Clinical Edge

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Widespread Zika screens not cost effective

Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977

Key clinical point: Individually screening all blood donations for Zika virus was low yield and costly.

Major finding: Testing confirmed only 8 authentic cases and cost nearly $42 million over 15 months.

Study details: Screening and confirmatory testing of 4,325,889 donations of blood in the United States during 2016-2017.

Disclosures: American Red Cross and Grifols Diagnostic Solutions provided funding. Grifols makes a test used in the study. Dr. Saá disclosed research support from Grifols but had no other conflicts of interest.

Source: Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977


Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977


Despite these findings, it would be premature to stop testing U.S. blood donations for Zika virus, wrote Evan M. Bloch, MBChB; Paul M. Ness, MD; Aaron A.R. Tobian, MD, PhD; and Jeremy Sugarman, MD, MPH, in an editorial accompanying the study.

Nonetheless, “actual and perceived risks to the blood supply seem to be conflated,” the experts wrote. They noted that the United States currently has no active areas of Zika virus transmission and that confirmed mosquito-borne, locally acquired infections fell from 226 in 2016 to two the following year.

There is no historical precedent for ending a policy of testing blood donations for pathogens, they added. Consequently, ending widespread screening “may actually prove to be far more challenging than the decision to start.” For now, a precautionary, risk-based approach should entail “continuous review” of screening policies and “reassessment as new data emerge.”

The editorialists are with Johns Hopkins University and Johns Hopkins University’s Bergman Institute of Bioethics, both in Baltimore. They reported having no relevant conflicts of interest. These comments are from their editorial (New Engl J Med. 2018;378:19:1837-41).

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