No 18/19 - 2016

Blood donor screening 2015

In 2015, a total of 271,513 units of blood were screened. Only ten donors tested positive for hepatitis B or C. The number of positive donors is presented in Table 1.

NAT screening (nucleic acid amplification technique) of donor blood for HIV, hepatitis B and C virus (HBV and HCV) was introduced by law on 1 January 2009, EPI-NEWS 2/10. 

HIV

One person who tested positive at the GP was a blood donor. Look-back did not find any infected persons.

Hepatitis B virus

In 2015, four first-time donors tested positive to HBV; two men and two women. All were born in hepatitis B endemic areas.
The two multiple donors had chronic hepatitis B with no detectable HBsAg, so-called occult hepatitis B.

Hepatitis C virus

In 2015, three first-time donors; two women and a man, aged 44-51 years, tested positive to HCV.
For two of the persons, information was provided that they had been tattooed or pierced.
Furthermore, a multiple donor with no information about risks tested positive to HCV. Look-back did not find any infected persons.

Commentary

The number of donors who tested positive to hepatitis B and C virus markers in Denmark in 2015 remained low, and the blood donor screening did not identify any HIV positives. One person who tested positive at the GP nevertheless turned out to be a blood donor. The person in question – who had become infected heterosexually by a person with no known risk – had not passed on the HIV infection through donor blood.

Two donors were NAT positive only to HBV and would therefore not have been detected by the donor screening scheme if NAT screening had not been introduced.

Expectedly, some donors will test positive to antibodies to hepatitis B core antigen when they undergo testing, EPI-NEWS 18/13. Such donors will be excluded from making donations in the future, but there are no plans to perform look-back on the large number of blood donations made over the years.
(A.H. Christiansen, S. Cowan, Department of Infectious Disease Epidemiology)

Ornithosis 2015

In 2015, a total of 25 persons were notified with ornithosis, psittacosis (parrot fever), which is caused by the zoonotic bacterium Chlamydophila psittaci - 20 men and 5 women. The median age was 66 years (range 34-84 years). All 25 were notified as having been infected in Denmark. One person died in timely association with ornithosis.

Diagnosis and clinical presentation

Of the 25 cases, 24 had been admitted to hospital where the diagnosis was confirmed by PCR at the Departments of Clinical Microbiology at Herlev Hospital, Hvidovre Hospital, Odense University Hospital, Vejle Hospital, Aarhus University Hospital, Skejby and at the SSI, respectively. In 21 of the cases, the sampling material was lower airway secretion, and in 3 cases it was a swab from the upper airways.

A total of 14 of the notified cases were diagnosed with pneumonia. High fever, cough or influenza-like symptoms were found in ten persons, for one of whom there was information about sepsis, and in three cases neurological symptoms were described. In one case, no information on symptoms was provided.

A total of seven persons are believed to have become infected by ducks. An additional five persons are believed to have become infected by doves, four by hens and two by mixed bird keeps. Two are believed to have become infected by caged birds (parrots/budgerigars) and three are believed to have become infected by wild birds. In two cases, no information was provided on bird exposure.

In 2015 there were several ornithosis outbreaks, as described in EPI-NEWS 37/15.

Commentary

The number of notified ornithosis cases was higher than in the previous years, and all the notified affected persons had been infected in Denmark, which is equivalent to an approx. 100% increase in Danish-acquired ornithosis in 2015.

The increase was due, among others, to an outbreak among several person groups with contact to sick ducks, EPI-NEWS 37/15, and to the fact that 2015 - like 2014 - recorded disease in persons who had moved ducklings to new habitats in preparation for hunting, EPI-NEWS 19/15.
(C. Kjelsø, Department of Infectious Disease Epidemiology, S. Uldum, Microbiology and Infection Control)

Measles in Aarhus

An 18-month old infant had morbili virus (measles) detected at Aarhus University Hospital, Skejby. The child had not received the MMR vaccination and became exposed to infection during a prolonged stay in Pakistan. The child presented with fever and a rash before departing from Pakistan; and after returning to Denmark the child was admitted to the Paediatric Department at Aarhus University Hospital, Skejby, in isolation on 1 May. The child ran a fever, had a rash and presented with encephalopathy, but was discharged in remission after a few days. The Medical Officers of Health is engaged in the handling of any infected persons in the child’s family.

Physicians in the Aarhus area are currently encouraged to be extra attentive to measles in children and young adults. It is important that any persons who are suspected of having measles avoid being in waiting rooms with other patients as measles is extremely infectious.

Diagnostically, morbili virus may be detected in throat swabs, naso-pharyngeal secretions and in urine during the acute stage, and by PCR and IgM antibodies in the blood for several weeks after acute illness. Any positive samples are sent for virus typing at the national WHO reference laboratory for morbili and rubella virus, the Department of Microbiological Diagnostics and Virology, Statens Serum Institut. Molecular characterisation of virus is today an important tool that supplements classic epidemiological monitoring. Molecular characterisation can determine the geographical origin of the virus and may be used in infection tracking as it is possible to follow the spreading of the individual virus strains. Laboratory-confirmed measles infection shall be reported to the Department of Infectious Disease Epidemiology, Statens Serum Institut, on form 1515.

Vaccination against measles is covered by the MMR vaccine, which is offered to all children via the childhood vaccination programme. Non-immune travellers are at risk of becoming infected and of subsequently introducing virus into Denmark. This was seen repeatedly in recent years, and you are encouraged to ensure that particularly children and younger adults have received MMR vaccination to avoid contracting the disease and reintroducing measles into Denmark. MMR vaccination is free for children and adolescents under the age of 18 years. Women above 18 years of age may receive vaccination against rubella free of charge, and the vaccination may be given as an MMR vaccine. Persons who are more than 18 years old will defray the vaccination costs themselves.

With a view to avoiding or weakening measles symptoms, MMR vaccination may be given to persons who have been exposed to measles infection within the past 3 days. In case of an outbreak, the vaccination may be given as from 6 months of age, EPI-NEWS 20-21/15. According to the summary of product characteristics, the MMR vaccine may, in exceptional cases, be used as from 9 months of age, but several international studies have documented that the majority of children of vaccinated mothers do not have measurable levels of measles antibodies as from 6 months of age, and therefore the vaccine may possibly be used off-label already from this age.

If the MMR vaccine is given before 12 months of age, the vaccination shall be repeated when the child reaches the age at which the first dose of MMR vaccine is normally given (15 months). Human normal immunoglobulin (Ig) may be used as prophylaxis or to weaken the disease in susceptible patients who have been exposed within 6 days. For a detailed description of post-exposure management, please see EPI-NEWS 50/15.

For further information about measles, symptoms diagnostics etc., please see here and visit the website of the Danish Health Authority
(L.K. Knudsen, Department of infectious Disease Epidemiology, A. Hempel-Jørgensen, The Medical Officers of Health North, T.K. Fischer, Microbiological Diagnostics and Virology)

Link to previous issues of EPI-NEWS

11 May 2016