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Rabies in donor organs killed three, CDC reports


By Rob Stein
The Washington Post

WASHINGTON — Three transplant patients died from rabies last month after receiving organs from a donor who had been infected by a bat, federal health officials said yesterday following an investigation. The case marked the first time that rabies is known to have been transmitted through infected organs, officials said.

As a result, officials plan to review their procedures to determine whether organ donors should be tested for the virus that causes the rare neurological disease.

"This is a very sad, tragic situation," said Mitchell Cohen, an infectious disease expert at the federal Centers for Disease Control and Prevention in Atlanta. "This has never happened before, but we need to do whatever we can to prevent this from happening again."

The CDC is working with health officials in four states to track down anyone who might have come into contact with either the donor or the organ recipients to determine whether any need shots to prevent them from becoming ill.

"Human-to-human transmission of rabies ... is also extremely rare," Cohen said. "However, as a precaution we are examining the exposures ... to determine whether or not they need to receive shots."

Officials stressed, however, that the case was extremely unusual and should not deter anyone from either donating organs or receiving them.

"The consequences of not receiving a donation far outweighs the risk," Cohen said.

The case began in the spring when a previously healthy Arkansas man arrived at a emergency room complaining a low-grade fever and other symptoms. He died two days later of what was diagnosed as a brain hemorrhage.

After his family agreed to donate his organs, his lungs, kidneys and liver were transplanted into four recipients on May 4.

The patient who received the man's lungs at the University of Alabama-Birmingham Hospital in Birmingham, Ala., died almost immediately from complications of the surgery.

The recipients of the other organs survived their operations, only to subsequently develop puzzling symptoms and die on June 7, June 8 and June 21, officials said.

Tests confirmed Wednesday that they were infected with a rabies virus commonly found in bats, Cohen said.

None of the names or ages of the patients were released. But officials said they were working with officials in Texas, Alabama, Oklahoma and Arkansas to trace family members and hospital workers who came in contact with the patients to determine whether any had been infected. If so, they will receive shots to protect them from the disease, the officials said.

CDC named the following hospitals: Baylor University Medical Center in Dallas; University of Alabama-Birmingham Hospital; Christus Saint Michael Healthcare Center in Texarkana, Texas; Wadley Regional Medical Center in Texarkana, and Good Shepherd Medical Center in Longview, Texas.

This is "very scary for all the health care workers and family members who might have come in contact with the disease and are concerned about their health," Cohen said.

Rabies is an acute, often fatal neurological disease that usually occurs when a person is bitten by an infected animal. It is rare in the U.S., with only one or two deaths usually reported each year.

Symptoms can take up to a year to develop. The disease begins with headache and fever and progresses to encephalopathy (swelling of the brain), marked by confusion, anxiety and agitation. Once symptoms begin, there is no treatment, and the disease is nearly 100 percent fatal, Coen said.

Although rabies transmission has occurred in a few previous cases through transplants of infected corneas, this is the first reported case of transmission through other transplanted tissue.