces donneurs-là sont acceptés après une période de quatre mois pouvant aller jusqu'à trois ans, à condition que leur test soit négatif. Les personnes provenant de zones non endémiques, mais qui ont séjourné en zone endémique de paludisme sont refusées pendant 4 à 12 mois. Quelques pays refusent ces donneurs pendant trois ans, ou définitivement, s'ils ont résidé plus de six mois en zone d'endémie. Le taux de refus pour risque de paludisme dans les différents pays est de 0.003–0,43 % sur l'ensemble des donations. Au cours des dix dernières années, seuls quelques cas de paludisme ont été enregistrés dans les différents pays. Dans plusieurs pays, on questionne les donneurs sur les risques de contracter le T. cruzi (maladie de Carlos Chagas) Dans certains pays, les donneurs sont exclus lorsqu'ils sont eux (ou leur mère) nés en Amérique du Sud ou en Amérique Centrale, s'ils ont été transfusés dans ces régions ou encore s'ils ont vécu dans des zones rurales endémiques plus de 4 semaines. Aucun des pays ne questionne les donneurs au sujet de la Babésiose ou de la Leishmania. A l'heure actuelle, les mesures qui ont été prises afin d'éviter la transmission du paludisme dans les pays européens sont très efficaces. Des efforts au niveau de la recherche sont nécessaires pour déterminer le risque de transmission de T. cruzi (maladie de Carlos Chagas) et de la Leishmania en Europe, avant que des mesures préventives puissent être envisagées.

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