Public Health

First rabies cases from organ transplant reported by CDC

Last Updated: 2004-07-01 15:22:04 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Three patients acquired rabies and died after receiving organs from the same infected donor, marking the first time rabies has been spread through solid organ donation, an infectious disease expert from the Centers for Disease Control and Prevention announced at a media briefing Thursday.

"This has never happened before," Dr. Mitchell Cohen, director of the coordinating center for infectious diseases at the CDC, told reporters. "Human rabies is very rare -- we see only a few human cases each year and it is usually in people who have been bitten or scratched by bats. The risk of healthcare-associated transmission is considered to be extremely low."

Although there have been reports of rabies transmission through cornea transplants, this is the first report of transmission from solid organ transplantation, CDC officials noted.

The rabies infections originated from a previously healthy male Arkansas resident who presented to an emergency room in Texas with mental status changes and fever. Neuroimaging revealed a brain hemorrhage and the patient died 48 hours later.

Routine donor eligibility testing revealed no contraindications to transplantation and the family gave consent for donation, Dr. Cohen said. Rabies testing is not currently part of the screening procedure.

The donor's lungs, kidney, and liver were transplanted into patients in Texas and Alabama on May 4,, 2004. Three recipients were later hospitalized with symptoms including hypotension, seizures, and lethargy. All three patients died.

In the last few weeks, a series of tests were performed on the recipients and, on Wednesday, the CDC confirmed that all three were infected with a strain of rabies commonly found in bats.

"The CDC is working with all the states and hospitals involved to determine who came in contact with the donor and the recipients and who might need shots to prevent rabies," Dr. Cohen said.

These include patient family members and healthcare workers at the following hospitals: Baylor University Medical Center, Dallas; University of Alabama-Birmingham Hospital; the Christus Saint Michael Healthcare Center and the Wadley Regional Medical Center, Texarkana, Texas; and the Good Shepherd Medical Center, Longview, Texas.

"The Health Resources and Services Administration will be carefully reviewing what happened and working with the CDC to see if there are steps that can be taken to further reduce this very small risk" of rabies transmission from organ transplantation, Dr. Cohen added.