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Enhanced classification of Chagas serologic results and epidemiologic characteristics of seropositive donors at three large blood centers in Brazil

Authors

  • Ester C. Sabino,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Nanci A. Salles,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Moussa Sarr,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Angela M. Barreto,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Marcio Oikawa,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Cláudia D. Oliveira,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Silvana C. Leao,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Anna B. Carneiro-Proietti,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Brian Custer,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • Michael P. Busch,

    1. From the Pró-Sangue Foundation and the University of São Paulo, São Paulo, Brazil; Westat, Rockville, Maryland; the Federal University of São João Del Rei, São João Del Rei, Brazil; Hemope Foundation, Recife, Pernambuco, Brazil; Hemominas Foundation, Belo Horizonte, Minas Gerais, Brazil; and Blood Systems Research Institute, San Francisco, California.
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  • NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II), International Component


  • This work was supported by NHLBI Contract HHSN268200417175C.

Ester C. Sabino, MD, PhD, Departamento de Molecular Biology, Divisão de Sorologia, Fundação Pro-Sangue-Hemocentro de São Paulo, Av Dr Enéas de Carvalho Aguiar 155 1 andar, São Paulo, SP 05403-000, Brazil; e-mail: sabinoec@gmail.com.

Abstract

BACKGROUND: A major problem in Chagas disease donor screening is the high frequency of samples with inconclusive results. The objective of this study was to describe patterns of serologic results among donors to the three Brazilian REDS-II blood centers and correlate with epidemiologic characteristics.

STUDY DESIGN AND METHODS: The centers screened donor samples with one Trypanosoma cruzi lysate enzyme immunoassay (EIA). EIA-reactive samples were tested with a second lysate EIA, a recombinant-antigen based EIA, and an immunfluorescence assay. Based on the serologic results, samples were classified as confirmed positive (CP), probable positive (PP), possible other parasitic infection (POPI), and false positive (FP).

RESULTS: In 2007 to 2008, a total of 877 of 615,433 donations were discarded due to Chagas assay reactivity. The prevalences (95% confidence intervals [CIs]) among first-time donors for CP, PP, POPI, and FP patterns were 114 (99-129), 26 (19-34), 10 (5-14), and 96 (82-110) per 100,000 donations, respectively. CP and PP had similar patterns of prevalence when analyzed by age, sex, education, and location, suggesting that PP cases represent true T. cruzi infections; in contrast the demographics of donors with POPI were distinct and likely unrelated to Chagas disease. No CP cases were detected among 218,514 repeat donors followed for a total of 718,187 person-years.

CONCLUSION: We have proposed a classification algorithm that may have practical importance for donor counseling and epidemiologic analyses of T. cruzi–seroreactive donors. The absence of incident T. cruzi infections is reassuring with respect to risk of window phase infections within Brazil and travel-related infections in nonendemic countries such as the United States.

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