CDC Documents First Human-to-Human Rabies Transmission Through Organ Donation

In the first documented cases of human-to-human transmission of rabies through donated organs, three transplant patients died last month from the virus after receiving organs from an infected man, officials for CDC said Thursday, the Washington Post reports. In the incident, a previously healthy Arkansas man was admitted to Christus St. Michael Health Care Center in Texas in early May after arriving at the emergency department with a low-grade fever, nausea and vomiting. He died two days later, and his cause of death was diagnosed as a brain hemorrhage. His lungs, kidneys and liver were subsequently transplanted into four recipients. The lung recipient died almost immediately of complications from surgery, while the three remaining recipients returned home following their transplants. However, they returned to the hospital weeks later complaining of conditions including fever, headache, confusion, sleepiness or agitation, all of which are rabies symptoms. The patients died on June 7, June 8 and June 21 (Stein, Washington Post, 7/2).

According to the Dallas Morning News, "extensive testing" by CDC later showed that the donor and the three organ recipients died from rabies (Jacobson, Dallas Morning News, 7/2). Dr. Mitchell Cohen, an infectious diseases expert at CDC, said that it is likely that the rabies virus was living in the nerves of the transplanted organs (AP/Washington Times, 7/2). However, he said it is not known when or where the donor was exposed to rabies, and the infection "was not thought of as a likely cause" of death for the organ donor when he was treated at Christus St. Michael. He added that it can take up to a year after exposure to rabies for symptoms to appear (Altman, New York Times, 7/2). Dr. Bill Sutker, chief of infectious diseases at Baylor University Medical Center in Dallas, where the transplants for the three patients infected with rabies were performed, said, "We never suspected it was rabies. I've never even seen rabies in the 25 years I've been involved in infectious diseases. It's not something that's expected or should have been expected" (Dallas Morning News, 7/2). Cohen said that the transplant patients who died after receiving the infected organs were found to have strains of rabies commonly associated with bats (Niedowski, Baltimore Sun, 7/2).

According to the Post, rabies is an "acute, often fatal neurological disease that usually occurs when a person is bitten by an infected animal" (Washington Post, 7/2). Human cases are very rare; rabies results in only one or two human deaths annually in the United States, according to CDC. Human-to-human transmissions of the disease are even more rare. At least eight people worldwide have contracted rabies through cornea transplants, but the current incident marks the first known cases of rabies being spread through donated organs, according to CDC (AP/Washington Times, 7/2). CDC is working with health officials in Alabama, Arkansas, Texas and Oklahoma -- where the donor and recipients lived or were treated -- to determine whether anyone who had contact with the recipients needs to be immunized against rabies. Treatment is effective only before the onset of symptoms, after which point death typically follows within days, according to the Sun (Baltimore Sun, 7/2). CDC officials said that the risk to health care workers who treated the patients is "very low" (Smith, Arkansas Democrat Gazette, 7/2).

Health officials say that as a result of the deaths, they plan to review donor organ screening procedures to determine whether donors should be tested for the virus. Cohen said, "This is a very sad, tragic situation. This has never happened before, but we need to do whatever we can to prevent it from happening again" (Washington Post, 7/2). In some states, transplant coordinators already ask families of potential donors whether the person was ever bitten by an animal suspected of carrying the disease (Baltimore Sun, 7/2). However, performing tests on potential donors prior to transplant could prove impractical because results can take days; transplants need to be completed within four hours of donation for lungs, six hours for hearts and 24 hours for liver and kidneys (Ackerman, Houston Chronicle, 7/1). Cohen stressed that that the case should not deter potential transplant patients, noting that the "consequences of not receiving a donation far outweig[h] the risk" (Washington Post, 7/2). Dr. Daniel Hayes, an organ transplant specialist with the United Network for Organ Sharing, said, "I don't think that such a rare event should trigger any kind of widespread panic or reaction to do testing on a disease that is so infrequent" (Arkansas Democrat Gazette, 7/2).