The Centers for Disease Control and Prevention and Maryland Department of Health and Mental Hygiene have confirmed that a patient who recently died of rabies contracted the infection through organ transplantation done more than a year ago, according to a CDC statement.
The patient was one of four people who had received an organ from the same donor. This week, CDC laboratories tested tissue samples from the donor and from the recipient who died to confirm transmission of rabies through organ transplantation.
In early March, the Maryland Department of Health and Mental Hygiene initiated an investigation after the organ recipient died, leading to the rabies diagnosis. The investigation revealed that the organ recipient had no reported animal exposures, the usual source of rabies transmission to humans, and identified the possibility of transplant-related transmission of rabies, which is “extremely rare,” according to the statement.
The organ transplantation occurred more than a year before the recipient developed symptoms and died of rabies. Such a period is much longer than the typical rabies incubation period of one to three months, but is consistent with prior case reports of long incubation periods.
The CDCs preliminary laboratory analysis indicates that the recipient and the donor both had the same type of rabies virus, a raccoon type. This type of rabies virus can infect not only raccoons, but also other wild and domestic animals. Only one other person in the United States is reported to have died from a raccoon-type rabies virus.
The donor became ill in 2011 and was admitted to a healthcare facility in Florida, and then died. At that time, the donors organs, including the kidneys, heart and liver, were recovered and sent to recipients in Florida, Georgia, Illinois and Maryland. At the time of the donors death, rabies was not suspected as the cause and testing for rabies was not performed. Rabies only recently was confirmed as the cause of death after the investigation began in Maryland.
The donor had moved to Florida shortly before becoming ill but was a previous resident of North Carolina, where it is believed the exposure may have occurred. How the donor may have gotten rabies is under investigation.
The three other people who received organs from the donor have been identified, and are being evaluated by their healthcare teams and receiving rabies anti-rabies shots (immune globulin and anti-rabies vaccination). The CDC is working with public health officials and healthcare facilities in Florida, Georgia, Illinois, Maryland and North Carolina to identify people who were in close contact with the initial donor or the four organ recipients and might need rabies post-exposure treatment.
All potential organ donors in the United States are screened and tested to identify whether the donor might present an infectious risk, the CDC stated. Organ procurement organizations are responsible for evaluating the suitability of each organ donor, with eligibility determined through a series of questions posed to family and close contacts, a physical examination and infectious disease testing, including HIV and hepatitis.
There typically are one to three cases of human rabies diagnosed annually in the U.S. each year, according to the CDC. If rabies is not clinically suspected, laboratory testing for rabies is not routinely performed, given the difficulty of confirming results in the short window of time for keeping organs viable for the recipient.
Organ screening is designed to ensure safe and successful transplantations, the CDC stated. The benefits from transplanted organs generally outweigh the risk of transmission of infectious diseases from screened donors.
Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death within days of the onset of illness. In the United States, bats, raccoons, skunks and foxes are the most commonly reported rabid animals.