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7/2/2004

Rabies Virus Transmissible by Organs, CDC Announces

Cheryl A. Thompson

Three transplant recipients have died from what federal authorities described Thursday as the first case of rabies virus transmission from a solid-organ donor.

Mitchell Cohen, director of the new Coordinating Center for Infectious Diseases at the Centers for Disease Control and Prevention, described the situation as not only tragic for the victims' families but "very scary for all the health care workers and family members who may have come into contact with the deceased and who are concerned about their health."

State and local public health officials, he said during a webcast for reporters, are evaluating the need to protect workers at the five hospitals linked to the liver, kidneys, and lungs of an Arkansas man who died two days after seeking emergency medical care at Christus St. Michael Health System in Texarkana, Texas.

A total of four people received the man's organs, Cohen said, but the recipient of the lungs died during the transplant operation. The other organ recipients died 34-48 days after their surgery.

The Arkansas man, who arrived at Christus St. Michael with a low-grade fever and recent severe changes in mental status, was diagnosed with a brain hemorrhage, Cohen said. Rabies was not initially suspected. Postmortem laboratory tests revealed the man had rabies, he said, with the particular virus type being one commonly found in bats.

A description of the cases was posted late Thursday as a Morbidity and Mortality Weekly Report Dispatch.

In addition to Christus St. Michael, the hospitals where health care workers might have been exposed to rabies virus are Baylor University Medical Center, Dallas, site of the liver and kidney transplantations; University of Alabama Hospital, Birmingham, site of the lung transplantation; Wadley Regional Medical Center, Texarkana; and Good Shepherd Medical Center, Longview, Texas.

Transmission of rabies virus from patients to health care professionals has never been documented, Cohen said.

Health care workers potentially at risk of rabies virus transmission are those whose wound or mucous membrane came in contact with the organ donor's or recipients' saliva or neural or brain tissue, he said. The virus is not present in blood.

At the time of the teleconference, Cohen said he did not know if anyone had been told to undergo rabies prophylaxis, which involves a dose of rabies immune globulin followed by five doses of rabies vaccine over a 28-day period.

Cohen said the virus, which resides in the nervous system, could have been a contaminant in the nerves of the transplanted organs.

Organ transplant expert Daniel H. Hayes, of United Network for Organ Sharing, said during the teleconference that there has been only one previously documented case in the United States of rabies virus transmission through an organ or tissue transplant. That case involved a corneal transplant.

Hayes said some, but not all, organ procurement organizations specifically ask potential donors whether they have been treated for or exposed to rabies in the past year.