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Article No.5 - Vol.28, No.3 - September 2009

Impact of the New Influenza A (H1N1) Virus on Blood Donation in Mexico City. Mexico - 2009

   In late March 2009, an increase in severe acute respiratory infections (SARI) was observed in Mexico. In the week of 17-23 April, 854 probable cases of influenza with severe pneumonia were reported, with 59 deaths. The cases occurred in 19 of the country’s 32 states, with the greatest geographic concentration found in the Federal District, the State of Mexico, and the State of San Luís Potosí and, the greatest concentration in terms of age, in previously healthy young adults. During the initial stages of the outbreak, only a very few SARI patients were children under 3 or adults over 59. Analysis of 18 specimens obtained from patients and sent to the laboratory in Winnipeg, Canada, confirmed the influenza infection, with eight of them positive for the influenza A(H1N1) virus, genetically similar to the viruses isolated in the United States.

   In Mexico City, the epidemiological alert on the new influenza A(H1N1) virus intensified in April and May 2009, affecting, inter alia, blood donation services, which saw a 13% drop in donations on average. (Table 1).

Table 1. Monthly blood donation. Mexico, Federal District—2008 and 2009

Source: Report on the donation and use of blood and blood components. National Blood Transfusion Center (CNTS).

   The main blood banks of the sector showed a 6% decline in donation over previous months, while others experienced a 25% increase in altruistic donations. Monthly reports from blood banks in this period indicate that the supply was sufficient to meet hospital needs. Nevertheless, there was a sharp drop in the transfusion of blood components over the previous year, as seen in Table 2.

 

Table 2. Comparison of Transfused Components. May 2008—May 2009

Source: Report on the donation and use of blood and blood components. CNTS.

   Virtually the entire blood supply in the developed countries today is obtained from voluntary donors (blood donors who donate because they want to; their motivation is to help patients for no personal gain). However, the developing countries still depend chiefly on donors who go when a relative or friend requests their help (replenishment donor) or who donate blood in exchange for money or some other compensation (paid donor); these latter can be dangerous, since people who donate blood for money or because they are pressured into it may conceal risk situations that would disqualify them as donors. The most salient differences between replenishment donation and voluntary donation are:

Replenishment donation:

• Meets a personal need

• Can conceal risky behaviors

• Donor may donate because he needs blood tests

• "Concealed" remuneration: the pressured family member may offer to pay a donor

• Does not identify the donor as a healthy individual

Voluntary donation:

• Meets a community need

• Donor has no reason to conceal information

• Altruistic donor knows that his blood is healthy

• It is a freely taken, unremunerated voluntary act

• Promotes the concept of a healthy life

   In the Americas, only Aruba, Canada, Curaçao, Cuba, the United States, the Cayman Islands, the British Virgin Islands, and Suriname report 100% voluntary blood donations. The vast majority of countries in Latin America report that the blood units obtained come from replenishment donors, and some countries acknowledge that of up to 24% of donors are remunerated.

   Donation in Mexico comes primarily from replenishment donors. As a result, mechanisms were sought to discourage large concentrations of people and to establish screening programs for detecting people with the infection.

   Despite the emergency, May saw a 2.4% increase in voluntary donations over the same period in 2008. In some hospitals, surgeries were rescheduled, and efforts were made to optimize the available resources.

   The National Blood Transfusion Center sent a bulletin to the directors of blood banks, transfusion services, and blood donation posts with recommendations in regard to the availability of blood and the influenza A(H1N1) epidemic.

These recommendations were:

1. Concerning the blood supply, blood banks should issue a call to their voluntary donors or other organizations, asking them to donate in small groups to prevent crowds.

2. When selecting donors, pay special attention to identify any symptom suggestive of a respiratory infection.

3. Reject candidates who have had contact with someone who has developed a respiratory illness with symptoms and signs that suggest infection with the influenza A (H1N1) virus.

4. Tell donors that they should immediately inform the blood bank about any respiratory event with fever that appears after donating that could pose a health hazard to the recipient.

5. Pursuant to the clinical recommendations, evaluate all transfusion requests to make sure the use of blood and blood components is justified.

   People with influenza can infect others up to 24 hours before realizing that they are sick, and they can continue to spread the disease seven days or more after recovery. People should not donate blood for at least 14 days after recovering from the flu.

   The close collaboration of the health sector institutions that make up Mexico’s blood network ensured that the impact of the epidemic was minimal, even though steps continue to be taken to deal with potential new outbreaks that could affect the work of the country’s blood services.

Some experiences of the Central Blood Bank, Centro Médico Nacional Siglo XXI and the Mexican Social Security Institute (IMSS). April and May 2009.

1. The number of blood donors fell by 17% in the month from 24 April to 23 May 2009.

2. The number of donors deferred due to symptoms of acute respiratory infection (ARI) fell by 48%; the monthly average of deferments due to ARI is 120, while in the period 24 April to 23 May 2009, it was 60. This suggests that donors with symptoms of ARI deferred themselves.

3. Donors with symptoms of ARI were differed for two weeks.

4. The Centro Médico Nacional Siglo XXI consists of four highly specialized hospitals: Specialities, Cardiology, Oncology, and Pediatrics. The first two suspended elective surgery for two weeks, from 27 April to 8 May 2009. The other two continued their normal level of operations.

5. Patient admissions fell sharply during the period 27 April to 8 May owing to the population’s fear of being exposed at the hospital to the influenza A(H1N1) virus.

6. The blood bank covered 100% of the requests for blood products, which doubled during the first two weeks of the emergency.

Source: Records of the Central Blood Bank of the Centro Médico Nacional Siglo XXI, IMSS.

   Donating blood saves lives, not only in times like these, but every day. Heeding the call from donation campaigns should remain a priority for donors who stay healthy or for those who are fully recovered from the flu.

For more information, contact: Dr. José Ramiro Cruz ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Source: Tecnologías de Salud para la Calidad de la Atención (HT)/ Technology, Health Care, and Research (THR). PAHO.

References

1. AABB Interorganizational Task Force on Pandemic Influenza and the Blood Supply. Pandemic Influenza Planning. Efforts to Ensure a Safe, Available Blood Supply. Planning Document Version 1.0- 3 October 2006. http:/www.state.nj.us/health/flu/documents/plan/hlth_app_4_2.pdf

2. AABB Interorganizational Task Force on Pandemic Influenza and the Blood Supply. Blood Collection Facility and Transfusion Service Pandemic Influenza Planning Checklist. http:/www.state.nj.us/health/flu/documents/plan/hlth_app_4_4.pdf

3. AABB Interorganizational Task Force on Pandemic Influenza and the Blood Supply * Pandemic Influenza Planning Efforts to Ensure a Safe, Available Blood Supply http:/www.state.nj.us/health/flu/documents/plan/hlth_app_4_2.pdf

4. Disaster Operations Handbook. Coordinating the Nation’s Blood Supply during Disasters and Biological Events. http:/www.aabb.org/Documents/Programs_and_Services/Disaster_Response/disastoph ndbkv2.pdf

5. Revista de Salud Pública y Nutrición (RESPYN). Volumen 8 No. 4. October-December 2007. Promoción de la donación voluntaria de sangre en la frontera México-Estados Unidos. Ana María Licón.

6. Organización Panamericana de la Salud. Documentos Técnicos. Acceso a Productos de Calidad. Suministro de Sangre para transfusiones en los países del Caribe y Latinoamérica en 2005. Datos basales para el plan regional de acción para seguridad transfusional 2006-2010. Área de Tecnología y Prestación de Servicios de Salud, Medicamentos Esenciales, Vacunas y Tecnologías de Salud. Washington, D.C., 2007.

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