A Maryland man died from a transplanted, rabies-infected kidney from a donor who wasn't known to have the disease, and the rare death has prompted authorities to treat three others who got organs from the same donor, federal health officials said Friday.
The Maryland man, who died last month, received the kidney more than a year ago. The recipients of the donor's heart, liver and other kidney are getting anti-rabies shots, the Centers for Disease Control and Prevention said Friday. Those patients live in Florida, Georgia and Illinois, the CDC said.
The donor, a 20-year-old North Carolina man, died in 2011 in Florida, where he was training to become an Air Force aviation mechanic, the Defense Department said.
The three other recipients have a strong chance of surviving since they haven't shown symptoms of the disease, said a rabies expert who successfully treated a teenage girl with rabies in 2004.
"They're getting a really excellent vaccine. This is the best we've got," said Dr. Rodney Willoughby of Milwaukee.
Public and military health officials said they're trying to identify people in all five states who were in close contact with the donor or the recipients. Those people might also need treatment, the CDC said. The CDC refused to disclose the identities of the donor and recipients.
In North Carolina, state health officials are recommending vaccine for at least one of the donor's relatives, the state's top public health veterinarian said Friday. Fewer than five family members from North Carolina visited the man while he was hospitalized in Florida, Dr. Carl Williams said. Local and state health departments have contacted them and are evaluating their risk.
"What generally happens in human rabies patients that are hospitalized is that there is a lot of close contact, not only from health care workers but from close family because the patient is going to die," Williams said. The disease could, in rare cases, be transmitted by saliva from a kiss on the lips or tears being wiped away by a visiting mother, Williams said.
Williams wouldn't describe where the donor lived before moving to Florida, saying even naming the county could identify the rabies victim. Rabies is common in wildlife statewide. How the donor may have gotten the raccoon rabies virus is under investigation, the CDC said.
Northwestern Memorial Hospital in Chicago confirmed the Illinois transplant was performed there and its doctors are administering the rabies treatment to that recipient. Illinois Department of Public Health spokeswoman Melaney Arnold said the patient has no rabies symptoms, but began treatment Thursday.
The Defense Department said the Maryland man who died was an Army veteran who had transplant surgery at Walter Reed National Military Medical Center in Bethesda, Md. He died in February, Defense Department spokeswoman Cynthia O. Smith said.
The CDC said there has been just one other reported instance of rabies transmission by transplanted solid organs, a 2004 case in which all four recipients died after receiving tissue from an infected donor. There have been at least eight instances of rabies transmission through transplanted corneas, CDC spokeswoman Barbara Reynolds said.
"Human rabies is very rare in the United States, and so, of course, when we're talking about organ transplantation, very, very rare," she said. Rabies is diagnosed as the cause of just one to three deaths per year in the United States, she said.
Rabies cannot be confirmed until after death, by examining the patient's brain tissue, health officials said. Because there is no rapid test, rabies testing is not routine in organ transplant situations, where every second counts, Reynolds said. Willoughby said such testing could be counterproductive: "To do it right away would probably mean that you throw away most of the organs while they're testing," he said.
The Maryland death was announced Tuesday by state health officials. State Public Health Veterinarian Katherine Feldman said the organ recipient had encephalitis, a brain inflammation that can be caused by rabies. Doctors suspected before he died that he had rabies, and they knew about his kidney transplant, but considered a rabies-infected kidney to be a remote possibility, Feldman said.
"This was a very long interval from transplant to onset and there was nothing that screamed, "This patient is ill because of his renal transplant,'" Feldman said. The man had no reported animal exposures, health officials said.
The Florida donor also had encephalitis, health officials said.
The CDC confirmed after the Maryland man's death that both he and the organ donor had died from the same type of raccoon rabies virus. This type of rabies virus can infect not only raccoons, but also other wild and domestic animals. In the United States, only one other person is reported to have died from a raccoon-type rabies virus, the CDC said.
That virus has a typical incubation period of one to three months, although there have been other cases of such long incubation periods, the CDC said.
The donor died at a Florida medical facility. At the time of the donor's death, rabies wasn't suspected as the cause and testing for rabies was not performed, the CDC said.
Florida Department of Health epidemiologist Carina Blackmore said investigators don't know how the donor contracted rabies.
"We are concerned that because of the time that has passed we may not ever know," she said.