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      Transmission of Eastern Equine Encephalitis Virus From an Organ Donor to 3 Transplant Recipients

      1 , 2 , 3 , 4 , 5 , 6 , 4 , 4 , 3 , 3 , 3 , 7 , 7 , 8 , 1 , 1 , 9 , 10 , 11 , 12 , 12 , 13 , 13 , 13 , 14 , 15 , 3 , 5 , 5 , 5 , 5 , 5 , 5 , 5 , 5 , Eastern Equine Encephalitis Virus Transplant Transmission Investigation Team

      Clinical Infectious Diseases

      Oxford University Press (OUP)

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          Abstract

          Background

          In fall 2017, 3 solid organ transplant (SOT) recipients from a common donor developed encephalitis within 1 week of transplantation, prompting suspicion of transplant-transmitted infection. Eastern equine encephalitis virus (EEEV) infection was identified during testing of endomyocardial tissue from the heart recipient.

          Methods

          We reviewed medical records of the organ donor and transplant recipients and tested serum, whole blood, cerebrospinal fluid, and tissue from the donor and recipients for evidence of EEEV infection by multiple assays. We investigated blood transfusion as a possible source of organ donor infection by testing remaining components and serum specimens from blood donors. We reviewed data from the pretransplant organ donor evaluation and local EEEV surveillance.

          Results

          We found laboratory evidence of recent EEEV infection in all organ recipients and the common donor. Serum collected from the organ donor upon hospital admission tested negative, but subsequent samples obtained prior to organ recovery were positive for EEEV RNA. There was no evidence of EEEV infection among donors of the 8 blood products transfused into the organ donor or in products derived from these donations. Veterinary and mosquito surveillance showed recent EEEV activity in counties nearby the organ donor’s county of residence. Neuroinvasive EEEV infection directly contributed to the death of 1 organ recipient and likely contributed to death in another.

          Conclusions

          Our investigation demonstrated EEEV transmission through SOT. Mosquito-borne transmission of EEEV to the organ donor was the likely source of infection. Clinicians should be aware of EEEV as a cause of transplant-associated encephalitis.

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          Most cited references 30

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          Transmission of West Nile virus from an organ donor to four transplant recipients.

          In August 2002, fever and mental-status changes developed in recipients of organs from a common donor. Transmission of West Nile virus through organ transplantation was suspected. We reviewed medical records, conducted interviews, and collected blood and tissue samples for testing with a variety of assays. Persons who donated blood to the organ donor and associated blood components were identified and tested for West Nile virus. We identified West Nile virus infection in the organ donor and in all four organ recipients. Encephalitis developed in three of the organ recipients, and febrile illness developed in one. Three recipients became seropositive for West Nile virus IgM antibody; the fourth recipient had brain tissue that was positive for West Nile virus by isolation and nucleic acid and antigen assays. Serum specimens obtained from the organ donor before and immediately after blood transfusions showed no evidence of West Nile virus; however, serum and plasma samples obtained at the time of organ recovery were positive on viral nucleic acid testing and viral culture. The organ donor had received blood transfusions from 63 donors. A review of blood donors and follow-up testing identified one donor who had viremia at the time of donation and who became seropositive for West Nile virus IgM antibodies during the next two months. Our investigation of this cluster documents the transmission of West Nile virus by organ transplantation. Organ recipients receiving immunosuppressive drugs may be at high risk for severe disease after West Nile virus infection. Blood transfusion was the probable source of the West Nile virus viremia in the organ donor. Copyright 2003 Massachusetts Medical Society
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            Transmission of West Nile virus through blood transfusion in the United States in 2002.

            During the 2002 West Nile virus epidemic in the United States, patients were identified whose West Nile virus illness was temporally associated with the receipt of transfused blood and blood components. Patients with laboratory evidence of recent West Nile virus infection within four weeks after receipt of a blood component from a donor with viremia were considered to have a confirmed transfusion-related infection. We interviewed the donors of these components, asking them whether they had had symptoms compatible with the presence of a viral illness before or after their donation; blood specimens retained from the time of donation and collected at follow-up were tested for West Nile virus. Twenty-three patients were confirmed to have acquired West Nile virus through transfused leukoreduced and nonleukoreduced red cells, platelets, or fresh-frozen plasma. Of the 23 recipients, 10 (43 percent) were immunocompromised owing to transplantation or cancer and 8 (35 percent) were at least 70 years of age. Immunocompromised recipients tended to have longer incubation periods than nonimmunocompromised recipients and infected persons in mosquito-borne community outbreaks. Sixteen donors with evidence of viremia at donation were linked to the 23 infected recipients; of these donors, 9 reported viral symptoms before or after donation, 5 were asymptomatic, and 2 were lost to follow-up. Fever, new rash, and painful eyes were independently associated with being an implicated donor with viremia rather than a donor without viremia. All 16 donors were negative for West Nile virus-specific IgM antibody at donation. Transfused red cells, platelets, and fresh-frozen plasma can transmit West Nile virus. Screening of potential donors with the use of nucleic acid-based assays for West Nile virus may reduce this risk. Copyright 2003 Massachusetts Medical Society
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              Evidence for Transmission of Zika Virus by Platelet Transfusion.

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                Author and article information

                Journal
                Clinical Infectious Diseases
                Oxford University Press (OUP)
                1058-4838
                1537-6591
                August 01 2019
                July 18 2019
                October 29 2018
                August 01 2019
                July 18 2019
                October 29 2018
                : 69
                : 3
                : 450-458
                Affiliations
                [1 ]Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
                [2 ]Infectious Diseases Physicians, Inc, Inova Fairfax Hospital Heart and Vascular Institute, Falls Church, Virginia
                [3 ]Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
                [4 ]Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
                [5 ]Division of Vector-Borne Diseases, NCEZID, CDC, Fort Collins, Colorado
                [6 ]Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, Georgia
                [7 ]American Red Cross, Gaithersburg, Maryland, Emory University School of Medicine, Atlanta, Georgia
                [8 ]Georgia Department of Public Health, Emory University School of Medicine, Atlanta, Georgia
                [9 ]Department of Neurology and Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
                [10 ]Division of Pulmonary Allergy and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
                [11 ]Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
                [12 ]Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
                [13 ]Department of Heart Failure and Transplantation, Inova Fairfax Hospital Heart and Vascular Institute, Falls Church, Virginia
                [14 ]Division of Acute Disease Epidemiology, South Carolina Department of Health and Environmental Control, Columbia
                [15 ]North Carolina Division of Public Health, Raleigh
                Article
                10.1093/cid/ciy923
                © 2018

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