Public health agencies in five U.S. states are assessing the rabies risk for hundreds of people who may have had close contact with an infected organ donor and four transplant recipients, one of whom died, officials said Saturday.
About 200 medical workers, relatives and others were assessed for potential exposure in Maryland, where the man who received an infected kidney died, state veterinarian Katherine Feldman said. She said fewer than two dozen were urged to get the rabies vaccine as a preventive measure.
In Florida, about 90 people were identified as potentially exposed, and three were offered the rabies vaccine as of Friday, state health department spokeswoman Ashley Carr said.
Illinois Department of Public Health spokeswoman Melaney Arnold said the only potential exposures there were people who worked with the patient or the transplanted organ. She said only the organ recipient is receiving rabies treatment.
Health officials in Georgia and North Carolina are also involved in the epidemiological investigation prompted by the Maryland man's death from rabies in late February, nearly 18 months after he got the kidney from a donor in Pensacola, Florida. However, officials in those states didn't respond to requests from The Associated Press about the number of people they're assessing.
Doctors in Florida didn't test the 20-year-old donor for rabies before he died in September 2011. His heart, liver and other kidney went to recipients in Florida, Georgia and Illinois. They started getting the vaccine this month, and none has had rabies symptoms. A rabies expert unconnected to the case, Dr. Rodney Willoughby of Milwaukee, said they have a strong chance of surviving since they haven't shown any symptoms.
Health officials say the virus can be spread through the infected person's saliva and mucous membranes, but human-to-human transmission is rare. The federal Centers for Disease Control and Prevention in Atlanta says there has been only one documented instance of transmission by a bite in the U.S.
Feldman said Friday that the search for potential exposure subjects in Maryland was wrapping up. She said medical workers typically take precautions, and "we don't share saliva with that many people in our day-to-day goings about."
CDC spokeswoman Melissa Dankel said investigators are still trying to learn how the transplant donor got infected with the raccoon rabies virus that was found in his brain tissue and that of the Maryland man. She said the donor was an outdoorsman who might have been bitten by a wild animal in his native North Carolina before moving to Florida and beginning training as an Air Force aviation mechanic 17 weeks before his death.
He visited a clinic at the Pensacola Naval Air Station in August 2011 for abdominal pain and vomiting and was transferred to a civilian hospital four days later, said Defense Department spokeswoman Cynthia Smith. He later developed encephalitis, a brain inflammation that can have a host of causes, including rabies, but he wasn't tested for the disease, CDC officials say.
Smith said the airman died of severe gastroenteritis—inflammation of the stomach and small intestine—complicated by dehydration, electrolyte abnormalities and seizure. The Florida Department of Health said he died of encephalitis of unknown origin.
Federal rules require organ banks to disclose any known or suspected infectious conditions that might be transmitted by donor organs. CDC officials say they don't know what information was communicated.
Federal guidelines published last year for evaluating organ donors with encephalitis urge "extreme caution" if the suspected cause is a viral pathogen, such as rabies.
Dr. Michael Green, a University of Pittsburgh professor who heads the committee that wrote the guidelines, said the guidelines hadn't been published when the Florida patient died. He also said rabies transmission through solid organ transplants is rare. There have been just two other documented instances worldwide—one in Germany and a 2004 U.S. case in which all four recipients died. The CDC says there have been eight documented instances of rabies being transmitted by transplanted corneas.
"Nonetheless, if asked whether or not I would use organs where concern for rabies was active in the potential donor, I would urge extreme caution before using organs from this person," Green said.
One of the patients who died in the 2004 case was 18-year-old Joshua Hightower, of Gilmer, Texas, after a kidney transplant. He had kidney problems since he was a child. His mother, Jennifer, said Saturday that if rabies is suspected in a transplant donor, doctors should go ahead and transplant the organs, and then give recipients the rabies vaccine.
"The word has got to get out there and something's got to change," she said. "These people, like my son, he thought the transplant was going to give him a new life and a new opportunity to move forward, and it killed him—over somebody's negligence and their plain old stupidity, and that's what it is."
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