Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-30T23:19:13.008Z Has data issue: false hasContentIssue false
  • English
  • Français

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
...Show all authors
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 ([email protected])
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jackson, AC, Warrell, MJ, Rupprecht, CE, et al. Management of rabies in humans. Clin Infect Dis 2003;36:60–63.CrossRefGoogle ScholarPubMed
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;352:1103–2211.Google Scholar
3. Investigation of rabies infections in organ donor and transplant recipients: Alabama, Arkansas, Oklahoma, and Texas, 2004. MMWR Morb Mortal Wkly Rep 2004;53:586–589.Google Scholar
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.Google Scholar
5. Rabies vaccines. Wkly Epidemiol Rec 2002;77:109–119.Google Scholar
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;81:375–381.Google Scholar
7. Houff, SA, Burton, RC, Wilson, RW, et al. Human-to-human transmission of rabies virus by corneal transplant. N Engl J Med 1979;300:603–604.CrossRefGoogle ScholarPubMed
8. Human rabies prevention-United States, 1999. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1999;48(RR-1):1–21.Google Scholar
9. Update: investigation of rabies infections in organ donor and transplant recipients: Alabama, Arkansas, Oklahoma, and Texas, 2004. MMWR Morb Mortal Wkly Rep 2004;53:615–616.Google Scholar
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.Google Scholar
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;7:397–400.Google Scholar
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;7:99–101.Google ScholarPubMed
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;5:208–210.Google Scholar
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;27:36–43.Google Scholar
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;71:287–292.Google Scholar