Human-to-Human Rabies Transmission via Solid Organ Transplantation from a Donor with Undiagnosed Rabies - United...

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Public Health

Background:

• Rabies virus is primarily transmitted by animal bites but can spread through organ and tissue transplantation.
• Human-to-human rabies transmission via transplantation is a rare but fatal event, with three documented cases in the US between 1978-2013 affecting nine recipients.
• Rabies is nearly always fatal without prompt postexposure prophylaxis (PEP).

Purpose of the Study:

• To investigate a suspected case of rabies in a kidney transplant recipient in Ohio.
• To identify the source of transmission and assess the risk to other recipients and exposed individuals.
• To emphasize the importance of donor screening for rabies risk factors.

Main Methods:

• Case investigation and confirmation of rabies diagnosis in the transplant recipient.
• Review of donor's history, including a recent skunk scratch.
• Viral RNA detection in archived donor kidney sample.
• Contact tracing and risk assessment for exposed individuals.

Main Results:

• Rabies was confirmed in the kidney transplant recipient who died 51 days post-transplant.
• The donor had a history of a skunk scratch approximately 6 weeks before death.
• Rabies virus RNA was detected in the donor's kidney, confirming organ transmission.
• Three cornea recipients received precautionary graft removal and PEP, remaining asymptomatic.
• Of 357 individuals assessed for exposure, 46 (13%) were recommended for PEP.

Conclusions:

• This case confirms organ-derived rabies transmission in the US.
• Early consultation with public health officials is crucial for identifying and managing rabies risk in organ donors.
• Donors with recent rabies-susceptible animal bites or scratches, especially with encephalopathy, warrant careful consideration for rabies risk.