APPENDIX 2

Chlamydia pneumoniae Transmission by Blood Transfusion: • Theoretical Disease Agent: Cases/Frequency in Population: • pneumoniae • Roughly 50% of adults show signs of previous expo- Disease Agent Characteristics: sure worldwide. 10% of community acquired pneu- • Gram-negative, coccoid, nonmotile, nonspore-form- monia, and 5% of sinusitis cases are thought to be ing, obligate intracellular bacterium caused by C. pneumoniae. • Order: Chamydiales; Family: Incubation Period: • Size: 0.2 to 0.4 mm • Nucleic acid: The of Chlamydia pneumoniae • Greater than 3 weeks based on is 1234 kb of DNA. Likelihood of Clinical Disease: Disease Name: • Unknown • Can be a cause of and Primary Disease Symptoms: Priority Level: • Cough, mild fever, , hoarseness, • Scientific/Epidemiologic evidence regarding blood pneumonitis safety: Theoretical Severity of Clinical Disease: • Public perception and/or regulatory concern regard- ing blood safety: Absent • Usually low, with elderly individuals at increased risk • Public concern regarding disease agent: Very low for severe disease • Has been associated with arthritis and atherosclerotic Background: heart disease in epidemiologic studies • Stable in the population • Well-designed secondary prevention trials using • Considered a common cause of pneumonia antibiotics active against C. pneumoniae have been worldwide uniformly negative raising questions about the sig- nificance of the association with coronary artery Common Human Exposure Routes: disease. • Person-to-person through respiratory droplets, no Mortality: other reservoirs known • Low except as complicated pneumonia Likelihood of Secondary Transmission: Chronic Carriage: • Inefficient by direct contact •Yes At-Risk Populations: Treatment Available/Efficacious: • Elementary school-age children (between 5 and 14 years) old at greater risk • Treatment with antibiotics (e.g., erythromycin, • General population—High seroprevalence (50% of , , fluoroquinolones and young adults) their derivatives [such as levofloxacin], and tetracy- clines [such as ]) Vector and Reservoir Involved: • In severe cases, treatment with intravenous antibiot- • Human reservoir ics and oxygen supplementation may be required.

Blood Phase: Agent-Specific Screening Question(s):

• Specific DNA and RNA transcripts demonstrated by • No specific question is in use. PCR in PBMC are found in a number of blood donors • Not indicated because transfusion transmission has and symptomatic and asymptomatic patients and not been demonstrated can persist for months or years. • No sensitive or specific question is feasible. • Culture has not been successful from blood. Laboratory Test(s) Available: Survival/Persistence in Blood Products: • No FDA-licensed blood donor screening test exists. • Not well studied. Only fresh products used in filtra- • Serology: Commercially available microimmunofluo- tion studies rescence (MIF) and EIAs are most commonly used.

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Although quite technically challenging, MIF appears Suggested Reading: more frequently in the literature as a “gold standard” 1. Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27- for serological confirmation. associated reactive arthritis: pathogenic and clinical • Nucleic acid methods: PCR, nested PCR, and touch- considerations. Clin Microbiol Rev 2004;17:348-69. down enzyme time-release PCR also noted as useful. 2. Hogan RJ, Mathews SA, Mukhopadhyay S, Summers- Prevalence of DNA detection highly dependent on gill JT, Timms P. Chlamydial persistence: beyond the which primers are used. biphasic paradigm. Infect Immun 2004;72:1843-55. Currently Recommended Donor Deferral Period: 3. Ikejima H, Friedman H, Leparc GF, Yamamoto Y. Depletion of resident Chlamydia pneumoniae • No FDA Guidance or AABB Standard exists. through leukoreduction by filtration of blood for • Prudent practice would be to defer donor until signs transfusion. J Clin Microbiol 2005;43:4580-4. and symptoms are gone and a course of treatment is 4. Kuo CC, Jackson LA, Campbell LA, Grayston JT. completed. Chlamydia pneumoniae (TWAR). Clin Microbiol Rev 1995;8:451-61. Impact on Blood Availability: 5. Paldanius M, Bloigu A, Alho M, Leinonen M, Saikku P. • Agent-specific screening question(s): Not applicable Prevalence and persistence of Chlamydia pneumo- • Laboratory test(s) available: Not applicable niae in healthy laboratory personnel in Finland. Clin Diagn Lab Immunol 2005;12:654-9. Impact on Blood Safety: 6. Smieja M, Mahony J, Petrich A, Boman J, Chernesky M. Association of circulating Chlamydia pneumoniae • Agent-specific screening question(s): Not applicable DNA with cardiovascular disease: a systematic review. • Laboratory test(s) available: Not applicable BMC Infect Dis 2002; 2:21. 7. Verkooyen RP, Willemse D, Hiep-van Casteren SC, Leukoreduction Efficacy: Mousavi Joulandan SA, Snijder RJ, van den Bosch JM, • Filtration significantly reduces the number of bacte- van Helden HP, Peeters MF,Verbrugh HA. Evaluation ria present in blood products and the number of posi- of PCR, culture, and serology for diagnosis of Chlamy- tive test results from those products. dia pneumoniae respiratory . J Clin Micro- biol 1998;36:2301-7. Pathogen Reduction Efficacy for Plasma Derivatives: 8. Wald NJ, Law MR, Morris JK, Zhou X, Wong Y, Ward ME. Chlamydia pneumoniae and mortality • Specific data indicate that the multiple steps in the from ischaemic heart disease: large prospective study. fractionation process are robust and capable of inac- BMJ 2000;321:204-7. tivating and/or removing at concentrations 9. Yamaguchi H, Yamada M, Uruma T, Kanamori M, that may be present in plasma. Goto H, Yamamoto Y, Kamiya S. Prevalence of viable Other Prevention Measures: Chlamydia pneumoniae in peripheral blood mono- nuclear cells of healthy blood donors. Transfusion • Unknown 2004;44:1072-8.

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