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Transmission of West Nile Virus from an Organ Donor to Four Transplant Recipients.
Iwamoto, Martha M.D., M.P.H.; Jernigan, Daniel B. M.D., M.P.H.; Guasch, Antonio M.D.; Trepka, Mary Jo M.D., M.S.P.H.; Blackmore, Carina G. D.V.M., Ph.D.; Hellinger, Walter C. M.D.; Pham, Si M. M.D.; Zaki, Sherif M.D., Ph.D.; Lanciotti, Robert S. Ph.D.; Lance-Parker, Susan E. D.V.M., Ph.D.; DiazGranados, Carlos A. M.D.; Winquist, Andrea G. M.D.; Perlino, Carl A. M.D.; Wiersma, Steven M.D., M.P.H.; Hillyer, Krista L. M.D.; Goodman, Jesse L. M.D., M.P.H.; Marfin, Anthony A. M.D., M.P.H.; Chamberland, Mary E. M.D., M.P.H.; Petersen, Lyle R. M.D., M.P.H.; for the West Nile Virus in Transplant Recipients Investigation Team *
[Article] New England Journal of Medicine. 348(22):2196-2203, May 29, 2003.

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BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

West nile virus infects birds and mosquitoes; humans and horses are incidental hosts. As of April 15, 2003, in the United States, 4156 cases had been reported in 39 states and the District of Columbia (Centers for Disease Control and Prevention [CDC]: unpublished data). Although transmission of West Nile virus through blood or organs has not previously been documented, such transmission has been postulated. 1 The virus may be transiently present in the blood or organs of infected persons, many of whom probably have no symptoms. The widespread epidemic of West Nile virus infections in 2002 in the United States has increased concern about such transmission.

In August 2002, two recipients of cadaveric kidneys from a single donor were readmitted to a Georgia hospital with headache and fever. Encephalitis subsequently developed in both, and clinicians suspected West Nile virus infection. Two Florida recipients of organs from the same donor also had an unexplained febrile illness while hospitalized, with encephalitis developing in one. We report on the investigation of these cases, which demonstrated the transmission of West Nile virus through transplanted organs and transfused blood.