ABSTRACT
Background/Case Studies: Blood donor based serosurveillance is a convenient and cost-effective strategy to monitor the extent of the COVID-19 pandemic and allows the detection of asymptomatic and recovered cases. The RESPONSE (REDS-IV-P Epidemiology, Surveillance and Preparedness of the Novel SARS-CoV-2 Epidemic) study conducted monthly cross-sectional serosurveys of 1000 routinely obtained donor samples in 6 metropolitan regions (see table). Study Design/Methods: Samples were captured monthly from March or April through June 2020. Siteswere selected based on reports of epidemic activity or as low prevalence control regions. Donations from COVID- 19 convalescent plasma donors were excluded. Coded samples, with routinely collected demographic data and zip code of residence, were tested for SARS-CoV-2 antibodies using the Ortho VITROS anti-SARS-CoV-2 S1 Total Ig (data reported below) with planned confirmation of reactivity on Roche Elecsys® NC Anti-SARS-CoV-2 and a pseudovirus-based neutralization assay. Results/Findings: Table 1 shows donor seroreactivity with 95% CI. For all sites, seroreactivity was <1.0% (range 0.1%-0.9%) at the beginning of the surveillance period. Donor seroreactivity in New York City (NYC) was about 10-fold higher in April through June as compared to March and was much higher than in other locations. There were modest increases in seroreactivity over the study timeframe for all other sites. Conclusions: Modest increases in seroreactivity from baseline were found in all sites, with the largest increase in NYC. SARS-CoV-2 antibody testing of routinely obtained blood donor samples allows for detection of asymptomatic and recovered COVID-19 cases and enables future estimation of infection incidence by geographic and other demographic parameters. This approach will be used in a significantly expanded CDC National serosurveillance study involving all 50 states over 18 months.
ABSTRACT
Background/Case Studies: Routine testing of donations for COVID-19 antibody was implemented as a tool to evaluate donor suitability for convalescent plasma (CCP) donation, monitor geographic and demographic trends, and associate COVID-related symptoms (Sx) to serological test results. We report initial results of antibodyreactive donors and associated responses regarding their Sx >14d prior to donation. Study Design/Methods: Starting June 15, 2020, allogeneic donors were tested using the Ortho Anti-SARSCoV2 Total Ig Test. Reactive donors were invited to an online survey ≈2 weeks post-donation;eligibility criteria were ≥ age 18, English proficiency and an email on file. The survey inquired about COVID-related Sx and COVID testing performed outside the blood center. Sx duration and severity were not ascertained. Donor responses were linked via DIN to operational data. Results/Findings: During the first 6 weeks, cumulative seroprevalence was 1.5% (8588 reactive/573,586 donations tested). Reactive rates were higher in first-time vs repeat donors (2.4 vs 1.3%, X2 p<0.0001), and in Hispanic and African American donors vs Caucasians (3.5% vs 1.4%, p<0.0001). Antibody (Ab) prevalence did not differ by sex, and the age group with the highest rate was 18-24yo (3.1%). Modest differences were observed by geography, ranging from 1.3% Ab prevalence in the West to 1.9% in the Northeast. The range of reported Sx from 1546 survey respondents was 0 to 12, with 44% of donors indicating they were asymptomatic pre-donation. The average number of Sx was 2.9 for all donors, and 5.2 from those with any reported symptom. Ortho-reactive donors who previously tested reactive reported more Sx on average than previously nonreactive donors (4.0 vs 2.5 Sx), as did those diagnosed with COVID-19 by a healthcare provider (5.0 vs 2.3). Fatigue (41%), myalgia (35%), headache (33%), cough (29%), loss of smell (29%) and taste (28%), and fever (22%) were most commonly reported. The number of Sx reported did not differ by presence or count of 5 chronic health conditions associated with increased COVID morbidity. An algorithm to select candidate CCP donors based on the 3 most common symptoms identified 357 donors (23%), while also requiring a diagnostic test or physician diagnosis yielded 177 donors (11.4%). S/CO ratios correlated with symptom number, with asymptomatic infections or those with 1-4 symptoms having lower S/COs (median S/CO < 85) than those with 5-8 Sx(median S/CO 108) or 9-12 Sx (median S/CO 170);Kruskal-Wallis p<0.0001. Conclusions: The demographics and geographic associations with COVID-19 Ab prevalence were generally consistent with widely reported findings. Prior symptoms of donors may be useful in identifying suitability for convalescent plasma collection.
ABSTRACT
Background/Case Studies: SARS-CoV-2 RNA has been detected by PCR in plasma, serum or whole blood specimens from hospitalized patients in studies from multiple countries. For asymptomatic individuals, several reports have described detection of SARS-CoV-2 RNA in plasma in a small number of blood donors, whereas other reports showed no detection of SARS-CoV-2 RNA in whole blood, serum or plasma from asymptomatic individuals including blood donors. No cases of transfusion-transmission of SARS-CoV-2 (or other human coronaviruses) have been reported, nor has virus been isolated from blood samples by tissue culture. We tested residual volumes of donor plasma from mini-pools (MPs) used for routine nucleic acid testing (NAT) screening to determine the frequency of SARS-CoV-2 RNAemia in blood donors in six US metropolitan regions (New York, Seattle, San Francisco, Los Angeles, Boston, Minneapolis). Study Design/Methods: Blood donations collected from 7 March 2020 to 30 June 2020 were tested for SARS-CoV-2 RNA. Donations were tested in plasma MPs of 6 or 16 donations (MP16 format for five regions and MP6 format for Seattle), targeting 500 MPs per region per month, using the Grifols Procleix SARS-CoV-2 transcriptionmediated amplification (TMA) assay on the Procleix Panther system. The test has a 95% limit of detection (LOD) of 16.5 copies/mL (95% CI, 12.8 to 23.6 copies/mL) by probit analysis. A confirmed positive result was defined by the detection of viral RNA upon repeat testing using the same assay and an alternate target region TMA assay (Grifols SARS-CoV-2 confirmatory TMA assay) with comparable sensitivity. Positive MPs were further tested using the Ortho VITROS anti-SARS-CoV-2 Total Ig test to detect antibodies and diluted 4-fold and tested using the Procleix SARS-CoV-2 TMA assay to determine whether the viral load was close to the 95% LOD. Results/Findings: A total of 8,496 MPs16 and 1,998 MPs 6, corresponding to ∼147,000 blood donations, were tested for SARS-CoV-2 RNA. One confirmed positive MP16 sample from a March donation in San Francisco was identified (0.0007% [95% CI 0.000035-0.004%]). The MP was negative for antibody and nonreactive when diluted 4-fold, suggesting a viral load below 1,000 RNA copies/mL in the individual donation. Conclusions: Blood donation MP-NAT indicated that SARS-CoV-2 RNAemia is rare, and when detected the RNA was at low concentration. Although future studies to determine the infectivity of RNA-positive plasma are warranted and in progress, these findings are reassuring with respect to transfusion safety and support current recommendations from WHO and regulatory agencies to not screen donors by NAT.