On 13 May 1981, John Paul II was shot and critically wounded in an assassination attempt. During the five-hour surgical procedure at a Rome hospital to repair his wounds, the Pope was given six pints of blood. On 20 June 1981, he was hospitalized with a high fever and inflammation of the right lung. The Pope was tested and found to be infected with cytomegalovirus (CMV), a herpes-type virus that can be transmitted by sexual contact and blood transfusion. He had acquired CMV from the blood administered during surgery. At the time, neither Italian law nor standard medical practice required the transfused units to be tested for CMV (Catholic News Service, 2005). A number of years later, filtering the white blood cells' blood components came into common use, which reduces the risk of CMV from transfusion. Pope John Paul's experience illustrates the link between human behavior and transfusion risk. There are a number of infectious agents associated with human high-risk sexual behavior and injecting drug use that are of special concern for safety of the blood supply. The first to be identified was syphilis, for which testing began just after World War II, at a time when the rate of syphilis infection was much higher in the general population. Then and now, however, the risk of acquiring syphilis via blood transfusion, if present at all, is exceedingly small - in fact, in the United States there have been no recorded cases transmitted by transfusion in many years, and only one report in the literature (in the 1970s) of a poorly documented case of syphilis transmitted by transfusion. Moreover, the spirochete that causes syphilis is fragile and becomes inactive during the first few days of refrigerated blood storage. The same cannot be said for hepatitis B, HIV, HTLV and CMV, however, as these infections are spread sexually and can also be transmitted by transfusion.
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