Infectious diseases and blood supply safety in the United States in 2026: A review

From the infectious diseases perspective, the safety of the US blood supply, already high-level, continues to improve via multiple mechanisms, making transfusion-transmitted infections (TTIs) now rare. Blood supply safety in 2026 rests on multiple, interdigitating cornerstones including: 1) updated donor questionnaires and guidances for blood collection centers from the Food and Drug Administration, 2) the long-term commitment and expertise of national organizations (e.g., the American Red Cross and the Association for the Advancement of Blood and Biotherapies), 3) screening of donor blood products using nucleic acid testing (NAT), and 4) retrospective hemovigilance. Recent efforts, reviewed here chronologically, include: 1) testing for babesiosis in endemic states, 2) strategies to control bacterial contamination of platelets (still a TTI problem in 2026), 3) a uniform, non-gender-based individual donor questionnaire with clear-cut donor deferrals to reduce HIV transmission even further, and soon, 4) testing for malaria in appropriately-selected donors, with the potential of eliminating malaria as a TTI in the US.