The Journal of Clinical Investigation (Sep 2022)

Frequent detection but lack of infectivity of SARS-CoV-2 RNA in presymptomatic, infected blood donor plasma

  • Paula Saá,
  • Rebecca V. Fink,
  • Sonia Bakkour,
  • Jing Jin,
  • Graham Simmons,
  • Marcus O. Muench,
  • Hina Dawar,
  • Clara Di Germanio,
  • Alvin J. Hui,
  • David J. Wright,
  • David E. Krysztof,
  • Steven H. Kleinman,
  • Angela Cheung,
  • Theresa Nester,
  • Debra A. Kessler,
  • Rebecca L. Townsend,
  • Bryan R. Spencer,
  • Hany Kamel,
  • Jacquelyn M. Vannoy,
  • Honey Dave,
  • Michael P. Busch,
  • Susan L. Stramer,
  • Mars Stone,
  • Rachael P. Jackman,
  • Philip J. Norris,
  • for the NHLBI Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P)

Journal volume & issue
Vol. 132, no. 17

Abstract

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Respiratory viruses such as influenza do not typically cause viremia; however, SARS-CoV-2 has been detected in the blood of COVID-19 patients with mild and severe symptoms. Detection of SARS-CoV-2 in blood raises questions about its role in pathogenesis as well as transfusion safety concerns. Blood donor reports of symptoms or a diagnosis of COVID-19 after donation (post-donation information, PDI) preceded or coincided with increased general population COVID-19 mortality. Plasma samples from 2,250 blood donors who reported possible COVID-19–related PDI were tested for the presence of SARS-CoV-2 RNA. Detection of RNAemia peaked at 9%–15% of PDI donors in late 2020 to early 2021 and fell to approximately 4% after implementation of widespread vaccination in the population. RNAemic donors were 1.2- to 1.4-fold more likely to report cough or shortness of breath and 1.8-fold more likely to report change in taste or smell compared with infected donors without detectable RNAemia. No infectious virus was detected in plasma from RNAemic donors; inoculation of permissive cell lines produced less than 0.7–7 plaque-forming units (PFU)/mL and in susceptible mice less than 100 PFU/mL in RNA-positive plasma based on limits of detection in these models. These findings suggest that blood transfusions are highly unlikely to transmit SARS-CoV-2 infection.

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