Skip to main content
×
Home
    • Aa
    • Aa

Risk of Rabies Infection and Adverse Effects of Postexposure Prophylaxis in Healthcare Workers and Other Patient Contacts Exposed to a Rabies Virus–Infected Lung Transplant Recipient

  • Frauke Mattner (a1), Cornelia Henke-Gendo (a2), Andreas Martens (a3), Christian Drosten (a4), Thomas F. Schulz (a2), Albert Heim (a2), Sebastian Suerbaum (a1), Sabine Kuhn (a5), Juliane Bruderek (a1), Petra Gastmeier (a1) and Martin Strueber (a3)...
Abstract
Background.

Rabies virus was inadvertently transmitted to a lung transplant recipient through donor lungs. The patient was given ventilatory assistance and cared for postoperatively for 6 weeks before a diagnosis of rabies virus infection was made. Postexposure prophylaxis (PEP) was offered to potentially exposed healthcare workers (HCWs).

Methods.

Only HCWs classified as belonging to possible and/or proven contact groups (according to a standardized interview) received PEP. The risk of individual HCWs being exposed to rabies virus was reassessed on the basis of viral concentrations measured in the patient's excretions and body fluids. HCWs who were vaccinated as part of PEP were followed up prospectively according to a standardized procedure.

Results.

Of 179 HCWs and other patient contacts, 132 met the eligibility criteria for PEP (118 [89.4%] with possible contact and 14 [10.6%] with proven contact with the patient's excretions and/or body fluids). One hundred thirty-one individuals started PEP, and 126 met the inclusion criteria for analysis. Of these, 48 (38%) developed at least 1 adverse effect (8 [6.3%] had fever, 37 [29.4%] had headache, 3 [2.4%] had lymphadenopathy, 17 [13.5%] had dizziness, and 6 [4.8%] had paresthesia). No HCW or other patient contact developed rabies or serious PEP-related adverse effects. Reassessment of the individual's risk of infection as a function of the viral concentration in the patient's excretions and/or body fluids (up to 5.12 × 107 copies/mL) revealed that 103 HCWs (78.0%) had contact with high-risk substances (89 [67.40%] had possible contact and 14 [10.7%] had proven contact).

Conclusion.

HCWs can be exposed to significant viral concentrations in excretions and/or body fluids from rabies virus-infected lung transplant recipients. Because widespread use of PEP entails the possibility of significant health problems for HCWs considered to be at risk of contracting rabies, applying a rational indication for PEP is crucial.

Copyright
Corresponding author
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany (Mattner.Frauke@mh-hannover.de)
References
Hide All
1.Jackson AC, Warrell MJ, Rupprecht CE, et al.Management of rabies in humans. Clin Infect Dis 2003;36:6063.
2.Srinivasan A, Burton EC, Kuehnert MJ, et al.Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med 2005;352:11032211.
3.Investigation of rabies infections in organ donor and transplant recipients: Alabama, Arkansas, Oklahoma, and Texas, 2004. MMWR Morb Mortal Wkly Rep 2004;53:586589.
4.Hellenbrand W, Meyer C, Rasch G, Steffens I, Ammon A. Cases of rabies in Germany following organ transplantation. Euro Surveill 2005;10:E050224.6.
5.Rabies vaccines. Wkly Epidemiol Rec 2002;77:109119.
6.Kamoltham T, Singhsa J, Promsaranee U, Sonthon P, Mathean P, Thin-younyong W. Elimination of human rabies in a canine endemic province in Thailand: five-year programme. Bull World Health Organ 2003;81:375381.
7.Houff SA, Burton RC, Wilson RW, et al.Human-to-human transmission of rabies virus by corneal transplant. N Engl J Med 1979;300:603604.
8.Human rabies prevention-United States, 1999. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1999;48(RR-1):121.
9.Update: investigation of rabies infections in organ donor and transplant recipients: Alabama, Arkansas, Oklahoma, and Texas, 2004. MMWR Morb Mortal Wkly Rep 2004;53:615616.
10.Abu Sin M, Matzdorf P, Heitlinger A, et al.Assessment of immunisation after rabies infection in organ transplant recipients. In: Program and abstracts of the Tenth EPIET Scientific Seminar (Mahon, Menorca, Spain). 2005:10.
11.Dreesen DW, Fishbein DB, Kemp DT, Brown J. Two-year comparative trial on the immunogenicity and adverse effects of purified chick embryo cell rabies vaccine for pre-exposure immunization. Vaccine 1989;7:397400.
12.Lumbiganon P, Chaiprasithikul P, Sookpranee T, Paholpak S, Wasi C. Pre-exposure vaccination with purified chick embryo cell rabies vaccines in children. Asian Pac J Allergy Immunol 1989;7:99101.
13.Nicholson KG, Farrow PR, Bijok U, Barth R. Pre-exposure studies with purified chick embryo cell culture rabies vaccine and human diploid cell vaccine: serological and clinical responses in man. Vaccine 1987;5:208210.
14.Sehgal S, Bhattacharya D, Bhardwaj M. Ten year longitudinal study of efficacy and safety of purified chick embryo cell vaccine for pre- and post-exposure prophylaxis of rabies in Indian population. J Commun Dis 1995;27:3643.
15.Thraenhart O, Kreuzfelder E, Hillebrandt M, et al.Long-term humoral and cellular immunity after vaccination with cell culture rabies vaccines in man. Clin Immunol Immunopathol 1994;71:287292.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 2 *
Loading metrics...

Abstract views

Total abstract views: 67 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th October 2017. This data will be updated every 24 hours.