TINY TICK, BIG THREAT: Dutchess leads state in babesiosis, another threat, besides Lyme disease, if you're bitten by a deer tick
Illness can be passed through blood, but no test screens for it
Babesiosis and the Blood Supply: LYME DISEASE -- Babesiosis and the Blood Supply. Video by Chrissie Williams
One was a 44-day-old baby with malformed lungs, another an 11-year-old boy on chemotherapy for a brain tumor. A third was a heart transplant recipient, 54, and three more were premature infants.
All received blood tainted with a rapidly spreading tick-borne parasite that infected four times as many New Yorkers last year as in 2002. The state ranked first nationwide in 2011 for the malaria-like malady, called babesiosis, and Dutchess County ranked first in the state, according to state and federal data obtained by the Poughkeepsie Journal.
As the number of cases rises, babesiosis is poised to become a tick-borne scourge akin to Lyme disease, but with an especially vicious twist. The sometimes-fatal disease can pass from blood donors who do not know they are infected into a blood supply that has no test to screen for it. That’s why transfusion-transmitted babesiosis tripled from 26 cases nationwide in the first half of the 2000s to 83 in the latter half, according to a 2011 study in the Annals of Internal Medicine, a medical journal. There were 60 cases in New York since 1979 — with nearly half, 28, from 2005 to 2011.
Of the six transfusion cases above, reported by physicians at two New York City hospitals, the heart recipient and two of the babies became ill, according to medical articles. They recovered, usually with treatment involving antibiotics and anti-malarial drugs.
But at least 26 people have died since 1979 after receiving blood tainted with the Babesia pathogen — 10 since 2007, federal research shows. They include a 43-year-old woman with hepatitis C; a woman, 47, with diabetes and kidney disease; and a 76-year-old man with leukemia. Indeed, the elderly and sick are most vulnerable to babesiosis — and most likely to need transfused blood.
Babesiosis is caused by a parasite, usually Babesia microti but other Babesia strains as well, that invades red blood cells; symptoms include fever, drenching sweats, muscle pain and anemia that may lead to internal bleeding and organ failure, according to the U.S. Centers for Disease Control and Prevention. The first national figures show 1,124 cases in 2011 from 17 reporting states. Nearly half of cases for which information was available resulted in hospitalization, while 6 percent to 9 percent of patients hospitalized for babesiosis died, according to one small study from the Lower Hudson Valley and two others from Long Island. The situation with rising risk and incidence of babesiosis is alarming,” said Richard Ostfeld, a senior scientist at Cary Institute for Ecosystem Studies in Millbrook who this month reported nearly 1 in 5 ticks infected with Babesia on lands near the institute. That’s likely the highest reported rate in nymphal, or juvenile, black-legged ticks, the most dangerous stage when barely visible to the people they bite.
Little progress
Though the first transfusion-transmitted babesiosis case was reported in Boston in 1979, little has been done to protect the blood supply except to preclude donors who are known to have had babesiosis, according to interviews and a review of scientific literature. But with only 123 out of 23 million donors reporting having babesiosis from 2005 to 2007, that measure has been “largely ineffective,” said David Leiby, top researcher on the disease for the American Red Cross. A case in point is the six New York transfusion cases, involving two donors — from Suffolk and Westchester counties — who had not been sick with an infection that may not emerge for years, if at all.
Just why tainted blood is slipping through the system relates to the high cost of developing a test that will have limited use and, therefore, limited earning potential for test manufacturers, scientists say. The test would be used primarily in just seven states — five in the Northeast and two in the upper Midwest — where the disease is considered native, or endemic. That’s a new challenge for a blood supply that operates on a national level, testing all blood for HIV, hepatitis B and C and West Nile virus.
“The return on investment is not sufficient,” said Michael Busch, director of Blood Systems Research Institute, a San Francisco-based blood-safety research center. “That’s kind of created a lack of willingness.”
Though at least three possible tests are in various stages of development, there was no indication when one might wend its way through the U.S. Food and Drug Administration licensing process, and the FDA said it could not comment on any trials. In the meantime, blood-supply officials sought to reassure the public on blood-supply reliability.
“Yes, we are concerned,” said Dr. Beth Shaz, chief medical officer for the New York Blood Center, which supplies 200 hospitals in four states with 400,000 units of blood a year. But she stressed: “The blood supply is as safe as it has ever been.”
Maureen Wellman, regional spokesperson for the Red Cross, contrasted the small risk of babesiosis infection — about 170 blood-borne cases since 1979 — with about 30 million blood products delivered each year to 5 million patients.
But known cases are just a tip of the iceberg, research suggests. One study estimated risks as high as one infection for every 601 units transfused in Connecticut; another, published last month in the medical journal Transfusion, reported that 2 percent of donors in endemic Minnesota harbored Babesia antibodies that would preclude donation. As Leiby wrote in a 2011 article in Clinical Microbiological Reviews, “In most instances, the rate of transmission is likely underestimated due to an ongoing failure to recognize true cases.”
In any event, “The number and frequency of transfusion-associated babesiosis cases are rapidly increasing,” warned an Annals of Internal Medicine editorial that accompanied the 2011 study, asserting that measures to protect the blood supply were “urgently needed.”
Babesiosis is contracted through the bite of the same black-legged tick infamous for spreading Lyme disease and may be delivered in a package of pathogens, according to Lyme physicians and published research. Seventy-one percent of 254 ticks from Westchester and Suffolk counties had at least one infection, and 30 percent had two or more, according to a 2010 study in the science journal Vector-Borne Zoonotic Diseases. Significantly, 19 percent of ticks were infected with both the Babesia and Lyme pathogens.
Infection 'cesspools'
“The number-one worldwide vector-spreading epidemic is Lyme disease,” said Dr. Richard Horowitz, a Hyde Park physician who treats people with multiple infections, “and babesiosis is being carried along with it.”
“Ticks are basically cesspools of infection,” said Dr. Kenneth Liegner, a Lyme disease physician from Pawling who has treated people with Lyme, babesiosis and other infections.
Both physicians raised the specter that people who have had Lyme disease could be at risk for unknowingly passing babesiosis through donated blood. In one study, 9.5 percent of people at Hartford (Conn.) Hospital with Lyme also tested positive for the Babesia parasite.
But officials of the Red Cross and New York Blood Center said that banning Lyme disease patients from donating would not be practical. “We would not have an adequate blood supply,” said the Blood Center’s Shaz. Further, Walter Gardner, FDA chief of consumer affairs, said it “would need to be supported by evidence of its effectiveness.”
After trying for several years to interest large manufacturers in developing a test, Busch, of the San Francisco research institute, said he enlisted a small Boston lab to help develop a blood-screening test. Under a $3.7 million National Institutes of Health grant, the company Immunetics Inc. is now trying the antibody test on 15,000 blood samples from New York Blood Center, Busch said, expanding to 30,000 samples next spring. The test “will hopefully be licensed for routine use … in the next few years,” Busch wrote in an email.
The Rhode Island Blood Center reported “encouraging” results in July in a trial of its own antibody test, while the Red Cross is also trying a test in Connecticut and Massachusetts.But even if a test is perfected, there are hazards to using it to screen blood regionally since donors move outside of endemic areas. In one case, a 57-year-old man died in Texas of a hemorrhage linked to tainted-blood babesiosis; his donor had contracted it months before on Cape Cod in Massachusetts, according to a 2008 article in Vox Sanguinis, a journal of transfusion medicine. Indeed, 13 percent of transfusion babesiosis cases in the Annals study occurred in non-endemic states, while babesiosis was reported in eight non-endemic states in 2011.
Shaz said the “cost-benefit” would need to be assessed of testing donors outside of endemic areas, noting a new Babesia test likely will double the cost of current blood screening.
Other risks remain
However, where to screen is not the only issue. While new tests aim to identify blood donors with Babesia microti, research shows that at least two other strains infect people. Babesia duncani infected three additional blood recipients in the Annals study, and Horowitz said 19 percent of his Lyme patients test positive for it.
“We are definitely seeing more babesiosis but especially this other strain of babesiosis,” he said, adding that primary-care physicians must be aware to test for both strains in patients with malaria-like symptoms or intractable Lyme disease.
Leiby, the Red Cross researcher, acknowledges reports of other Babesia strains that could foil any test for Babesia microti. But he is focused on getting at least this test in place.
“If we wait for the 100 percent solution,” he wrote in his article, “blood recipients will continue to be infected, and in some cases die, at ever-increasing rates.”
Mary Beth Pfeiffer: mbpfeiff@poughkeepsie journal.com, (845) 437-4869, Twitter: @marybethpf
