Lovick S, Bycholski K, Gröner A
Synergies Economic Consulting, Melbourne, Vic., Australia.
Vox Sang. 2014 Nov;107(4):315-23. doi: 10.1111/vox.12167. Epub 2014 Jun 16.
For a given plasma-derived product, the risk of final product contamination by hepatitis B virus, hepatitis C virus and human immunodeficiency virus depends upon the epidemiology in the donor population, the virus load in a donation, the product yield and the effective virus reduction capacity in manufacturing.
A Monte Carlo simulation model was developed to estimate the risk of virus contamination of a final product resulting from virus contamination of plasma pools for fractionation. The model was run for both source and recovered plasma at various incidence rates for the three viruses to determine virus loads in minipools and fractionation pools resulting from donations with virus levels below test sensitivities. Together with the virus reduction capacity and yield of a theoretical worst case plasma-derived product, the contamination risk in a final vial was calculated.
Acceptable upper-bound centre-level incidence rates in the donor population (per donor centre) result in final products with very high margins of virus safety; the largest determinant of these 'Process Limits' is the virus reduction capacity of the manufacturing process. Short donation intervals and long inventory hold periods for source plasma compensates the lower incidence rates typically observed in recovered plasma donors.
The model calculates process limits for epidemiological data at collection centres based on an appropriate margin of virus safety for final products. The model also takes into consideration the impact of different donor/donation management systems for source and recovered plasma on the number of low viraemic donations entering the plasma pool for fractionation.
对于某一特定的血浆衍生产品,最终产品被乙型肝炎病毒、丙型肝炎病毒和人类免疫缺陷病毒污染的风险取决于献血人群中的流行病学情况、单次献血中的病毒载量、产品产量以及生产过程中的有效病毒去除能力。
开发了一个蒙特卡洛模拟模型,以估计因用于分馏的血浆池被病毒污染而导致最终产品被病毒污染的风险。该模型针对三种病毒的不同发病率,对原料血浆和回收血浆进行了运行,以确定病毒水平低于检测灵敏度的献血所导致的微量血浆池和分馏血浆池中的病毒载量。结合理论上最坏情况的血浆衍生产品的病毒去除能力和产量,计算了最终小瓶中的污染风险。
献血人群(每个献血中心)可接受的上限中心水平发病率会使最终产品具有很高的病毒安全边际;这些“工艺限值”的最大决定因素是生产工艺的病毒去除能力。原料血浆较短的献血间隔和较长的库存保存期弥补了回收血浆献血者中通常观察到的较低发病率。
该模型根据最终产品适当的病毒安全边际计算采集中心流行病学数据的工艺限值。该模型还考虑了原料血浆和回收血浆不同的献血者/献血管理系统对进入分馏血浆池的低病毒血症献血数量的影响。