Inside NAT CentreNAT TourAfter the symposium, where many<strong>int</strong>ernational and nationalperspectives were debated,delegates were treated to a tour ofthe pristine NAT centre laboratoryin Tokyo. Between November 1997and November 1999, 5.6 milliondonations, screened serologicallynegative, were tested manually byNAT <strong>with</strong> a view to reducing theviral load from source plasma forplasma derived products. 78positive donations were found forHBV (1:72,000), 10 for HCV(1:560,000) and 2 for HIV-1(1:2,800,000), the highest windowdonation risk being HBV. Thesedata show that blood transfusionin Japan has become safer thanever through 100% voluntaryblood donations and serologicalscreening, although a residual riskmay still occur in later stages <strong>with</strong>virus mutants or viral load <strong>with</strong> anundetectable level of currentserological screening.Because of the need to containcosts, tests are currently carriedout on pool, as rapidly as possibleto enable transfusion of cellularcomponents. As HBV genomeswere quantified in 6 hepatitis Bseroconversion panels in the earlystages of infection, the virusgrowth curve showed anexponential straight line againstthe date of bleeding. Doubling timewas 2 days and log time was 6.5days. Therefore, a highly sensitiveNAT assay <strong>with</strong> the appropriatepool size could narrow the windowperiod of HBV resulting inexponential reduction of the virusload not detected in the presentserological screening.In late 1998, a highly sensitivemultiplex HBV/HCV/HIV-1 (MPX)reagent was developed for NATthat can reduce the test cost andtime as compared to the reagentsfor individual viruses. In July1999, thanks to technologicaladvances, nationwide serologicalNAT screening of negativevoluntary donated blood wasinitiated. After resolution of MPXpositive samples <strong>int</strong>o individualvirus, each blood centre informeddonors of the results and followedup NAT-positive cases todifferentiate between transient orchronic infections, <strong>with</strong> the aim ofreducing positive donors andimproving the health care ofvoluntary blood donors. Over twomillion units were tested by 500pools and 19 HBV and 8 HCVcases were identified. SinceFebruary 2000, NAT screening hasidentified 18 HBC, 5 HCV and 2HIV-positive cases from the 1.3million units tested.Cost-benefit analysis<strong>Blood</strong> donations must bevoluntary, yet funds are stillrequired to ma<strong>int</strong>ain an organizedsystem and to research andbenefit from technology to assuresafety. A cost-benefit analysisshould therefore not be basedalone on the cost of an individualtransfused patient, since unsafeblood transfusion results in healthcare expenditure and, moreseriously, a threatened life. Soinvestment in technology such asNAT screening, if expensive,becomes cost-effective and to beencouraged.108 ▲ WORLD HEALTH DAY ▼ SAFE BLOOD STARTS WITH ME
An altruistic IssueIt is not only in donating bloodthat we must think of others.Japan realizes that helping othersinvolves training, blood safetypractices and technology transfer.Moreover, <strong>int</strong>ernationalstandardization needs to take thedeveloping world’s epidemiologicaland socio-economical situation<strong>int</strong>o account if it is to fulfil real<strong>int</strong>ernational harmonization.The Japanese challengeAs stated above, self-sufficiencymay have been achieved for bloodtransfusion, but remains an unmettarget for plasma-derivedproducts emanating fromvoluntary, non-remunerateddonors. To achieve this safetylevel, increased efforts will be putto recruiting and retaining suchdonors at the individual, socialand governmental level. Thismulti-tiered approach is based onthe premise that, although safeblood starts <strong>with</strong> me, it cannot bethe sole responsibility of theindividual to assure the success ofa safe blood system. Together,however, we can succeed.In conclusion, Japan has identifiedfour clear areas of focus over thenext five years:— clarify the roles andaccountability of centralgovernment, local authoritiesand the Japanese Red Cross— elucidate the policy of selfsufficiency of blood productsfor the general public— set up a concrete strategy toensure blood safety andDr Nishioka reads message fromWHO Director-Generalimplement national bloodlegislation— take administrative measuresfor compensation forunavoidable accidents in bloodtransfusion.As Dr Brundtland states in hermessage, this is but the beginning,and Japan stands ready tocollaborate in the WHO five-yearplan to reinforce global bloodsafety. ▲For more information on bloodsafety activities in Japan, contact:The DirectorCentral <strong>Blood</strong> CentreJapanese Red Cross Society1-31 Hiroo, 4-Chome, Shibuya-kuTokyo 150 0012Tel: +813 343 81311Fax: +813 3343 58509E-mail: rcjpn@ppp.bekkoame.or.jpInternet: www.jrc.or.jp/english109 ▲ WORLD HEALTH DAY ▼ SAFE BLOOD STARTS WITH ME
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WHO/BCT/01.03 • Original: English
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It is our hope that the ideas and e
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continual technical assistance toen
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leaflets, flags, pins, stickers and
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WHO House in New Delhi. In thisregi
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Another example of industrialpartne
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the University of Bujumburatwirled,
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Faithful Blood Donor Prizes1st 150k
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The Johannesburg cycling team.Polic
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Masiyarwa Secondary School bannerpr
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Healy, American Association ofBlood
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What is blood used for?Red cells ar
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Youth solidarity with the blood don
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MaterialsEvery form imaginable was
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targeted at health personnel of the
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Metropolitan North HealthService: t
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Campaign at local universityBlood d
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— Love of our fellow humanbeings;
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Laboratory in Coahuilatragedy, or p
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During the event, diplomas andT-shi
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own video film on blood safety,usin
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pressure. The Bahrain DiabetesSocie
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Quality management— quality depar
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