July 1, 2004 -- Public health officials are investigating the deaths of three organ transplant recipients who received donated organs that were infected with the deadly rabies virus.
The CDC today said the deaths mark the first known cases of rabies transmission from solid organ transplantation. Although rabies transmission has occurred previously through cornea transplants, this is the first report of rabies transmission via solid organ transplantation.
The recipient of both lungs died during the organ transplant procedure. The other three organ transplant recipients died weeks later on June 7, 8, and 21 in Texas, but rabies was only recently identified as the cause of death.
"CDC confirmed yesterday that all three transplant recipients were infected with a strain of rabies commonly found in bats," says Mitchell Cohen, MD, director of the CDC's coordinating center for infectious diseases.
Although some organ procurement organizations screen potential donors for possible rabies exposure, officials say there is no national requirement to screen or test organ donors for rabies. That issue is expected to be debated by federal health officials as the investigation into the transplant-related rabies deaths continues.
"This has never happened before, but we need to do whatever we can to prevent it from happening again," says Virginia McBride, a public health organ donation specialist at the Health Resources and Services Administration.
But experts stress the benefits of receiving a donated organ still far outweigh the potential risks.
"Human rabies is extremely rare, and we see only a few human cases each year, usually in people who are bitten or scratched by certain types of bats and often don't know it," says Cohen.
"The benefits of receiving an organ transplant far outweigh the risk of any infectious disease acquired through transplantation."
Rabies Strain Usually Found in Bats
Rabies is a virus that is most commonly transmitted through the bite of an infected animal.
The source of the donor's infection has not been identified, but officials say it is consistent with a strains of the rabies virus commonly found in bats. Wild animals such as bats, raccoons, skunks, and foxes account for about 90% of the rabies cases documented each year.
The virus lives within the nervous system and is not found in the blood or detected by standard screening tests. In addition, symptoms of rabies may emerge as late as one year after infection, which would make screening for the disease difficult.
Experts say the virus was most likely passed via the nerves within the organs that were taken from the donor.
Human-to-human transmission of rabies is also very rare and has been documented in only two cases in Ethiopia. Officials believe those cases may have been caused by direct contact with saliva of an infected individual from a kiss or a bite.
But 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.
The hospitals that cared for the donor and transplant recipients include:
- Baylor University Medical Center, Dallas
- University of Alabama-Birmingham Hospital, Birmingham, Alabama
- Christus Saint Michael Healthcare Center, Texarkana, Texas
- Wadley Regional Medical Center, Texarkana, Texas
- Good Shepherd Medical Center, Longview, Texas
Rabies can be prevented if a series of six shots is given over a 28-day period to boost the body's defenses against the virus.
However, once symptoms develop, rabies is nearly always fatal. Early symptoms in humans are non-specific and include fever, headache, and general malaise. As the condition progresses, other symptoms include:
- Slight or partial paralysis
- Excessive salivation
- Difficulty swallowing
- Fear of water
SOURCES: CDC telebriefing, July 1, 2004. News release, CDC. Mitchell Cohen, MD, director, coordinating center for infectious diseases, CDC. Virginia McBride, public health organ donation specialist, Health Resources and Services Association. Daniel H. Hayes, MS, United Network for Organ Sharing. CDC.