(CNN) -- A Maryland man recently died of rabies
that he contracted from a tainted kidney he received in a transplant
operation a year and a half ago, the Centers for Disease Control and
Prevention said Friday.
Health care teams are now
giving anti-rabies shots to three other patients who received organs
from the same donor as the patient, the CDC said.
The Maryland man and
three other people -- in Florida, Georgia and Illinois -- received
organs from a person who died in Florida in 2011.
Doctors knew the donor
had encephalitis, an inflammation of the brain, when they harvested the
organs. However, they didn't know rabies was the cause.
At the time, rabies
wasn't suspected as the cause of the donor's death, and no rabies test
was done before the donor's kidneys, heart and liver were delivered for
transplantation in September 2011, the CDC said.
The Maryland recipient
died February 27 at a VA Medical Center in Washington after falling ill.
Health officials investigating his death made the rabies diagnosis this
month. Officials then re-examined the donor's death and determined the
donor also died of rabies, according to the CDC.
The agency is looking for
family members or health care workers who might have had close contact
with the donor or the recipients to see if they have rabies, according
to CDC spokeswoman Melissa Dankel.
It marks the second time
organ transplant recipients have fallen ill with rabies in the United
States. In 2004, four people died when tainted organs and tissue were
taken from a rabies-infected donor. No one knew the donor had rabies
until after the recipients became ill.
In this most recent
case, the donor was experiencing "changes in mental status" before he
died, according to Dr. Matthew Kuehnert, director of the CDC's Office of
Blood, Organ, and Other Tissue Safety. He said doctors in Florida
tested the donor for various causes of encephalitis, including West Nile
Virus and herpes, but did not test for rabies.
Organ donors are not
routinely tested for rabies, even if they show the signs. One reason is
rabies is extremely rare, with only one to three cases a year
nationwide, according to Dr. Richard Franka, the CDC's acting rabies
team lead.
Also, many lifesaving
organs would be lost if the donors were tested for rabies. Only three or
four facilities in the country are capable of testing for rabies in
humans, Franka said, which means most hospitals would have to ship a
potential donor's blood or tissue. It could take two days to get test
results, and by then the organs would no longer be usable.
Hospitals do test for other causes of encephalitis, and if no cause is found, the organs are donated.
Perhaps this needs to be changed, Kuehnert said.
"What we need looking
forward is a standardized approach when you have encephalitis of unknown
cause so very important things like this aren't missed," he said.
Because rabies was
suspected, portions of the patient's brain were sent to the CDC, which
did testing and confirmed rabies. At the request of the CDC, the Florida
hospital sent part of the donor's brain, which had been saved. The CDC
quickly determined that both donor and recipient died from the
raccoon-type rabies virus.
The other three
recipients were immediately contacted. They show no signs of rabies but
are being treated with five doses of the rabies vaccine and rabies
immune globulin, which gives the body antibodies to protect itself
against the rabies virus. Both treatments are shots in the upper arm.
Kuehnert said the recipients' doctors were shocked to learn the donor's organs were tainted with rabies.
"Their first reaction was that it seemed unlikely because it's been almost a year and a half since the transplant," he said.
In 2004, the recipients of the tainted organs died within a month of the transplant.
"This kind of incubation period -- 17 months -- is quite unusual," he said.
CNN's Miriam Falco and Georgiann Caruso contributed to this report.
A Maryland man who died last month was one of four people who received an organ transplant from a donor with rabies.
