Probable Rabies Virus Transmission through Organ Transplantation, China, 2015

Zhou, Hang; Zhu, Wuyang; Zeng, Jun; He, Jianfeng; Liu, Kai; Liu, Yu; Zhou, Shuwu; Mu, Di; Zhang, Kechun; Yu, Pengcheng; Z, Li; Zhang, Meng; Chen, Xueqiong; Guo, Chun; Yu, Hongjie

doi:10.3201/eid2208.151993

Cited by 23 publications

(17 citation statements)

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“…This is surprising, as there are ample examples that the transmission of pathogenic viruses, albeit commonly rare, can occur. Prominent examples in renal transplantation are West Nile virus [5], lymphocytic choriomeningitis virus [6], human gammaherpesvirus 8 [7], and rabies lyssavirus [8]. Analyses of the virome thus far have focused solely on the kidney transplant recipients [9,10].…”

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confidence: 99%

Metagenomic Virome Sequencing in Living Donor and Recipient Kidney Transplant Pairs Revealed JC Polyomavirus Transmission

Schreiber

Kufner

Hübel

et al. 2018

Clinical Infectious Diseases

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Background. Before kidney transplantation, donors and recipients are routinely screened for viral pathogens using specific tests. Little is known about unrecognized viruses of the urinary tract that potentially result in transmission. Using an open metagenomic approach, we aimed to comprehensively assess virus transmission in living-donor kidney transplantation.Methods. Living kidney donors and their corresponding recipients were enrolled at the time of transplantation. Follow-up study visits for recipients were scheduled 4-6 weeks and 1 year thereafter. At each visit, plasma and urine samples were collected and transplant recipients were evaluated for signs of infection or other transplant-related complications. For metagenomic analysis, samples were enriched for viruses, amplified by anchored random polymerase chain reaction (PCR), and sequenced using high-throughput metagenomic sequencing. Viruses detected by sequencing were confirmed using real-time PCR.Results. We analyzed a total of 30 living kidney donor and recipient pairs, with a follow-up of at least 1 year. In addition to viruses commonly detected during routine post-transplant virus monitoring, metagenomic sequencing detected JC polyomavirus (JCPyV) in the urine of 7 donors and their corresponding recipients. Phylogenetic analysis confirmed infection with the donor strain in 6 cases, suggesting transmission from the transplant donor to the recipient, despite recipient seropositivity for JCPyV at the time of transplantation.Conclusions. Metagenomic sequencing identified frequent transmission of JCPyV from kidney transplant donors to recipients. Considering the high incidence rate, future studies within larger cohorts are needed to define the relevance of JCPyV infection and the donor's virome for transplant outcomes.

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confidence: 99%

Metagenomic Virome Sequencing in Living Donor and Recipient Kidney Transplant Pairs Revealed JC Polyomavirus Transmission

Schreiber

Kufner

Hübel

et al. 2018

Clinical Infectious Diseases

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“…In China, most human rabies cases can be ascribed to dog bites, and transmission via organ transplantation is rare (Tang et al, 2005 ). To our knowledge, a single rabies case via organ transplantation was reported in 2015 in Beijing (Zhou et al, 2016 ). In this study, RABV was identified in the saliva specimens from two kidney recipients at a hospital in Hunan, Changsha, using real time RT-PCR and NGS.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first report of rabies transmission by corneal transplantation in 1979 (Houff et al, 1979 ), few cases ascribed to solid organ or vascular-tissue transplantation have been reported (Srinivasan et al, 2005 ; Vora et al, 2013 ). A transplantation-infectious case was reported in China in 2015 (Zhou et al, 2016 ). In January 2016, two kidney transplant recipients, who received organs from the same donor, presented with vomiting, abdominal pain, and right lower extremity weakness.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological and Genetic Characteristics of Rabies Virus Transmitted Through Organ Transplantation

Chen

Liu

Jin

et al. 2018

Front. Cell. Infect. Microbiol.

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In January 2016, two patients died of rabies after receiving kidney transplants from a common organ donor at a hospital in Changsha, Hunan, China. The medical records, epidemiological data of the organ donor, two kidney and a liver recipients were reviewed. Intravitam saliva samples of the two kidney recipients were tested for rabies virus (RABV) using real-time RT-PCR, and the nucleoprotein (N) gene was amplified and sequenced by Sanger sequencing. Whole genome sequences were analyzed using next-generation sequencing. The N genes of the two kidney recipients showed 100% nucleic acid identity. Phylogenetic analysis of the complete genome, N and glycoprotein (G) genes indicated that the RABV was homologous with dog isolates from the Hunan province and belong to the China I lineage, which is widespread in China. The organ donor was a 22-month-old boy who died from unknown acute progressive encephalitis. After undergoing sub-hypothermia hibernation therapy, rabies-associated symptoms were atypical, and rabies was neglected because serum RABV-specific antibodies were negative. An unknown wound on the forehead of the donor was found 2 months before the onset of symptoms. Based on the clinical, epidemiological, and molecular findings, we speculated that the RABV initially originated in the donor from a dog bite, and was then transmitted to the recipients by organ transplantation. An uncertain exposure history and misdiagnosis played important roles in the spread of the RABV. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially in potential organ donors.

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“…Many of the ‘uncommon’ disease transmissions such as rabies have come with the use of organs from a previously healthy person who subsequently died with an undiagnosed/misdiagnosed neurologic event. Dozens of rabies virus transmissions to recipients via organs or tissues from donors with either undiagnosed or misdiagnosed inflammatory conditions of meningoencephalitis were reported [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Rabies virus transmission via solid organs or tissue allotransplantation

Zhu

2018

Infect Dis Poverty

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BackgroundRabies, for which the mortality rate is almost 100%, is a zoonotic viral disease that can be transmitted via solid organs or tissue allotransplantation. Dozens of deaths from rabies via solid organs or tissues allotransplantation (ROTA) have been documented during the last decades. In 2015 and 2016, two cases of rabies virus transmission via solid organs or tissue allotransplantation were reported in China, which further underscore the risk and importance of this special type of rabies for organ transplant recipients.Main textFrom 1978 to 2017, at least 13 cases of ROTA, causing dozens of deaths, have been reported worldwide, whether in the high-risk or low-risk countries of rabies. The reported incubation period of ROTA ranges from 11 days to more than 17 months, while the historical incubation period of rabies is generally considered to range from ~ 1 week to several years. The pathogenesis of ROTA is not clear, but the use of post-exposure prophylaxis (PEP) can play a protective role in the transplant recipients. We also summarize reports about ROTA in China, combined with the actual situation regarding work on rabies surveillance and elimination, and suggest countermeasures for the prevention and control of ROTA in the future.ConclusionsUnderstanding the significance of ROTA, screening the suspected organs, assessing the risk and protecting the related population will be effective way to prevent and control further occurrence of ROTA.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0467-7) contains supplementary material, which is available to authorized users.

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Probable Rabies Virus Transmission through Organ Transplantation, China, 2015

Abstract: Implementation of an effective regulatory system for testing donors would decrease the occurrence of donor-derived infectious diseases.

Cited by 23 publications

References 13 publications

Metagenomic Virome Sequencing in Living Donor and Recipient Kidney Transplant Pairs Revealed JC Polyomavirus Transmission

Metagenomic Virome Sequencing in Living Donor and Recipient Kidney Transplant Pairs Revealed JC Polyomavirus Transmission

Epidemiological and Genetic Characteristics of Rabies Virus Transmitted Through Organ Transplantation

Rabies virus transmission via solid organs or tissue allotransplantation

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