title: Transmission of West Nile virus from an organ donor to four transplant recipients.
abstract: 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.
authors.affiliation: Epidemic Intelligence Service, Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta 30333, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jernigan
authors.forename: Antonio
authors.initials: A
authors.lastname: Guasch
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Trepka
authors.forename: Carina G
authors.initials: CG
authors.lastname: Blackmore
authors.forename: Walter C
authors.initials: WC
authors.lastname: Hellinger
authors.forename: Si M
authors.initials: SM
authors.lastname: Pham
authors.forename: Sherif
authors.initials: S
authors.lastname: Zaki
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lanciotti
authors.forename: Susan E
authors.initials: SE
authors.lastname: Lance-Parker
authors.forename: Carlos A
authors.initials: CA
authors.lastname: DiazGranados
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Winquist
authors.forename: Carl A
authors.initials: CA
authors.lastname: Perlino
authors.forename: Steven
authors.initials: S
authors.lastname: Wiersma
authors.forename: Krista L
authors.initials: KL
authors.lastname: Hillyer
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Goodman
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Marfin
authors.forename: Mary E
authors.initials: ME
authors.lastname: Chamberland
authors.forename: Lyle R
authors.initials: LR
authors.lastname: Petersen
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M