{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:51:26Z","timestamp":1788447086497,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T00:00:00Z","timestamp":1545091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vox Sanguinis"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Donor syphilis testing began in the 1940s amidst widespread transfusion\u2010transmitted syphilis (<jats:styled-content style=\"fixed-case\">TTS<\/jats:styled-content>). Since then, the introduction of penicillin, pre\u2010donation screening questionnaires and improved storage conditions have contributed to reducing transmission risk. Consequently, universal testing may no longer be cost\u2010effective. This study analysed alternative options for donor syphilis testing to determine the optimal strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>A model was developed using conservative parameter estimates for factors affecting <jats:styled-content style=\"fixed-case\">TTS<\/jats:styled-content> and 2009\u20102015 Australian donations to calculate risk outcomes (<jats:styled-content style=\"fixed-case\">TTS<\/jats:styled-content> infections, tertiary syphilis in recipients and transfusion\u2010associated congenital syphilis) and cost\u2010effectiveness of alternative testing strategies. The strategies modelled were as follows: universal testing, targeted\u2010testing of high\u2010risk groups (males \u226450 years old and first\u2010time donors) and no testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The estimated risk of <jats:styled-content style=\"fixed-case\">TTS<\/jats:styled-content> is one in 49\u00b75 million transfusions for universal testing, one in 6 million for targeted\u2010testing of males \u226450 years old, one in 4 million for targeted\u2010testing of first\u2010time donors and one in 2\u00b78 million for no testing. For all strategies, the risk of tertiary and congenital syphilis is &lt;1 in 100 million. Universal testing is the least cost\u2010effective strategy with an incremental cost\u2010effectiveness ratio (ICER) estimated at $538\u00b75 million per disability\u2010adjusted life year averted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Universal testing is not required to maintain the risk of <jats:styled-content style=\"fixed-case\">TTS<\/jats:styled-content> within tolerable limits and is estimated to greatly exceed acceptable <jats:styled-content style=\"fixed-case\">ICER<\/jats:styled-content>s for blood safety interventions. However, despite a strong economic and risk\u2010based rationale, given the epidemiology of syphilis in Australia is changing, feedback from critical stakeholders is not currently supportive of reducing testing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/vox.12741","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T01:14:48Z","timestamp":1545182088000},"page":"107-116","source":"Crossref","is-referenced-by-count":19,"title":["Modelling the risk of transfusion\u2010transmitted syphilis: a reconsideration of blood donation testing strategies"],"prefix":"10.1111","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4477-9960","authenticated-orcid":false,"given":"Thisuri","family":"Jayawardena","sequence":"first","affiliation":[{"name":"Faculty of Health and Medical Sciences University of Western Australia Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7827-3661","authenticated-orcid":false,"given":"Veronica","family":"Hoad","sequence":"additional","affiliation":[{"name":"Australian Red Cross Blood Service Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3840-847X","authenticated-orcid":false,"given":"Claire","family":"Styles","sequence":"additional","affiliation":[{"name":"Australian Red Cross Blood Service Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0234-4507","authenticated-orcid":false,"given":"Clive","family":"Seed","sequence":"additional","affiliation":[{"name":"Australian Red Cross Blood Service Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8680-922X","authenticated-orcid":false,"given":"Peter","family":"Bentley","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences University of Western Australia Perth WA Australia"},{"name":"Australian Red Cross Blood Service Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Clifford","sequence":"additional","affiliation":[{"name":"Australian Red Cross Blood Service Melbourne VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarina","family":"Lacey","sequence":"additional","affiliation":[{"name":"Centre for International Economics Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Gastrell","sequence":"additional","affiliation":[{"name":"Centre for International Economics Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2008.09.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/tm.2001.26956"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2009.02119.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1990.30991048793.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000466290"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.1985.tb01131.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.4297\/najms.2011.3329"},{"key":"e_1_2_7_9_1","first-page":"299","article-title":"Spirochetal survival in frozen plasma","volume":"71","author":"Ravitch MM","year":"1942","journal-title":"Bull Johns Hopk Hosp"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3148.2006.00709.x"},{"key":"e_1_2_7_11_1","first-page":"3","article-title":"The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re\u2010study of the Boeck\u2010Bruusgaard material","volume":"35","author":"Gjestland T","year":"1955","journal-title":"Acta Derm Venereol Suppl (Stockh)"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1086\/655832"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2008.02042.x"},{"key":"e_1_2_7_14_1","unstructured":"JanssenM vanHoevenL RautmannG:Trends and observations on the collection testing and use of blood and blood components in Europe.2013"},{"key":"e_1_2_7_15_1","volume-title":"Implementation of pathogen reduction technologies for blood components for transfusion: updated table 2009\u20102010","author":"Lozano M","year":"2010"},{"key":"e_1_2_7_16_1","unstructured":"European Centre for Disease Prevention and Control (ECDC):Syphilis: reporting on data retrieved from the European Surveillance System on 19 November 2015. 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[Last accessed 15 Jan 2018]"},{"key":"e_1_2_7_20_1","unstructured":"World Health Organization (WHO):WHO recommendations for the production control and regulation of human plasma for fractionation. World Health Organization 2005. Available from:http:\/\/www.who.int\/biologicals\/publications\/ECBS%202005%20Annex%204%20Human%20Plasma%20Fractionation.pdf. [Last accessed 15 Jan 2018]"},{"key":"e_1_2_7_21_1","unstructured":"Australian Commission on Safety and Quality in Health Care (ACSQHC):AURA 2017: second Australian report on antimicrobial use and resistance in human health. ACSQHC 2017. Available from:http:\/\/www.safetyandquality.gov.au\/antimicrobial-use-and-resistance-in-australia\/resources-page\/. [Last accessed 1 May 2018]"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268814002830"},{"key":"e_1_2_7_23_1","first-page":"197","article-title":"Syphilis testing in blood donors: an update","volume":"13","author":"Kaur G","year":"2015","journal-title":"Blood Transfus"},{"key":"e_1_2_7_24_1","volume-title":"Assessing cost\u2010effectiveness in prevention (ACE\u2010Prevention): final report","author":"Vos T","year":"2010"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12805"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03319.x"},{"key":"e_1_2_7_27_1","unstructured":"Australian Government Department of Health:National Notifiable Diseases Surveillance System (NNDSS). Australian Government Department of Health 2018. Available from:http:\/\/www.health.gov.au\/internet\/main\/publishing.nsf\/Content\/cda-surveil-nndss-nndssintro.htm. [Last accessed 30 Sep 2017]"},{"key":"e_1_2_7_28_1","volume-title":"Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: annual surveillance report","author":"Kirby Institute","year":"2017"},{"key":"e_1_2_7_29_1","unstructured":"Australian Institute of Health and Welfare (AIHW):The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples: 2015. AIHW 2015. Cat.no. 147. Available from:www.aihw.gov.au\/reports\/indigenous-health-welfare\/indigenous-health-welfare-2015\/contents\/table-of-contents. [Last accessed 30 Jan 2018]"},{"key":"e_1_2_7_30_1","unstructured":"Department of Health and Human Services Victoria:Increase in syphilis and gonorrhoea in men who have sex with men (MSM); Health advisory.2016. Available from:https:\/\/www2.health.vic.gov.au\/about\/news-and-events\/healthalerts\/increase-in-syphilis-men-7-December-2016. [Last accessed 30 Jan 2018]"},{"key":"e_1_2_7_31_1","unstructured":"Kirby Institute University of New South Wales (UNSW) Australian Red Cross Blood Service:Transfusion\u2010transmissible infections in Australia: 2017 Surveillance Report. Kirby Institute UNSW 2017. Available from:https:\/\/kirby.unsw.edu.au\/report\/transfusion-transmissible-infections-australia-surveillance-report-2017. [Last accessed 15 Jan 2018]"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2014.07.005"},{"key":"e_1_2_7_33_1","unstructured":"Department of Health Western Australia:Silver book \u2010 Guidelines for managing sexually transmitted infections and blood\u2010borne viruses.2015. Available from:http:\/\/ww2.health.wa.gov.au\/Silver-book. [Last accessed 1 May 2017]"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.12734"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12111"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2009.02516.x"},{"key":"e_1_2_7_37_1","first-page":"120","article-title":"Factors affecting the survival of Treponema pallidum in vitro","volume":"48","author":"Nelson RA","year":"1948","journal-title":"Am J Hyg"},{"key":"e_1_2_7_38_1","first-page":"401","article-title":"Factors influencing the in vitro survival of Treponema pallidum","volume":"71","author":"Weber MM","year":"1960","journal-title":"Am J Hyg"},{"key":"e_1_2_7_39_1","unstructured":"Australian Commission on Safety and Quality in Health Care:Antimicrobial use in Australian hospitals: 2014 annual report of the National Antimicrobial Utilisation Surveillance Program. SA Health Government of South Australia 2015. 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[Last accessed 18 June 2017]"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.12.2.187"},{"key":"e_1_2_7_45_1","unstructured":"The Pharmaceutical Benefits Scheme:Benzathine benzylpenicillin. Department of Health Australian Government 2017. Available from:http:\/\/www.pbs.gov.au\/medicine\/item\/2267H-5027N. [Last accessed 31 Oct 2017]"},{"key":"e_1_2_7_46_1","unstructured":"Institute of Health Metrics and Evaluation (IHME):Global burden of disease study 2015 disability weights. IHME 2016. Available from:http:\/\/ghdx.healthdata.org\/record\/global-burden-disease-study-2015-gbd-2015-disability-weights. [Last accessed 31 Oct 2017]"},{"key":"e_1_2_7_47_1","unstructured":"World Health Organization (WHO):The global burden of disease: 2004 update. Geneva WHO 2004. Available from:www.who.int\/healthinfo\/global_burden_disease\/GBD2004_DisabilityWeights.pdf. [Last accessed 31 Oct 2017]"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix326"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815001168"},{"key":"e_1_2_7_50_1","doi-asserted-by":"crossref","first-page":"e0153106","DOI":"10.1371\/journal.pone.0153106","article-title":"Disease burden of 32 infectious diseases in the Netherlands, 2007\u20102011","volume":"11","author":"Lier A","year":"2016","journal-title":"PLoS ONE"},{"key":"e_1_2_7_51_1","unstructured":"World Health Organization (WHO) STI Guideline Development Group:WHO guidelines for the treatment of Treponema pallidum (syphilis). Geneva WHO 2016. Available from:http:\/\/www.who.int\/reproductivehealth\/publications\/rtis\/syphilis-treatment-guidelines\/en\/. 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