Blood Donor Malaria Deferral for Travel to Cancun

The following question was submitted by a Transfusion Medicine physician/Blood Bank Director in Southern California:

In review of the CDC Yellowbook for malaria deferral it was noted that the resort city of Cancun is currently designated as "very low risk". Our donor center has exempted such resort cities in the past based on non-inclusion in risk locations for malaria in the Yellowbook. Though there was no notification of a change in status, we were able to verify that earlier editions indicated Cancun was not an endemic malarial area.

We searched for more definitive guidelines on this issue and found a transcript from 2011 AABB Annual Meeting," Ask the FDA" section. In response to question 26, which deals with stratification of malarial risk by the CDC, Dr. Mied answered "FDA considers that *any degree of malaria risk* -- from the subjective designations of very low to high -- for a particular area should cause that area to be considered a malaria endemic area, and should be sufficient to trigger deferral of a donor who has traveled to that area. Now, we intend to issue a guidance document and address this point and make it perfectly clear in future guidance."

Our concern is that this will significantly impact our donor base and we will see many new deferrals.

We also asked some of our local colleagues and found that Cancun continues to be an exception (acceptable travel) for other institutions. We are interested in how this is being handled by others.

The following comments have been received.

ADDENDA Mar. 29, 2012

1. Dr. Jay Brooks, Professor of Pathology at University of Florida/Shands Hospital, Gainesville (attribution with permission) states that at his previous institution (his current hospital does not collect blood from donors), they considered blood donors who stayed in the Cancun resort areas to be exempt from the malaria deferral. If the Cancun visitor made day trips to remote areas, then they would defer. However, in his experience, most visitors stayed in the resorts at Cancun.
   
   He notes that Cancun is a frequent tourist destination for people living in the Southern United States and deferral of all Cancun visitors would have dire consequences for the blood supply in this region. Dr. Brooks awaits the FDA guidance document, but it is of his opinion that the CDC Yellowbook “very low risk” designation is not substantively different from “no risk” for the purposes of blood donors who travel to Cancun. Dr. Brooks also notes that this year’s ISBT meeting is being held in Cancun in July and asks if all meeting attendees should therefore be deferred as donors.

ADDENDA April 20, 2012

2. A Blood Center Medical Director agrees that Cancun should NOT be a travel deferral for malaria. However, his blood center was cited recently by the FDA for not considering ANY risk of malaria mentioned in the Yellowbook (including Cancun) as reason for deferral. This citation caused his blood center to institute a deferral for Cancun travel, despite his opinion that this deferral is not scientifically valid. The medical director agrees that an FDA Guidance for malaria-risk travel would give clarity to this issue.

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