Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Current Good Manufacturing Practices and Related Regulations for Blood and Blood Components; and Requirements for Donor Testing, Donor Notification, and “Lookback”, 66901-66906 [E8-26863]
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Federal Register / Vol. 73, No. 219 / Wednesday, November 12, 2008 / Notices
promotion programs; administering a
national occupational safety and health
program; controlling the introduction and
spread of infectious diseases; and providing
consultation and assistance to other nations
and international agencies to assist in
improving their disease prevention and
control, environmental health, and health
promotion activities. CDC carries out these
functions through a number of Coordinating
Centers/Offices and National Centers and
Institutes with expertise and responsibilities
in specific areas.
Matters to be Discussed: The agenda will
include discussions on program activities,
including scientific programs, that will assist
in consolidating and refining NCHM vision,
mission, goals, organizational structure and
expanding and implementing its science for
the National Center for Health Marketing;
and discussions related to the National
Center’s role in preparedness, response and
recovery with regards to an outbreak of
pandemic influenza
Agenda items are tentative and subject to
change.
Contact Person for More Information:
Dionne R. Mason, Committee Management
Specialist, NCHM, 1600 Clifton Road, Mail
Stop E–21, Atlanta, Georgia 30333,
Telephone: (404) 498–2314, Fax (404) 498–
2221. The deadline for notification of
attendance is November 20, 2008.
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authority to sign Federal Register notices
pertaining to announcements of meetings and
other committee management activities for
both CDC and the Agency for Toxic
Substances and Disease Registry.
Dated: November 4, 2008.
Elaine L. Baker,
Director, Management Analysis and Services
Office, Centers for Disease Control and
Prevention (CDC).
[FR Doc. E8–26803 Filed 11–10–08; 8:45 am]
Purpose: This group is charged with
providing advice and guidance to the
Secretary, Department of Health and Human
Services, and the Director, CDC, concerning
the scientific and technical merit of grant and
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Matters to be Discussed: The meeting will
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reviews conducted in response to Fiscal Year
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following individual research
announcements: (1) RFA–CD–08–001,
‘‘Elimination of Health Disparities Through
Translation Research (R18)’’ and (2) RFA–
CE–09–001, ‘‘Grants for the Injury Control
Research Centers’’. Agenda items are subject
to change as priorities dictate.
Contact Person for More Information: Rick
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Research Program Office, NCIPC and
Executive Secretary, NCIPC IRG, CDC, 4770
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Atlanta, Georgia 30341, Telephone: (770)
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The Director, Management Analysis and
Services Office has been delegated the
authority to sign Federal Register notices
pertaining to announcements of meetings and
other committee management activities for
both CDC and the Agency for Toxic
Substances and Disease Registry.
Dated: November 4, 2008.
Elaine L. Baker,
Director, Management Analysis and Services
Office, Centers for Disease Control and
Prevention.
[FR Doc. E8–26801 Filed 11–10–08; 8:45 am]
BILLING CODE 4163–18–P
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
Centers for Disease Control and
Prevention (CDC)
Agency Information Collection
Activities; Submission for Office of
Management and Budget Review;
Comment Request; Current Good
Manufacturing Practices and Related
Regulations for Blood and Blood
Components; and Requirements for
Donor Testing, Donor Notification, and
‘‘Lookback’’
[Docket No. FDA–2008–N–0345]
National Center for Injury Prevention
and Control, Initial Review Group,
(NCIPC, IRG)
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In accordance with section 10(a)(2) of
the Federal Advisory Committee Act
(Pub. L. 92–463), CDC announces the
following meeting for the
aforementioned committee:
Times and Date: 1 p.m.–2:30 p.m.,
December 8, 2008 (Closed).
Place: Teleconference.
Status: The meeting will be closed to the
public in accordance with provisions set
forth in Section 552b(c)(4) and (6), Title 5,
U.S.C., and the Determination of the Director,
Management Analysis and Services Office,
CDC, pursuant to Section 10(d) of Public Law
92–463.
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AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
SUMMARY: The Food and Drug
Administration (FDA) is announcing
that a proposed collection of
information has been submitted to the
Office of Management and Budget
(OMB) for review and clearance under
the Paperwork Reduction Act of 1995.
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66901
Fax written comments on the
collection of information by December
12, 2008.
ADDRESSES: To ensure that comments on
the information collection are received,
OMB recommends that written
comments be faxed to the Office of
Information and Regulatory Affairs,
OMB, Attn: FDA Desk Officer, FAX:
202–395–6974, or e-mailed to
oira_submission@omb.eop.gov. All
comments should be identified with the
OMB control number 0910–0116. Also
include the FDA docket number found
in brackets in the heading of this
document.
FOR FURTHER INFORMATION CONTACT:
Jonna Capezzuto, Office of Information
Management (HFA–710), Food and Drug
Administration, 5600 Fishers Lane,
Rockville, MD 20857, 301–796–3794.
SUPPLEMENTARY INFORMATION: In
compliance with 44 U.S.C. 3507, FDA
has submitted the following proposed
collection of information to OMB for
review and clearance.
DATES:
Current Good Manufacturing Practices
and Related Regulations for Blood and
Blood Components; and Requirements
for Donor Testing, Donor Notification,
and ‘‘Lookback’’ (OMB Control Number
0910–0116—Extension)
All blood and blood components
introduced or delivered for introduction
into interstate commerce are subject to
section 351(a) of the Public Health
Service Act (PHS Act) (42 U.S.C. 262).
Section 351(a) requires that
manufacturers of biological products,
which include blood and blood
components intended for further
manufacture into injectable products,
have a license, issued upon a
demonstration that the product is safe,
pure and potent and that the
manufacturing establishment meets all
applicable standards, including those
prescribed in the FDA regulations
designed to ensure the continued safety,
purity, and potency of the product. In
addition, under section 361 of the PHS
Act (42 U.S.C. 264), by delegation from
the Secretary of Health and Human
Services, FDA may make and enforce
regulations necessary to prevent the
introduction, transmission, or spread of
communicable diseases from foreign
countries into the States or possessions,
or from one State or possession into any
other State or possession.
Section 351(j) of the PHS Act states
that the Federal Food, Drug, and
Cosmetic (FD&C) Act also applies to
biological products. Blood and blood
components for transfusion or for
further manufacture into injectable
products are drugs, as that term is
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defined in section 201(g)(1) of the FD&C
Act (21 U.S.C. 321(g)(1)). Because blood
and blood components are drugs under
the act, blood and plasma
establishments must comply with the
substantive provisions and related
regulatory scheme of the FD&C Act. For
example, under section 501 of the FD&C
Act (21 U.S.C. 351(a)), drugs are deemed
‘‘adulterated’’ if the methods used in
their manufacturing, processing,
packing, or holding do not conform to
current good manufacturing practice
(CGMP) and related regulations.
The CGMP regulations (part 606) (21
CFR part 606) and related regulations
implement FDA’s statutory authority to
ensure the safety, purity, and potency of
blood and blood components. The
public health objective in testing human
blood donors for evidence of infection
due to communicable disease agents
and in notifying donors is to prevent the
transmission of communicable disease.
For example, the ‘‘lookback’’
requirements are intended to help
ensure the continued safety of the blood
supply by providing necessary
information to users of blood and blood
components and appropriate
notification of recipients of transfusion
who are at increased risk for
transmitting human immunodeficiency
virus (HIV) or hepatitis C virus (HCV)
infection.
The information collection
requirements in the CGMP, donor
testing, donor notification, and
‘‘Lookback’’ regulations provide FDA
with the necessary information to
perform its duty to ensure the safety,
purity, and potency of blood and blood
components. These requirements
establish accountability and traceability
in the processing and handling of blood
and blood components and enable FDA
to perform meaningful inspections. The
recordkeeping requirements serve
preventive and remedial purposes. The
disclosure requirements identify the
various blood and blood components
and important properties of the product,
demonstrate that the CGMP
requirements have been met, and
facilitate the tracing of a product back
to its original source. The reporting
requirements inform FDA of any
deviations that occur and that may
require immediate corrective action.
Under the reporting requirements,
§ 606.170(b), in brief, requires that
facilities notify FDA’s Center for
Biologics Evaluation and Research
(CBER), as soon as possible after
confirming a complication of blood
collection or transfusion to be fatal. The
collecting facility is to report donor
fatalities, and the compatibility testing
facility is to report recipient fatalities.
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The regulation also requires the
reporting facility to submit a written
report of the investigation within 7 days
after the fatality. In fiscal years 2006 and
2007, FDA received, on average, 100 of
these reports.
Section 610.40(c)(1)(ii) (21 CFR
610.40(c)(1)(ii)), in brief, requires that
each donation dedicated to a single
identified recipient be labeled as
required under § 606.121 and with a
label entitled ‘‘INTENDED RECIPIENT
INFORMATION LABEL’’ containing the
name and identifying information of the
recipient.
Section 610.40(g)(2) (21 CFR
610.40(g)(2)) requires an establishment
to obtain written approval from FDA to
ship human blood or blood components
for further manufacturing use prior to
completion of testing for evidence of
infection due to certain communicable
disease agents.
Section 610.40(h)(2)(ii)(A) (21 CFR
610.40(h)(2)(ii)(A)), in brief, requires an
establishment to obtain written approval
from FDA to use or ship human blood
or blood components found to be
reactive by a screening test for evidence
of certain communicable disease
agent(s) or collected from a donor with
a record of a reactive screening test.
Furthermore, § 610.40(h)(2)(ii)(C) and
(h)(2)(ii)(D) (21 CFR 610.40(h)(2)(ii)(C)
and (h)(2)(ii)(D)), in brief, requires an
establishment to label certain reactive
human blood and blood components
with the appropriate screening test
results, and, if they are intended for
further manufacturing use into
injectable products, include a statement
on the label indicating the exempted use
specifically approved by FDA. Finally,
§ 610.40(h)(2)(vi) (21 CFR
610.40(h)(2)(vi)) requires each donation
of human blood or blood components,
excluding Source Plasma, that tests
reactive by a screening test for syphilis
and is determined to be a biological
false positive to be labeled with both
test results.
Section 610.42(a) (21 CFR 610.42(a))
requires a warning statement
‘‘indicating that the product was
manufactured from a donation found to
be reactive by a screening test for
evidence of infection due to the
identified communicable disease
agent(s)’’ in the labeling for medical
devices containing human blood or a
blood component found to be reactive
by a screening test for evidence of
infection due to a communicable
disease agent(s) or syphilis.
In brief, §§ 610.46 and 610.47 (21 CFR
610.46 and 610.47) require blood
collecting establishments to establish,
maintain, and follow an appropriate
system for performing HIV and HCV
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prospective ‘‘lookback’’ when: (1) A
donor tests reactive for evidence of HIV
or HCV infection or (2) the collecting
establishment becomes aware of other
reliable test results or information
indicating evidence of HIV or HCV
infection (‘‘prospective lookback’’). (See
§§ 610.46(a)(1) and 610.47(a)(1).) The
requirement for ‘‘an appropriate
system’’ requires the collecting
establishment to design standard
operating procedures (SOPs) to identify
and quarantine all blood and blood
components previously collected from a
donor who later tests reactive for
evidence of HIV or HCV infection, or
when the collecting establishment is
made aware of other reliable test results
or information indicating evidence of
HIV or HCV infection. Within 3
calendar days of the donor testing
reactive by an HIV or HCV screening
test or the collecting establishment
becoming aware of other reliable test
results or information, the collecting
establishment must, among other things,
notify consignees to quarantine all
identified previously collected in-date
blood and blood components
(§§ 610.46(a)(1)(ii)(B) and
610.47(a)(1)(ii)(B)) and, within 45 days,
notify the consignees of supplemental
test results, or the results of a reactive
screening test if there is no available
supplemental test that is approved for
such use by FDA (§§ 610.46(a)(3) and
610.47(a)(3)).
Consignees also must establish,
maintain, and follow an appropriate
system for performing HIV and HCV
‘‘lookback’’ when notified by the
collecting establishment that they have
received blood and blood components
previously collected from donors who
later tested reactive for evidence of HIV
or HCV infection, or when the collecting
establishment is made aware of other
reliable test results or information
indicating evidence of HIV or HCV
infection in a donor (§§ 610.46(b) and
610.47(b)). This provision for a system
requires the consignee to establish SOPs
for, among other things, notifying
transfusion recipients of blood and
blood components, or the recipient’s
physician of record or legal
representative, when such action is
indicated by the results of the
supplemental (additional, more specific)
tests or a reactive screening test if there
is no available supplemental test that is
approved for such use by FDA, or if
under an investigational new drug
application (IND) or an investigational
device exemption (IDE), is exempted for
such use by FDA. The consignee must
make reasonable attempts to perform the
notification within 12 weeks of receipt
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of the supplemental test result or receipt
of a reactive screening test result when
there is no available supplemental test
that is approved for such use by FDA,
or if under an IND or IDE, is exempted
for such use by FDA (§§ 610.46(b)(3)
and 610.47(b)(3)).
Section 630.6(a) (21 CFR 630.6(a))
requires an establishment to make
reasonable attempts to notify any donor
who has been deferred as required by
§ 610.41 (21 CFR 610.41), or who has
been determined not to be eligible as a
donor. Section 630.6(d)(1) requires an
establishment to provide certain
information to the referring physician of
an autologous donor who is deferred
based on the results of tests as described
in § 610.41.
Under the recordkeeping
requirements, § 606.100(b), in brief,
requires that written SOPs be
maintained for all steps to be followed
in the collection, processing,
compatibility testing, storage, and
distribution of blood and blood
components used for transfusion and
further manufacturing purposes. Section
606.100(c) requires the review of all
records pertinent to the lot or unit of
blood prior to release or distribution.
Any unexplained discrepancy or the
failure of a lot or unit of final product
to meet any of its specifications must be
thoroughly investigated, and the
investigation, including conclusions
and followup, must be recorded.
In brief, § 606.110(a) provides that the
use of plateletpheresis and
leukapheresis procedures to obtain a
product for a specific recipient may be
at variance with the additional
standards for that specific product if,
among other things, the physician
certifies in writing that the donor’s
health permits plateletpheresis or
leukapheresis. Section 606.110(b)
requires establishments to request prior
approval from CBER for plasmapheresis
of donors who do not meet donor
requirements. The information
collection requirements for § 606.110(b)
are approved under OMB control
number 0910–0338 and, therefore, are
not reflected in tables 1 and 2 of this
document.
Section 606.151(e) requires that SOPs
for compatibility testing include
procedures to expedite transfusion in
life-threatening emergencies; records of
all such incidents must be maintained,
including complete documentation
justifying the emergency action, which
must be signed by a physician.
So that each significant step in the
collection, processing, compatibility
testing, storage, and distribution of each
unit of blood and blood components can
be clearly traced, § 606.160 requires that
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legible and indelible contemporaneous
records of each such step be made and
maintained for no less than 10 years.
Section 606.160(b)(1)(viii) requires
records of the quarantine, notification,
testing and disposition performed under
the HIV and HCV ‘‘lookback’’
provisions. Furthermore,
§ 606.160(b)(1)(ix) requires a blood
collection establishment to maintain
records of notification of donors
deferred or determined not to be eligible
for donation, including appropriate
followup. Section 606.160(b)(1)(xi)
requires an establishment to maintain
records of notification of the referring
physician of a deferred autologous
donor, including appropriate followup.
Section 606.165, in brief, requires that
distribution and receipt records be
maintained to facilitate recalls, if
necessary.
Section 606.170(a) requires records to
be maintained of any reports of
complaints of adverse reactions arising
as a result of blood collection or
transfusion. Each such report must be
thoroughly investigated, and a written
report, including conclusions and
followup, must be prepared and
maintained. When an investigation
concludes that the product caused the
transfusion reaction, copies of all such
written reports must be forwarded to
and maintained by the manufacturer or
collecting facility.
Section 610.40(g)(1) (21 CFR
610.40(g)(1)) requires an establishment
to appropriately document a medical
emergency for the release of human
blood or blood components prior to
completion of required testing.
In addition to the CGMP regulations
in part 606, there are regulations in part
640 (21 CFR part 640) that require
additional standards for certain blood
and blood components as follows:
Sections 640.3(a)(1), (a)(2), and (f);
640.4(a)(1) and (a)(2); 640.25(b)(4) and
(c)(1); 640.27(b); 640.31(b); 640.33(b);
640.51(b); 640.53(b) and (c); 640.56(b)
and (d); 640.61; 640.63(b)(3), (e)(1), and
(e)(3); 640.65(b)(2); 640.66; 640.71(b)(1);
640.72; 640.73; and 640.76(a) and (b).
The information collection requirements
and estimated burdens for these
regulations are included in the part 606
burden estimates, as described in tables
1 and 2 of this document.
Respondents to this collection of
information are licensed and unlicensed
blood establishments that collect blood
and blood components, including
Source Plasma and Source Leukocytes,
inspected by FDA, and other transfusion
services inspected by Centers for
Medicare and Medicaid Services (CMS).
Based on information received from
CBER’s database systems, there are
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66903
approximately 81 licensed Source
Plasma establishments with multiple
locations and approximately 2,000
registered blood collection
establishments, for an estimated total of
2,081 establishments. Of these
establishments, approximately 696
perform plateletpheresis and
leukapheresis. These establishments
annually collect approximately 28
million units of Whole Blood and blood
components, including Source Plasma
and Source Leukocytes, and are
required to follow FDA ‘‘lookback’’
procedures. In addition, there are
another 4,980 establishments that fall
under the Clinical Laboratory
Improvement Amendments of 1988
(formerly referred to as facilities
approved for Medicare reimbursement)
that transfuse blood and blood
components.
The following reporting and
recordkeeping estimates are based on
information provided by industry, CMS,
and FDA experience. Based on
information received from industry, we
estimate that there are approximately 13
million donations of Source Plasma
from approximately 2 million donors
and approximately 15 million donations
of Whole Blood, including
approximately 300,000 (2 percent of 15
million) autologous donations, from
approximately 8 million donors.
Assuming each autologous donor makes
an average of 2 donations, FDA
estimates that there are approximately
150,000 autologous donors.
FDA estimates that approximately 5
percent (12,000) of the 240,000
donations that are donated specifically
for the use of an identified recipient
would be tested under the dedicated
donors’ testing provisions in
§ 610.40(c)(1)(ii).
Under § 610.40(g)(2) and (h)(2)(ii)(A),
the only product currently shipped
prior to completion of testing for
evidence of certain communicable
disease agents is a licensed product,
Source Leukocytes, used in the
manufacture of interferon, which
requires rapid preparation from blood.
Shipments of Source Leukocytes are
pre-approved under a biologics license
application and each shipment does not
have to be reported to the agency. Based
on information from CBER’s database
system, FDA receives less than one
application per year from manufacturers
of Source Leukocytes. However, for
calculation purposes, we are estimating
one application annually.
Under § 610.40(h)(2)(ii)(C) and
(h)(2)(ii)(D), FDA estimates that each
manufacturer would ship an estimated 1
unit of human blood or blood
components per month (12 per year)
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that would require 2 labels; one as
reactive for the appropriate screening
test under § 610.40(h)(2)(ii)(C), and the
other stating the exempted use
specifically approved by FDA under
§ 610.40(h)(2)(ii)(D). According to
CBER’s database system, there are
approximately 40 licensed
manufacturers that ship known reactive
human blood or blood components.
Based on information we received
from industry, we estimate that
approximately 18,000 donations: (1)
Annually test reactive by a screening
test for syphilis, (2) are determined to be
biological false positives by additional
testing, and (3) are labeled accordingly
(§ 610.40(h)(2)(vi)).
Human blood or a blood component
with a reactive screening test, as a
component of a medical device, is an
integral part of the medical device, e.g.,
a positive control for an in vitro
diagnostic testing kit. It is usual and
customary business practice for
manufacturers to include on the
container label a warning statement that
identifies the communicable disease
agent. In addition, on the rare occasion
when a human blood or blood
component with a reactive screening
test is the only component available for
a medical device that does not require
a reactive component, then a warning
statement must be affixed to the medical
device. To account for this rare occasion
under § 610.42(a), we estimate that the
warning statement would be necessary
no more than once a year.
FDA estimates that approximately
3,500 repeat donors will test reactive on
a screening test for HIV. We also
estimate that an average of three
components was made from each
donation. Under § 610.46(a)(1)(ii)(B) and
(a)(3), this estimate results in 10,500
(3,500 x 3) notifications of the HIV
screening test results to consignees by
collecting establishments for the
purpose of quarantining affected blood
and blood components, and another
10,500 (3,500 x 3) notifications to
consignees of subsequent test results.
We estimate an average of 10 minutes
per notification of consignees.
Moreover, we estimate that
§ 610.46(b)(3) will require 4,980
consignees to notify transfusion
recipients, their legal representatives, or
physicians of record an average of 0.35
times per year resulting in a total
number of 1,755 (585 confirmed
positive repeat donors x 3) notifications.
Under § 610.46(b)(3), we also estimate 1
hour to accommodate the time to gather
test results and records for each
recipient and to accommodate multiple
attempts to contact the recipient.
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Furthermore, we estimate that
approximately 7,800 repeat donors per
year would test reactive for antibody to
HCV. Under § 610.47(a)(1)(ii)(B) and
(a)(3), collecting establishments would
notify the consignee 2 times for each of
the 23,400 (7,800 x 3 components)
components prepared from these
donations, once for quarantine purposes
and again with additional HCV test
results for a total of 46,800 notifications
as an annual ongoing burden. Under
§ 610.47(b)(3), we estimate that
approximately 4,980 consignees would
notify approximately 2,050 recipients or
their physicians of record annually.
Finally, we estimate 1.0 hours to
complete notification.
Industry estimates that approximately
13 percent of 10 million potential
donors (1.3 million donors) who come
to donate annually are determined not
to be eligible for donation prior to
collection because of failure to satisfy
eligibility criteria. It is the usual and
customary business practice of
approximately 2,000 blood collecting
establishments to notify onsite and to
explain why the donor is determined
not to be suitable for donating. Based on
such available information, we estimate
that two-thirds (1,333) of the 2,000
blood collecting establishments
provided onsite additional information
and counseling to a donor determined
not to be eligible for donation as usual
and customary business practice.
Consequently, we estimate that only
one-third, or 667, approximately, blood
collecting establishments would need to
provide, under § 630.6(a), additional
information and onsite counseling to the
estimated 430,000 (one-third of
approximately 1.3 million) ineligible
donors.
It is estimated that another 4.5 percent
of 10 million potential donors (450,000
donors) are deferred annually based on
test results. We estimate that currently
approximately 95 percent of the
establishments that collect 99 percent of
the blood and blood components notify
donors who have reactive test results for
HIV, Hepatitis B Virus (HBV), HCV,
Human T-Lymphotropic Virus (HTLV),
and syphilis as usual and customary
business practice. Consequently, 5
percent of the 2,081 establishments
(104) collecting 1 percent (4,500) of the
deferred donors (450,000) would notify
donors under § 630.6(a).
As part of usual and customary
business practice, collecting
establishments notify an autologous
donor’s referring physician of reactive
test results obtained during the donation
process required under § 630.6(d)(1).
However, we estimate that
approximately 5 percent of the 2,000
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blood collection establishments (100)
may not notify the referring physicians
of the estimated 2 percent of 150,000
autologous donors with the initial
reactive test results (3,000) as their
usual and customary business practice.
The recordkeeping chart reflects the
estimate that approximately 95 percent
of the recordkeepers, which collect 99
percent of the blood supply, have
developed SOPs as part of their
customary and usual business practice.
Establishments may minimize burdens
associated with CGMP and related
regulations by using model standards
developed by industries’ accreditation
organizations. These accreditation
organizations represent almost all
registered blood establishments.
Under § 606.160(b)(1)(ix), we estimate
the total annual records based on the
approximately 1.3 million donors
determined not to be eligible to donate
and each of the estimated 1.75 million
(1.3 million + 450,000) donors deferred
based on reactive test results for
evidence of infection because of
communicable disease agents. Under
§ 606.160(b)(1)(xi), only the 2,000
registered blood establishments collect
autologous donations and, therefore, are
required to notify referring physicians.
We estimate that 4.5 percent of the
150,000 autologous donors (6,750) will
be deferred under § 610.41, which in
turn will lead to the notification of their
referring physicians.
FDA has concluded that the use of
untested or incompletely tested but
appropriately documented human blood
or blood components in rare medical
emergencies should not be prohibited.
We estimate the recordkeeping under
§ 610.40(g)(1) to be minimal with 1 or
fewer occurrences per year. The
reporting of test results to the consignee
in § 610.40(g) does not create a new
burden for respondents because it is the
usual and customary business practice
or procedure to finish the testing and
provide the results to the manufacturer
responsible for labeling the blood
products.
The hours per response and hours per
record are based on estimates received
from industry or FDA experience with
similar recordkeeping or reporting
requirements.
In the Federal Register of June 24,
2008 (73 FR 35694) (June 2008
document), FDA published a 60-day
notice requesting public comment on
the information collection provisions.
We received one public comment on the
proposed information collection.
The comment cited numerous
problems that it stated were caused by
the labeling requirement contained in
§ 610.40(h)(2)(vi), which requires each
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Federal Register / Vol. 73, No. 219 / Wednesday, November 12, 2008 / Notices
donation of human blood or blood
components, excluding Source Plasma,
that tests reactive by a screening test for
syphilis and is determined to be a
biological false positive to be labeled
with both test results. For example, the
comment stated that the labeling
requirement ‘‘causes unnecessary work
and interrupts routine operations,
thereby introducing risk of error, with
no increase in safety.’’ The comment
also stated that the requirement
‘‘generates inappropriate concerns on
the part of healthcare personnel,
transfusion recipients and their
families.’’ The comment asked that this
requirement be deleted. These concerns
pertain to matters that are outside the
scope of the proposed information
collection. Consequently, we decline to
adopt the comment’s recommendations.
The comment also questioned FDA’s
estimate of 5 minutes in connection
with § 610.40(h)(2)(vi). We had
estimated that the time associated with
the labeling requirement contained in
this rule was 5 (4.8) minutes. The
comment stated, ‘‘Any non-routine
activity that interrupts normal labeling
operations, [sic] causes delays that take
more than 4.8 minutes.’’ The comment
later went on to acknowledge that the
application of a label to a unit, which
is only one step in the labeling process,
may take only five minutes. We wish to
clarify that we only are referring to the
application of a label to a unit in this
proposed information collection.
Therefore, consistent with the comment,
our estimate remains the same.
Moreover, the comment referred to
page 35697 and table 1 of the June 2008
document, and stated that ‘‘FDA
estimated that labeling directed and
reactive or untested units for shipment
would take five minutes. If labeling
refers only to the application of the label
to the unit, which is only one step in the
labeling process, then 5 minutes may be
adequate.’’ We are unclear what the
comment is referring to on page 35697
of the June 2008 document and note that
66905
table 1 refers to an estimate of 0.08 (4.8
minutes) with respect to
§§ 610.40(c)(1)(ii), 610.40(h)(2)(vi), and
630.6(a). We are assuming that the
comment is referring to the first two
regulations, as the third goes to donor
notification. We wish to clarify that in
this information collection, we are only
referring to the application of the label
to the unit. Therefore, consistent with
the comment, our estimate remains the
same.
Finally, the comment pointed out an
error in calculation of total hours
associated with § 606.160(b)(1)(ix) in
table 2 of the June 2008 document. The
total hours calculated was listed as
875,000, instead of 87,500 (0.05 x
1,750,000). Therefore, the total
estimated recordkeeping burden is
362,426. We have corrected this error
accordingly.
FDA estimates the burden of this
collection of information as follows:
TABLE 1.—ESTIMATED ANNUAL REPORTING BURDEN1
No. of
Respondents
21 CFR Section
Annual Frequency
per Response
Total Annual
Responses
Hours per
Response
Total Hours
606.170(a)
3535
1.20
424
0.5
212
606.170(b)2
100
1
100
20
2,000
2,081
5.77
12,000
0.08
960
610.40(g)(2)
1
1
1
1
1
610.40(h)(2)(ii)(A)
1
1
1
1
1
40
12
480
0.2
96
2,081
8.65
18,000
0.08
1,440
1
1
1
1
1
610.46(a)(1)(ii)(B)
2,000
5.25
10,500
0.17
1,785
610.46(a)(3)
2,000
5.25
10,500
0.17
1,785
610.47(b)(3)
4,980
0.41
2,050
1.0
2,050
610.47(a)(1)(ii)(B)
2,000
11.70
23,400
0.17
3,978
610.47(a)(3)
2,000
11.70
23,400
0.17
3,978
610.47(b)(3)
4,980
0.41
2,050
1.0
2,050
630.6(a)3
667
644.68
430,000
0.08
34,400
630.6(a)4
104
43.27
4,500
1.5
6,750
630.6(d)(1)
100
30
3,000
1
3,000
610.40(c)(1)(ii)
610.40(h)(2)(ii)(C) and (h)(2)(ii)(D)
610.40(h)(2)(vi)
mstockstill on PROD1PC66 with NOTICES
610.42(a)
Total
64,487
1There
are no capital costs or operating and maintenance costs associated with this collection of information.
2The reporting requirement in § 640.73, which addresses the reporting of fatal donor reactions, is included in the estimate for § 606.170(b).
3Notification of donors determined not to be eligible for donation based on failure to satisfy eligibility criteria.
4Notification of donors deferred based on reactive test results for evidence of infection due to communicable disease agents.
5Five percent of establishments that fall under the Clinical Laboratory Improvement Amendments of 1988 that transfuse blood and components
and FDA-registered blood establishments (0.05 x 4,980 + 2,081).
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Federal Register / Vol. 73, No. 219 / Wednesday, November 12, 2008 / Notices
TABLE 2.—ESTIMATED ANNUAL RECORDKEEPING BURDEN1
No. of
Recordkeepers
21 CFR Section
Annual Frequency
per Recordkeeping
Total Annual
Records
Hours per
Record
Total Hours
606.100(b)2
3535
1
353
24
8,472
606.100(c)
3535
10
3,530
1
3,530
606.110(a)3
356
1
35
0.5
18
606.151(e)
3535
12
4,236
0.083
352
606.1604
3535
793.20
280,000
0.75
210,000
2,000
10.50
21,000
.17
3,570
4,980
4.21
21,000
.17
3,570
2,000
23.40
46,800
.17
7,956
4,980
9.4
46,800
.17
7,956
HIV recipient notification
4,980
0.35
1,755
.17
298
HCV recipient notification
4,980
0.41
2,050
.17
349
606.160(b)(1)(ix)
2,081
840.94
1,750,000
0.05
87,500
606.160(b)(1)(xi)
2,000
3.375
6,750
0.05
338
606.165
3535
793.20
280,000
0.083
23,240
606.170(a)
3535
12
4,236
1.00
4,236
610.40(g)(1)
2,081
1
2,081
0.50
1,041
606.160(b)(1)(viii)
HIV consignee notification
HCV consignee notification
Total
362,426
1There
are no capital costs or operating and maintenance costs associated with this collection of information.
recordkeeping requirements in §§ 640.3(a)(1), 640.4(a)(1), and 640.66, which address the maintenance of SOPs, are included in the estimate for § 606.100(b).
3The recordkeeping requirements in § 640.27(b), which address the maintenance of donor health records for the plateletpheresis, are included
in the estimate for § 606.110(a).
44 The recordkeeping requirements in §§ 640.3(a)(2) and (f); 640.4(a)(2); 640.25(b)(4) and (c)(1); 640.31(b); 640.33(b); 640.51(b); 640.53(b)
and (c); 640.56(b) and (d); 640.61; 640.63(b)(3), (e)(1), and (e)(3); 640.65(b)(2); 640.71(b)(1); 640.72; and 640.76(a) and (b), which address the
maintenance of various records are included in the estimate for § 606.160.
5Five percent of establishments that fall under the Clinical Laboratory Improvement Amendments of 1988 that transfuse blood and components
and FDA-registered blood establishments (0.05 x 4,980 + 2,081).
6Five percent of plateletpheresis and leukopheresis establishments (0.05 x 696).
2The
Dated: November 3, 2008.
Jeffrey Shuren,
Associate Commissioner for Policy and
Planning.
[FR Doc. E8–26863 Filed 11–10–08; 8:45 am]
BILLING CODE 4160–01–S
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
mstockstill on PROD1PC66 with NOTICES
Notice of Approval of Original
Abbreviated New Animal Drug
Application; Phenylbutazone Tablets
Food and Drug Administration,
HHS.
ACTION:
Notice.
VerDate Aug<31>2005
18:30 Nov 10, 2008
Jkt 217001
John
K. Harshman, Center for Veterinary
Medicine (HFV–104), Food and Drug
Administration, 7500 Standish Pl.,
Rockville, MD 20855, 240–276–8197, email: john.harshman@fda.hhs.gov.
SUPPLEMENTARY INFORMATION: First
Priority, Inc., 1585 Todd Farm Dr.,
Elgin, IL 60123, filed ANADA 200–433
providing for veterinary prescription
FOR FURTHER INFORMATION CONTACT:
[Docket No. FDA–2008–N–0039]
AGENCY:
SUMMARY: The Food and Drug
Administration (FDA) is providing
notice that it has approved an original
abbreviated new animal drug
application (ANADA) filed by First
Priority, Inc. The ANADA provides for
veterinary prescription use of
phenylbutazone tablets in horses for the
relief of inflammatory conditions
associated with the musculoskeletal
system.
PO 00000
Frm 00072
Fmt 4703
Sfmt 4703
use of Phenylbutazone Tablets in horses
for the relief of inflammatory conditions
associated with the musculoskeletal
system. First Priority, Inc.’s, ANADA for
Phenylbutazone Tablets is approved as
a generic copy of First Priority, Inc.’s,
PRIBUTAZONE Tablets, approved
under NADA 48–647. In accordance
with section 512(i) of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C.
360b(i)) and part 514 (21 CFR part 514),
in §§ 514.105(a) and 514.106(a), the
Center for Veterinary Medicine is
providing notice that this ANADA is
approved as of October 23, 2008.
In accordance with the freedom of
information provisions of 21 CFR part
20 and 21 CFR 514.11(e)(2)(ii), a
summary of safety and effectiveness
data and information submitted to
support approval of this application
may be seen in the Division of Dockets
E:\FR\FM\12NON1.SGM
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Agencies
[Federal Register Volume 73, Number 219 (Wednesday, November 12, 2008)]
[Notices]
[Pages 66901-66906]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-26863]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA-2008-N-0345]
Agency Information Collection Activities; Submission for Office
of Management and Budget Review; Comment Request; Current Good
Manufacturing Practices and Related Regulations for Blood and Blood
Components; and Requirements for Donor Testing, Donor Notification, and
``Lookback''
AGENCY: Food and Drug Administration, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Food and Drug Administration (FDA) is announcing that a
proposed collection of information has been submitted to the Office of
Management and Budget (OMB) for review and clearance under the
Paperwork Reduction Act of 1995.
DATES: Fax written comments on the collection of information by
December 12, 2008.
ADDRESSES: To ensure that comments on the information collection are
received, OMB recommends that written comments be faxed to the Office
of Information and Regulatory Affairs, OMB, Attn: FDA Desk Officer,
FAX: 202-395-6974, or e-mailed to oira_submission@omb.eop.gov. All
comments should be identified with the OMB control number 0910-0116.
Also include the FDA docket number found in brackets in the heading of
this document.
FOR FURTHER INFORMATION CONTACT: Jonna Capezzuto, Office of Information
Management (HFA-710), Food and Drug Administration, 5600 Fishers Lane,
Rockville, MD 20857, 301-796-3794.
SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, FDA has
submitted the following proposed collection of information to OMB for
review and clearance.
Current Good Manufacturing Practices and Related Regulations for Blood
and Blood Components; and Requirements for Donor Testing, Donor
Notification, and ``Lookback'' (OMB Control Number 0910-0116--
Extension)
All blood and blood components introduced or delivered for
introduction into interstate commerce are subject to section 351(a) of
the Public Health Service Act (PHS Act) (42 U.S.C. 262). Section 351(a)
requires that manufacturers of biological products, which include blood
and blood components intended for further manufacture into injectable
products, have a license, issued upon a demonstration that the product
is safe, pure and potent and that the manufacturing establishment meets
all applicable standards, including those prescribed in the FDA
regulations designed to ensure the continued safety, purity, and
potency of the product. In addition, under section 361 of the PHS Act
(42 U.S.C. 264), by delegation from the Secretary of Health and Human
Services, FDA may make and enforce regulations necessary to prevent the
introduction, transmission, or spread of communicable diseases from
foreign countries into the States or possessions, or from one State or
possession into any other State or possession.
Section 351(j) of the PHS Act states that the Federal Food, Drug,
and Cosmetic (FD&C) Act also applies to biological products. Blood and
blood components for transfusion or for further manufacture into
injectable products are drugs, as that term is
[[Page 66902]]
defined in section 201(g)(1) of the FD&C Act (21 U.S.C. 321(g)(1)).
Because blood and blood components are drugs under the act, blood and
plasma establishments must comply with the substantive provisions and
related regulatory scheme of the FD&C Act. For example, under section
501 of the FD&C Act (21 U.S.C. 351(a)), drugs are deemed
``adulterated'' if the methods used in their manufacturing, processing,
packing, or holding do not conform to current good manufacturing
practice (CGMP) and related regulations.
The CGMP regulations (part 606) (21 CFR part 606) and related
regulations implement FDA's statutory authority to ensure the safety,
purity, and potency of blood and blood components. The public health
objective in testing human blood donors for evidence of infection due
to communicable disease agents and in notifying donors is to prevent
the transmission of communicable disease. For example, the ``lookback''
requirements are intended to help ensure the continued safety of the
blood supply by providing necessary information to users of blood and
blood components and appropriate notification of recipients of
transfusion who are at increased risk for transmitting human
immunodeficiency virus (HIV) or hepatitis C virus (HCV) infection.
The information collection requirements in the CGMP, donor testing,
donor notification, and ``Lookback'' regulations provide FDA with the
necessary information to perform its duty to ensure the safety, purity,
and potency of blood and blood components. These requirements establish
accountability and traceability in the processing and handling of blood
and blood components and enable FDA to perform meaningful inspections.
The recordkeeping requirements serve preventive and remedial purposes.
The disclosure requirements identify the various blood and blood
components and important properties of the product, demonstrate that
the CGMP requirements have been met, and facilitate the tracing of a
product back to its original source. The reporting requirements inform
FDA of any deviations that occur and that may require immediate
corrective action.
Under the reporting requirements, Sec. 606.170(b), in brief,
requires that facilities notify FDA's Center for Biologics Evaluation
and Research (CBER), as soon as possible after confirming a
complication of blood collection or transfusion to be fatal. The
collecting facility is to report donor fatalities, and the
compatibility testing facility is to report recipient fatalities. The
regulation also requires the reporting facility to submit a written
report of the investigation within 7 days after the fatality. In fiscal
years 2006 and 2007, FDA received, on average, 100 of these reports.
Section 610.40(c)(1)(ii) (21 CFR 610.40(c)(1)(ii)), in brief,
requires that each donation dedicated to a single identified recipient
be labeled as required under Sec. 606.121 and with a label entitled
``INTENDED RECIPIENT INFORMATION LABEL'' containing the name and
identifying information of the recipient.
Section 610.40(g)(2) (21 CFR 610.40(g)(2)) requires an
establishment to obtain written approval from FDA to ship human blood
or blood components for further manufacturing use prior to completion
of testing for evidence of infection due to certain communicable
disease agents.
Section 610.40(h)(2)(ii)(A) (21 CFR 610.40(h)(2)(ii)(A)), in brief,
requires an establishment to obtain written approval from FDA to use or
ship human blood or blood components found to be reactive by a
screening test for evidence of certain communicable disease agent(s) or
collected from a donor with a record of a reactive screening test.
Furthermore, Sec. 610.40(h)(2)(ii)(C) and (h)(2)(ii)(D) (21 CFR
610.40(h)(2)(ii)(C) and (h)(2)(ii)(D)), in brief, requires an
establishment to label certain reactive human blood and blood
components with the appropriate screening test results, and, if they
are intended for further manufacturing use into injectable products,
include a statement on the label indicating the exempted use
specifically approved by FDA. Finally, Sec. 610.40(h)(2)(vi) (21 CFR
610.40(h)(2)(vi)) requires each donation of human blood or blood
components, excluding Source Plasma, that tests reactive by a screening
test for syphilis and is determined to be a biological false positive
to be labeled with both test results.
Section 610.42(a) (21 CFR 610.42(a)) requires a warning statement
``indicating that the product was manufactured from a donation found to
be reactive by a screening test for evidence of infection due to the
identified communicable disease agent(s)'' in the labeling for medical
devices containing human blood or a blood component found to be
reactive by a screening test for evidence of infection due to a
communicable disease agent(s) or syphilis.
In brief, Sec. Sec. 610.46 and 610.47 (21 CFR 610.46 and 610.47)
require blood collecting establishments to establish, maintain, and
follow an appropriate system for performing HIV and HCV prospective
``lookback'' when: (1) A donor tests reactive for evidence of HIV or
HCV infection or (2) the collecting establishment becomes aware of
other reliable test results or information indicating evidence of HIV
or HCV infection (``prospective lookback''). (See Sec. Sec.
610.46(a)(1) and 610.47(a)(1).) The requirement for ``an appropriate
system'' requires the collecting establishment to design standard
operating procedures (SOPs) to identify and quarantine all blood and
blood components previously collected from a donor who later tests
reactive for evidence of HIV or HCV infection, or when the collecting
establishment is made aware of other reliable test results or
information indicating evidence of HIV or HCV infection. Within 3
calendar days of the donor testing reactive by an HIV or HCV screening
test or the collecting establishment becoming aware of other reliable
test results or information, the collecting establishment must, among
other things, notify consignees to quarantine all identified previously
collected in-date blood and blood components (Sec. Sec.
610.46(a)(1)(ii)(B) and 610.47(a)(1)(ii)(B)) and, within 45 days,
notify the consignees of supplemental test results, or the results of a
reactive screening test if there is no available supplemental test that
is approved for such use by FDA (Sec. Sec. 610.46(a)(3) and
610.47(a)(3)).
Consignees also must establish, maintain, and follow an appropriate
system for performing HIV and HCV ``lookback'' when notified by the
collecting establishment that they have received blood and blood
components previously collected from donors who later tested reactive
for evidence of HIV or HCV infection, or when the collecting
establishment is made aware of other reliable test results or
information indicating evidence of HIV or HCV infection in a donor
(Sec. Sec. 610.46(b) and 610.47(b)). This provision for a system
requires the consignee to establish SOPs for, among other things,
notifying transfusion recipients of blood and blood components, or the
recipient's physician of record or legal representative, when such
action is indicated by the results of the supplemental (additional,
more specific) tests or a reactive screening test if there is no
available supplemental test that is approved for such use by FDA, or if
under an investigational new drug application (IND) or an
investigational device exemption (IDE), is exempted for such use by
FDA. The consignee must make reasonable attempts to perform the
notification within 12 weeks of receipt
[[Page 66903]]
of the supplemental test result or receipt of a reactive screening test
result when there is no available supplemental test that is approved
for such use by FDA, or if under an IND or IDE, is exempted for such
use by FDA (Sec. Sec. 610.46(b)(3) and 610.47(b)(3)).
Section 630.6(a) (21 CFR 630.6(a)) requires an establishment to
make reasonable attempts to notify any donor who has been deferred as
required by Sec. 610.41 (21 CFR 610.41), or who has been determined
not to be eligible as a donor. Section 630.6(d)(1) requires an
establishment to provide certain information to the referring physician
of an autologous donor who is deferred based on the results of tests as
described in Sec. 610.41.
Under the recordkeeping requirements, Sec. 606.100(b), in brief,
requires that written SOPs be maintained for all steps to be followed
in the collection, processing, compatibility testing, storage, and
distribution of blood and blood components used for transfusion and
further manufacturing purposes. Section 606.100(c) requires the review
of all records pertinent to the lot or unit of blood prior to release
or distribution. Any unexplained discrepancy or the failure of a lot or
unit of final product to meet any of its specifications must be
thoroughly investigated, and the investigation, including conclusions
and followup, must be recorded.
In brief, Sec. 606.110(a) provides that the use of
plateletpheresis and leukapheresis procedures to obtain a product for a
specific recipient may be at variance with the additional standards for
that specific product if, among other things, the physician certifies
in writing that the donor's health permits plateletpheresis or
leukapheresis. Section 606.110(b) requires establishments to request
prior approval from CBER for plasmapheresis of donors who do not meet
donor requirements. The information collection requirements for Sec.
606.110(b) are approved under OMB control number 0910-0338 and,
therefore, are not reflected in tables 1 and 2 of this document.
Section 606.151(e) requires that SOPs for compatibility testing
include procedures to expedite transfusion in life-threatening
emergencies; records of all such incidents must be maintained,
including complete documentation justifying the emergency action, which
must be signed by a physician.
So that each significant step in the collection, processing,
compatibility testing, storage, and distribution of each unit of blood
and blood components can be clearly traced, Sec. 606.160 requires that
legible and indelible contemporaneous records of each such step be made
and maintained for no less than 10 years. Section 606.160(b)(1)(viii)
requires records of the quarantine, notification, testing and
disposition performed under the HIV and HCV ``lookback'' provisions.
Furthermore, Sec. 606.160(b)(1)(ix) requires a blood collection
establishment to maintain records of notification of donors deferred or
determined not to be eligible for donation, including appropriate
followup. Section 606.160(b)(1)(xi) requires an establishment to
maintain records of notification of the referring physician of a
deferred autologous donor, including appropriate followup.
Section 606.165, in brief, requires that distribution and receipt
records be maintained to facilitate recalls, if necessary.
Section 606.170(a) requires records to be maintained of any reports
of complaints of adverse reactions arising as a result of blood
collection or transfusion. Each such report must be thoroughly
investigated, and a written report, including conclusions and followup,
must be prepared and maintained. When an investigation concludes that
the product caused the transfusion reaction, copies of all such written
reports must be forwarded to and maintained by the manufacturer or
collecting facility.
Section 610.40(g)(1) (21 CFR 610.40(g)(1)) requires an
establishment to appropriately document a medical emergency for the
release of human blood or blood components prior to completion of
required testing.
In addition to the CGMP regulations in part 606, there are
regulations in part 640 (21 CFR part 640) that require additional
standards for certain blood and blood components as follows: Sections
640.3(a)(1), (a)(2), and (f); 640.4(a)(1) and (a)(2); 640.25(b)(4) and
(c)(1); 640.27(b); 640.31(b); 640.33(b); 640.51(b); 640.53(b) and (c);
640.56(b) and (d); 640.61; 640.63(b)(3), (e)(1), and (e)(3);
640.65(b)(2); 640.66; 640.71(b)(1); 640.72; 640.73; and 640.76(a) and
(b). The information collection requirements and estimated burdens for
these regulations are included in the part 606 burden estimates, as
described in tables 1 and 2 of this document.
Respondents to this collection of information are licensed and
unlicensed blood establishments that collect blood and blood
components, including Source Plasma and Source Leukocytes, inspected by
FDA, and other transfusion services inspected by Centers for Medicare
and Medicaid Services (CMS). Based on information received from CBER's
database systems, there are approximately 81 licensed Source Plasma
establishments with multiple locations and approximately 2,000
registered blood collection establishments, for an estimated total of
2,081 establishments. Of these establishments, approximately 696
perform plateletpheresis and leukapheresis. These establishments
annually collect approximately 28 million units of Whole Blood and
blood components, including Source Plasma and Source Leukocytes, and
are required to follow FDA ``lookback'' procedures. In addition, there
are another 4,980 establishments that fall under the Clinical
Laboratory Improvement Amendments of 1988 (formerly referred to as
facilities approved for Medicare reimbursement) that transfuse blood
and blood components.
The following reporting and recordkeeping estimates are based on
information provided by industry, CMS, and FDA experience. Based on
information received from industry, we estimate that there are
approximately 13 million donations of Source Plasma from approximately
2 million donors and approximately 15 million donations of Whole Blood,
including approximately 300,000 (2 percent of 15 million) autologous
donations, from approximately 8 million donors. Assuming each
autologous donor makes an average of 2 donations, FDA estimates that
there are approximately 150,000 autologous donors.
FDA estimates that approximately 5 percent (12,000) of the 240,000
donations that are donated specifically for the use of an identified
recipient would be tested under the dedicated donors' testing
provisions in Sec. 610.40(c)(1)(ii).
Under Sec. 610.40(g)(2) and (h)(2)(ii)(A), the only product
currently shipped prior to completion of testing for evidence of
certain communicable disease agents is a licensed product, Source
Leukocytes, used in the manufacture of interferon, which requires rapid
preparation from blood. Shipments of Source Leukocytes are pre-approved
under a biologics license application and each shipment does not have
to be reported to the agency. Based on information from CBER's database
system, FDA receives less than one application per year from
manufacturers of Source Leukocytes. However, for calculation purposes,
we are estimating one application annually.
Under Sec. 610.40(h)(2)(ii)(C) and (h)(2)(ii)(D), FDA estimates
that each manufacturer would ship an estimated 1 unit of human blood or
blood components per month (12 per year)
[[Page 66904]]
that would require 2 labels; one as reactive for the appropriate
screening test under Sec. 610.40(h)(2)(ii)(C), and the other stating
the exempted use specifically approved by FDA under Sec.
610.40(h)(2)(ii)(D). According to CBER's database system, there are
approximately 40 licensed manufacturers that ship known reactive human
blood or blood components.
Based on information we received from industry, we estimate that
approximately 18,000 donations: (1) Annually test reactive by a
screening test for syphilis, (2) are determined to be biological false
positives by additional testing, and (3) are labeled accordingly (Sec.
610.40(h)(2)(vi)).
Human blood or a blood component with a reactive screening test, as
a component of a medical device, is an integral part of the medical
device, e.g., a positive control for an in vitro diagnostic testing
kit. It is usual and customary business practice for manufacturers to
include on the container label a warning statement that identifies the
communicable disease agent. In addition, on the rare occasion when a
human blood or blood component with a reactive screening test is the
only component available for a medical device that does not require a
reactive component, then a warning statement must be affixed to the
medical device. To account for this rare occasion under Sec.
610.42(a), we estimate that the warning statement would be necessary no
more than once a year.
FDA estimates that approximately 3,500 repeat donors will test
reactive on a screening test for HIV. We also estimate that an average
of three components was made from each donation. Under Sec.
610.46(a)(1)(ii)(B) and (a)(3), this estimate results in 10,500 (3,500
x 3) notifications of the HIV screening test results to consignees by
collecting establishments for the purpose of quarantining affected
blood and blood components, and another 10,500 (3,500 x 3)
notifications to consignees of subsequent test results. We estimate an
average of 10 minutes per notification of consignees.
Moreover, we estimate that Sec. 610.46(b)(3) will require 4,980
consignees to notify transfusion recipients, their legal
representatives, or physicians of record an average of 0.35 times per
year resulting in a total number of 1,755 (585 confirmed positive
repeat donors x 3) notifications. Under Sec. 610.46(b)(3), we also
estimate 1 hour to accommodate the time to gather test results and
records for each recipient and to accommodate multiple attempts to
contact the recipient.
Furthermore, we estimate that approximately 7,800 repeat donors per
year would test reactive for antibody to HCV. Under Sec.
610.47(a)(1)(ii)(B) and (a)(3), collecting establishments would notify
the consignee 2 times for each of the 23,400 (7,800 x 3 components)
components prepared from these donations, once for quarantine purposes
and again with additional HCV test results for a total of 46,800
notifications as an annual ongoing burden. Under Sec. 610.47(b)(3), we
estimate that approximately 4,980 consignees would notify approximately
2,050 recipients or their physicians of record annually. Finally, we
estimate 1.0 hours to complete notification.
Industry estimates that approximately 13 percent of 10 million
potential donors (1.3 million donors) who come to donate annually are
determined not to be eligible for donation prior to collection because
of failure to satisfy eligibility criteria. It is the usual and
customary business practice of approximately 2,000 blood collecting
establishments to notify onsite and to explain why the donor is
determined not to be suitable for donating. Based on such available
information, we estimate that two-thirds (1,333) of the 2,000 blood
collecting establishments provided onsite additional information and
counseling to a donor determined not to be eligible for donation as
usual and customary business practice. Consequently, we estimate that
only one-third, or 667, approximately, blood collecting establishments
would need to provide, under Sec. 630.6(a), additional information and
onsite counseling to the estimated 430,000 (one-third of approximately
1.3 million) ineligible donors.
It is estimated that another 4.5 percent of 10 million potential
donors (450,000 donors) are deferred annually based on test results. We
estimate that currently approximately 95 percent of the establishments
that collect 99 percent of the blood and blood components notify donors
who have reactive test results for HIV, Hepatitis B Virus (HBV), HCV,
Human T-Lymphotropic Virus (HTLV), and syphilis as usual and customary
business practice. Consequently, 5 percent of the 2,081 establishments
(104) collecting 1 percent (4,500) of the deferred donors (450,000)
would notify donors under Sec. 630.6(a).
As part of usual and customary business practice, collecting
establishments notify an autologous donor's referring physician of
reactive test results obtained during the donation process required
under Sec. 630.6(d)(1). However, we estimate that approximately 5
percent of the 2,000 blood collection establishments (100) may not
notify the referring physicians of the estimated 2 percent of 150,000
autologous donors with the initial reactive test results (3,000) as
their usual and customary business practice.
The recordkeeping chart reflects the estimate that approximately 95
percent of the recordkeepers, which collect 99 percent of the blood
supply, have developed SOPs as part of their customary and usual
business practice. Establishments may minimize burdens associated with
CGMP and related regulations by using model standards developed by
industries' accreditation organizations. These accreditation
organizations represent almost all registered blood establishments.
Under Sec. 606.160(b)(1)(ix), we estimate the total annual records
based on the approximately 1.3 million donors determined not to be
eligible to donate and each of the estimated 1.75 million (1.3 million
+ 450,000) donors deferred based on reactive test results for evidence
of infection because of communicable disease agents. Under Sec.
606.160(b)(1)(xi), only the 2,000 registered blood establishments
collect autologous donations and, therefore, are required to notify
referring physicians. We estimate that 4.5 percent of the 150,000
autologous donors (6,750) will be deferred under Sec. 610.41, which in
turn will lead to the notification of their referring physicians.
FDA has concluded that the use of untested or incompletely tested
but appropriately documented human blood or blood components in rare
medical emergencies should not be prohibited. We estimate the
recordkeeping under Sec. 610.40(g)(1) to be minimal with 1 or fewer
occurrences per year. The reporting of test results to the consignee in
Sec. 610.40(g) does not create a new burden for respondents because it
is the usual and customary business practice or procedure to finish the
testing and provide the results to the manufacturer responsible for
labeling the blood products.
The hours per response and hours per record are based on estimates
received from industry or FDA experience with similar recordkeeping or
reporting requirements.
In the Federal Register of June 24, 2008 (73 FR 35694) (June 2008
document), FDA published a 60-day notice requesting public comment on
the information collection provisions. We received one public comment
on the proposed information collection.
The comment cited numerous problems that it stated were caused by
the labeling requirement contained in Sec. 610.40(h)(2)(vi), which
requires each
[[Page 66905]]
donation of human blood or blood components, excluding Source Plasma,
that tests reactive by a screening test for syphilis and is determined
to be a biological false positive to be labeled with both test results.
For example, the comment stated that the labeling requirement ``causes
unnecessary work and interrupts routine operations, thereby introducing
risk of error, with no increase in safety.'' The comment also stated
that the requirement ``generates inappropriate concerns on the part of
healthcare personnel, transfusion recipients and their families.'' The
comment asked that this requirement be deleted. These concerns pertain
to matters that are outside the scope of the proposed information
collection. Consequently, we decline to adopt the comment's
recommendations.
The comment also questioned FDA's estimate of 5 minutes in
connection with Sec. 610.40(h)(2)(vi). We had estimated that the time
associated with the labeling requirement contained in this rule was 5
(4.8) minutes. The comment stated, ``Any non-routine activity that
interrupts normal labeling operations, [sic] causes delays that take
more than 4.8 minutes.'' The comment later went on to acknowledge that
the application of a label to a unit, which is only one step in the
labeling process, may take only five minutes. We wish to clarify that
we only are referring to the application of a label to a unit in this
proposed information collection. Therefore, consistent with the
comment, our estimate remains the same.
Moreover, the comment referred to page 35697 and table 1 of the
June 2008 document, and stated that ``FDA estimated that labeling
directed and reactive or untested units for shipment would take five
minutes. If labeling refers only to the application of the label to the
unit, which is only one step in the labeling process, then 5 minutes
may be adequate.'' We are unclear what the comment is referring to on
page 35697 of the June 2008 document and note that table 1 refers to an
estimate of 0.08 (4.8 minutes) with respect to Sec. Sec.
610.40(c)(1)(ii), 610.40(h)(2)(vi), and 630.6(a). We are assuming that
the comment is referring to the first two regulations, as the third
goes to donor notification. We wish to clarify that in this information
collection, we are only referring to the application of the label to
the unit. Therefore, consistent with the comment, our estimate remains
the same.
Finally, the comment pointed out an error in calculation of total
hours associated with Sec. 606.160(b)(1)(ix) in table 2 of the June
2008 document. The total hours calculated was listed as 875,000,
instead of 87,500 (0.05 x 1,750,000). Therefore, the total estimated
recordkeeping burden is 362,426. We have corrected this error
accordingly.
FDA estimates the burden of this collection of information as
follows:
Table 1.--Estimated Annual Reporting Burden\1\
----------------------------------------------------------------------------------------------------------------
No. of Annual Frequency Total Annual Hours per
21 CFR Section Respondents per Response Responses Response Total Hours
----------------------------------------------------------------------------------------------------------------
606.170(a) 353\5\ 1.20 424 0.5 212
----------------------------------------------------------------------------------------------------------------
606.170(b)\2\ 100 1 100 20 2,000
----------------------------------------------------------------------------------------------------------------
610.40(c)(1)(ii) 2,081 5.77 12,000 0.08 960
----------------------------------------------------------------------------------------------------------------
610.40(g)(2) 1 1 1 1 1
----------------------------------------------------------------------------------------------------------------
610.40(h)(2)(ii) 1 1 1 1 1
(A)
----------------------------------------------------------------------------------------------------------------
610.40(h)(2)(ii) 40 12 480 0.2 96
(C) and
(h)(2)(ii)(D)
----------------------------------------------------------------------------------------------------------------
610.40(h)(2)(vi) 2,081 8.65 18,000 0.08 1,440
----------------------------------------------------------------------------------------------------------------
610.42(a) 1 1 1 1 1
----------------------------------------------------------------------------------------------------------------
610.46(a)(1)(ii) 2,000 5.25 10,500 0.17 1,785
(B)
----------------------------------------------------------------------------------------------------------------
610.46(a)(3) 2,000 5.25 10,500 0.17 1,785
----------------------------------------------------------------------------------------------------------------
610.47(b)(3) 4,980 0.41 2,050 1.0 2,050
----------------------------------------------------------------------------------------------------------------
610.47(a)(1)(ii) 2,000 11.70 23,400 0.17 3,978
(B)
----------------------------------------------------------------------------------------------------------------
610.47(a)(3) 2,000 11.70 23,400 0.17 3,978
----------------------------------------------------------------------------------------------------------------
610.47(b)(3) 4,980 0.41 2,050 1.0 2,050
----------------------------------------------------------------------------------------------------------------
630.6(a)\3\ 667 644.68 430,000 0.08 34,400
----------------------------------------------------------------------------------------------------------------
630.6(a)\4\ 104 43.27 4,500 1.5 6,750
----------------------------------------------------------------------------------------------------------------
630.6(d)(1) 100 30 3,000 1 3,000
----------------------------------------------------------------------------------------------------------------
Total 64,487
----------------------------------------------------------------------------------------------------------------
\1\There are no capital costs or operating and maintenance costs associated with this collection of information.
\2\The reporting requirement in Sec. 640.73, which addresses the reporting of fatal donor reactions, is
included in the estimate for Sec. 606.170(b).
\3\Notification of donors determined not to be eligible for donation based on failure to satisfy eligibility
criteria.
\4\Notification of donors deferred based on reactive test results for evidence of infection due to communicable
disease agents.
\5\Five percent of establishments that fall under the Clinical Laboratory Improvement Amendments of 1988 that
transfuse blood and components and FDA-registered blood establishments (0.05 x 4,980 + 2,081).
[[Page 66906]]
Table 2.--Estimated Annual Recordkeeping Burden\1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
No. of Annual Frequency Total Annual
21 CFR Section Recordkeepers per Recordkeeping Records Hours per Record Total Hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
606.100(b)\2\ 353\5\ 1 353 24 8,472
--------------------------------------------------------------------------------------------------------------------------------------------------------
606.100(c) 353\5\ 10 3,530 1 3,530
--------------------------------------------------------------------------------------------------------------------------------------------------------
606.110(a)\3\ 35\6\ 1 35 0.5 18
--------------------------------------------------------------------------------------------------------------------------------------------------------
606.151(e) 353\5\ 12 4,236 0.083 352
--------------------------------------------------------------------------------------------------------------------------------------------------------
606.160\4\ 353\5\ 793.20 280,000 0.75 210,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
606.160(b)(1)(viii)
--------------------------------------------------------------------------------------------------------------------------------------------------------
HIV consignee notification 2,000 10.50 21,000 .17 3,570
-------------------------------------------------------------------------------------------------
4,980 4.21 21,000 .17 3,570
--------------------------------------------------------------------------------------------------------------------------------------------------------
HCV consignee notification 2,000 23.40 46,800 .17 7,956
-------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
HIV recipient notification 4,980 0.35 1,755 .17 298
--------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total 362,426
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\There are no capital costs or operating and maintenance costs associated with this collection of information.
\2\The recordkeeping requirements in Sec. Sec. 640.3(a)(1), 640.4(a)(1), and 640.66, which address the maintenance of SOPs, are included in the
estimate for Sec. 606.100(b).
\3\The recordkeeping requirements in Sec. 640.27(b), which address the maintenance of donor health records for the plateletpheresis, are included in
the estimate for Sec. 606.110(a).
\4\4 The recordkeeping requirements in Sec. Sec. 640.3(a)(2) and (f); 640.4(a)(2); 640.25(b)(4) and (c)(1); 640.31(b); 640.33(b); 640.51(b);
640.53(b) and (c); 640.56(b) and (d); 640.61; 640.63(b)(3), (e)(1), and (e)(3); 640.65(b)(2); 640.71(b)(1); 640.72; and 640.76(a) and (b), which
address the maintenance of various records are included in the estimate for Sec. 606.160.
\5\Five percent of establishments that fall under the Clinical Laboratory Improvement Amendments of 1988 that transfuse blood and components and FDA-
registered blood establishments (0.05 x 4,980 + 2,081).
\6\Five percent of plateletpheresis and leukopheresis establishments (0.05 x 696).
Dated: November 3, 2008.
Jeffrey Shuren,
Associate Commissioner for Policy and Planning.
[FR Doc. E8-26863 Filed 11-10-08; 8:45 am]
BILLING CODE 4160-01-S