Chien Yu-Wen, Shu Yu-Chen, Chuang Kun-Ta, Yeh Chun-Yin, Ko Wen-Chien, Ko Nai-Ying, Perng Guey-Chuen
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan.
Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Transfusion. 2017 Nov;57(11):2649-2656. doi: 10.1111/trf.14281. Epub 2017 Aug 24.
Southern Taiwan experienced a severe dengue epidemic in 2015. Adult asymptomatic cases would raise concerns on transfusion-transmitted dengue virus (DENV) infection. The aim of this study was to evaluate the magnitude of such a risk in Tainan City during this epidemic.
The daily prevalence of asymptomatic dengue viremia in blood donors in Tainan City and in selected high-incidence districts during the 2015 dengue epidemic was estimated by an established mathematical model. Duration of viremia, duration of viremia before symptom onset, apparent-to-inapparent infection ratio, and reporting-to-underreporting ratio were four main parameters used in the model.
The estimated maximal and mean daily prevalence of asymptomatic dengue viremia in blood donors in Tainan during this dengue epidemic was 74.4 (95% confidence interval [CI], 60.8-88.0) and 15.0 (95% CI, 12.3-17.7) per 10,000, respectively. In the district with the highest incidence, the maximal and mean daily prevalence of asymptomatic viremia was 328.8 (95% CI, 271.1-386.2) and 55.3 (95% CI, 43.4-63.3) per 10,000, respectively. Approximately 234 (95% CI, 191-276) blood components containing DENV were produced during the epidemic.
Although dengue is currently not endemic in Taiwan, physicians need to be aware of the risk of transfusion-transmitted DENV infection. Our results suggest that screening measures to ensure blood safety should be evaluated and implemented during dengue epidemics even in nonendemic areas. Timely estimation of daily asymptomatic viremia prevalence by districts can help to select high-risk areas for such measures and to evaluate cost-effectiveness.
2015年台湾南部地区经历了一场严重的登革热疫情。成人无症状病例引发了对输血传播登革病毒（DENV）感染的担忧。本研究旨在评估此次疫情期间台南市此类风险的程度。
通过一个既定的数学模型估算了2015年登革热疫情期间台南市及选定高发病区献血者中无症状登革病毒血症的每日流行率。病毒血症持续时间、症状出现前病毒血症持续时间、显性感染与隐性感染比率以及报告率与漏报率是该模型中使用的四个主要参数。
此次登革热疫情期间，台南市献血者中无症状登革病毒血症的估计最高每日流行率和平均每日流行率分别为每10000人74.4例（95%置信区间[CI]，60.8 - 88.0）和15.0例（95% CI，12.3 - 17.7）。在发病率最高的地区，无症状病毒血症的最高每日流行率和平均每日流行率分别为每10000人328.8例（95% CI，271.1 - 386.2）和55.3例（95% CI，43.4 - 63.3）。疫情期间大约产生了234份（95% CI，191 - 276）含有DENV的血液成分。
尽管目前登革热在台湾并非地方病，但医生需要意识到输血传播DENV感染的风险。我们的结果表明，即使在非流行地区，在登革热疫情期间也应评估并实施确保血液安全的筛查措施。按地区及时估算每日无症状病毒血症流行率有助于为此类措施选择高风险地区并评估成本效益。
