Washington baby bitten by bat treated for rabies

Published May 15, 2013

Associated Press

PASCO, Wash. –  A baby is being treated for rabies after it was bitten by a bat that flew out of a patio umbrella on the deck of her grandparents' Pasco home, the Tri-City Herald reported.

Dan and Sandra Anderson were babysitting 11-month-old Alanna on Saturday evening when Dan Anderson opened the umbrella and Sandra Anderson noticed something flutter out toward Alanna.

"It was weird. I thought maybe it was moths," Sandra Anderson said.

Then she saw the bat clinging to Alanna's back near her left shoulder. She brushed the bat away and then noticed two pair of tiny bite marks, even though the bat had been on the baby only a few seconds.

Alanna didn't cry — until she noticed how upset her grandmother was. The baby was given shots at Kadlec Regional Medical Center in Richland. Her grandparents are getting vaccine shots for rabies, too, as a precaution.

The family thought it had seen the last of the bat, but they were on the patio again Sunday for Mother's Day when they noticed something black inside the closed umbrella.

This time, Alanna's father, Derek Anderson, killed it with a piece of metal. He turned it over to the Benton Franklin Health Department and it tested positive for rabies.

The virus can be fatal without medical attention.

"I'm thankful we saw the bat on her and could take her for treatment," said Sandra Anderson.

"Everything's fine. It's 100 percent curable," Derek Anderson said.

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New transplant guidance could have stopped rabies case, experts say

Experts say a Maryland man who died last month of rabies might have been spared under transplant recommendations that hadn't yet been published when he got a kidney from an infected donor in 2011.

The guidance from the federally funded United Network for Organ Sharing came out in June, nine months after organs from the Florida donor went to four patients. The guidelines urge caution when considering donors with encephalitis, a brain inflammation that is one symptom of rabies. The Florida donor suffered from the condition.

The only other known U.S. case of rabies transmission through a transplant occurred in 2004 in Texas. Four organ recipients died, and the case helped stir the creation of a UNOS committee dedicated to reducing disease transmission through transplants. The Disease Transmission Advisory Committee was formed in 2006 as part of a government agreement with the private group, based in Richmond, Va.

The committee says it took so long to publish the encephalitis guidelines partly because it had to gather and analyze enough data about rare transmission events to provide a solid basis for its recommendations.

The committee also decided to address more common diseases first.

In 2010, it issued guidance on influenza, suggesting that lungs and intestines from donors infected with the H1N1 virus not be recovered for transplant. In 2011, the panel published guidance on the cancer-causing HTLV-1 virus, and last November, recommendations on tuberculosis. The group now is working on guidance for West Nile virus.

The encephalitis document urges organ banks and transplant surgeons to be cautious in considering organs from donors whose symptoms suggest a central nervous system infection, such as rabies. It urges "extreme caution" when the encephalitis appears to be from a virus. The document lists the rabies virus as one possible cause of encephalitis.

When the donor — 20-year-old William Edward Small — died in September 2011, doctors at Sacred Hearth Heath System in Pensacola, Fla., thought his symptoms were caused by a food-borne toxin, ciguatera, carried in saltwater fish, said Kathy Giery, director of LifeQuest Organ Recovery Services, which approved his organs for transplant.

She said nobody suspected the donor had rabies until after the Maryland recipient died. If they had, the organs wouldn't have been offered, she said.

"The guidelines from 2012 were different from what was in place in 2011, when this took place, so for our cases today and going forward, I think everyone would be looking at this through a different lens," Giery said.

Dr. Michael Green, a University of Pittsburgh pediatric surgeon and chairman of the Disease Transmission Advisory Committee, said a concern for rabies in potential donors would call for extreme caution. But he said every transplant carries risk.

"In every instance, the transplant team must weigh the rare risk of donor disease transmission against the possibly greater risk that a candidate will die without a transplant opportunity," Green wrote in an email.

Compared with other diseases, rabies is rare. It kills just a handful of U.S. residents a year. Usually transmitted by a wild animal bite, it's almost always fatal once symptoms appear. But the disease can be stopped if a bitten person gets treatment, including a series of vaccinations, soon after exposure. The people in Florida, Georgia and Illinois who also received organs from Small have shown no symptoms and are getting the vaccines.

Thirty-two other people in five states who had close contact with the recipients or donor also have been urged to get the vaccine, according to the Centers for Disease Control and Prevention.
Committee member Dr. Timothy Pruett, surgical chief of the University of Minnesota transplant programs, said deaths from transmitted diseases are horrible events — but part and parcel of the organ donation system.

"The risk of dying without an organ still is so much greater than the risk of dying with a transmitted disease, but I don't want to be cavalier about it — it's something no one wants to see," he said.

The eight years it took for the rabies guidance seems unreasonable to Jennifer Hightower of Gilmer, Texas, whose 18-year-old son Joshua was among those killed by rabies-infected transplants in 2004.

"I think it took way too long," she said. "I believe any time there's signs of encephalitis or any kind of anything wrong with the brain that they can't point to, they shouldn't use them.

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North Carolina woman IDs donor in rabies case

Published March 18, 2013

Associated Press

RALEIGH, N.C. –  A North Carolina woman says her child's father is the Air Force mechanic whose rabies-infected organs were transplanted into multiple recipients, including a Maryland man who died.

Alecia Mercer of Trenton, N.C., said Monday that military and state health officials told her last week that William Edward Small had died of rabies in September 2011. At the time of his death, Mercer says she was told that Small died of complications from a stomach virus.

Doctors in Florida didn't test the 20-year-old Small for rabies before he died. A man who received an infected kidney died. His heart, liver and other kidney went to recipients in Florida, Georgia and Illinois.

Small had been in the Air Force for 17 weeks before he died. He was in Florida to train as aviation mechanic.

Kathy Giery of LifeQuest Organ Recovery Services in Gainesville, Fla., said the hospital found he died from food poisoning from a toxin sometimes found in large saltwater fish. She says the organs were not tested for rabies because no one suspected it at the time.

The Defense Department has said he died of severe stomach and intestinal inflammation. The Florida Department of Health believed it was encephalitis.

  

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State health agencies check hundreds for rabies after transplant death

Public health agencies in five states are assessing the rabies risk for hundreds of people who may have had close contact with an infected organ donor and four transplant recipients, one of whom died, officials said Saturday.

About 200 medical workers, relatives and others were assessed for potential exposure in Maryland, where the man who received an infected kidney died, state veterinarian Katherine Feldman said. She said fewer than two dozen were urged to get the rabies vaccine as a preventive measure.

In Florida, about 90 people were identified as potentially exposed, and three were offered the rabies vaccine as of Friday, state health department spokeswoman Ashley Carr said.

Illinois Department of Public Health spokeswoman Melaney Arnold said the only potential exposures there were people who worked with the patient or the transplanted organ. She said only the organ recipient is receiving rabies treatment.

Health officials in Georgia and North Carolina are also involved in the epidemiological investigation prompted by the Maryland man's death from rabies in late February, nearly 18 months after he got the kidney from a donor in Pensacola, Fla. However, officials in those states didn't respond to requests from The Associated Press about the number of people they're assessing.

Doctors in Florida didn't test the 20-year-old donor for rabies before he died in September 2011. His heart, liver and other kidney went to recipients in Florida, Georgia and Illinois. They started getting the vaccine this month, and none has had rabies symptoms. A rabies expert unconnected to the case, Dr. Rodney Willoughby of Milwaukee, said they have a strong chance of surviving since they haven't shown any symptoms.

Health officials say the virus can be spread through the infected person's saliva and mucous membranes, but human-to-human transmission is rare. The federal Centers for Disease Control and Prevention in Atlanta says there has been only one documented instance of transmission by a bite in the U.S.

Feldman said Friday that the search for potential exposure subjects in Maryland was wrapping up. She said medical workers typically take precautions, and "we don't share saliva with that many people in our day-to-day goings about."

CDC spokeswoman Melissa Dankel said investigators are still trying to learn how the transplant donor got infected with the raccoon rabies virus that was found in his brain tissue and that of the Maryland man. She said the donor was an outdoorsman who might have been bitten by a wild animal in his native North Carolina before moving to Florida and beginning training as an Air Force aviation mechanic 17 weeks before his death.

He visited a clinic at the Pensacola Naval Air Station in August 2011 for abdominal pain and vomiting and was transferred to a civilian hospital four days later, said Defense Department spokeswoman Cynthia Smith. He later developed encephalitis, a brain inflammation that can have a host of causes, including rabies, but he wasn't tested for the disease, CDC officials say.

Smith said the airman died of severe gastroenteritis — inflammation of the stomach and small intestine — complicated by dehydration, electrolyte abnormalities and seizure. The Florida Department of Health said he died of encephalitis of unknown origin.

Federal rules require organ banks to disclose any known or suspected infectious conditions that might be transmitted by donor organs. CDC officials say they don't know what information was communicated.

Federal guidelines published last year for evaluating organ donors with encephalitis urge "extreme caution" if the suspected cause is a viral pathogen, such as rabies.

Dr. Michael Green, a University of Pittsburgh professor who heads the committee that wrote the guidelines, said the guidelines hadn't been published when the Florida patient died. He also said rabies transmission through solid organ transplants is rare. There have been just two other documented instances worldwide — one in Germany and a 2004 U.S. case in which all four recipients died. The CDC says there have been eight documented instances of rabies being transmitted by transplanted corneas.

"Nonetheless, if asked whether or not I would use organs where concern for rabies was active in the potential donor, I would urge extreme caution before using organs from this person," Green said.

One of the patients who died in the 2004 case was 18-year-old Joshua Hightower, of Gilmer, Texas, after a kidney transplant. He had kidney problems since he was a child. His mother, Jennifer, said Saturday that if rabies is suspected in a transplant donor, doctors should go ahead and transplant the organs, and then give recipients the rabies vaccine.

"The word has got to get out there and something's got to change," she said. "These people, like my son, he thought the transplant was going to give him a new life and a new opportunity to move forward, and it killed him — over somebody's negligence and their plain old stupidity, and that's what it is."

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