(P-TS-129) Trends in the Incidence of Transfusion-Transmissible Infections in the United States, 2000–2023: Implications for Blood Safety and Donor Risk

Background/Case Studies: Syphilis, HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) remain major transfusion-transmissible infections (TTIs). After decades of risk mitigation, transmission of TTIs in the US is very rare at approximately < 1 per 1 million transfusions. Nonetheless, there is a need for ongoing surveillance as the evolving epidemiology of the general population can influence the blood donor pool. We sought to evaluate national and regional trends in the epidemiology of these TTIs from 2000 to 2023 using CDC AtlasPlus data.

Study

Design/Methods: The CDC AtlasPlus tool provides access to standard surveillance data via mandatory reporting of annual new diagnoses of HIV (2008–2022) and reported cases of primary/secondary syphilis (2000-2023), acute HBV (2000–2022), and acute HCV (2000–2022). Data were stratified by sex, age group, race/ethnicity, and US Census region, and reported below as rates per 100,000 population. National and regional trends and percent changes were evaluated. Pearson correlation coefficients were calculated to quantify associations between TTI incidence rates.

Results/Findings: From 2000 to 2023, reported cases of primary/secondary syphilis rose from 2.1 to 15.8 per 100,000 (+652%, Figure A). In 2023, the highest rates were observed in American Indian/Alaska Native (58.2) and Black (39.7) individuals. Males aged 30–34 (42.0) were disproportionately affected, particularly in the South and West Census regions. HIV diagnoses declined 28.5% from 2008 to 2022 (18.6 to 13.3) but remained elevated in Black and Hispanic males, with the highest rates in 2022 observed in Washington, DC and the southeastern US. Moderate positive correlation was observed between syphilis and HIV rates at state (r=0.35) and regional (r=0.56) levels. Co-endemicity was concentrated in urban areas and the South. Acute HBV incidence declined 79% (2.9 to 0.6), but plateaued after 2008, rising in some southeastern states. In 2022, HBV rates were highest among Black individuals, males, and adults aged 45–54. Acute HCV decreased by 73% (1.1 to 0.3) between 2000 and 2010 but increased by 400% (0.3 to 1.5) by 2022. In 2022, the highest HCV rates were observed in American Indian/Alaska Native individuals, those aged 25–44, and in Maine, Florida, and Utah. Co-endemicity of HIV, syphilis, and HCV was notable in the South and Northeast.

Conclusions: Rising TTI rates and persistent inequities in TTI burden—particularly among racially minoritized populations, who accounted for 12% of donations in 2021—present ongoing challenges as the US seeks to diversify its blood supply. New infections pose the greatest risk to blood supply, though the window period is short in the contemporary era. Enhanced outreach, region-stratified donor risk modeling, expanded pathogen reduction technology, and public health surveillance with attention to regional TTI co-infection will be vital to optimizing blood safety and donor diversity.