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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

Published online by Cambridge University Press:  02 January 2015

Frauke Mattner ,
Cornelia Henke-Gendo ,
Andreas Martens ,
Christian Drosten ,
Thomas F. Schulz ,
Albert Heim ,
Sebastian Suerbaum ,
Sabine Kuhn ,
Juliane Bruderek  and
Petra Gastmeier
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Frauke Mattner*
Affiliation:
Institute of Medical Microbiology and Hospital Epidemiology, Germany
Cornelia Henke-Gendo
Affiliation:
Institute of Virology, Germany
Andreas Martens
Affiliation:
Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Germany
Christian Drosten
Affiliation:
Hannover Medical School, Hannover, and the Bernhard-Nocht-Institut, Institut für Virologie, Hamburg, Germany
Thomas F. Schulz
Affiliation:
Institute of Virology, Germany
Albert Heim
Affiliation:
Institute of Virology, Germany
Sebastian Suerbaum
Affiliation:
Institute of Medical Microbiology and Hospital Epidemiology, Germany
Sabine Kuhn
Affiliation:
Department of Occupational Health, Germany
Juliane Bruderek
Affiliation:
Institute of Medical Microbiology and Hospital Epidemiology, Germany
Petra Gastmeier
Affiliation:
Institute of Medical Microbiology and Hospital Epidemiology, Germany
Martin Strueber
Affiliation:
Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Germany
*
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany (Mattner.Frauke@mh-hannover.de)
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 5 , May 2007 , pp. 513 - 518
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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