The tragedy of transfusion-associated
hepatitis and HIV spurred a decades-long overhaul of the regulatory oversight and practice of
blood transfusion. Consequent to improved
donor selection, testing, process control, clinical transfusion practice and post-transfusion surveillance, transfusion in the United States and other high-income countries is now a very safe medical procedure. Nonetheless, pathogens continue to emerge and threaten the blood supply, highlighting the need for a proactive approach to
blood transfusion safety. Blood donor populations and the global transfusion infrastructure are under-utilized resources for the study of
infectious diseases. Blood donors are large, demographically diverse subsets of general populations for whom cross-sectional and longitudinal samples are readily accessible for serological and molecular testing. Blood donor collection networks span diverse geographies, including in low- and middle-income countries, where agents, especially zoonotic pathogens, are able to emerge and spread, given limited tools for recognition, surveillance and control. Routine laboratory storage and transportation, coupled with data capture, afford access to rich epidemiological data to assess the epidemiology and pathogenesis of established and emerging
infections. Subsequent to the State of the Science in Transfusion Medicine symposium in 2022, our working group (WG), "Emerging
Infections: Impact on Blood Science, the Blood Supply, Blood Safety, and Public Health" elected to focus on "leveraging donor populations to study the epidemiology and pathogenesis of transfusion-transmitted and
emerging infectious diseases." The 5 landmark studies span (1) the implication of hepatitis C virus in post-transfusion
hepatitis, (2) longitudinal evaluation of plasma donors with incident
infections, thus informing the development of a widely used staging system for acute
HIV infection, (3) explication of the dynamics of early
West Nile Virus infection, (4) the deployment of combined molecular and serological
donor screening for Babesia microti, to characterize its epidemiology and infectivity and facilitate routine
donor screening, and (5) national serosurveillance for SARS-CoV-2 during the
COVID-19 pandemic. The studies highlight the interplay between
infectious diseases and transfusion medicine, including the imperative to ensure
blood transfusion safety and the broader application of blood donor populations to the study of
infectious diseases.