Risk of rabies infection and adverse effects of postexposure prophylaxis in healthcare workers and other patient contacts exposed to a rabies virus-infected lung transplant recipient.
BACKGROUND
Rabies virus was inadvertently transmitted to a lung transplant recipient through donor lungs. The patient was given ventilatory assistance and cared for postoperatively for 6 weeks before a diagnosis of rabies virus infection was made. Postexposure prophylaxis (PEP) was offered to potentially exposed healthcare workers (HCWs).


METHODS
Only HCWs classified as belonging to possible and/or proven contact groups (according to a standardized interview) received PEP. The risk of individual HCWs being exposed to rabies virus was reassessed on the basis of viral concentrations measured in the patient's excretions and body fluids. HCWs who were vaccinated as part of PEP were followed up prospectively according to a standardized procedure.


RESULTS
Of 179 HCWs and other patient contacts, 132 met the eligibility criteria for PEP (118 [89.4%] with possible contact and 14 [10.6%] with proven contact with the patient's excretions and/or body fluids). One hundred thirty-one individuals started PEP, and 126 met the inclusion criteria for analysis. Of these, 48 (38%) developed at least 1 adverse effect (8 [6.3%] had fever, 37 [29.4%] had headache, 3 [2.4%] had lymphadenopathy, 17 [13.5%] had dizziness, and 6 [4.8%] had paresthesia). No HCW or other patient contact developed rabies or serious PEP-related adverse effects. Reassessment of the individual's risk of infection as a function of the viral concentration in the patient's excretions and/or body fluids (up to 5.12 x 10(7) copies/mL) revealed that 103 HCWs (78.0%) had contact with high-risk substances (89 [67.40%] had possible contact and 14 [10.7%] had proven contact).


CONCLUSIONS
HCWs can be exposed to significant viral concentrations in excretions and/or body fluids from rabies virus-infected lung transplant recipients. Because widespread use of PEP entails the possibility of significant health problems for HCWs considered to be at risk of contracting rabies, applying a rational indication for PEP is crucial.
Mattner
Frauke
F
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany. Mattner.Frauke@mh-hannover.de
Henke-Gendo
Cornelia
C
Martens
Andreas
A
Drosten
Christian
C
Schulz
Thomas F
TF
Heim
Albert
A
Suerbaum
Sebastian
S
Kuhn
Sabine
S
Bruderek
Juliane
J
Gastmeier
Petra
P
Strueber
Martin
M
D018890:Chemoprevention; D016358:Contact Tracing; D003428:Cross Infection / Q000517:prevention & control / Q000821:virology*; D018562:Disease Transmission, Infectious; D005260:Female; D005858:Germany / Q000453:epidemiology; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional; D007362:Intensive Care Units; D007407:Interviews as Topic; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D010356:Patient Isolation; D011247:Pregnancy; D011818:Rabies / Q000517:prevention & control* / Q000635:transmission*; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D013183:Sputum / Q000821:virology; D019737:Transplants / Q000821:virology*; D014611:Vaccination / Q000009:adverse effects / Q000706:statistics & numerical data*
D011819:Rabies Vaccines