E-alert 18 February: Cases of rabies in Germany following organ
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 .These three patients, who
received lung, kidney and kidney/pancreas transplants following the donor’s
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 Essen’s Institute
of Virology confirmed the diagnosis of rabies in the donor and two of the
recipients on 16 and 17 February, 2005 . 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.
This article was first published as an e-alert in Eurosurveillance
on 18 February 2005, and was originally available at http://www.eurosurveillance.org/ew/2005/050217.asp#1