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Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

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  • Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

    Source: http://washingtonexaminer.com/md.-re...rticle/2524100

    Md. resident dies of rabies in state's first case since 1976
    March 12, 2013 | 5:49 pm
    Matt Connolly
    Examiner Staff Writer
    The Washington Examiner

    A Maryland resident died of rabies in the state's first such case in nearly four decades.

    The death was confirmed by the state's Department of Health and Mental Hygiene, which did not release any other information about the victim. Officials don't know how the individual came to contract the virus...
    Last edited by Emily; March 15, 2013, 03:46 PM. Reason: Title update.

  • #2
    Re: Md. resident dies of rabies in state's first case since 1976


    Man dies of rabies from year-old kidney transplant
    Elizabeth Weise, USA TODAY3:13p.m. EDT March 15, 2013
    The fact that it took over a year for the recipient to begin to show symptoms threw investigators off, as usually rabies develops within a month or two...
    _____________________________________________

    Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

    i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

    "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

    (My posts are not intended as advice or professional assessments of any kind.)
    Never forget Excalibur.

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    • #3
      Re: Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

      Source: http://www.pnj.com/viewart/20130316/...-rabies-sought


      Other people who had contact with Pensacola recruit who died of rabies sought
      Mar. 16, 2013 2:32 PM, |


      Public and military health officials say they?re trying to identify people in at least five states who had close contact with an organ donor who died of rabies or with the organ recipients because they might require treatment.

      A 20-year-old Air Force recruit from North Carolina who died of rabies in Florida had symptoms of the disease but wasn?t tested before his organs were transplanted to four patients, one of whom died of rabies nearly 18 months later, federal health officials said Friday.

      The recruit was training to become an aviation mechanic in Pensacola when he got sick, Defense Department spokeswoman Cynthia O. Smith said...

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      • #4
        Re: Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

        Questions and Answers - Human Rabies Due to Organ Transplantation, 2013



        Summary

        The Centers for Disease Control and Prevention (CDC) and Maryland Department of Health and Mental Hygiene have confirmed that a patient who recently died of rabies in Maryland contracted the infection through organ transplantation done more than a year ago. The patient was one of four people who had received an organ from the same donor. CDC laboratories tested tissue samples from the donor and from the recipient who died to confirm transmission of rabies through organ transplantation.

        The Maryland Department of Health and Mental Hygiene initiated an investigation after the organ recipient died, which led to the rabies diagnosis. The investigation revealed that the organ recipient had no reported animal exposures, the usual source of rabies transmission to humans, and identified the possibility of transplant-related transmission of rabies, which is extremely rare.

        The organ transplantation occurred more than a year before the recipient developed symptoms and died of rabies; this period is much longer than the typical rabies incubation period of 1 to 3 months, but is consistent with prior case reports of long incubation periods. CDC's preliminary laboratory analysis indicates that the recipient and the donor both had the same type of rabies virus?a raccoon type. This type of rabies virus can infect not only raccoons, but also other wild and domestic animals. In the United States, in the past 50 years, only one other person is reported to have died from a raccoon-type rabies virus.

        How common is it for organ recipients to get diseases from their donors?

        While organ transplantations are often life-saving procedures, illness and death rarely can occur from transmission of undetected infections from donors. Diseases that have been unknowingly transmitted through transplants include a wide array of viruses, bacteria, and parasites despite extensive donor screening.

        The Health Resources and Services Administration (HRSA) oversees organ transplantation through the Organ Procurement and Transplantation Network (OPTN), established by Congress under the National Organ Transplant Act of 1984. In late 2004, a new OPTN policy required organ procurement organizations and transplant centers to report to the United Network for Organ Sharing (UNOS) suspected donor-derived disease transmissions (infections and malignancies). Reporting is increasing, but the rate of transmission of infectious diseases that are unrecognized at the time of transplantation is still not well understood. It is estimated that about 1% of all transplant recipients are suspected to have a transplant-transmitted infection. Death associated with infectious disease transmission is more unusual, but has been reported, including in this most recent rabies transmission.

        Has anyone else ever gotten rabies from an organ donor before? What happened in that case?

        In 2004, CDC confirmed the first reported cases of rabies transmission through solid organ transplantation. Although rabies transmission had occurred previously through cornea transplants, this was the first report of rabies transmission via solid organ transplantation. The organ donor had undergone routine eligibility screening, including laboratory testing. One of the organ recipients died during transplant surgery, and the other three recipients died later of rabies. When questioned after the donor's death, friends of the donor indicated the donor had recently reported being bitten by a bat.

        A similar rabies transmission through organ transplantation occurred in Germany in 2005. Six recipients received organs or tissues from a donor with rabies. Two recipients receiving donor corneas were not infected after their grafts were removed. Recipients who received lung, kidney and combined kidney and pancreas organs died. The liver recipient had been previously vaccinated against rabies and survived.

        Are organs routinely screened for rabies when they are donated in the United States? What diseases are organs screened for in the United States?

        All potential organ donors in the United States are screened and tested to identify if the donor might present an infectious risk. Organ procurement organizations are responsible for evaluating the suitability of each organ donor. Donor eligibility is determined through a series of questions posed to the person consenting to organ donation, physical examination of the donor, and infectious disease testing, including screening for HIV and hepatitis B and C viruses. Transplant centers are prohibited from accepting and transplanting organs from donors infected with HIV.

        Could rabies screening have detected infection in this donor?

        After the transmission cluster in 2004, many organ procurement organizations added a screening question about rabies exposure. In this instance, the screening did not identify a risk for rabies. The recent transmission of a rare rabies virus infection through an organ donor underscores the fact that screening prior to organ transplantation cannot always detect every possible donor-derived infection. Fortunately, the risk of rabies transmission remains very low as this is only the second known organ donor with rabies in the United States (the first was identified in July 2004). Laboratory testing needs to be carefully considered for accuracy and ability to obtain results in time.

        How was the donor exposed to rabies?

        It is believed that the donor was exposed to rabies through contact with an infected animal. CDC, in conjunction with state health departments and other public health collaborators, is actively working to learn more about and ultimately confirm the nature of the donor's exposure.

        What's the status of the other organ recipients?

        The three other recipients are being evaluated by their healthcare teams. These individuals are being monitored closely and are showing no signs of rabies infection.

        When administered in a timely fashion, rabies postexposure prophylaxis (anti-rabies shots that consist of immune globulin and anti-rabies vaccination) is highly effective at preventing infection. Post exposure prophylaxis has been recommended for the other three organ recipients.

        If I had an organ transplant a year or two ago, could I have an infection?

        The vast majority of transplant-transmitted infections show evidence of infection soon after the transplantation. If patients are concerned about infection after organ transplantation, they should contact their transplant team.

        How long does it take for rabies to make someone sick?

        Typically, the time from exposure to rabies virus until clinical symptoms appear (also known as the incubation period) ranges from 1 to 3 months.
        In the only known previous cluster of rabies transmission through organ transplantation in the United States, all 4 recipients died or developed rabies within 30 days of transplantation. In the recent case, the organ transplantation occurred approximately 16 months prior to the onset of symptoms and death of the recipient. Incubation periods exceeding one year are very rare, making this one of the longer rabies incubation periods recorded.

        The type of rabies virus found in both the donor and the recipient was of raccoon origin, which is only found in North America. In the United States, only one other person has ever died from this type of rabies virus. It is unknown, however, whether the route of infection, type of virus, or immune suppression drugs may be factors in changing the time course for infection in the transplant setting.

        How is raccoon rabies different from dog or bat rabies?

        Many types of the rabies virus exist and are often associated with a particular animal. Examples include raccoon rabies and bat rabies virus variants. The type of rabies caused by dogs, which is now eliminated in the United States, is another example. Each type of rabies can be transmitted to other animals. As an example, it is possible for a bat with bat rabies to infect a dog that then bites a human, exposing the person to bat rabies even though there was no exposure to a bat. Any mammal can get rabies and potentially transmit it through bites, but in the United States there are only a few major reservoirs (such as raccoons, skunks, bats, and foxes) that maintain circulation of virus and are a source of infection for humans and other mammals.

        Human rabies cases resulting from raccoons are very rare. In 2003, the first death associated with the raccoon rabies virus variant was reported. In this case, the animal that caused the human exposure was ultimately unable to be identified. The animal exposure of the donor associated with the most recent rabies transplant transmission is actively being investigated.


        Page last reviewed: March 15, 2013
        Page last updated: March 15, 2013




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        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
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        • #5
          Re: Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

          http://www.witn.com/news/headlines/T...198827441.html
          Posted: Mon 3:04 PM, Mar 18, 2013
          A A
          Updated: Tue 2:47 PM, Mar 19, 2013
          Back to News
          Trenton Woman Says Child's Father Donated Rabies-Infected Organs
          A North Carolina woman said Monday that her child?s father is the Air Force aviation mechanic whose rabies-infected organs were transplanted into other recipients, including a Maryland man who died...
          She had been told that Mr. Small had died from complications from a stomach virus. This case raises questions about the organ donor screening process.

          Why was this risk for rabies not noticed during screening?

          Mercer said she wasn?t surprised to learn that Small had died of rabies, and not a stomach virus, because he liked to hunt and trap animals.

          ?He did a lot of trapping and hunting and stuff,? she said. ?He did the trapping, and he didn?t care what the animal looked like. He just picked it up.
          _____________________________________________

          Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

          i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

          "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

          (My posts are not intended as advice or professional assessments of any kind.)
          Never forget Excalibur.

          Comment


          • #6
            Re: Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

            Source: http://www.wftv.com/news/ap/top-news...n-bites/nY2D6/


            Updated: 4:21 p.m. Tuesday, July 23, 2013 | Posted: 4:21 p.m. Tuesday, July 23, 2013
            Study: Organ donor with rabies had 2 raccoon bites
            By ERIC TUCKER

            The Associated Press

            WASHINGTON ?

            An Air Force recruit whose organs were donated to four patients including a kidney recipient who died of rabies had at least two untreated raccoon bites several months before he became sick, and tests confirm his rabies-infected kidney caused the recipient's disease, according to a medical journal report...

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            • #7
              Re: Md. resident dies of rabies (source was transplanted kidney) in state's first case since 1976- FL donor contacts sought

              Published Date: 2013-07-26 02:28:05
              Subject: PRO/AH/EDR> Rabies - USA (13): organ transplant, report
              Archive Number: 20130726.1846194
              RABIES - USA (13): ORGAN TRANSPLANT, REPORT
              *******************************************

              Date: Wed 25 Jul 2013
              Source: Journal of the American Medical Association (JAMA) 2013; 310(4): 398-407 [edited]



              Raccoon rabies virus variant transmission through solid organ transplantation
              -------------------------------------------------------------
              (NM Vora, et al, and the Transplant-Associated Rabies Virus Transmission Investigation Team. JAMA. 2013;310(4):398-407. doi:10.1001/jama.2013.7986.)

              Abstract
              --------
              Importance: Rabies virus causes a fatal encephalitis and can be transmitted through tissue or organ transplantation. In February 2013, a kidney recipient with no reported exposures to potentially rabid animals died from rabies 18 months after transplantation.

              Objectives: To investigate whether organ transplantation was the source of rabies virus exposure in the kidney recipient, and to evaluate for and prevent rabies in other transplant recipients from the same donor.

              Design: Organ donor and all transplant recipient medical records were reviewed. Laboratory tests to detect rabies virus-specific binding antibodies, rabies virus neutralizing antibodies, and rabies virus antigens were conducted on available specimens, including serum, cerebrospinal fluid, and tissues from the donor and the recipients. Viral ribonucleic acid was extracted from tissues and amplified for nucleoprotein gene sequencing for phylogenetic comparisons.

              Main outcomes and measures: Determination of whether the donor died from undiagnosed rabies and whether other organ recipients developed rabies.

              Results: In retrospect, the donor's clinical presentation (which began with vomiting and upper extremity paresthesias [tingling] and progressed to fever, seizures, dysphagia [difficulty swallowing], autonomic dysfunction, and brain death) was consistent with rabies. Rabies virus antigen was detected in archived autopsy brain tissue collected from the donor. The rabies viruses infecting the donor and the deceased kidney recipient were consistent with the raccoon rabies virus variant and were more than 99.9 per cent identical across the entire N gene (1349/1350 nucleotides), thus confirming organ transplantation as the route of transmission. The 3 other organ recipients remained asymptomatic, with rabies virus neutralizing antibodies detected in their serum after completion of postexposure prophylaxis (range, 0.3-40.8 IU/mL).

              Conclusions and relevance: Unlike the 2 previous clusters of rabies virus transmission through solid organ transplantation, there was a long incubation period in the recipient who developed rabies, and survival of 3 other recipients without pretransplant rabies vaccination. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially for potential organ donors. A standard evaluation of potential donors who meet screening criteria for infectious encephalitis should be considered, and risks and benefits for recipients of organs from these donors should be evaluated.

              --
              communicated by:
              ProMED-mail
              <promed@promedmail.org>

              [The above report concludes a detailed investigation of the incident described previously in ProMED-mail (see references below) whereby rabies virus infection was transmitted from a donor with a cryptic raccoon rabies virus infection to organ recipients (only one of whom died as a consequence). A significant feature of this incident was the prolonged survival of the organ recipient who eventually succumbed to rabies virus infection. - Mod.CP]

              The salvage of human life ought to be placed above barter and exchange ~ Louis Harris, 1918

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