HPR volume 17 issue 12: news (16 October 2023)
Updated 28 December 2023
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Annual report from NHS Blood and Transplant and UKHSA Epidemiology Unit
The latest annual report of the joint NHS Blood and Transplant (NHSBT) and UK Health Security Agency (UKHSA) Epidemiology Unit, ‘Safe supplies 2022: monitoring safety in donors and recipients’, has been published on the NHSBT website.
The joint NHSBT and UKHSA Epidemiology Unit, established in 1995, monitors infections in blood, tissue and organ donors, and in transfusion recipients, collates epidemiological data on bloodborne infections among donors and assesses associated risk of transmission through transfusion and transplant. The unit comprises a small team of epidemiologists and public health specialists working with scientific and clinical colleagues across both NHSBT and UKHSA.
The 2022 annual review shows the number of infections in all donor groups has remained low, supporting good compliance with donor selection. In 2022, the number of blood donations continued to increase on 2020 and 2021’s numbers; 1.8 million donations were made by 950,000 donors across the UK with small numbers of donations reactive and removed from the supply.
Some 271 donations (1 in 6,500) were confirmed positive for hepatitis B virus (HBV), hepatitis C virus, HIV, Human T lymphotropic virus or syphilis and discarded, similar to 2021. There were 130 viral infections and 142 syphilis infections including 1 dual HBV and syphilis infection. The majority of cases removed were new donors, mostly with longstanding infection, which increased from January 2021 – these donors were permanently withdrawn from donation. In addition to this, there were 368 donations (1 in 4,700) discarded following confirmed positivity for hepatitis E RNA, also similar to 2021.
The FAIR donor selection policy, which has allowed gay, bisexual and other men who have sex with men (GBMSM) to give blood in the UK since June 2021, has not impacted on the safety of the UK blood supply: the chance of not detecting a recently acquired hepatitis B, hepatitis C or HIV infection on routine screening remained below 1 in 1 million donations.
Confirmed positive donors displayed good compliance with the FAIR policy criteria, helping to maintain safety. Of the confirmed positive donors, 80% were compliant with donor selection criteria, similar to 2021 levels of compliance.
Routine blood donation screening for antibodies to hepatitis B core was rolled out across the UK in 2022 following ministers’ acceptance of a recommendation from the Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO). This has already had an impact on increased detection of potentially transmissible hepatitis B virus from donors with occult hepatitis B.
NHSBT operates a clear process for risk assessment and action to identify potential risks to UK blood and tissue supply, including horizon scanning of outbreaks, emerging and re-emerging infections. In May 2022, horizon scanning to allow a risk assessment of potential emerging threats to blood safety picked up the mpox (monkeypox) outbreak. Working closely with UKHSA colleagues, the joint unit carried out a blood safety risk assessment, concluding that the risk to recipients was minimised through pre-donation information to donors and existing mitigation steps, including the FAIR donor selection policy.
Transfusion-transmitted infections (TTIs) remain extremely rare in the UK due to risk reduction strategies including donor selection and rigorous testing of blood donations. All suspected TTIs investigated by the UK blood services are reported to the NHSBT and UKHSA Epidemiology Unit for monitoring and form part of the Serious Hazards of Transfusion (SHOT) haemovigilance scheme. The 2022 annual SHOT report was published in July 2023 and is available via the SHOT website.
During 2022, the UK Blood Services investigated 115 suspected bacterial incidents, 1 suspected parasitic incident and 8 suspected viral incidents. One viral incident was concluded a confirmed hepatitis B virus TTI involving 2 recipients: in collaboration with SHOT, this was identified as the first confirmed transmission of hepatitis B from a donor with occult hepatitis B infection (OBI) in the UK. The transfusions occurred in 2021, prior to the introduction of hepatitis B core antibody testing.
Between 2018 and 2022, TTI investigations concluded 4 confirmed (1 HBV, 1 HBV lookback and 2 hepatitis E virus (HEV) lookback) and 4 probable (3 HBV and 1 HEV) transmissions. All HBV TTIs originated from donors with OBI. There are very low rates of bacterial contamination confirmed in platelets, with a small number of clinically relevant bacteria identified. The most recent confirmed bacterial TTI was in 2015.
Evidence of Creutzfeldt-Jakob disease (CJD) transfusion-transmission has been gathered through Transfusion Medicine Epidemiological Review (TMER) in collaboration with the National CJD Research and Surveillance Unit since 1997. Cases have been low in number and rarely linked to the blood supply. In 2018, the risk was downgraded such that plasma collection for manufacturing in the UK could safely be restarted. In 2022, both the USA and Australia removed the deferral for people who had spent time in the UK during the years of the vCJD outbreak, 1980 to 1996.
We continue to recruit to and manage the Human T-cell Lymphotropic virus (HTLV) National Register, in collaboration with Imperial College London. Health information reported by participants (mostly asymptomatic blood donors) in the eighth follow-up at the end of 2022 showed onset of severe disease to be rare.
Organ donation from deceased donors increased in 2022 compared to annual data from 2020 and 2021. However, the number of consented donors has not returned to pre-pandemic levels. Consented donors are tested for pathogen reactivity and no donor-derived transmissions were documented in 2022. NHSBT also manages programmes for living and deceased tissue donors, and cord blood donors to a similar protocol as blood donors, generally only small numbers of markers of infections are identified, usually due to chronic, previously unidentified infections.
The full NHSBT and UKHSA Epidemiology Unit report for 2022 is available in PDF format on the NHSBT website.
A detailed summary of data from all the unit’s surveillance schemes is available on request to: epidemiology@nhsbt.nhs.uk
The full 2022 annual SHOT report is available in PDF format on the SHOT website.
UKHSA commences weekly publication of detailed influenza and COVID-19 surveillance reports
UKHSA has commenced weekly (Thursday) publication of its detailed National Influenza and COVID-19 Surveillance Report that provides up-to-date summary information on levels of flu and COVID-19 activity in the UK population.
The weekly report includes graphical presentations of detailed epidemiological and virological data generated by various national surveillance schemes. The first weekly report is based on data from week 40 (2 to 8 October) of the 2023 to 2024 winter season.
Health professionals can subscribe to a weekly email (comprising a summary and links to the main report and related documents) by sending their names and email addresses to: respscidsc@ukhsa.gov.uk
Infection reports in this issue
National enhanced surveillance reports for acute hepatitis B (England): January to December 2021