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

7:22 PM, Dec 23, 2012

Babesiosis, a tick-borne disease that is growing more common, can be passed through blood transfusion from donors who do not know they are infected. This unit of donated red blood cells was seen at a blood bank in 2008. / Darryl Bautista/Poughkeepsie Journal

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.
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ABOUT THIS SERIES

This is part 7 in a Poughkeepsie Journal series on the prevalence and problems of Lyme disease, the nation’s most common vector-borne disease. Go to www.pough- keepsiej- ournal.com/ lyme to read previous installments, view videos and read reports on Lyme disease and babesiosis.