Heightened non-testing risk mitigation blood donor screening with retrospective transcription-mediated amplification testing during a 2023 local Florida malaria cluster

Heightened non-testing risk mitigation blood donor screening with retrospective transcription-mediated amplification testing during a 2023 local Florida malaria cluster | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Heightened non-testing risk mitigation blood donor screening with retrospective transcription-mediated amplification testing during a 2023 local Florida malaria cluster David J. Sullivan , Marion Lanteri , Vanessa Bres , Measa Hanhan , Marlene Pagan , Alejandro Rey , Korena Thomas , Betsy Sasnett , Rita A. Reik doi: https://doi.org/10.1101/2025.02.21.25322106 David J. Sullivan 1 W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: dsulliv7{at}jhmi.edu rita.reik{at}oneblood.org Marion Lanteri 2 Creative Testing Solutions , Tempe, AZ, USA 3 Department of Laboratory Medicine University of San Francisco , CA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Vanessa Bres 4 Grifols Diagnostic Solutions Inc. , San Diego, CA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Measa Hanhan 4 Grifols Diagnostic Solutions Inc. , San Diego, CA, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Marlene Pagan 5 OneBlood, Inc. , St. Petersburg, FL, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Alejandro Rey 2 Creative Testing Solutions , Tempe, AZ, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Korena Thomas 5 OneBlood, Inc. , St. Petersburg, FL, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Betsy Sasnett 5 OneBlood, Inc. , St. Petersburg, FL, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rita A. Reik 5 OneBlood, Inc. , St. Petersburg, FL, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: dsulliv7{at}jhmi.edu rita.reik{at}oneblood.org Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Transfusion-transmitted malaria risk in the USA is estimated at less than one per ten million blood donations or about 1 case every 2 years. A total of 18 autochthonous malaria infections have been reported in the USA since 2003: eight cases in 2003 and ten cases in 2023 with fifteen reported from Florida. From May to July 2023 in Sarasota County, Florida, symptomatic P. vivax malaria was detected in seven individuals with no recent malaria travel history. Study Design and Methods In the absence of an FDA-approved blood donor screening test for malaria at the time, the local blood center responded to this 2023 cluster by implementing a non-testing risk mitigation strategy of escalating blood donor screening measures and pathogen reduction. Potential blood supply safety enhancement by use of additional nucleic acid testing (NAT) on samples from donors in impacted areas was studied retrospectively using the Procleix Plasmodium Assay, a transcription-mediated amplification detecting five human Plasmodium species 18S ribosomal RNA with a limit of detection ranging from 2-7 infected erythrocytes per mL. Results Among the 435 valid study samples from accepted healthy blood donors, screened with heightened non-testing measures in the 4-6 mile radius of malaria-impacted area, all samples were nucleic acid test non-reactive. Discussion The blood center strategy in response to the local 2023 malaria outbreak maintained the blood supply safety with no transfusion-transmitted malaria and no retrospective evidence of Plasmodium in the 435 valid samples collected from blood donors residing in impacted areas. Introduction Blood donors represent a population of healthy individuals comprising about 6.5 million people donating an estimated 11.8 million units of whole blood and red cell products annually in the U.S 1 . Presently, the Uniform Donor History Questionnaire (UDHQ) and an in-person mini-physical are used to screen prospective blood donors. Additionally, U.S. blood donors are deferred within 3 months of travel to a malaria endemic area. Former malaria endemic residents and recent malaria cases are deferred for 3 years. Using these measures, there have been only 13 transfusion-transmitted malaria (TTM) cases between 2000 and 2021, (average 0.59/year) or less than 1 in 10 million blood donations in the U.S. 2 , 3 . Malaria elimination in the U.S. in the 1950s had little influence on Anopheles species mosquito populations over the past 70 years 4 . Although Anopheles mosquitoes are widespread in the U.S, most malaria cases are travel-associated 3 . The presence of the mosquito vector in the U.S. has been associated with small self-contained rare local malaria outbreaks recently in 2003 in Palm Beach County Florida with eight P. vivax cases 5 , then twenty years later in 2023. Seven of the ten 2023 malaria cases were P. vivax cases from Sarasota county Florida 6 , 7 . A single case of P. falciparum was reported in Maryland 8 with two more P. vivax cases in Texas 7 and Arkansas 9 . Local malaria is geographically restricted as most mosquitoes reside within 1-2 kilometers of larval hatching for the 2–6-week normal total lifespan of the female mosquito. In the Sarasota Florida 2023 cluster, all of the 7 local malaria P. vivax cases remained within a 4-mile radius. There were three homeless individuals among the 7 without history of travel. After notification by the Florida Department of Health of local malaria confined to a specific location, the blood center (BC) implemented its “Vector-borne Pathogen Mitigation Strategy” (VPMS) which consists of heightened donor education and screening measures, product embargoes and donor call backs, along with pathogen reduction of eligible products (INTERCEPT ™ for Platelets and Plasma, Cerus corporation, Concord, USA) for blood donors in the affected area. The VPMS has been successfully employed by the blood center since 2013 during outbreaks of dengue, chikungunya, Zika and malaria with modifications based on known characteristics of the vector and pathogen involved. Additionally, blood samples from 435 donors residing in the impacted area from July 2023 to October 2023 were retained for future investigation aimed at identifying subclinical infections using a sensitive Plasmodium nucleic acid test (NAT). Methods Retrospective testing of collected samples The donor study protocol was approved by the Institutional Review Board Advarra with protocol number Pro00079961. Donors were initially screened and accepted using the non-testing VPMS ( Table 1 ). The collections during that period ranged from 1 to 21 donors a day on 77 days of the 91-day span over the three months. Whole blood samples from 436 blood donors residing in the impacted area were harvested and individual whole blood lysates were manually prepared by mixing 0.9 mL of fresh whole blood with 2.7 mL of Parasite Transport Media (PTM), a proprietary lysis and RNA-stabilizing solution (Grifols Diagnostic Solutions Inc), in an individual donor lysate (IDL) tube. IDLs were then frozen at ≤-20°C until testing was performed. View this table: View inline View popup Download powerpoint Table 1. FL BC “Vector-borne Pathogen Mitigation Strategy” including Malaria Sample Testing Samples were retrospectively tested for Plasmodium using a highly sensitive nucleic acid test (Procleix Plasmodium Assay, Grifols Diagnostic Solutions Inc, San Diego, USA). The Procleix Plasmodium Assay is a qualitative in vitro transcription-mediated nucleic acid amplification (TMA) test for the detection of 18S ribosomal RNA (rRNA) from five Plasmodium species ( P. falciparum, P. ovale, P. vivax, P. malariae , and P. knowlesi ). This assay is not yet available for blood donor screening in the U.S. but used in countries/regions recognizing the CE mark. The assay is conducted on a fully automated Procleix Panther System (Grifols Diagnostic Solutions Inc, San Diego, CA). Frozen lysates were thawed and loaded on the Procleix Panther System, which uses 0.5 mL of lysate to perform the Procleix Plasmodium Assay. This involves three main steps: magnetic-based target capture, RNA target amplification by transcription-mediated amplification, and chemiluminescent detection. The assay specific software determines if the sample is reactive or nonreactive for the presence of Plasmodium RNA. Specimens with an Analyte Signal/ Cutoff (S/CO) ≥1.00 are considered reactive 10 . Results Local malaria outbreak in Sarasota Florida 2023 An imported malaria case with disease onset in April was diagnosed in 2023 7 . A second P. vivax local malaria case (homeless status unknown) presented in May with a 14-day history of symptoms. After two weeks with no malaria cases, 4 more local cases presented in the middle of June with two more local cases late June and early July ( Figure 1 ). The prepatent (time of symptomatic parasitemia from infected mosquito bite) is approximately 12 to 14 days in P. vivax case presentations 11 , 12 . In order to transmit to humans, the mosquito needs to acquire the P. vivax infectious gametocytes in a previous bloodmeal at least 8 days prior to transmission bite, because of a temperature dependent development process and relocation from midgut to salivary glands in the mosquito 13 . The average daily temperature in April was 25⍰C, in May 26⍰C, in June 29⍰C and July 31⍰C. Because infected mosquitoes can live from 1 to 7 weeks, all the local cases can be explained by feeding on the second P. vivax case who has a 14-day symptom period before heath evaluation. In a genome sequence analysis by the University of South Florida working with the Florida Health Department, malaria cases 4, 6, 7 and 8 who presented as the last four cases were identical or clonal 14 . The initial P. vivax imported case did not have evaluable DNA material. If the imported malaria case 1 had been parasitemic and asymptomatic for 2 weeks prior to symptom onset then all the cases were related. Another more remote possibility is the second case acquired the P. vivax from an asymptomatic immigrant/traveler. The CDC investigated 30 people with syndromes suggestive of malaria, but all were diagnosis test negative with the BinaxNOW point of care rapid diagnostic tests which have a sensitivity of 10,000 to 100,000 per mL of blood 7 . In the local area of 407 mosquitoes tested, 3 were positive for P. vivax DNA in mosquito in midguts, but all were negative for infected sporozoites stages 7 . Download figure Open in new tab Figure 1. Timeline of P. vivax cases, range of mosquito feeding for acquisition and transmission and risk period for other malaria cases. Malaria case 1 (April presentation) was infected by a mosquito at least a week prior to case presentation and was not sequenced. Case 2 (May presentation) with 14 days of previous symptoms during which this person could have infected other mosquitoes. The gold X represent the range if initial mosquito acquisition of P. vivax with subsequent minimum blood feeding transmission a week before clinical case presentation represented by red *. In the local area of 407 mosquitoes tested 3 were positive for P. vivax DNA in mosquito in midguts, but negative for infected sporozoites stages. Represented buy green stars in early June. The right Y-axis noted the number of Plasmodium test negative donors over 3 months indication no measurable contamination of blood supply. The time period of maximum risk is June to September for blood supply. Donor malaria testing The 436 donors from Sarasota had blood collected from July 2023 to October 2023. They were outside deferral windows as well as asymptomatic (i.e. not febrile) and passed heightened blood donor screening per the BCVPMS, and their eligible products were pathogen-reduced as indicated and released into the blood supply. The Procleix Plasmodium Assay analyzes 500 µL of whole blood lysate for the detection of 18s ribosomal RNA, which would be present in thousands of copies per cell, if one infected red blood cell was captured in the whole blood lysate. Out of 436 samples, five samples had an initial invalid result, of which four samples were valid upon re-test and one was invalid. The overall final validity was 99.77% (435/436). All 435 samples with a valid results collected in the local area from July 2023 to October 2023 were all non-reactive for Plasmodium ( Figure 1 ). Discussion In reviewing the tempo and location of the local cases observed in the 2023 FL malaria cluster, we posit that the second local case infected subsequent mosquitoes and initiated the genetically identical infections occurring in people up to the first week of July from mosquitoes feeding two months previously. In this case the risk period for malaria in the blood supply could be predicted to primarily extend into September. This pattern proved to be consistent with the known tendency for U.S. malaria clusters to remain small and local. Also of note is that although a total of 18 local (autochthonous) malaria cases (17 due to P. vivax and 1 due to P. falciparum ) transmissions have been recorded in the U.S. since 2003 3 , 15 , during the past 20 years there have been only 13 cases of TTM with 9 P. falciparum , 2 P. malariae and 2 P. ovale with no P. vivax 16 , 17 . Additionally, all traced donors were former malaria endemic residents, and none were U.S. citizens traveling back from malaria endemic areas 17 . This contrasts with the 93 TTM cases from 1963 to 1999 where 33 were P. falciparum , 25 P. vivax , 25 P. malariae and 5 P. ovale 18 . In this group the longest time from travel to a malaria region and donation of malaria infected blood was 44 years in the case of P. malariae , 5 years in the case of P. falciparum , 7 years in the case of P. ovale and 2.5 years in a case of P. vivax with most outside of the deferral interval of 3 years 18 . In that last century time period only 3 were U.S. citizens returning from travel and subsequently becoming infected blood donors. Ten of the 93 TTM recipients died from severe malaria 18 . Preparedness for emerging infectious disease outbreaks is one of the strategic initiatives undertaken by the BC to maintain the safety and availability of the blood supply during local vector-borne agent outbreak. Indeed, the blood center is mostly collecting blood in FL, a U.S. state known to be impacted by local outbreak of mosquito-borne agents. Past FL experience includes responses to outbreaks of dengue, chikungunya and Zika viruses as well as malaria. Close collaboration with the local health department and CDC has allowed for appropriate communication for optimum reactivity to local emerging threats. As vector-borne outbreaks are unpredictable, BC developed the VPMS which was used successfully several times over the past twelve years including deployment during the 2023 malaria cluster. Although the VPMS, has proven effective to date, with no cases of transfusion-transmission associated with its use during outbreaks in FL, concerns remain regarding subclinical blood donor infections. Similarly, donor follow up after donation only partially addresses the risk associated with donations collected during the pre-symptomatic phase of infection due to variability in symptom development times. Another mitigation strategy employed by the BC during clusters and outbreaks is the use of an approved amotosalen and ultraviolet light pathogen reduction (PR) system for the inactivation of infectious agents in platelets and plasma 19 . Such a system has been in use at the BC since 2016. A different nonapproved PR with amustaline and glutathione adequately inactivates erythrocytic Plasmodium among other species 20 . Over the period July to October platelets and plasma were treated with PR maintaining the safety of transfused patients. With the implementation of the VPMS and the containment efforts of the Florida health department, the blood supply was not significantly impacted by the local outbreak, as demonstrated by highly sensitive NAT testing non-reactive results in the 435 valid donor samples from the area and no TTM. From a blood center perspective, the highly sensitive Procleix Plasmodium Assay offers the opportunity to be utilized to enhance blood safety and during local malaria outbreaks. Data Availability All data produced in the present study are available upon reasonable request to the authors Footnotes Source of support OneBlood, Inc., Grifols Diagnostic Solutions Inc., Creative Testing Solutions, Bloomberg Philanthropies Declaration of competing interests DJS is Founder, Board Member, and stock/option owner of AliquantumRx(macrolide for antimicrobial and malaria use); coinventor on USP 7,270,948 (Detection of malaria parasites by laser desorption mass spectrometry), USP9,568,471 (Malaria diagnosis in urine), USP 9,642,865 (New angiogenesis inhibitors), and PCT/US2015/046665 (Salts and polymorphs of cethromycin for the treatment of disease); and has received royalties from Binax Inc/D/B/A Inverness Medical for plasmids for HRP2 and aldolase for malaria diagnostic kit. ML and AR are employees of CTS; VB and MH are employees of Grifols Diagnostic Solutions Inc; RAR is an employee of OneBlood and serves on the Medical Advisory Board of Creative Testing Solutions; MP, KT, BS are employees of OneBlood; OneBlood is part owner of, and has representation on the Board of Directors of Creative Testing Solutions References 1. ↵ Kracalik I , Sapiano MRP , Wild RC , Chavez Ortiz J , Stewart P , Berger JJ , Basavaraju SV , Free RJ . Supplemental findings of the 2021 National Blood Collection and Utilization Survey . Transfusion 2023 ; 63 Suppl 4 : S19 – s42 . OpenUrl 2. ↵ COMMITTEE BPA . FDA Blood Products Advisory Committee Briefing Document , 2024 . 3. ↵ Mace KE , Lucchi NW , Tan KR . Malaria Surveillance - United States, 2018 . MMWR Surveill Summ 2022 ; 71 : 1 – 35 . OpenUrl CrossRef 4. ↵ Ochomo E , Rund SSC , Mthawanji RS , Antonio-Nkondjio C , Machani M , Samake S , Wolie RZ , Nsango S , Lown LA , Matoke-Muhia D , Kamau L , Lukyamuzi E , Njeri J , Chabi J , Akrofi OO , Ntege C , Mero V , Mwalimu C , Kiware S , Bilgo E , Traoré MM , Afrane Y , Hakizimana E , Muleba M , Orefuwa E , Chaki P , Juma EO . Mosquito control by abatement programmes in the United States: perspectives and lessons for countries in sub-Saharan Africa . Malar J 2024 ; 23 : 8 . OpenUrl CrossRef PubMed 5. ↵ Eliades MJ , Shah S , Nguyen-Dinh P , Newman RD , Barber AM , Nguyen-Dinh P , Roberts JM , Mali S , Parise ME , Barber AM , Steketee R. Malaria surveillance--United States, 2003 . MMWR Surveill Summ 2005 ; 54 : 25 – 40 . OpenUrl PubMed 6. ↵ Bagcchi S. Locally acquired malaria cases in the USA . Lancet Infect Dis 2023 ; 23 : e401 . OpenUrl CrossRef PubMed 7. ↵ Blackburn D , Drennon M , Broussard K , Morrison AM , Stanek D , Sarney E , Ferracci C , Huard S , Brennan W , Eaton J , Nealeigh S , Barber N , Zimler RA , Adams JN , Blackmore C , Gordillo M , Mercado R , Vore H , Scanlan K , Motie I , Stanfield L , Farooq A , Widel K , Tomson K , Kerr N , Nasir J , Cone M , Rice C , Larkin T , Hernandez E , Bencie J , Lesser CR , Dersch M , Ramirez-Lachmann S , Clark M , Rollo S , Bashadi A , Tyler R , Bolling B , Moore B , Sullivan B , Fonken E , Castillo R , Gonzalez Y , Olivares G , Mace KE , Sayre D , Lenhart A , Sutcliffe A , Dotson E , Corredor C , Rogers E , Raphael BH , Sapp SGH , Qvarnstrom Y , Ridpath AD , McElroy PD . Outbreak of Locally Acquired Mosquito-Transmitted (Autochthonous) Malaria - Florida and Texas, May-July 2023 . MMWR Morb Mortal Wkly Rep 2023 ; 72 : 973 – 8 . OpenUrl CrossRef PubMed 8. ↵ Duwell M , DeVita T , Torpey D , Chen J , Myers RA , Mace K , Ridpath AD , Odongo W , Raphael BH , Lenhart A , Tongren JE , Stanley S , Blythe D. Notes from the Field: Locally Acquired Mosquito-Transmitted (Autochthonous) Plasmodium falciparum Malaria - National Capital Region, Maryland, August 2023 . MMWR Morb Mortal Wkly Rep 2023 ; 72 : 1123 – 5 . OpenUrl PubMed 9. ↵ Courtney AP , Boyanton BL , Jr . ., Strebeck PV , Blount K , Ledford S , Ridpath AD , Mace KE , Smith C , Garner K , Waters C , Cima MJ , Patil N , McElroy PD , Raphael BH , Sapp SGH , Qvarnstrom Y , Lenhart A , Sutcliffe A , Dulski TM , Rothfeldt L. Locally Acquired (Autochthonous) Mosquito-Transmitted Plasmodium vivax Malaria - Saline County, Arkansas, September 2023 . MMWR Morb Mortal Wkly Rep 2024 ; 73 : 646 – 9 . OpenUrl PubMed 10. ↵ Tonnetti L , Groves JA , Self D , Yadav M , Spencer BR , Livezey K , Linnen JM , Stramer SL . A novel mitigation strategy for the prevention of transfusion-transmitted malaria . Transfusion 2024 ; 64 : 94 – 103 . OpenUrl 11. ↵ Collins WE , Sullivan JS , Jeffery GM , Williams A , Galland GG , Nace D , Williams T , Barnwell JW . The Chesson strain of plasmodium vivax in humans and different species of Aotus monkeys . Am J Trop Med Hyg 2009 ; 80 : 152 – 9 . OpenUrl Abstract / FREE Full Text 12. ↵ Craige B , Jr . ., Alving AS , et al. The Chesson strain of Plasmodium vivax malaria; relationship between prepatent period, latent period and relapse rate . J Infect Dis 1947 ; 80 : 228 – 36 . OpenUrl CrossRef PubMed 13. ↵ Zollner GE , Ponsa N , Garman GW , Poudel S , Bell JA , Sattabongkot J , Coleman RE , Vaughan JA . Population dynamics of sporogony for Plasmodium vivax parasites from western Thailand developing within three species of colonized Anopheles mosquitoes . Malar J 2006 ; 5 : 68 . OpenUrl CrossRef PubMed 14. ↵ Muneer A , Adapa SR , Silbert S , Scanlan K , Vore H , Cannons A , Morrison AM , Stanek D , Blackmore C , Adams JH , Kim K , Jiang RHY , Cui L. Autochthonous Plasmodium vivax Infections, Florida, USA, 2023 . Emerg Infect Dis 2024 ; 30 : 1214 – 7 . OpenUrl PubMed 15. ↵ Mace KE , Lucchi NW , Tan KR . Malaria Surveillance - United States, 2017 . MMWR Surveill Summ 2021 ; 70 : 1 – 35 . OpenUrl CrossRef 16. ↵ Stubbs LA , Price M , Noland D , Fuchs J , Filkins L , McElvania E , Luu HS , Sebert M , Waters A , Hsiang MS . Transfusion-Transmitted Malaria: Two Pediatric Cases From the United States and Their Relevance in an Increasingly Globalized World . J Pediatric Infect Dis Soc 2021 ; 10 : 1092 – 5 . OpenUrl PubMed 17. ↵ Anand A , Mace KE , Townsend RL , Madison-Antenucci S , Grimm KE , Espina N , Losco P , Lucchi NW , Rivera H , Breen K , Tan KR , Arguin PM , White JL , Stramer SL . Investigation of a case of suspected transfusion-transmitted malaria . Transfusion 2018 ; 58 : 2115 – 21 . OpenUrl 18. ↵ Mungai M , Tegtmeier G , Chamberland M , Parise M. Transfusion-transmitted malaria in the United States from 1963 through 1999 . N Engl J Med 2001 ; 344 : 1973 – 8 . OpenUrl CrossRef PubMed Web of Science 19. ↵ Lanteri MC , Santa-Maria F , Laughhunn A , Girard YA , Picard-Maureau M , Payrat JM , Irsch J , Stassinopoulos A , Bringmann P. Inactivation of a broad spectrum of viruses and parasites by photochemical treatment of plasma and platelets using amotosalen and ultraviolet A light . Transfusion 2020 ; 60 : 1319 – 31 . OpenUrl 20. ↵ Sow C , Bouissou A , Girard YA , Singh GB , Bounaadja L , Payrat JM , Haas D , Isola H , Lanteri MC , Bringmann P , Grellier P. Robust inactivation of Plasmodium falciparum in red blood cell concentrates using amustaline and glutathione pathogen reduction . Transfusion 2022 ; 62 : 1073 – 83 . OpenUrl View the discussion thread. Back to top Previous Next Posted February 25, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Heightened non-testing risk mitigation blood donor screening with retrospective transcription-mediated amplification testing during a 2023 local Florida malaria cluster Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Heightened non-testing risk mitigation blood donor screening with retrospective transcription-mediated amplification testing during a 2023 local Florida malaria cluster David J. Sullivan , Marion Lanteri , Vanessa Bres , Measa Hanhan , Marlene Pagan , Alejandro Rey , Korena Thomas , Betsy Sasnett , Rita A. Reik medRxiv 2025.02.21.25322106; doi: https://doi.org/10.1101/2025.02.21.25322106 Share This Article: Copy Citation Tools Heightened non-testing risk mitigation blood donor screening with retrospective transcription-mediated amplification testing during a 2023 local Florida malaria cluster David J. Sullivan , Marion Lanteri , Vanessa Bres , Measa Hanhan , Marlene Pagan , Alejandro Rey , Korena Thomas , Betsy Sasnett , Rita A. Reik medRxiv 2025.02.21.25322106; doi: https://doi.org/10.1101/2025.02.21.25322106 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Infectious Diseases (except HIV/AIDS) Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (299) Cardiovascular Medicine (4422) Dentistry and Oral Medicine (443) Dermatology (382) Emergency Medicine (607) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15219) Forensic Medicine (30) Gastroenterology (1123) Genetic and Genomic Medicine (6584) Geriatric Medicine (667) Health Economics (997) Health Informatics (4524) Health Policy (1367) Health Systems and Quality Improvement (1611) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15909) Intensive Care and Critical Care Medicine (1103) Medical Education (622) Medical Ethics (145) Nephrology (667) Neurology (6585) Nursing (345) Nutrition (998) Obstetrics and Gynecology (1143) Occupational and Environmental Health (956) Oncology (3330) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1690) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5437) Public and Global Health (9218) Radiology and Imaging (2194) Rehabilitation Medicine and Physical Therapy (1369) Respiratory Medicine (1195) Rheumatology (593) Sexual and Reproductive Health (709) Sports Medicine (529) Surgery (709) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ff7389689e9593a',t:'MTc3OTQwNDY3NQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();