Guidance on the management of asymptomatic blood donors who test positive for Babesia

Evan M Bloch; Jeremy W Jacobs; Edouard Vannier; Gary P Wormser; Jeffrey A Gelfand; Vijay K Sikand; Howard M Heller; Sunil K Sood; Laura Kirkman; Jennie E Johnson; Luis A Marcos; Jacob E Lemieux; Robert P Smith; Ann E Woolley; Whitney A Perry; Philip M Polgreen; Susan E Beekmann; David J Sullivan; Paul G Auwaerter; Peter J Krause

doi:10.1093/cid/ciaf721

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Guidance on the management of asymptomatic blood donors who test positive for Babesia

Journal article

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Guidance on the management of asymptomatic blood donors who test positive for Babesia

Evan M Bloch, Jeremy W Jacobs, Edouard Vannier, Gary P Wormser, Jeffrey A Gelfand, Vijay K Sikand, Howard M Heller, Sunil K Sood, Laura Kirkman, Jennie E Johnson, …

Clinical infectious diseases, PMID 9203213

12/26/2025

DOI: 10.1093/cid/ciaf721

PMCID: PMC12831819

PMID: 41452032

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Abstract

Babesiosis is a tick-borne disease that is endemic in the United States (US). The major species, Babesia microti, is readily transmissible via blood transfusion. Since 2019, blood donors in 14 US states and Washington DC have been routinely screened for Babesia infection using highly sensitive and specific nucleic acid testing (NAT). Currently, there are no recommendations regarding the management of asymptomatic blood donors who test positive for Babesia. A multidisciplinary expert panel was convened to develop guidance for the management of asymptomatic Babesia-infected blood donors. A survey was distributed through the Infectious Diseases Society of America (IDSA) Emerging Infections Network (EIN) to evaluate how a geographically diverse group of infectious diseases specialists would approach this problem. The expert panel recommends that all Babesia NAT positive blood donors should be referred for clinical evaluation and retested using peripheral blood smear (PBS) and B. microti PCR within two months of blood donation screening. The panel also recommends observation rather than treatment for a reactive molecular test alone. Antimicrobial therapy should be considered for PBS positive cases. Donors should be counseled regarding the typically self-limiting nature of this infection and instructed to seek medical care if symptoms develop. The EIN survey results are consistent with these recommendations. Several factors support these management recommendations. Blood donors typically comprise healthy, immunocompetent adults in whom most Babesia infections are self-limited based on studies showing that molecular evidence of infection clears in almost all asymptomatic blood donors without intervention.

blood donors

screening

babesiosis

guideline

Babesia

Details

Title: Subtitle: Guidance on the management of asymptomatic blood donors who test positive for Babesia
Creators: Evan M Bloch - Johns Hopkins University
Jeremy W Jacobs - Vanderbilt University
Edouard Vannier - Tufts Medical Center
Gary P Wormser - New York Medical College
Jeffrey A Gelfand - Massachusetts General Hospital
Vijay K Sikand - Tufts University
Howard M Heller - Harvard University
Sunil K Sood - Cohen Children's Medical Center
Laura Kirkman - Weill Cornell Medicine
Jennie E Johnson - Brown University
Luis A Marcos - Stony Brook University
Jacob E Lemieux - Broad Institute
Robert P Smith - Maine Medical Center Research Institute
Ann E Woolley - Brigham and Women's Hospital
Whitney A Perry - Tufts Medical Center
Philip M Polgreen - University of Iowa
Susan E Beekmann - University of Iowa
David J Sullivan - Johns Hopkins University
Paul G Auwaerter - Johns Hopkins University
Peter J Krause - Yale University
Resource Type: Journal article
Publication Details: Clinical infectious diseases, PMID 9203213
DOI: 10.1093/cid/ciaf721
PMID: 41452032
PMCID: PMC12831819
NLM abbreviation: Clin Infect Dis
ISSN: 1537-6591
eISSN: 1537-6591
Publisher: Oxford University Press
Grant note: National Heart Lung and Blood Institute: 1K23HL151826 Centers for Disease Control and Prevention: NU50CK000574 Ken and Sherrilyn Fisher Center for Environmental Infectious Diseases
E.M.B.'s effort is supported in part by the National Heart Lung and Blood Institute (1K23HL151826). Work pertaining to the EIN was funded by the Centers for Disease Control and Prevention (cooperative agreement number 5, grant number NU50CK000574 to P. M. P. and S. E. B.). This work was supported in part by a gift from The Llura A. Gund Laboratory for Vector borne Disease Research and the Gordon and Llura Gund Foundation (to P. J. K.). This work was supported by the Ken and Sherrilyn Fisher Center for Environmental Infectious Diseases.
Language: English
Electronic publication date: 12/26/2025
Academic Unit: Infectious Diseases; Epidemiology; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9985096042602771

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