A Michigan resident who received a transplant in December died after having been infected with rabies from the new organ, the state health department said Wednesday.
“A public health investigation determined they contracted rabies through the transplanted organ,” Lynn Sutfin, a spokesperson for the state's Department of Health and Human Services, said in a statement.
A spokesperson for the Centers for Disease Control and Prevention said the same donor also provided corneal grafts for three patients in different states.
“Based on the concerning symptoms of the kidney recipient who died, CDC worked with Missouri health officials to intercept a fourth corneal graft before it could be implanted into a Missouri resident — even before rabies was confirmed in the donor,” the CDC said. “All corneal tissue recipients have gotten post-exposure prophylaxis (PEP) shots to prevent rabies and are currently healthy.”
The Michigan patient died in January, after receiving a kidney transplant at a hospital in Ohio, the CDC said.
The donor did not show traditional rabies symptoms, according to the agency, so the infection was not detected until the recipient's illness was discovered. After that, "public health officials learned the organ donor was exposed to a wild animal in Idaho five weeks before death" — likely a skunk, the CDC said.
The agency said it has notified close contacts of both the donor and the kidney recipient and that "those with potential risk for getting rabies have been advised to start rabies PEP."
Sutfin said the Michigan and Ohio health departments “worked closely” together and with the CDC to investigate the death. The CDC’s rabies laboratory confirmed the diagnosis.
The Michigan Health Department declined to provide additional information. The Ohio Health Department said the kidney transplant patient was hospitalized in Toledo, and that health care workers who may have been exposed have been offered rabies shots accordingly.
Potential organ donors in the United States are screened for viruses, bacteria and other infections; however, rabies is not usually among those tests, in part because the test for it takes too long (organs are only viable for a limited window of time) and because the infection is so rare in people. The responsibility for those screenings falls on organ procurement organizations.
The CDC has conducted four investigations since 1978 related to rabies transmission from organ and tissue donors to recipients.
A patient who received a kidney transplant in 2013 died after contracting rabies through the organ. The donor was found to have died of rabies in Florida but, like the recent Michigan case, the cause of death was discovered only after an investigation into the recipient’s death. Three other patients also received organs from the donor.
In 2004, three transplant recipients died of rabies after they received organs from an infected donor in Arkansas.
Rabies can spread to humans if they come into contact with saliva or blood from infected animals, such as bats, raccoons, skunks or stray dogs. It is not always clear right away that a person has contracted rabies, as the initial symptoms are similar to those of the flu, including fever, headache and nausea. As the illness progresses, patients then experience difficulty swallowing, excessive salivation and hallucinations.
If a person does not seek medical care quickly after having been scratched or bitten by a potentially infected animal, rabies is fatal. Before 1960, several hundred people died of it each year, but the annual number has shrunk to fewer than 10 in recent years, according to the CDC.
