Lefrère Jean-Jacques, Hewitt Patricia
National Institute of Blood Transfusion, Paris, France.
Transfusion. 2009 Apr;49(4):797-812. doi: 10.1111/j.1537-2995.2008.02044.x. Epub 2009 Jan 2.
Transfusion transmission of the prion, the agent of variant Creutzfeldt-Jakob disease (vCJD), is now established. Subjects infected through food may transmit the disease through blood donations. The two nations most affected to date by this threat are the United Kingdom (UK) and France. The first transfusion cases have been observed in the UK over the past 5 years. In France, a few individuals who developed vCJD had a history of blood donation, leading to a risk of transmission to recipients, some of whom could be incubating the disease. In the absence of a large-scale screening test, it is impossible to establish the prevalence of infection in the blood donor population and transfused patients. This lack of a test also prevents specific screening of blood donations. Thus, prevention of transfusion transmission essentially relies at present on deferral of "at-risk" individuals. Because prions are present in both white blood cells and plasma, leukoreduction is probably insufficient to totally eliminate the transfusion risk. In the absence of a screening test for blood donations, recently developed prion-specific filters could be a solution. Furthermore, while the dietary spread of vCJD seems efficiently controlled, uncertainty remains as to the extent of the spread of prions through blood transfusion and other secondary routes.
现已证实，变异型克雅氏病（vCJD）的病原体朊病毒可通过输血传播。通过食物感染的个体可能会通过献血传播该疾病。迄今为止，受这一威胁影响最大的两个国家是英国和法国。过去5年里，英国已发现首例输血感染病例。在法国，一些患上vCJD的人有过献血史，这就导致了将疾病传播给受血者的风险，其中一些受血者可能正处于疾病潜伏期。由于缺乏大规模筛查检测，无法确定献血人群和输血患者中的感染率。这种检测手段的缺失也使得无法对献血进行针对性筛查。因此，目前预防输血传播主要依靠推迟“高危”个体献血。由于朊病毒存在于白细胞和血浆中，白细胞滤除可能不足以完全消除输血风险。在缺乏献血筛查检测的情况下，最近研发的朊病毒特异性过滤器可能是一种解决办法。此外，虽然vCJD通过饮食传播似乎已得到有效控制，但朊病毒通过输血及其他次要途径传播的范围仍存在不确定性。
