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Heightened Nontesting Risk Mitigation Blood Donor Screening with Retrospective Transcription-Mediated Amplification
David J Sullivan1, Marion C Lanteri2,3, Vanessa Bres4
1W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
The American Journal of Tropical Medicine and Hygiene
|February 9, 2026
Summary
Transfusion-transmitted malaria is rare in the U.S. Following a 2023 Florida outbreak, enhanced screening and pathogen reduction strategies were implemented, finding no malaria in blood donations.
Area of Science:
- Infectious Diseases
- Public Health
- Blood Transfusion Safety
Background:
- Transfusion-transmitted malaria (TTM) poses a minimal but persistent risk in the U.S., with recent cases linked to individuals outside deferral periods.
- Autochthonous malaria outbreaks, such as the 2023 Plasmodium vivax outbreak in Florida, highlight potential transmission routes beyond travel history.
- The absence of an approved blood donor screening test for malaria necessitates proactive risk mitigation strategies.
Purpose of the Study:
- To evaluate the effectiveness of enhanced blood donor screening and pathogen reduction measures implemented during a local malaria outbreak.
- To assess the prevalence of malaria in blood donors from affected and surrounding areas using nucleic acid testing (NAT).
- To investigate the risk of transfusion-transmitted malaria in the context of an autochthonous malaria outbreak.
Main Methods:
- Retrospective analysis of blood donor samples using transcription-mediated amplification (TMA) NAT.
- Targeted nucleic acid testing on samples from specific zip codes in Sarasota and Miami, Florida.
- Implementation of non-testing donor risk mitigation strategies including enhanced screening and pathogen reduction by a local blood center.
Main Results:
- All tested donor samples (n=436) from Sarasota and Miami zip codes were nonreactive for malaria via nucleic acid testing.
- No transfusion-transmitted malaria cases were reported locally during the study period.
- Mosquito control, increased syndromic surveillance, and blood center interventions were implemented concurrently.
Conclusions:
- Enhanced blood donor screening and pathogen reduction strategies appear effective in mitigating TTM risk during local malaria outbreaks.
- Nucleic acid testing did not detect malaria in the studied donor population, supporting the safety of the blood supply.
- A multi-faceted approach involving public health, vector control, and blood banking is crucial for managing TTM risks.
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