Correspondence

Global Distribution of Transfusion-Transmitted Virus

N Engl J Med 1998; 339:776-777September 10, 1998

Article

To the Editor:

Transfusion-transmitted virus has recently been identified as a potential cause of post-transfusion non-A, non-B, non-C hepatitis.1 The virus has a single-stranded DNA genome whose organization is similar to those of members of the Parvoviridae.2 Transient viremia due to transfusion-transmitted virus was detected by the polymerase chain reaction (PCR) in three patients six to eight weeks after the transfusion of blood components and coincided with modest elevations of alanine aminotransferase. It has been proposed that transfusion-transmitted virus is the chloroform-resistant non-A, non-B agent shown to cause transient alanine aminotransferase elevations in chimpanzees.3

To understand more about the distribution of transfusion-transmitted virus infection, we investigated the prevalence of infection in a wide range of geographically separated human populations and among chimpanzees in Africa. Blood samples were obtained from people inhabiting equatorial forests in Ecuador, northern Brazil, and Papua New Guinea (Karkar Island) and from people living in predominantly rural, farming communities in Gedaref in eastern Sudan, the Lower River Division in the Gambia, around Lagos in Nigeria, and the Kinshasa region in the Democratic Republic of the Congo. Samples were obtained from blood donors in Karachi, Pakistan, and from wild animals in an area extending from Central Africa to West Africa. The samples had originally been collected for studies of other viruses and parasites.

Sequences of transfusion-transmitted virus were amplified by heminested PCR according to previously described conditions.2 Full precautions were taken to prevent contamination of the PCR, with primary and secondary reactions performed in separate laboratories and negative controls included with each set of samples.

We found high frequencies of viremia due to transfusion-transmitted virus in most of the study populations, with values ranging from 16 percent in Pakistan to 83 percent in the Gambia (Table 1Table 1Viremia Due to Frequency of Transfusion-Transmitted Virus on PCR Testing in Various Groups.). Transfusion-transmitted virus DNA sequences were also detected in one of the chimpanzees. Although Nishizawa et al. reported that infection with transfusion-transmitted virus was transient among blood recipients,1 the high frequencies of viremia that we found indicate that the infection can also be persistent. The mechanism by which infection can be maintained at such high frequencies and the routes of transmission are unclear. It is also difficult to assess the clinical significance of the infection and whether it causes disease without detailed clinical assessment or prospective longitudinal studies. However, the finding of transfusion-transmitted virus infection in such a large proportion of the study groups highlights the need for further investigations.

(The international collaborators were Professor D.I. Pritchard, University of Nottingham, Nottingham, United Kingdom; Dr. D.E. Arnot and Dr. E.M. Riley, University of Edinburgh, Edinburgh, United Kingdom; Dr. B.M. Greenwood, Medical Research Council Laboratories, Fajara, the Gambia; Dr. S. Hamid, Aga Khan University, Karachi, Pakistan; Dr. M.O. McClure, St. Mary's Hospital, London; Dr. J.C.M. Lewis, International Zoo Veterinary Group, Keighley, United Kingdom, and Dr. J. Mokili, University of Edinburgh, Edinburgh, United Kingdom.)

Linda E. Prescott, Ph.D.
Peter Simmonds, M.R.C.Path.
University of Edinburgh, Edinburgh, EH8 9AG, United Kingdom

and International Collaborators

4 References

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