Evolving approaches to infectious threats in transfusiology: A systematic literature review

UDC: 
614.2, 614.3, 614.4
DOI: 
10.21668/health.risk/2026.2.15.eng
Authors: 

N.I. Shulakova, A.V. Tutelyan, V.G. Akimkin

Organization: 

Central Research Institute of Epidemiology, 3a Novogireevskaya Str., Moscow, 111123, Russian Federation

Abstract: 

In today's world, issues of infectious safety of blood and its components are becoming increasingly important. Due to significance of this problem, evolving approaches to infectious threats remain central to modernization of transfusion policy and practices.

A significant number of publications by Russian and international authors are devoted to the risks associated with transmission of bloodborne pathogens (BBIs) during transfusion of blood and its components. It is well known that, when ensuring infection safety of donor blood, risks may arise related to HIV infection, parenteral viral hepatitis, and emerging infections. Literary data indicate that since the beginning of the 21st century, at least 13 new pathogens have required the attention of blood services, highlighting the need for a proactive approach to transfusion safety aimed at reducing risks associated with transfusion of blood and its components.

Prevalence of hepatitis B (HBV) and C (HCV) viruses among the population, as well as the potential donor population, varies in terms of the risk of such individuals becoming part of the donor population. The risk of TTI transmission depends on regional endemicity and varies across individual regions, populations, and donor groups, requiring careful screening and monitoring of pathogens. Microbial evolution and insufficient knowledge of the spectrum of potential pathogens, as well as the limited mandatory donor screening regimen and sensitivity of diagnostic methods, can alter the risk of TTI transmission.

Donor selection is a priority for prevention, ensuring the viral safety of blood transfusion media and minimizing the risk of recipient infection. Screening for TTIs to exclude blood donations that pose a risk of transmitting infection to recipients remains a significant component of ensuring safe transfusion. Priority areas of the transfusion safety system should include a set of measures aimed at reducing the risk of infection with bloodborne pathogens at all stages of blood handling: from collection to clinical use.

Keywords: 
blood, donor, transfusion, risk, infections, hepatitis, safety, prevention
Shulakova N.I., Tutelyan A.V., Akimkin V.G. Evolving approaches to infectious threats in transfusiology: a systematic lit-erature review. Health Risk Analysis, 2026, no. 2, pp. 169–180. DOI: 10.21668/health.risk/2026.2.15.eng
References: 
  1. Blood safety and availability. WHO, 2025. Available at: https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availa... (March 02, 2026).
  2. Razvitie donorstva v Rossii [Development of blood donation in Russia]. Portal Pravitel'stva Omskoi oblasti [Portal of Omsk Region Government]. Available at: https://mzdr.omskportal.ru/oiv/mzdr/otrasl/sluzhba-krovi/istoria-donorst... (March 02, 2026).
  3. Mamedov M.K. Virusnye zabolevaniya cheloveka: printsipy diagnostiki, lechenie i profilaktika [Viral Diseases in Humans: Principles of Diagnostics, Treatment, and Prevention]. Baku, Bilik Publ., 2002, pp. 107–141 (in Russian).
  4. Golosova T.V., Bondarenko I.A. Transfuzionnye infektsii: epidemiologiya, diagnostika v sluzhbe krovi [Transfusion-transmitted infections: epidemiology and diagnostics in the blood service]. Vestnik sluzhby krovi Rossii, 2007, no. 1, pp. 16–21 (in Russian).
  5. Dadasheva A.A. Transfuzionnye virusnye infektsii: problemy klassifikatsii i nomenklatury [Transfusion viral infections: problems of classification and nomenclature]. Sovremennye dostizheniya azerbaidzhanskoi meditsiny, 2008, no. 2, pp. 55–60 (in Russian).
  6. Thakur S.K., Sinha A.K., Sharma S.K., Jahan A., Negi D.K., Gupta R., Singh S. Prevalence of transfusion transmissi-ble infections among various donor groups: A comparative analysis. World J. Virol., 2025, vol. 14, no. 1, pp. 96098. DOI: 10.5501/wjv.v14.i1.96098
  7. Mamedov M.K., Mikhailov M.I., Dadasheva A.E. Transfusion viral hepatitis: traditional and non-traditional aspects of the medico-social significance. Biomeditsina (Baku), 2004, no. 3, pp. 11–18 (in Russian).
  8. Belyakova V.V., Ragimov A.A. Opyt raboty po vyyavleniyu markerov gemotransmissivnykh infektsii v Rossii i za rubezhom [Experience in identifying markers of hemato-transmissible infections in Russia and abroad]. Vestnik sluzhby krovi Rossii, 2012, no. 3, pp. 59–64 (in Russian).
  9. Shakhgil'dyan I.V., Mikhailov M.I., Onishchenko G.G. Parenteral'nye virusnye gepatity (epidemiologiya, diagnostika, profilaktika) [Parenteral viral hepatitis (epidemiology, diagnosis, prevention)]. Moscow, GOU VUNMTs MZ RF Publ., 2003, 384 p. (in Russian).
  10. Radzikhovskaya M.V., Moskvicheva M.G., Kafayeva E.I. Regulatory support for the organization of medical care for patients with HIV infection at the Federal and Regional levels (historical background). Ural'skii meditsinskii zhurnal, 2018, no. 4 (159), pp. 119–125. DOI: 10.25694/URMJ.2018.04.052 (in Russian).
  11. Guertler L. Virus safety of human blood, plasma, and derivative products. Thromb. Res., 2002, vol. 107, suppl. 1, pp. S39–S45. DOI: 10.1016/s0049-3848(02)00151-2
  12. Pokhabov D.S., Shestakov E.A., Romanenkova A.S., Madzaev S.R., Shalygin L.D., Zhiburt E.B. ‘Forgotten’ technol-ogies for the prevention of blood-borne infections. Transfusiologiya, 2024, vol. 25, no. 2, pp. 96–101 (in Russian).
  13. Fong I.W. Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges. Current Trends and Concerns in Infectious Diseases, 2020, pp. 191–215. DOI: 10.1007/978-3-030-36966-8_8
  14. Cardozo M., Ragan I., Hartson L., Goodrich R.P. Emerging Pathogen Threats in Transfusion Medicine: Improving Safety and Confidence with Pathogen Reduction Technologies. Pathogens, 2023, vol. 12, no. 7, pp. 911. DOI: 10.3390/pathogens12070911
  15. Tagi-zadeh R. The virology security of transfusions. Biomeditsina, 2005, no. 4, pp. 48–49 (in Russian).
  16. Jing W., Zhao S., Liu J., Liu M. ABO blood groups and hepatitis B virus infection: a systematic review and meta-analysis. BMJ Open, 2020, vol. 10, pp. e034114. DOI: 10.1136/bmjopen-2019-034114
  17. Samo A.A., Laghari Z.A., Baig N.M., Khoso G.M. Prevalence and risk factors associated with hepatitis B and C in Nawabshah, Sindh, Pakistan. Am. J. Trop. Med. Hyg., 2020, vol. 104, no. 3, pp. 1101–1105. DOI: 10.4269/ajtmh.20-1228
  18. Weldemhret L. Epidemiology and challenges of HBV/HIV co-infection amongst HIV-Infected Patients in Endemic Areas: Review. HIV AIDS (Auckl.), 2021, vol. 13, pp. 485–490. DOI: 10.2147/HIV.S273649
  19. Tupoleva T.A., Tikhomirov D.S., Ignatova E.N., Kulikov S.M., Kapranov N.M., Demidov V.P., Tupolev D.A., Rekst’yn A.V., Gaponova T.V. Blood borne infections in blood donors and the epidemiological situation in the Russian Federation. Gematologiya i transfuziologiya, 2025, vol. 70, no. 3, pp. 348–358. DOI: 10.35754/0234-5730-2025-70-3-348-358 (in Russian).
  20. Jain R., Gupta G. Family and friend donors are not true voluntary donors. Asian J. Transfus. Sci., 2012, vol. 6, no. 1, pp. 29–31. DOI: 10.4103/0973-6247.95047
  21. Singogo E., Chagomerana M., Van Ryn C., M'bwana R., Likaka A., M'baya B., Puerto-Meredith S., Chipeta E. [et al.]. Prevalence and incidence of transfusion-transmissible infections among blood donors in Malawi: A population-level study. Transfus. Med., 2023, vol. 33, no. 6, pp. 483–496. DOI: 10.1111/tme.13006
  22. Thakur S.K., Singh S., Negi D.K., Sinha A.K. Prevalence of TTI among Indian blood donors. Bioinformation, 2023, vol. 19, no. 5, pp. 582–589. DOI: 10.6026/97320630019582
  23. Polunina N.V., Gubanova M.N., Zhiburt E.B. The risk of infection transfer during blood transfusion. Rossiiskii med-itsinskii zhurnal, 2016, vol. 22, no. 6, pp. 284–286. DOI: 10.18821/0869-2106-2016-22-6-284-286 (in Russian).
  24. Viet L., Husebekk A., Husum H., Skjerve E. Stochastic model for estimating the risk of transfusion-transmitted hepatitis B in Vietnam. Transfus. Med., 2013, vol. 23, no. 6, pp. 423–431. DOI: 10.1111/tme.12053
  25. Servant-Delmas A., Chuteau C., Lefort C., Piquet Y., Chevaleyre S., Betbeze V., Delhoume M., Hantz S. [et al.]. Two cases of transfusion-transmitted hepatitis B virus (HBV) infection in a low-endemic country before implementation of HBV nucleic acid testing. Transfusion, 2013, vol. 53, no. 2, pp. 291–296. DOI: 10.1111/j.1537-2995.2012.03736.x
  26. Takuissu G.R., Kenmoe S., Amougou Atsama M., Atenguena Okobalemba E., Mbaga D.S., Ebogo-Belobo J.T., Bowo-Ngandji A., Oyono M.G. [et al.]. Global epidemiology of occult hepatitis B virus infections in blood donors, a systematic review and meta-analysis. PLoS One, 2022, vol. 17, no. 8, pp. e0272920. DOI: 10.1371/journal.pone.0272920
  27. Niederhauser C., Tinguely C., Stolz M., Vock M., El Dusouqui S.A., Gowland P. Evolution of blood safety in Swit-zerland over the last 25 years for HIV, HCV, HBV, and Treponema pallidum. Viruses, 2022, vol. 14, no. 12, pp. 2611. DOI: 10.3390/v14122611
  28. Bloch E.M., Busch M.P., Corash L.M., Dodd R., Hailu B., Kleinman S., O'Brien S., Petersen L. [et al.]. Leveraging Donor Populations to Study the Epidemiology and Pathogenesis of Transfusion-Transmitted and Emerging Infectious Diseases. Transfus. Med. Rev., 2023, vol. 37, no. 4, pp. 150769. DOI: 10.1016/j.tmrv.2023.150769
  29. Haas K.A., Sapiano M.R.P., Savinkina A., Kuehnert M.J., Basavaraju S.V. Transfusion-Transmitted Infections Re-ported to the National Healthcare Safety Network Hemovigilance Module. Transfus. Med. Rev., 2019, vol. 33, no. 2, pp. 84–91. DOI: 10.1016/j.tmrv.2019.01.001
  30. Domanovic D., Ushiro-Lamb I., Compernolle V., Brusin S., Funk M., Gallian P., Georgsen J., Janssen M. [et al.]. Pathogen reduction of blood components during outbreaks of infectious diseases in the European Union: an expert opinion from the European Centre for Disease Prevention and Control consultation meeting. Blood Transfus., 2019, vol. 17, no. 6, pp. 433–448. DOI: 10.2450/2019.0288-19
  31. Belyakova V.V., Gukasyan I.A., Donskaya O.V., Ivanova N.V., Maiorova O.A., Dashkova N.G., Ragimov A.A. Re-sidual risks of transfusion transmissive transfer of HIV infection and viral hepatitis C in the Moscow region in laboratory screen-ing of donor blood by NAT technologies. Gematologiya i transfuziologiya, 2014, vol. 59, no. 1, pp. 15–18 (in Russian).
  32. Hatu G., Brumboiu M.I., Gorgan I.N., Bocşan I.S. Romanian blood donors screening: is it really necessary and/or mandatory? Rev. Med. Chir. Soc. Med. Nat. Iasi, 2013, vol. 117, no. 3, pp. 741–746.
  33. Iqbal H., Din A.T.U., Din A.T.U., Din Chaudhary F.M., Younas M., Jamil A. Frequency and causes of Deferral among Blood Donors Presenting to Combined Military Hospital Multan. Cureus, 2020, vol. 12, no. 1, pp. e6657. DOI: 10.7759/cureus.6657
  34. Sultan F., Mehmood T., Mahmood M.T. Infectious pathogens in volunteer and replacement blood donors in Pakistan: a ten-year experience. Int. J. Infect. Dis., 2007, vol. 11, no. 5, pp. 407–412. DOI: 10.1016/j.ijid.2006.10.004
  35. Tupoleva T.A., Ignatova E.N., Gulyaeva A.A., Ovchinnikova E.N., Tikhomirov D.S., Abakarov R.R., Romanova T.Yu., Yaroslavtseva N.G. [et al.]. The screening of donor blood on antibodies to nuclear antigen of hepatitis B virus as a tool of increasing of safety of transfusion for patients with diseases of blood system. Klinicheskaya laboratornaya diagnostika, 2016, vol. 61, no. 5, pp. 311–316. DOI: 10.18821/0869-2084-2016-5-311-316 (in Russian).
  36. Bochkova G.D., Ishchenkova I.V., Palukhin S.I., Kudinova E.E., Ryabikina E.V., Gerasimova O.V., Alaverdyan A.I. Frequency of detection of markers of hemotrasmissive infections in donors of the Rostov region. Glavnyi vrach Yuga Rossii, 2019, no. 2 (66), pp. 4–6 (in Russian).
  37. Bogoslovskaya E.V., Tsyganova G.M., Shipulin G.A. Skrining donorskoi krovi s pomoshch'yu molekulyarno-geneticheskikh metodov [Screening of donated blood using molecular genetic methods]. Laboratornaya meditsina, 2008, no. 9, pp. 31–33 (in Russian).
  38. Tikhomirov D.S., Tupoleva T.A., Gulyaeva A.A., Starkova O.G., Abakarov R.R., Kulikov S.M., Gaponova T.V.
    A comprehensive measures ensuring the safety of blood component transfusions. Gematologiya i transfuziologiya, 2020, vol. 65, no. 3, pp. 321–334. DOI: 10.35754/0234-5730-2020-65-3-321-334 (in Russian).
  39. Kleinman S.H., Lelie N., Busch M.P. Infectivity of Human Immunodeficiency Virus-1, Hepatitis C Virus, and Hepatitis B Virus and Risk of Transmission by Transfusion. Transfusion, 2009, vol. 49, no. 11, pp. 2454–2489. DOI: 10.1111/j.1537-2995.2009.02322.x
  40. Hewitt P.E., Ijaz S., Brailsford S.R., Brett R., Dicks S., Heywood B., Kennedy I.T.R., Kitchen A. [et al.]. Hepatitis E virus in blood components: a prevalence and transmission study in southeast England. Lancet, 2014, vol. 384, no. 9956, pp. 1766–1773. DOI: 10.1016/S0140-6736(14)61034-5
  41. Giménez-Richarte A., Ortiz de Salazar M.I., Giménez-Richarte M.-P., Collado M., Fernández P.L., Clavijo C., Navarro L., Arbona C. [et al.]. Transfusion-transmitted arboviruses: Update and systematic review. PLoS Negl. Trop. Dis., 2022, vol. 16, no. 10, pp. e0010843. DOI: 10.1371/journal.pntd.0010843
  42. Saa P., Proctor M., Foster G., Krysztof D., Winton C., Linnen J.M., Gao K., Brodsky J.P. [et al.]. Investigational Test-ing for Zika Virus among U.S. Blood Donors. N. Engl. J. Med., 2018, vol. 378, no. 19, pp. 1778–1788. DOI: 10.1056/NEJMoa1714977
  43. Zhiburt Ye.B., Gubanova M.N., Maksimov V.A. Blood transmission of West Nile virus. Epidemiologiya i infektsionnye bolezni, 2007, no. 3, pp. 28–32. (in Russian).
  44. Kaur G., Kaur P. Syphilis testing in blood donors: an update. Blood Transfus., 2015, vol. 13, no. 2, pp. 197–204. DOI: 10.2450/2014.0146-14
  45. Busch M.P., Bloch E.M., Kleinman S. Prevention of transfusion-transmitted infections. Blood, 2019, vol. 133, no. 17, pp. 1854–1864. DOI: 10.1182/blood-2018-11-833996
  46. Zhiburt E.B. Novoe v transfuziologii (na XVII Regional'nom Evropeiskom kongresse Mezhdunarodnogo obshchestva perelivaniya krovi) [New in Transfusiology (at the XVII Regional European Congress of the International Society of Blood Transfusion)]. Transfuziologiya, 2008, vol. 9, no. 1, pp. 25–94 (in Russian).
  47. Ye X., Xiong W., Xu X., Zeng J., Xie H., Li B., He B., Chen L., Mo Q. Cost-benefit analysis of serological and nucleic acid testing for hepatitis B virus in blood donors in southern China. BMC Infect. Dis., 2024, vol. 24, no. 1, pp. 909. DOI: 10.1186/s12879-024-09786-z
  48. Awan S.A., Junaid A., Sheikh S. Transfusion Transmissible Infections: Maximizing Donor Surveillance. Cureus, 2018, vol. 10, no. 12, pp. e3787. DOI: 10.7759/cureus.3787
  49. Tupoleva T.A., Romanova T.Yu., Gulyaeva A.A., Tikhomirov D.S., Ignatova E.N., Ovchinnikova E.N., Yaroslav¬tseva N.G., Abakarov R.R. [et al.]. Risk of transmission of hepatitis B and C viruses by blood transfusion. Gematologiya i trans-fuziologiya, 2017, vol. 62, no. 1, pp. 32–36. DOI: 10.18821/0234-5730-2017-62-1-32-36 (in Russian).
  50. Zhiburt E.B., Shestakov E.A., Kodenev A.T., Klyueva E.A., Karavaev A.V., Gubanov M.N. Novoe v transfuziologii (na ХIХ Regional'nom kongresse Mezhdunarodnogo obshchestva perelivaniya krovi) [New in Transfusiology (at the 19th Re-gional Congress of the International Society of Blood Transfusion)]. Transfusiologiya, 2009, vol. 10, no. 3–4, pp. 64–91 (in Russian).
  51. Gonzalez M., Regine V., Piccinini V., Vulcano F., Giampaolo A., Hassan H.J. Residual risk of transfusion-transmitted human immunodeficiency virus, hepatitis C virus, and hepatitis B virus infection in Italy. Transfusion, 2005, vol. 45, no. 10, pp. 1670–1675. DOI: 10.1111/j.1537-2995.2005.00576.x
  52. Strobl F. NAT in blood screening around the world. MLO Med. Lab. Obs., 2011, vol. 43, no. 4, pp. 12–4, 16, 18; quiz 20-1.
  53. Zou S., Dorsey K.A., Notari E.P., Foster G.A., Krysztof D.E., Musavi F., Dodd R.Y., Stramer S.L. Prevalence, inci-dence, and residual risk of human immunodeficiency virus, hepatitis C virus infections among United States blood since the introduction of nucleic acid testing. Transfusion, 2010, vol. 50, no. 7, pp. 1495–1504. DOI: 10.1111/j.1537-2995.2010.02622.x
  54. Allain J.-P. Occult hepatitis B virus infection: implications in transfusion. Vox Sang., 2004, vol. 86, no. 2, pp. 83–91. DOI: 10.1111/j.0042-9007.2004.00406.x
  55. Raimondo G., Allain J.-P., Brunetto M.R., Buendía M.-A., Chen D.-S., Colombo M., Craxì A., Donato F. [et al.]. Statements from the Taormina expert meeting on occult hepatitis B virus infection. J. Hepatol., 2008, vol. 49, no. 4, pp. 652–657. DOI: 10.1016/j.jhep.2008.07.014
  56. Raimondo G., Locarnini S., Pollicino T., Levrero M., Zoulim F., Loc A.S., Taormina Workshop on Occult HBV Infec-tion Faculty Members. Update of the statements on biology and clinical impact of occult hepatitis B virus infection. J. Hepatol., 2019, vol. 71, no. 2, pp. 397–408. DOI: 10.1016/j.jhep.2019.03.034
  57. Bazie M.M., Sanou M., Djigma F.W., Compaore T.R., Obiri-Yeboah D., Kabamba B., Nagalo B.M., Simpore J., Ouédraogo R. Genetic diversity and occult hepatitis B infection in Africa: A comprehensive review. World J. Hepatol., 2024 vol. 16, no. 5, pp. 843–859. DOI: 10.4254/wjh.v16.i5.843
  58. Huang L., He B., Mo Q., Li B., Yan X., Lai R., Wang X., Li J. [et al.]. Transfusion-transmitted occult hepatitis B virus infection: current understanding, challenges, and its implication in blood safety. Front. Immunol., 2025, vol. 16, pp. 1663306. DOI: 10.3389/fimmu.2025.1663306
  59. Hollinger F.B. Hepatitis B virus infection and transfusion medicine: science and the occult. Transfusion, 2008, vol. 48, no. 5, pp. 1001–1026. DOI: 10.1111/j.1537-2995.2008.01701.x
  60. Candotti D., Boizeau L., Laperche S. Occult hepatitis B infection and transfusion-transmission risk. Transfus. Clin. Biol., 2017, vol. 24, no. 3, pp. 189–195. DOI: 10.1016/j.tracli.2017.06.014
  61. Covolo L., Pollicino T., Raimondo G., Donato F. Occult hepatitis B virus and the risk for chronic liver disease: a meta-analysis. Dig. Liver Dis., 2013, vol. 45, no. 3, pp. 238–244. DOI: 10.1016/j.dld.2012.09.021
  62. Huang X., Hollinger F.B. Occult hepatitis B virus infection and hepatocellular carcinoma: a systematic review. J. Viral Hepat., 2014, vol. 21, no. 3, pp. 153–162. DOI: 10.1111/jvh.12222
  63. Azzam A., Khaled H., El-Kayal E.S., Gad F.A., Omar S. Prevalence of occult hepatitis B virus infection in Egypt: a sys-tematic review with meta-analysis. J. Egypt. Public Health Assoc., 2023, vol. 98, no. 1, pp. 13. DOI: 10.1186/s42506-023-00138-4
  64. Ladnaya N.N., Sokolova E.V., Pokrovsky V.V. Transmission of healthcare associated HIV infection in the Russian Federation. Kontrol' i profilaktika infektsii, svyazannykh s okazaniem meditsinskoi pomoshchi (ISMP-2023): sbornik tezisov XI kongressa s mezhdunarodnym uchastiem. Moscow, Central Research Institute of Epidemiology Publ., 2023, pp. 53–54 (in Rus-sian).
  65. Ladnaya N.N., Chekryzhova D.G., Sokolova E.V., Pokrovsky V.V. Transmission of HIV infection by transfusion of blood components in the Russian Federation. Kontrol' i profilaktika infektsii, svyazannykh s okazaniem meditsinskoi pomoshchi (ISMP-2022): sbornik tezisov X Kongressa s mezhdunarodnym uchastiem. Moscow, Central Research Institute of Epidemiology Publ., 2022, pp. 62–63 (in Russian).
  66. Vasil’ev N.I., Mikhailova N.M. Algoritm obespecheniya infektsionnoi bezopasnosti komponentov krovi [Algorithm for Ensuring the Infectious Safety of Blood Components]. Vestnik sluzhby krovi Rossii, 2007, no. 4, pp. 15–19 (in Russian).
  67. Romanova T.Yu., Tupoleva T.A., Tikhomirov D.S., Yaroslavtseva N.G., Ignatova E.N., Gulyaeva A.A., Starkova O.G., Gaponova T.V. Pursuing epidemiological investigation of cases of possible HBV or HCV infection of the recipient with transfusions of donor blood components. Epidemiologiya i infektsionnye bolezni, 2017, vol. 22, no. 5, pp. 228–238. DOI: 10.18821/1560-9529-2017-22-5-228-238 (in Russian).
  68. Potapnev M.P., Eremin V.F. Donor blood infection safety: problems and solutions. Gematologiya i transfuziologiya, 2013, vol. 58, no. 3, pp. 49–56 (in Russian).
Received: 
21.03.2026
Approved: 
05.06.2026
Accepted for publication: 
28.06.2026

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