Veronica C. Hoad

Background and Objectives: Sexual activity–based blood donation restrictions aim to reduce incident transfusion‐transmissible infections (TTIs) but are not required for source plasma because of additional pathogen reduction. On 13 July 2025, Australian Red Cross Lifeblood introduced a plasma pathway (PP) allowing previously ineligible individuals to donate source plasma irrespective of recent sexual activity or human immunodeficiency virus (HIV) pre‐exposure prophylaxis (PrEP) use. This study describes donor demographics and donation prevalence of tested TTIs from the program's first 6 months. Separately, associated PP changes facilitated a contemporary TTI prevalence estimate among transgender donors during this period. Materials and Methods: Descriptive demographics and TTI results were extracted from identified cohort donors from 13 July 2025 to 13 January 2026. TTI prevalence (per 10,000 plasma donations) was estimated by detected TTIs divided by the total number of donations. Results: The PP supported 6673 donations from 7832 attendances by 3465 donors over 6 months. Zero (upper 95% confidence limit 6.94 per 10,000 donations) cases of HIV, hepatitis B virus or hepatitis C virus were detected. New donors constituted 40% of PP donors. Donations were predominantly from men reporting sex with men without (48%) or with PrEP use (30%). No TTIs (0, upper 95% confidence limit 25.76 per 10,000 donations) were detected from transgender donors during this period. Conclusion: TTI prevalence was lower than predicted. The PP demonstrates an inclusive way to limit restrictions on sexual activity and PrEP use without changing the safety profile. Other blood services should consider its introduction.

Background and Aim: In 2018, a pasteurised donor human milk (PDHM) service was established within Australia's national blood service, Lifeblood, and subsequently expanded to a national service. Before 2018, five milk banks operated in Australia, but most infants admitted to Australian neonatal intensive care units (NICUs) still did not have access to PDHM. This study aimed to compare infant outcomes before and after Australian NICUs had access to an assured supply of PDHM from Lifeblood. Methods: Cohort study utilising Australian and New Zealand Neonatal Network data for infants born < 32 weeks' gestation admitted to 15 NICUs across Australia over a 3‐year period (2018–2020; n = 4395 infants). The primary study factor was NICU access to an assured supply of PDHM from Lifeblood. Neonatal outcomes were compared in periods with “PDHM available” versus “PDHM not available”. The primary outcome was the proportion of infants born < 28 weeks' gestation who developed NEC. Secondary outcomes included duration of parenteral nutrition, retinopathy of prematurity, infection, death, length of stay, weight at discharge, and breast milk feeding at discharge. Results: After adjusting for confounding risks, NEC relative risk was 38% lower for infants born < 28 weeks' (aRR 0.62, 95% CI 0.46–0.83) when Lifeblood PDHM was available. Weight at discharge (2828.8 vs. 2939.56 g, p = 0.001) was lower when PDHM was available. Breast milk feeding at discharge, infections and death were not associated with PDHM availability. Conclusions: Reliable access to PDHM was associated with reduced risk of NEC for infants born < 28 weeks' gestation in Australian NICUs.

Background and Objectives: Understanding differences in blood donor vaccine uptake is essential for accurately interpreting serosurveillance of vaccine‐preventable diseases and other research using donor samples and/or data. We aimed to assess vaccination uptake in donors and non‐donors. Materials and Methods: We linked the Sax Institute's 45 and Up Study data to blood donation records, the Australian Immunization Register and death records. Participants were categorized as active donors, lapsed donors or non‐donors. Influenza, herpes‐zoster, pneumococcal and COVID‐19 vaccine uptake were analysed in the age groups recommended and eligible for free vaccination and for pertussis in the age group recommended. We calculated age‐ and sex‐adjusted uptake percentages and differences averaged across 2021–2023, except for COVID‐19 vaccine. Multivariable regression models were used to assess the association between donor status and vaccination uptake, adjusting for potential confounders. Results: Of the 266,432 participants available for this research, 216,338 were eligible for analysis in 2021. Of these, 5734 (2.7%) were active donors, 29,237 (13.5%) were lapsed donors and 181,367 (83.8%) were non‐donors. Active donors had higher vaccination uptake than non‐donors (adjusted uptake ratio [95% confidence interval, CI] for influenza 1.05 [1.04, 1.06], herpes‐zoster 1.20 [1.13, 1.28], pneumococcal 1.10 [1.03, 1.17], pertussis 1.09 [1.00, 1.18]), ≥2 doses of COVID‐19 vaccine in 2021 1.02 [1.01, 1.02] and booster COVID‐19 dose in the second half of 2023 1.08 [1.02, 1.15]. Similarly, lapsed donors had higher vaccination uptake than non‐donors. Conclusion: Blood donors have a higher uptake for funded/recommended adult vaccines than non‐donors. These findings provide evidence of vaccination rate differences that may impact interpretation of studies where blood donor samples and/or data are used.

Background and Objectives: Dengue can cause mild or no symptoms, meaning infected individuals can donate blood during the viraemic phase. Although transfusion transmission is rare, globally many blood operators restrict or test donors returning from dengue transmission areas before donating in non‐endemic regions. While Australia does not have endemic dengue, it has receptive areas with established competent mosquitoes, and local transmission has occurred. We assessed the residual risk to transfusion safety posed by travellers from outbreak‐affected receptive areas to other areas of Australia to inform evidence‐based blood safety policies. Materials and Methods: Dengue outbreaks were identified using National Notifiable Disease Surveillance System data, spatial classification, outbreak thresholds and literature‐based parameters. We used the European Up‐Front Risk Assessment Tool alongside national surveillance and population data to model transfusion risk at national and sub‐national levels during significant local outbreak periods in Australia. Results: The estimated risk of severe outcomes from dengue‐infected blood components was extremely low—between 1 in 13.4 billion and 1 in 1.34 trillion at the national level. The risk differed regionally but still had only a negligible absolute impact. Conclusion: The residual risk of transfusion‐transmitted dengue from travellers returning from outbreaks in Australia to non‐receptive regions is extremely low. These findings support that additional travel questions, restrictions or testing are unnecessary beyond the outbreak areas. This study provides a robust, evidence‐based framework for geographically targeted, risk‐based policies and concludes that additional restrictions outside the outbreak areas are not required to maintain negligible blood safety risk in Australia.

Background and Objectives: In July 2019, Australia removed the upper age limit for returning donors (previously 80 years) and increased the upper age for new donors from 70 to 75 years. This study assessed the safety of our new policy for our newly eligible upper age donors (NEUADs).Materials and Methods: For the period, 14 July 2019 to 30 June 2023, the relative risk (RR) of individual adverse events in NEUADs was compared with younger cohorts.Results: There were 4529 NEUADs who made 8000 donations. The overall rates of vasovagal reactions (VVRs) were significantly lower in the NEUAD cohort. However, compared with younger donors; returning NEUADs had a significantly higher rate of loss of consciousness (RR 2.62; 95% confidence interval [CI]: 1.41–4.86) and new NEUADs had a significantly higher rate of offsite VVRs (RR 1.60; 95% CI: 1.08–2.37). Both new and returning NEUADs had significantly higher rates of VVR requiring outside medical care (RR 2.48; 95% CI: 1.28–4.79 and RR 4.45; 95% CI: 2.00–9.91 respectively).Conclusion: Our findings support historical findings that overall VVR rates decline with age but suggest a higher risk of more serious VVRs.

Background: Currently in Australia, men are deferred from donating blood if they have had sex with another man within the past 3 months. However, a proposed gender‐neutral assessment (GNA) process will ask all donors questions about sex with new or multiple recent partners, with deferral based on responses to a question about anal sex. Understanding the acceptability of such questions among existing and potential blood donors is paramount for successful implementation of GNA.Study Design and Methods: We used data from a nationally representative survey to estimate the levels of comfort with the proposed GNA questions among the Australian population and subgroups, defined by self‐reported ethnicity and religion. Respondents were aged over 18 and living in Australia. Results were weighted to represent the population.Results: Most of the 5178 respondents described themselves as comfortable with answering questions about new partners (73.1%) or anal sex (64.0%) to donate blood. However, 2.2% and 4.5% indicated that questions about new sex partners and anal sex, respectively, would stop them from donating, and 4.4% and 7.7% respectively, said they were “completely uncomfortable.” By religion, the least comfortable were Muslim or Eastern Orthodox respondents, and by country of birth, the least comfortable were those born in the Middle East, followed by those born in Southern Europe and Asia.Discussion: GNA appears to be broadly acceptable in the Australian context, but our findings suggest that key GNA questions are less acceptable in some population subgroups, indicating a need for targeted campaigns that consider cultural sensitivities.

Background and Objectives: To reduce the risk of transfusion‐transmitted malaria (TTM) from transfusible components, Australia tests for malaria antibodies in both travellers returning from and former residents of malaria‐endemic areas. The testing is performed a minimum of 120 days after last potential exposure. TTM is an extremely rare event and managing the risk adds considerable complexity. The objectives of this study were to analyse various testing and deferral strategies, considering the risk, donation numbers and operational complexities.Materials and Methods: A residual risk model was developed to calculate the risk of TTM in five testing/deferral strategies. Australian blood donor data from 2020 and 2021 were used and incorporated the incidence of parasitaemia, Plasmodium species and the malaria enzyme immunoassay test's failure rate. Donor and donation loss or gain and an operational assessment were performed.Results: The current model's estimated risk of TTM is 1 in 67.9 million transfused units. Testing residents with a 120‐day plasma restriction for visitors without testing was found to have the same estimated risk, with an expected increase of 342 donations per year, significant cost savings and a 62% reduction in the number of donors requiring assessment.Conclusion: A strategy that involves testing residents of malaria areas only and a 120‐day plasma travel restriction would not significantly increase the risk of TTM, is operationally simpler, costs less and results in a small increase in donations.

Background and Objectives: The risk of transfusion‐transmitted malaria (TTM) infections is extremely low in Australia, and the cost‐effectiveness of the current screening strategy has not been assessed. This study aims to conduct a cost‐effectiveness analysis of different malaria screening strategies in blood donors as part of the risk‐based decision‐making framework.Materials and Methods: A decision tree model was developed to assess the cost‐effectiveness of five alternative malaria screening strategies from a healthcare sector perspective. Screening strategies combining total or partial removal of malaria testing with different deferral periods were considered. The probabilities of developing severe and uncomplicated TTM were based on a literature review of cases in non‐endemic areas since 2000. The health outcomes were quantified using disability‐adjusted life years. The costs of non‐returning donors due to deferral were also included. Deterministic and probabilistic sensitivity analyses were conducted to account for data uncertainty.Results: The residual risks for all strategies were so low that the costs, mortality and morbidity associated with TTM are almost negligible. The overall costs were predominantly influenced by the costs of non‐returning blood donors. As a result, removal of malaria testing and applying a 28‐day deferral for at‐risk donors were the least costly and most cost‐effective of all the options considered.Conclusion: The current screening strategy for malaria in blood donors in Australia is not an efficient use of healthcare resources. Partial or total removal of malaria testing would bring significant cost savings without significantly compromising blood safety.