Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Syphilis seroprevalence and incidence in U.S. blood donors from 2020 to 2022
September 2024—Syphilis, an infectious disease caused by the spirochete bacterium Treponema pallidum, can be transmitted by blood transfusion. Therefore, donor blood has been routinely screened for syphilis since the 1950s. Although a case of transfusion-transmitted syphilis has not been documented in more than 50 years, routine serological testing is still performed because there is not sufficient evidence that it is no longer necessary. Syphilis testing can contribute to disease monitoring for overall public health by identifying infected blood donors so they can seek treatment to prevent further spread. The Transfusion Transmissible Infections Monitoring System (TTIMS) monitors infectious disease and demographic changes in donors who contribute approximately 60 percent of the U.S. blood supply, including at four major blood-collection organizations. The TTIMS monitors HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections, and, since 2020, syphilis, at which time the system was named TTIMS2. The authors conducted a study to report the prevalence and incidence of syphilis infection over the first two-year period of TTIMS2 overall and based on demographics and other risk factors, as well as the correlation of syphilis infection with other transfusion-transmissible infections. They collected data from October 2020 to September 2022 from donors of allogeneic and directed donations with valid test results for transfusion-transmissible infection markers, including syphilis, HBV, HCV, and HIV. Donors were categorized by age, race/ethnicity, geographic region, and repeat or first-time donor since September 2010. A donation was defined as consensus positive for syphilis if screening was reactive for detecting T. pallidum antibodies and equivocal or positive on confirmation testing. Alternatively, a donation was considered an active infection if a syphilis consensus-positive donation further tested positive on a rapid plasma reagin test. The results showed that among 14.75 million donations, syphilis prevalence was 28.4 per 100,000 donations and significantly higher during the second year compared with the first. The overall incidence of syphilis was 10.8 per 100,000 person-years for the two-year period. The adjusted odds of a consensus-positive infection were 1.18 times higher in the second year than in the first. For active infection, it was 1.22 times higher in year two. The highest rates occurred among male, first-time, Black, and younger (ages 18–39) donors, and those living in the South. In addition, syphilis consensus-positive donors were 64 times more likely to be HIV consensus positive, and donors with active infection were 77 times more likely to be HIV consensus positive than non-consensus-positive donors, when controlling for confounding variables. The authors noted that as the TTIMS2 program continues, syphilis trends will be continuously monitored to understand the trajectory of infection in the United States and evaluate the adoption of an FDA-approved individual donor risk assessment implemented at TTIMS2 centers between August and October 2023. They concluded that the data suggest that syphilis prevalence increased during the study period, which is consistent with CDC reports covering national trending of the disease. The study also demonstrated that syphilis infection was significantly associated with being HIV consensus positive.
Conti G, Notari EP, Dodd RY, et al. Syphilis seroprevalence and incidence in US blood donors from 2020 to 2022. Transfusion. 2024;64:325–333.
Correspondence: Galen Conti at galen.conti@redcross.org
PathElective.com as a model for novel pathology pedagogy and a primer
for curricular evolution
Medical education transformed overnight from an in-person to a virtual experience during the COVID-19 pandemic. Recent changes in United States Medical Licensing Examination step one to pass/fail reporting and revision of the curriculum to even less preclinical pathology education has increased the need for educators to be innovative and flexible in teaching pathology. PathElective.com is a novel approach to teaching that was developed in response to restrictions imposed during the pandemic. Since its inception in May 2020, PathElective.com has been incorporated into many medical student and resident training programs worldwide. The authors conducted a study to provide an overview of PathElective relative to student usage, course choice, change in medical knowledge, and attrition rates to gain insight into the effectiveness of virtual education for guiding future curricula. The company Squarespace developed the PathElective.com website. Using functionality provided by Squarespace, PathElective.com collected website analytics. PathElective.com included course content in anatomic and clinical pathology, which was designed, composed, and curated by a course coordinator who was a pathologist or another experienced medical laboratory professional. Subscriptions to PathElective are free, but users must provide an email to which certificates can be sent and to confirm their agreement with terms and conditions and use of their quiz data for research. Using a dual-form crossover quiz, students were assessed, for purposes of the study, before and after participating in the course, with the intent of measuring their assimilation of new knowledge. The data collected on the quizzes were anonymized and analyzed with a paired t test to account for the differences in student backgrounds. A second analysis examined the attrition rate of students across multiple modules. The results showed that during the study period of May 2020 to October 2021, PathElective.com received 577,483 page views, 126,180 visits, 59,928 unique visitors, and 10,278 registered users who earned 15,305 certificates. A total of 7,338 pre- and post-module quiz pairs were analyzed. The overall increase in average score was 13.83 percent (P=.02). All but five of the 56 courses showed a statistically significant increase in scores. In the six assessment domains, all courses received median scores of very satisfied/satisfied. Attrition data revealed a unique, negative polynomial relationship (R2= 0.656). The authors concluded that PathElective.com is an effective means of enhancing anatomic and clinical pathology training for medical students, residents, fellows, and physicians. Future research could focus on utilizing PathElective in select educational settings as well as its teaching style and impact on student performance. The authors noted that experiences from PathElective.com could drive the development of online medical education resources.
Lilley CM, Arnold CA, Arnold MA, et al. Virtual pathology elective, real education. The PathElective.com experience as a model for novel pathology pedagogy and a primer for curricular evolution. Arch Pathol Lab Med. 2024;148:595–602.
Correspondence: Dr. Kamran M. Mirza at kamran.mirza@lumc.edu