Transmission of West Nile virus from an organ donor to four transplant recipients.
BACKGROUND
In August 2002, fever and mental-status changes developed in recipients of organs from a common donor. Transmission of West Nile virus through organ transplantation was suspected.


METHODS
We reviewed medical records, conducted interviews, and collected blood and tissue samples for testing with a variety of assays. Persons who donated blood to the organ donor and associated blood components were identified and tested for West Nile virus.


RESULTS
We identified West Nile virus infection in the organ donor and in all four organ recipients. Encephalitis developed in three of the organ recipients, and febrile illness developed in one. Three recipients became seropositive for West Nile virus IgM antibody; the fourth recipient had brain tissue that was positive for West Nile virus by isolation and nucleic acid and antigen assays. Serum specimens obtained from the organ donor before and immediately after blood transfusions showed no evidence of West Nile virus; however, serum and plasma samples obtained at the time of organ recovery were positive on viral nucleic acid testing and viral culture. The organ donor had received blood transfusions from 63 donors. A review of blood donors and follow-up testing identified one donor who had viremia at the time of donation and who became seropositive for West Nile virus IgM antibodies during the next two months.


CONCLUSIONS
Our investigation of this cluster documents the transmission of West Nile virus by organ transplantation. Organ recipients receiving immunosuppressive drugs may be at high risk for severe disease after West Nile virus infection. Blood transfusion was the probable source of the West Nile virus viremia in the organ donor.
Iwamoto
Martha
M
Epidemic Intelligence Service, Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta 30333, USA.
Jernigan
Daniel B
DB
Guasch
Antonio
A
Trepka
Mary Jo
MJ
Blackmore
Carina G
CG
Hellinger
Walter C
WC
Pham
Si M
SM
Zaki
Sherif
S
Lanciotti
Robert S
RS
Lance-Parker
Susan E
SE
DiazGranados
Carlos A
CA
Winquist
Andrea G
AG
Perlino
Carl A
CA
Wiersma
Steven
S
Hillyer
Krista L
KL
Goodman
Jesse L
JL
Marfin
Anthony A
AA
Chamberland
Mary E
ME
Petersen
Lyle R
LR
D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D001782:Blood Donors; D017848:Blood-Borne Pathogens; D017809:Fatal Outcome; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D014019:Tissue Donors; D065227:Transfusion Reaction; D014766:Viremia / Q000175:diagnosis / Q000635:transmission; D014901:West Nile Fever / Q000175:diagnosis / Q000635:transmission*; D014902:West Nile virus / Q000276:immunology / Q000302:isolation & purification
D000914:Antibodies, Viral; D007075:Immunoglobulin M