Vidyya Medical News Service
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Volume 7 Issue 53 Published - 14:00 UTC 08:00 EST 22-Feb-2005 Next Update - 14:00 UTC 08:00 EST 23-Feb-2005
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Cases of rabies in Germany following organ transplantation

(22 February 2005: VIDYYA MEDICAL NEWS SERVICE) -- On 16 February 2005, the Deutsche Stiftung Organtransplantation (German Foundation for Organ Transplantation, http://www.dso.de/) announced possible rabies cases in three of six patients who received organs from a donor who died in late December 2004 [1].These three patients, who received lung, kidney and kidney/pancreas transplants following the donorís death, are in a critical condition. The remaining three organ recipients (two corneal, one liver) have not shown any signs of rabies.

The organ donor suffered cardiac arrest in a hospital, where she was resuscitated several times. Her circulatory system was stabilised, but prolonged hypoxemia led to brain death. There were no clinical indications that the donor patient was infected with rabies.

The Bernhard-Nocht-Institute for Tropical Medicine in Hamburg (http://www.bni-hamburg.de/) and the Konsiliarlabor for Rabies at the University Clinic in Essenís Institute of Virology confirmed the diagnosis of rabies in the donor and two of the recipients on 16 and 17 February, 2005 [2]. As a precaution, all contacts of the infected donor and the infected patients in Germany have received rabies immunoglobulin and started a course of rabies vaccination. A warning was posted on the European Early Warning and Response System on 18 February.

The risk of rabies infection in Germany is extremely low. The last two deaths due to rabies in Germany occurred in 1996 and 2004 [3,4]. In both cases, the infection was acquired abroad, through an animal bite.

Transmission of the rabies virus to humans usually occurs through the bite of an infected animal, but can also occur through direct contact of mucous membranes or fresh breaks in the skin with infectious material (e.g. saliva, neural tissue, cerebrospinal fluid). Person-to-person transmission has been observed only in rare isolated cases after transplantation. Rabies in transplant recipients was last reported in 2004 in the United States [5,6]. Based on a risk analysis (http://www.cdc.gov/ncidod/dvrd/rabies/organ_update_070204.htm), 174 contacts associated with these cases received post-exposure prophylaxis with simultaneous passive immunisation with rabies immunoglobulin and active immunisation with rabies vaccine.

As a result of this situation, in consultation with the Konsiliarlabor for Rabies and the Bernhard-Nocht-Institute, the Robert Koch-Institut has defined indications for immunisation after contact with a person suspected of or confirmed as having rabies. These are available at http://www.rki.de.

Wiebke Hellenbrand (hellenbrandw@rki.de), Christiane Meyer, Gernot Rasch, Ines Steffens and Andrea Ammon, Robert Koch-Institut, Berlin, Germany

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