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Public Health Dispatch: West Nile Virus Infection in Organ Donor and Transplant Recipients --- Georgia and Florida, 2002

On August 23, 2002, the Georgia Division of Public Health (GDPH) and CDC were notified of two cases of unexplained fever and encephalitis in recipients of organ transplants from a common donor. An investigation has identified illness in two other recipients from the same donor: one with encephalopathy and the other with febrile illness. CDC, the Food and Drug Administration, GDPH, and the Florida Department of Health are conducting the investigation. This cluster could possibly represent the first recognized transmission of West Nile virus (WNV) by organ donation.

On August 1, four organs were recovered from a single donor and subsequently transplanted into four persons. The donor had been previously healthy before a fatal injury. Before death, the organ donor received numerous transfusions of blood products. Testing performed at CDC with polymerase chain reaction (PCR) during this investigation revealed the presence of WNV in donor serum collected before organ procurement. Of the four organ recipients, three met the case definition for WNV encephalitis. Testing is pending on the fourth recipient.

A recipient of one of the donor kidneys developed a febrile illness 13 days after transplant which progressed to encephalitis requiring transient mechanical ventilation; the patient's clinical condition is improving. Cerebrospinal fluid (CSF) was positive for WNV IgM antibody. A second kidney recipient had a febrile illness 17 days after transplant progressing to fatal encephalitis. Brain tissues obtained at autopsy were strongly positive for WNV by quantitative PCR and also were positive by flavivirus specific immunohistochemical staining. A third patient who received a heart transplant had ataxia 8 days following transplant; the patient later became unresponsive and required mechanical ventilation. WNV IgM antibody testing of the patient's CSF and serum at the Florida Department of Health Bureau of Laboratories was strongly positive. This patient's mental status has improved, and the patient no longer requires ventilatory support. A fourth patient who underwent liver transplantation had fever, cough, and malaise 7 days following transplant; the patient had no clinical evidence of encephalitis. The patient's symptoms resolved, allowing discharge from the hospital. Laboratory evaluation of serum for WNV is in progress.

WNV infection in organ transplant recipients has not been reported previously, and the risk for transmission of WNV through donated organs is not known. Three of the four organ recipients had encephalitis; typically, one in 150 WNV infections results in encephalitis or meningitis. It is unknown whether immunosuppressed persons, such as organ transplant recipients, are at increased risk for severe WNV-related disease following infection. Similarly, it is unknown if the route of transmission increased the risk for encephalitis in these organ transplant recipients.

The organ donor might have become infected from a mosquito bite or from blood products received following the fatal injury. On the basis of preliminary results from this investigation, clinicians should be aware of the possibility of WNV infection in organ transplant recipients and patients receiving blood transfusions. Clinicians who suspect WNV infection can obtain rapid testing through state and local health departments. Public health officials have initiated precautionary measures including a withdrawal and testing of any remaining blood products from blood donors whose blood product was given to the organ donor. Donors of blood given to the organ donor and other recipients of blood from these donors are being contacted for West Nile virus testing. This is the first report of possible transmission of WNV by organ transplantation. Current data are insufficient to warrant changes to organ or blood donor screening and testing practices or the clinical use of donated organs and blood.

Reported by: Florida Dept of Health. Georgia Div of Public Health. Center for Biologics Evaluation and Research, Food and Drug Administration. Div of Healthcare Quality Promotion, Div of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC.

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