Effective public health strategies incentives education screening and procedures

Relatively low-cost, low-technology public health strategies continue to be the first-line and most important defenses to protect blood safety. They include

Figure 7.1 Graph of safety measures and mean red cell fees, 1985-2005. Reproduced with permission of America's Blood Centers.

establishing an altruistic system for blood donation, effective public education, rigorous professional training, and continuous epidemiological surveillance and consistent front-line screening (not testing) of prospective donors before they give blood. While the array of accurate laboratory screening tests continues to grow, it is probably fair to predict that there never will be a fully effective laboratory test for every infectious agent that can be transmitted via blood transfusion. The environment of infectious microbes is always changing, as is the ecology of human activities that can spread them. It is therefore realistic to expect that the next infectious agent will be present in asymptomatic blood donors before there is a test for it. Other sources of risk include the donor that is infectious but not yet positive by available testing; an infection that is immuno-silent; lab error; and the eruption of a new infectious agent or new variant of a known agent. With this reality in mind, continuous epidemiological surveillance to uncover changing disease patterns and a willingness to be creative, diligent, and rapid in adapting to new challenges are the keys to maintaining public health. In addition, as we learned from the outset of the AIDS epidemic, public health measures will have to adapt to ethical and legal parameters of pluralistic societies. The challenges to maintaining sufficient blood supplies for life-saving medical needs are constantly changing while demand is always increasing. Not long ago, there were concerns related to discriminating against vulnerable and stigmatized groups. Today, a concern is rejecting people that have traveled to or lived in Western Europe.

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