Hawaii’s blood supply is particularly vulnerable should there be a widespread outbreak of mosquito-borne illnesses such as Zika or dengue fever on the islands.
Currently, there are no clinically approved tests available either for dengue or for Zika, officials say; that lack of tests would make it difficult, in an outbreak, to ensure that donations in affected areas were free of either disease.
During the recent dengue outbreak on the Big Island, the Blood Bank of Hawaii – the state’s only blood supply – responded by halting all donations from areas actively affected by the outbreak, including Kona.
The blood bank keeps enough blood on hand at any given time to sustain three days’ worth of necessary transfusions, according to Maura Dolormente, the organization’s marketing director.
She said it’s difficult to know exactly how many people that may serve, since the amount of blood needed in transfusions can widely vary by patient; but the individuals most critically in need of blood would have priority and be evaluated for a transfusion on a case-by-case basis.
During a six-week Zika outbreak in Puerto Rico, that island spent $4.2 million to import all its blood supplies.
If necessary, Dolormente said, the Blood Bank of Hawaii would import blood from the mainland, but that would carry a high cost. When Puerto Rico’s blood supply center (slightly larger than the Blood Bank of Hawaii) had to shut down for six weeks following a Zika virus outbreak, it cost $4.2 million to import all of its blood supply, she said.
Blood Bank of Hawaii officials said they are well aware of the risks of an outbreak, and of the limitations they face in responding — so they are focusing on prevention, and have put new policies in place to try to get ahead of the spread of Zika.
Kim-Anh Nguyen, president and CEO of the blood bank, said she’s very concerned about the potential for Zika to reach and establish itself in Hawaii, since the virus is currently active in the South Pacific.
“We believe that Hawaii is geographically positioned to be a high Zika risk,” Nguyen said. “We know that Hawaii harbors the mosquitoes that carry both dengue and Zika.”
To date, seven people in Hawaii (including a baby born with the virus) are known to have been infected by Zika while traveling.
The Blood Bank of Hawaii has developed a three-pronged plan to address the potential spread of Zika. It consists of:
• Checking potential donors for symptoms and encouraging them to report symptoms. Eighty percent of those infected with Zika virus do not show symptoms immediately, Nguyen said.
Donors are questioned in detail about any travel, including to areas known to have active Zika or dengue outbreaks.
• Exploring ways to test donated blood for the virus. While there is currently no licensed test to check for Zika virus, Nguyen said that the U.S. Food and Drug Administration recently approved a clinical trial of a prospective test for the virus.
Puerto Rico is taking part in that trial, and the Blood Bank of Hawaii has asked to take part; officials hope to have an answer from the FDA within the next month, Dolormente said.
• Exploring ways to sterilize blood donations. Technology exists, on the mainland, to sterilize blood platelets and plasma, and clinical trials are underway for “pathogen inactivation,” as it is termed, of red blood cells, Dolormente said. The Blood Bank of Hawaii is looking into the costs and challenges of acquiring the existing technology, which would require revamping the organization’s blood-processing facility.
“We can’t estimate the costs yet,” said Dolormente, “or whether we’d have to ask hospitals to help share in that expense.”
A Significant Threat
Within the U.S., Hawaii and Florida seem to be most at risk of a Zika outbreak, Nguyen said.
She said the possibility of the Zika virus reaching and spreading across the state poses a significant threat to the Blood Bank of Hawaii’s supply. The biggest concern would be not having enough blood on the shelves if it’s needed.
During the recent series of Big Island dengue fever cases, Nguyen said the blood bank cancelled a series of blood drives on the island in areas affected by the outbreak. That included Kona, where the vast majority of donations on the island are made. Instead, the Blood Bank relied on blood supplies from Oahu.
Nguyen said the blood bank is interested in obtaining a blood test for dengue fever, but that clinical trials of the test are not yet being run.
Randal Covin, the Blood Bank of Hawaii’s medical director, said after the FDA came out with guidelines for blood banks to reduce the risk of transmitting Zika, the blood bank began revising its current procedure and looking for ways to test for the virus.
The FDA’s policy change prompted the blood bank to add Zika-related questions to a questionnaire that donors are required to complete before donating blood. This method of “donor screening” allows the blood bank to keep tabs on people whom it bars from donating temporarily or for life, he said.
The Blood Bank of Hawaii has put up signs showing areas known to be affected by the Zika virus, to encourage donors to alert staffers if they may have been in contact with the virus. Donors also are asked to call if they feel symptoms of illness within two weeks after making a donation.
He said studies have shown that unpaid blood donation is the safest way to collect blood.
Currently, Covin said, all donated blood is tested for viruses including HIV, hepatitis B and C, syphilis and West Nile, among other illnesses.
Covin said the Blood Bank of Hawaii checks the Center for Disease Control and Prevention’s website daily for new information about the Zika virus. The blood bank is in regular communication with the state Department of Health about mosquito-borne viruses, he said.
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