Using these guidelines

This index has been prepared to assist the accurate assessment of the geographical risks and contains information on:

• Malaria
• T. cruzi
• HIV risk in Sub Saharan Africa
• WNV
• Chikungunya virus (CHIKV)
• Viral Haemorrhagic Fever Risk (endemic countries only)

View guideline cross-references

The GDRI should be used to assist selection of donors giving whole blood, blood components (red cells, platelets, plasma and granulocytes), haemopoietic progenitor cells and tissues for therapeutic use.

Donor Selection Procedures aim to minimize the risk of transfusion transmitted infection. Travel to; birth/maternal birth or residency in; and in some cases sexual activity with residents of certain countries, is associated with an increased risk of exposure to infections such as malaria, T cruzi, WNV and HIV. These risks may vary over time and new diseases may occur. Where there is a rapidly emerging geographical disease risk (e.g. SARS or Pandemic Flu) these will be communicated via a Change Notification to be used in conjunction with this document.

This list is compiled specifically for risks to the blood and tissue supply in the United Kingdom and may vary from risks or recommendations provided for the protection of the traveller.

To assess the risk of an individual carrying such infections, look up the countries:

• that they have visited
• for which they report sexual contact with a resident or former resident
• in which they were born
• in which their mother was born

If a risk is shown for that country, look at the relevant entry in the appropriate Donor Selection Guidelines (DSG) for the donation type (e.g. Whole Blood & Components or the relevant Tissue DSG) to assess the individual’s suitability to donate.

View guideline cross-references

Information concerning malaria risk has been sourced from Health Protection Scotland (www.travax.nhs.uk/) with some modifications to account for typical donor travel patterns, entry points to the countries concerned, areas where reporting is compromised and ease of use for end users. They are not identical to those found on the ‘Fit for Travel’ website which is designed to inform travellers decisions about anti-malarial therapy rather than give assurance of safety of blood donations for recipient patients.

Countries with malarial risk have been categorised into three groups:

Category A

Countries where the malarial risk is present in the whole country all year or with very clear seasonal guidance

Category B

Countries where only parts of the country are affected

Category C

Indicates that only part of the country is affected in discrete pockets, or the risk of infection is low or that there are few visitors to the affected areas.

It is likely that tourists who visit these countries will be able to donate but individual assessment must be applied. Donors are likely to have detailed knowledge of the malarial areas visited.

The health care professional should establish whether the donor sought advice prior to travel or not and if they were advised to take anti malarial precautions.

Malaria Maps

The maps included are to be used to accompany the GDRI when assessing the malaria risk for a donor. They have been sourced from the Fit for travel website. It is important to apply the GDRI guidance for all infection risks; these maps only provide advice for malaria risk.

Use Of Maps

Maps are provided to allow staff to assess the malaria risk for the areas within these countries that a donor has visited. The text of the GDRI should be taken as the main source to make decisions. The maps present information about neighbouring countries but this should not be used for malarial assessment. The advice below each map relates to the Fit for travel website. Decisions regarding malaria guidance should be made using the template below.

The colours used in the maps are presented below.

Red

Risk: high risk

Action: apply Malaria guidance

Dark pink / hatched

Risk: variable risk / low risk

Action: apply Malaria guideline

Light pink

Risk: low to no risk

Action: can donate

Yellow

Risk: surrounding country with malaria risk

Action: do not use for malaria assessment

Green

Risk: surrounding country with no malaria risk

Action: do not use for malaria assessment

All malaria maps are downloaded from the Fit for travel website (www.fitfortravel.nhs.uk)

Airport Stopovers

The definition of an Airport Stopover, as approved by The Standing Advisory Committee on Transfusion Transmitted Infections, is a transit through an airport during which the traveller has not left the airport.

When the donor's visit has consisted only of an airport stopover there is no need to refer to the Geographical Disease Risk Index.

HIV/AIDS is common in some areas of the world, and sexual activity with partners in these countries carries a risk of infection. This Index identifies the countries of Sub Saharan Africa to facilitate interpretation of the guidance. However the health care professional should consider all other risks of HIV associated with travel and remember that this is not restricted to Sub Saharan Africa.

If the donor reports sexual activity with a partner in one of the countries listed as Sub Saharan Africa in the table, or with a partner who may have been sexually active in one of these areas, refer to the Blood Safety Entry in the Donor Selection Guidelines.

The GDRI is under the continuing review of the Standing Advisory Committees for the Care and Selection of Donors (SACCSD) and for Transfusion Transmitted Infection (SACTTI). This is to ensure that they are accurate and up to date. All changes have the approval of the UKBTS Joint Professional Advisory Committee (JPAC).

Change Notification

Changes are notified to the Medical Director and to the Quality Manager of each of the four national services by a Change Notification from the Chairman of JPAC. All changes will have the approval of JPAC.

Implementation of changes is the responsibility of the individual national service.

Version terminology

A version shall be any of the following:

Extensive revisions of this document are known as 'Editions'.

Changes following the issue of 'Change Notification Letters' are known as 'Releases'.

Changes to the website, which do not involve a change to the medical or scientific content, are given an 'Issue' number.

Edition Date, Release Date and Issue Date is the date on which an Edition, Release or Issue is first published on the UKBTS website.

Changes to printed versions

The Quality Manager of each Blood Service will effect changes to the document. They will be informed when a new electronic version is released.

The Quality Manager is responsible for ensuring that there is an effective Document Control and Document Change procedure in operation within their Blood Service to ensure that only up to date versions are in use and that all authorized copies, both electronic and paper, are traceable.

Individual users of the GDRI are responsible for ensuring that they are using an up-to-date version.

Changes to the website versions

The website will always display the up to date version. Any errors should be notified to JPACOffice@nhsbt.nhs.uk