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First reported case of transfusion-transmitted Ross River virus infection

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We describe the first documented case of Ross River virus (RRV) infection transmitted by blood transfusion. The recipient had a clinically compatible illness, and RRV infection was confirmed by serological tests. The implicated donation was positive for RRV RNA. We discuss the risk to blood recipients and the implications for blood donation in Australia.

Clinical record

In May 2014, the Australian Red Cross Blood Service (the Blood Service) in Western Australia received a delayed notification from a donor who had developed fatigue and arthralgia 2 days after giving blood in March 2014 and was subsequently diagnosed with acute Ross River virus (RRV) infection (Box).

PathWest Laboratory Medicine WA detected RRV IgM antibodies using an inhouse indirect immunofluorescence antibody (IFA) test, but no RRV antibodies were detected using an inhouse haemagglutination inhibition (HI) antibody test 10 days after blood donation. RRV IgM antibodies are detected by IFA testing within a few days of onset of illness and routinely persist for several weeks or, occasionally, months or years. IFA tests are less prone to false-positive results compared with enzyme immunoassays. The HI antibody test primarily detects IgG antibodies, which appear within several weeks but after the IgM response.

Blood Service procedure stipulates that donors with a diagnosed RRV infection are unable to donate…