title: A large-scale, rapid public health response to rabies in an organ recipient and the previously undiagnosed organ donor.
abstract: This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.
authors.affiliation: Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology (DHCPP), Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Wallace
authors.forename: D
authors.initials: D
authors.lastname: Stanek
authors.forename: S
authors.initials: S
authors.lastname: Griese
authors.forename: D
authors.initials: D
authors.lastname: Krulak
authors.forename: N M
authors.initials: NM
authors.lastname: Vora
authors.forename: L
authors.initials: L
authors.lastname: Pacha
authors.forename: V
authors.initials: V
authors.lastname: Kan
authors.forename: M
authors.initials: M
authors.lastname: Said
authors.forename: C
authors.initials: C
authors.lastname: Williams
authors.forename: T H
authors.initials: TH
authors.lastname: Burgess
authors.forename: S S
authors.initials: SS
authors.lastname: Clausen
authors.forename: C
authors.initials: C
authors.lastname: Austin
authors.forename: J
authors.initials: J
authors.lastname: Gabel
authors.forename: M
authors.initials: M
authors.lastname: Lehman
authors.forename: L N
authors.initials: LN
authors.lastname: Finelli
authors.forename: G
authors.initials: G
authors.lastname: Selvaggi
authors.forename: P
authors.initials: P
authors.lastname: Joyce
authors.forename: F
authors.initials: F
authors.lastname: Gordin
authors.forename: D
authors.initials: D
authors.lastname: Benator
authors.forename: A
authors.initials: A
authors.lastname: Bettano
authors.forename: S
authors.initials: S
authors.lastname: Cersovsky
authors.forename: C
authors.initials: C
authors.lastname: Blackmore
authors.forename: S V
authors.initials: SV
authors.lastname: Jones
authors.forename: B D
authors.initials: BD
authors.lastname: Buchanan
authors.forename: A I
authors.initials: AI
authors.lastname: Fernandez
authors.forename: D
authors.initials: D
authors.lastname: Dinelli
authors.forename: K
authors.initials: K
authors.lastname: Agnes
authors.forename: A
authors.initials: A
authors.lastname: Clark
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.forename: M
authors.initials: M
authors.lastname: Irmler
authors.forename: D
authors.initials: D
authors.lastname: Blythe
authors.forename: K
authors.initials: K
authors.lastname: Mitchell
authors.forename: T J
authors.initials: TJ
authors.lastname: Whitman
authors.forename: M J
authors.initials: MJ
authors.lastname: Zapor
authors.forename: S
authors.initials: S
authors.lastname: Zorich
authors.forename: C
authors.initials: C
authors.lastname: Witkop
authors.forename: P
authors.initials: P
authors.lastname: Jenkins
authors.forename: P
authors.initials: P
authors.lastname: Mora
authors.forename: D
authors.initials: D
authors.lastname: Droller
authors.forename: S
authors.initials: S
authors.lastname: Turner
authors.forename: L
authors.initials: L
authors.lastname: Dunn
authors.forename: P
authors.initials: P
authors.lastname: Williams
authors.forename: C
authors.initials: C
authors.lastname: Richards
authors.forename: G
authors.initials: G
authors.lastname: Ewing
authors.forename: K
authors.initials: K
authors.lastname: Chapman
authors.forename: C
authors.initials: C
authors.lastname: Corbitt
authors.forename: T
authors.initials: T
authors.lastname: Girimont
authors.forename: R
authors.initials: R
authors.lastname: Franka
authors.forename: S
authors.initials: S
authors.lastname: Recuenco
authors.forename: J D
authors.initials: JD
authors.lastname: Blanton
authors.forename: K A
authors.initials: KA
authors.lastname: Feldman
mesh_terms: D016358:Contact Tracing; D003428:Cross Infection / Q000821:virology; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D056990:Post-Exposure Prophylaxis; D011634:Public Health; D011818:Rabies / Q000635:transmission* / Q000821:virology; D011820:Rabies virus / Q000302:isolation & purification*; D018570:Risk Assessment; D014019:Tissue Donors