HIV and the Blood Supply An Analysis of Crisis Decisionmaking (1995) / Chapter Skim
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3 History of the Controversy
3 History of the Controversy
Pages 57-80
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From page 57... ...
(3) Meetings and other occasions for decisionmaking from mid-1983 through the end of 1983 provided many opportunities for blood banks, blood product manufacturers, regulatory organizations, and other agencies to reconsider the decisions of early 1983.
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From page 58... ...
July 16, 1982 Public Health Service Working Group on Opportunistic Infections in Hemophiliacs meeting to exchange information about the three cases of AIDS in hemophilia patients. July 27, 1982 Working Group on Opportunistic Infections in Hemophiliacs second meeting to determine if other groups with acquired immunodeficiency showed similar etiology and if blood products were risk factors for AIDS.
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From page 59... ...
AIDS caused the nation to take note of homosexuality and drug use, which were easily avoided before these issues became such obvious matters of public health, and AIDS required clinicians and public health officials to address matters of personal behavior that had been heretofore taboo. Personnel changes at the highest levels of the Public Health Service may have influenced the federal government's response to AIDS, and to concerns about the safety of the blood supply.
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. With the possible outbreak of a new infectious disease in the United States coming to the attention of public health officials, the CDC established a task force in July 1981 to monitor the cases of opportunistic infections, to investigate additional cases, to formalize a definition of the disease, and to design a case/control study to examine the prevalence and epidemiology of the disease.
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62 a en Em o ._ in ._ U
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One month later, the CDC reported 34 cases of opportunistic infections in Haitian patients. The pattern of infections was "similar to the pattern recently described among homosexual males and IV drug users" (CDC, MMWR, July 9, 1982~.
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In addition, he asked physicians to immediately report cases of opportunistic infections or suspected acquired immune deficiency through state health departments to the CDC (Foege 1982a)
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. None of the patients had any prior opportunistic infections, all had been profoundly lymphopenic, and all had exhibited reversed ratios of CD4:CD8 lymphocytes.
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From page 69... ...
The present report supports the infectious-agent hypothesis and the possibility that transmission of Me putative "AIDS agent" may occur among bow heterosexual and male homosexual couples. At this tune, CDC has received a total of 43 previously healthy females who have developed PCP or over opportunistic infections typical of AIDS [CDC, MMWR, January 7, 19831.
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IMMEDIATE RESPONSES TO EVIDENCE OF BLOOD-BORNE AIDS TRANSMISSION In the first months of 1983, the epidemiologic evidence that the AIDS agent was blood-borne led to official meetings and public and private decisions that set the pattern of the blood industry's response to AIDS, starting with a public meeting convened by the CDC in Atlanta on January 4, 1983. Later that month, the leading blood bank organizations and, separately, the National Hemophilia Foundation (NHF)
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From page 71... ...
The Blood Bank Community's Statement A week after the Atlanta meeting in January 1983, the American Association of Blood Banks, the Council of Community Blood Centers, and the American Red Cross issued a joint statement that "direct or indirect questions about a donor's sexual preference are inappropriate." The statement recommended questions to detect possible AIDS exposure (i.e., a donor health history) , but did not recommend any laboratory screening tests.
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From page 72... ...
The NHF directed their recommendations to treating physicians, regional and community blood collection centers, and plasma fractionators; in some instances, the NHF also told their chapters to distribute the information to the chapter members. Position of the Plasma Fractionation Industry On January 28, 1983, the American Blood Resources Association (ABRA)
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From page 73... ...
The FDA also advised the blood and plasma collection facilities to establish educational programs to inform persons at increased risk for AIDS that they should stop donating and to train personnel who screen donors to recognize the early signs of AIDS. The FDA also announced that it had approved a new heat treatment to inactivate viruses in AHF concentrate.
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If you have any questions regarding this matter, they should be directed to your treating physician and/or the NHF [NHF, 19833. On June 22, 1983, the American Association of Blood Banks, the Council of Community Blood Centers, and the American Red Cross issued a second joint statement, stating that "it appears at this time that the risk of possible transfusion-associated AIDS is on the order of one case per million patients transfused.
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From page 75... ...
Many officials of the blood banks, the plasma fractionation industry, and the FDA accepted with little question estimates that the risk of AIDS was low ("one in a million transfusions") , and they accepted advice that control strategies (such as automatic withdrawal of AHF concentrate lots containing blood from donors suspected of having AIDS, or a switch from AHF concentrate to cryoprecipitate
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From page 76... ...
laboratory studies of the immunologic competence of individuals with hemophilia who had no symptoms of opportunistic infections, and (b) applied research to determine practical techniques for eliminating the risk of infection from AHF concentrate (Foege 1982b)
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to mcommend-surrogate testing or Aver measures to reduce AIDS transmission. ~ ~ - ~ In March 1983 Assistant Secretary of Health Edward Brandt announced the formation of a PHS Executive Committee on AIDS.
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Subsequently, all blood banks and plasma collection centers implemented the ELISA. The first ELISA tests detected 96-98 percent of HIV-infected blood samples.
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Presentation at the National Institutes of Heals consensus conference; January 1995. Centers for Disease Control, Morbidity and Mortality Weekly Report, June 5, 1981.
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From page 80... ...
National Hemophilia Foundation. Chapter Advisory #8; May 11, 1983.
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