Overseas Travel Deferral Criteria
Our priority is always to provide the safest possible blood to all patients in need. Overseas travel to an area with a risk of insect-borne or animal-borne infections can result in infections that may be transmitted through blood transfusion by asymptomatic donors.
Our areas of concern related to infection risks with overseas travel are:
The overseas travel deferral measures that we have adopted are in line with international guidelines and best practices in blood banking. We will continue to closely monitor scientific developments in blood screening that may enable us to review these precautionary measures from time to time.
If you have visited a country with a travel risk and planning to donate blood, please call us:
Bloodbank@Outram – 62130626
Bloodbank@Dhoby Ghaut – 63335532
Bloodbank@Woodlands – 67660576
Bloodbank@West Gate - 67107548
Our medical staff will inform you if the city or specific area in the country that you have visited is affected (or not) and they will be able to advise you when can you come back to continue donating blood.
Malaria is caused by Plasmodia, a parasitic infection transmitted through the bite of an infected Anopheles mosquito. Malaria can also be transmitted by blood transfusion and organ transplants. Click here for more information about malaria. The incubation period for malaria is typically 4 weeks for falciparum malaria, and typically 4 to 8 weeks for vivax malaria.
However, symptoms of malaria (such as fever, vomiting, headache, dark urine) can occur as early as a week after infection and even up to a year after exposure in an area with malaria. Persons who have had malaria can also be re-infected more than once, and can have relapses, depending on the malaria type and treatment.
To ensure our blood supply is free of malaria, we test the blood of donors if they previously resided in a malaria endemic area in the past or visited a malaria endemic area in the past 12 months, since they may have been infected or exposed to malaria. Donors who return less than 4 months from a malaria endemic area will be deferred from blood donation for at least 4 months from the day they left the area. The deferral period enables us to reliably test for malaria in the donated blood as it takes about 4 months for the body to develop antibody after exposure. “The above advice on travel to malaria endemic areas applies only to those who stayed in a malaria endemic area “overnight” (meaning they spent at least one night in a malaria endemic area). Donors who visited a malaria endemic area for a short “day trip” (that is, the visit was only during the daytime) are not considered to be at risk and can donate as per normal (whole blood and apheresis plasma and platelets). Donors are welcome to call the blood bank and speak to our medical staff if they have questions regarding our donor criteria for travel to malaria endemic areas or if they are unsure whether the place you have visited is considered malaria endemic.”
The malaria endemic areas* in the commonly visited countries include:
- Bangladesh (All areas, except in the city of Dhaka)
- Cambodia (Present throughout the country including Siem Reap city. None in the city of Phnom Penh and the temple complex at Angkor Wat)
- India (All areas throughout country, including cities of Bombay (Mumbai) and Delhi, except none in areas above 2,000m in Himachal Pradesh, Jammu and Kashmir, and Sikkim).
- Indonesia (All areas of eastern Indonesia (provinces of Maluku, Maluku Utara, Nusa Tenggara Timur, Papua, and Papua Barat) including town of Labuan Bajo and Komodo Islands in the Nusa Tengarra region. Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi and Sumatra. Low transmission in rural areas of Java including Pangandaran, Sukalumi, and Ujung Kulong; Batam, Bintan)
- Laos (All areas except in the city of Vientiane)
- Malaysia (Present in rural areas. None in Georgetown, Kuala Lumpur and Penang State (includes Penang Island))
- Myanmar (All areas at altitude below 1000m which includes Yangon, Mandalay and Bagan)
- Thailand (Present in provinces that border Burma (Myanmar), Cambodia, and Laos, and the provinces of Kalasin, Krabi (Plai Phraya District), Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (including Phang Nga City), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala, especially the rural forest and forest fringe areas of these provinces. None in the islands of Krabi Province (Koh Phi Phi, Koh Yao Noi, Koh Yao Yai, and Ko Lanta) and Pattaya City.
- Vietnam (Rural areas only. Rare cases in the Mekong and Red River Deltas. None in the cities of Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), Nha Trang, Qui Nhon)
First-time donors with a history of malaria, as well as regular donors whose blood are tested positive for malaria, will be deferred indefinitely. Persons who have had malaria may still carry a low level of parasites in their body although they have recovered and display no symptoms.
Donors' blood donations will be tested if they have:
- Visited a malaria endemic area in the last 12 months
- Lived in a malaria endemic area for more than 6 months continuously
Click here for the latest list of malaria endemic areas.
Variant Creutzfeldt-Jakob disease (vCJD) is a rare but fatal human neurodegenerative condition. As with the Creutzfeldt-Jakob disease, vCJD is classified as a Transmissible Spongiform Encephalopathy (TSE) because of the characteristic spongy degeneration of the brain and its ability to be transmitted.
In contrast to the traditional forms of CJD, vCJD has affected younger patients (average age of 29 years, as opposed to 65 years), and has a relatively longer duration of illness (median of 14 months as opposed to 4.5 months). vCJD is strongly linked to exposure, probably through food, to a TSE of cattle called Bovine Spongiform Encephalopathy (BSE).
Click here to learn more about vCJD.
HSA has adopted the policy of excluding donors from the United Kingdom (UK) and most European countries due to the incidence of endogenous human clinical vCJD (“Mad Cow Disease”) infections and outbreaks of vCJD in their cattle industry.
Donors will not be eligible to donate blood if they have:
- Visited or lived in the United Kingdom (England, Northern Ireland, Scotland, Wales, the Isle of Man or the Channel Island) between 1980 and 1996 for a cumulative period of 3 months or longer
- Visited or lived in France since 1980 for a cumulative period of 5 years or longer
- Received a transfusion of blood or blood components in France or the United Kingdom since 1980
Donors who have lived in other European countries (excluding France and UK) for 5 years or more are advised to donate only plasma via apheresis procedure.
These precautionary deferral measures have been adopted by Singapore as well as many other countries/regions such as the USA, Australia, New Zealand, Japan and Hong Kong. There is currently no reliable screening test for vCJD in the blood. As vCJD has been reported to be transmitted through blood transfusion in at least 3 cases in the UK, we have decided to adopt these stringent precautions in the interests of blood safety for our patients.
• West Nile Virus
West Nile Virus (WNV) is an arthropod-borne virus of the family Flaviviridae. It mainly infects birds, but humans can be infected through the bite of an infected Culex mosquito. The incubation period is about 3 to 14 days. Most of the infected patients are asymptomatic. Some may present as mild fever with flu-like symptoms. Rarely, it may present as meningitis or encephalitis.
Click here to learn more about WNV.
Persons considered to be at risk of WNV infection are those who have travelled to areas with risk of WNV transmission in the past 28 days. Hence, donors who have travelled to these countries or regions can only donate 4 weeks upon return to Singapore.
Click here for the latest list of West Nile Virus endemic areas.
• Chagas Disease
Chagas disease is widely endemic throughout Central and South America, and Mexico, where the main mode of transmission is exposure to infected triatomine (or reduviid) bugs. Most infections are asymptomatic or cause non-specific, flu-like symptoms and are not diagnosed. Chagas disease can cause serious complications of the heart and gastrointestinal tract in approximately 30 per cent of infected individuals. Donors who were diagnosed to have Chagas disease are deferred permanently. Since screening tests for donors are not available, donors with an identified risk of Chagas disease should be permanently deferred. Risk factors include:
- Donors born in South America or Central America and Mexico
- Donors whose mother was born in South America or Central America and Mexico
- Those who have received blood transfusion in South America or Central America and Mexico
- Those who have lived or worked in rural subsistence farming communities in South America or Central America and Mexico for a continuous period of four weeks or more
Click here for the latest list of Chagas Disease endemic areas.
• Zika Virus
The Health Sciences Authority is taking additional precautionary measures to reduce the risk of Zika virus entering Singapore’s blood supply.
Universal testing of all blood donations for Zika virus was implemented 16th Jan 2017. With the implementation of Zika virus testing for all blood donations, donors who visit countries with ongoing outbreaks of Zika infection will no longer need to be deferred for 4 weeks after travel. However donors who travel to areas with concurrent endemic malaria and Chagas disease will still be advised on the post-travel donation restrictions mentioned in the above sections.
Thank you for your understanding and support in ensuring a safe and sustainable blood supply for patients in Singapore.