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Organ Donor's Rabies Kills 3 Recipients

There was no screening for rare virus

THURSDAY, July 1, 2004 (HealthDayNews) -- Three people have died of rabies after receiving organs from a man who was infected with the virus and showed no signs of having the disease when he died from a brain hemorrhage.

This marks the first time that rabies has been spread through solid organ transplantation.

Officials with the U.S. Centers for Disease Control and Prevention said Thursday that a fourth organ recipient died on the operating table, and didn't have time to develop the disease. Rabies is always fatal once symptoms occur, but is preventable if a person is treated with shots soon after being exposed to a potentially rabid animal.

The donor was not screened for rabies when he died, the CDC said.

Although human-to-human transmission is extremely rare, health officials are working furiously to track down family members, health-care workers and others who may have come into contact with the victims. Anyone suspected to have had exposure to the virus will be advised to get shots immediately.

The rabies virus is usually transmitted to humans through a bite or scratch from an infected mammal, often a bat. Transmission has occurred eight times in the past through cornea transplants, only one of them in the United States.

The organ donor in this case was an apparently healthy male resident of Arkansas who arrived at the Christus St. Michael Hospital in Texarkana, Texas, with "severe mental status changes" and low-grade fever. Neurological imaging subsequently revealed a brain hemorrhage, and the man died 48 hours later. His family agreed to donate his organs, and the usual donor eligibility testing and screening was conducted.

Officials didn't disclose the donor's identity or age, and also declined to give the gender, age and identities of the recipients.

Speaking at a sometimes confused news conference Thursday, Dr. Mitch Cohen, director of the coordinating center for infectious diseases at the CDC, said he was not sure when the donor died, but that it had to have been shortly before May 4, when the transplants took place.

The man's lungs were transplanted into an Alabama patient by doctors at the University of Alabama at Birmingham. That patient died during the May 4 procedure, not long enough for rabies to develop.

Three others received the man's liver and a kidney apiece during procedures at Baylor Medical Center in Dallas. The liver recipient lived in Oklahoma. All three patients subsequently developed lethargy, seizures, hypertension, respiratory problems and neurological symptoms, and were hospitalized in their home states. The liver recipient died on June 7, the first kidney recipient on June 8, and the second kidney recipient on June 21. Laboratory tests later confirmed that all three were infected with a strain of rabies commonly found in bats.

No other organs or tissues from this man were donated.

Because the virus is so rare in humans, "testing for rabies is not routinely done," said Virginia McBride, a public health organ donation specialist at the Health Resources and Services Administration. Only one to three human cases are reported in the United States each year.

The odds of human-to-human transmission are even lower, yet officials are nevertheless trying to determine who came into contact with the three recipients and the donor. Officials would not say how many potential contacts were out there, but five hospitals are involved: Baylor University Medical Center, the University of Alabama at Birmingham Hospital, Christus St. Michael Hospital, Watley Regional Medical Center, also in Texarkana, and Good Shepherd Medical Center in Longview, Tex.

"The risk of health care-associated transmission is considered to be extremely low, and transmission of rabies virus from patients to health-care providers has never been documented," Cohen said. "Among household contacts it is also very rare, and has been reported in two cases -- both in Ethiopia -- and neither was laboratory confirmed to be rabies."

Transmission could occur if there was contact between the patient's saliva (the virus is not carried in the blood) and a wound or mucus membrane such as the eyes or nose.

Most cases of the disease actually occur within the first several months of exposure, but some can occur up to a year after, Cohen said. Shots need to be administered before symptoms appear because afterwards, the disease "is pretty close to being 100 percent fatal," Cohen said.

It's too soon to know whether organ donors will need to be tested for rabies, said Cohen. who emphasized the overall safety of transplantation.

"We are learning as we go, as new information is being made available," Cohen said. "This has never happened before."

Experts had been surprised to learn in the past that organ donors can pass on dangerous food allergies and even melanoma -- many years after the transplant.

More information

The U.S. Centers for Disease Control and Prevention has more on rabies.

SOURCES: July 1, 2004, news conference with Mitch Cohen, M.D., director, coordinating center for infectious diseases, U.S. Centers for Disease Control and Prevention, and Virginia McBride, R.N., M.P.H., public health organ donation specialist, Health Resources and Services Administration
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