Last Friday, March 15, the CDC confirmed that a rabies death in Maryland was caused by an organ transplant from an infected donor. Three other patients received organs from the now deceased donor, and all are being evaluated by healthcare facilities.
According to the CDC, the donor was admitted to a Florida healthcare facility in 2011, shortly after moving there from North Carolina. Officials believe the patient was exposed to rabies in North Carolina; investigations to determine the source of infection are underway.
Soon after being admitted, the patient died. Organs (kidneys, heart and liver) were sent to Florida, Georgia, Illinois, and Maryland. Sixteen months later, after the death of the Maryland recipient, officials learned that the strain of rabies in both the donor and the recipient match, and is likely from a raccoon.
Infection with rabies through organ transplants is extremely rare. In 2004, the United States recorded three deaths from rabies-infected organs. There have also been cases of rabies transmission through cornea (the transparent part of your eye that covers the iris and the pupil, and greatly contributes to your ability to focus) transplants, but once the risk was realized, doctors implemented measures to screen for rabies.
So, why didn’t doctors pick up on rabies in this particular donor? Again, rabies infection through solid organ transplants (kidney transplant versus cornea transplant) is extremely rare. Also, testing for rabies is pretty difficult and time consuming. According to the CDC, each year there are one to three recorded cases of human rabies infection in the United States. Potential organ donors undergo serious screening to determine whether or not they present a risk. Donors and their close contacts are interviewed, there is a physical examination, and screening tests for HIV and hepatitis. If there is no reason to suspect rabies, the tests will not be performed.
Time is also an issue. CNN points out, through an interview with CDC health officials, that in the time it takes to take a sample, send it out for testing, and receive the results, the organ could deteriorate and become unusable. In a time of donor organ shortages, this is an important concern. Both CNN and the New York Times highlight the question doctors are now facing: should potential donors with poorly defined neurological conditions (such as encephalitis of an unknown cause) be under increased scrutiny?
Rabies is a viral zoonotic disease, or a virus that is transmitted from animals to humans. Depending on where you are in the world, different animals are likely to carry rabies. In areas of Africa, Asia and South America, dogs present the biggest risk for rabies infection. According to the WHO, more than 90 percent of human rabies cases come from rabid dogs. Other animals that carry rabies include skunks, raccoons, jackals, foxes and bats. Despite popular belief, the number of human rabies infections caused by bats is actually quite small in comparison to those caused by dogs.
Rabies symptoms include fever, agitation, difficulty swallowing, insomnia, hallucinations, and hydrophobia, or fear of water. If you are bitten by an animal, the Mayo Clinic recommends that you see a doctor immediately, rather than waiting for any symptoms to appear. According to the CDC, once clinical symptoms of rabies appear, the prognosis (outlook) is dire.
If left untreated, rabies is fatal. There is a rabies vaccine that includes multiple doses, but rabies prevention focuses largely on animal vaccination and control and increasing rabies awareness in humans. The CDC recommends that you vaccinate your pets, report stray or wild animals, maintain a safe distance from stray or wild animals, and to seek appropriate medical care if you do come into contact with wild animals that typically carry rabies.