Document Type
Article
Publication Date
8-3-2023
Abstract
BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients.
METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor.
FINDINGS: We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation.
INTERPRETATION: This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains.
FUNDING: US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases.
Recommended Citation
Gould, Carolyn V.; Free, Rebecca J.; Bhatnagar, Julu; Soto, Raymond A.; Royer, Tricia L.; Maley, Warren R.; Moss, Sean; Berk, Matthew A.; Craig-Shapiro, Rebecca; Kodiyanplakkal, Rosy Priya L.; Westblade, Lars F.; Muthukumar, Thangamani; Puius, Yoram A.; Raina, Amresh; Hadi, Azam; Gyure, Kymberly A.; Trief, Danielle; Pereira, Marcus; Kuehnert, Matthew J.; Ballen, Vennus; Kessler, Debra A.; Dailey, Kimberly; Omura, Charles; Doan, Thuy; Miller, Steve; Wilson, Michael R.; Lehman, Jennifer A.; Ritter, Jana M.; Lee, Elizabeth; Silva-Flannery, Luciana; Reagan-Steiner, Sarah; Velez, Jason O.; Laven, Janeen J.; Fitzpatrick, Kelly A.; Panella, Amanda; Davis, Emily H.; Hughes, Holly R.; Brault, Aaron C.; St George, Kirsten; Dean, Amy B.; Ackelsberg, Joel; Basavaraju, Sridhar V.; Chiu, Charles Y.; and Staples, J. Erin, "Transmission of Yellow Fever Vaccine Virus Through Blood Transfusion and Organ Transplantation in the USA in 2021: Report of an Investigation" (2023). Department of Medicine Faculty Papers. Paper 423.
https://jdc.jefferson.edu/medfp/423
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Supplementary Appendix
PubMed ID
37544313
Language
English
Included in
Infectious Disease Commons, Surgery Commons, Virus Diseases Commons
Comments
This article is the author's final published version in The Lancet Microbe, Volume 4, Issue 9, September 2023, Pg. e711 - e721.
The published version is available at https://doi.org/10.1016/s2666-5247(23)00170-2. Copyright © 2023 The Author(s). Published by Elsevier Ltd.