Status:
Ready to upload
Record number:
1797
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Unknown (first reported transmission of HAV through organ transplantation)
Time to detection:
1 year
Alerting signals, symptoms, evidence of occurrence:
Diagnosis of HAV infection in 2 healthcare workers caring for recipient 9 months after transplant; 7 year old multi–visceral organ recipient (liver, small bowel, and pancreas transplantation) had elevated liver enzymes, increased stool output first attributed to other causes; recipient had HAV in serum for over a year and stool for over 15 months but survived.
Demonstration of imputability or root cause:
Genetically identical HAV RNA sequences from donor (serum), healthcare workers (serum) and multi–visceral organ recipient (serum, feces, liver and intestine biopsy specimens). The organ donor, an 8-year-old who died in a motor vehicle collision, traveled to Guatemala, a country to which HAV is endemic, 6 months before death. The heart and both kidneys of the same donor were transplanted into 3 other recipients that tested negative for HAV RNA and negative HAV IgM approximately 10 months after transplant (all previously vaccinated).
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
HAV transmission; organ transplantation; healthcare worker infection
Reference attachment:
Suggest references:
Monique A. Foster, Lauren M. Weil, Sherry Jin, et al. Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 23, No.4, April 2017
Expert comments for publication:
Example of delayed recognition of transmission because of lack of precedence of pathogen being transmitted through transplant. The infectious period of the multi–visceral organ recipient is among the longest documented in a person infected with HAV, typically an acute disease. The recipient had history of vaccination but immune suppression probably blunted antibody response (role of different immunosuppression and types of organs transplanted in preventing infection transmission unknown). Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to the healthcare workers.