Rhabdovirus (Rabies Virus) At-Risk Populations

Home , Lyssavirus, Rabies virus, Rhabdoviridae

APPENDIX 2

Rhabdovirus (Rabies Virus) At-Risk Populations:

Disease Agent: • Animal handlers (veterinarians, etc.) • Individuals living in proximity to infected mammals, • Rabies virus especially bats. Those at risk include urban residents as well as rural populations. Disease Agent Characteristics: Vector and Reservoir Involved: • Family: Rhabdoviridae; Genus: Lyssavirus • Virion morphology and size: Enveloped, bullet- • Wild animals: bats, raccoons, skunks, foxes shaped, 45-100 nm in diameter, 100-430 nm in length • Domestic animals can be infected following contact • Nucleic acid: Single-stranded, linear, negative-sense with infected feral species. RNA genome, ~11.9 kb in length • Physicochemical properties: Susceptible to 1% sod- Blood Phase: ium hypochlorite, 2% glutaraldehyde, 70% ethanol, • None formaldehyde, and quarternary ammonium com- pounds. Inactivated on exposure to ultraviolet radia- Survival/Persistence in Blood Products: tion, by heat (1 hour at 50°C), and by lipid solvents. Rabies virus is inactivated rapidly in sunlight and • No data does not survive for long periods out of the host Transmission by Blood Transfusion: unless protected in a cool, dark area. • There has never been a reported case of rabies infec- Disease Name: tion via a blood transfusion. Viremia has not been • Rabies demonstrated, and the virus is intraneuronal during the incubation period. There is no evidence to suggest Priority Level that an apparently healthy blood donor can transmit rabies, even if incubating clinical rabies. • Scientiﬁc/Epidemiologic evidence regarding blood safety: Absent; rare cases of transmission by organ/ Cases/Frequency in Population: tissue transplantation probably associated with infec- tion of neurologic tissue; no recognized viremic phase • One to four human cases per year in the US • Public perception and/or regulatory concern regarding blood safety: Very low Incubation Period: • Public concern regarding disease agent: Moderate • <30 days (25%) Background: • 30-90 days (50%) • 90 days-1 year (20%) • Human cases in the US have been stable since the • >1 year (5%) 1960s. Pathogenesis involves transport of virus centripetally along peripheral nerves to the central Likelihood of Clinical Disease: nervous system, where virus replicates, followed by • High after signiﬁcant exposure without postexposure centrifugal transport via peripheral nerves to multiple prophylaxis organs and tissues. The latter is responsible for transmission via transplantation. Viremia has not been Primary Disease Symptoms: demonstrated. • Fever, malaise, anorexia Common Human Exposure Routes: • Paresthesias or pain at wound site • Rapidly progressive to cerebral dysfunction and death • Rabid animal bite, which can be inapparent espe- • Two polar clinical syndromes: “furious” or encephal- cially from infected bats itic rabies and “dumb” or paralytic rabies • Aerosol exposure has been recognized in laboratory spread and natural settings. Severity of Clinical Disease: • Organ and tissue transplants have been implicated. • High Likelihood of Secondary Transmission: Mortality: • Low; rare cases in organ/tissue transplant recipients receiving a kidney, liver, arterial segment, or cornea • Virtually 100%

146S TRANSFUSION Volume 49, August 2009 Supplement APPENDIX 2

Chronic Carriage: Other Prevention Measures:

• None, although incubation period may last >1 year • Postexposure prophylaxis with hyperimmune globu- Treatment Available/Efﬁcacious: lin and vaccine • Vaccination (with inactivated vaccine) • Investigational and anecdotal • Education • Postexposure prophylaxis

Agent-Speciﬁc Screening Question(s): Suggested Reading

• No specific question is in use, except for recent 1. Bleck TP, Ruprecht CE. Rhabdoviruses. In: Richman immunizations DD, Whitley RJ, Hayden FG, editors. Clinical virology, • Not indicated because transfusion transmission has 2nd ed. Ann Arbor: ASM Press; 2002. p. 857-73. not been demonstrated 2. Centers for Disease Control and Prevention. Investi- • No sensitive or specific question is feasible. gation of rabies infections in organ donor and transplant recipients–Alabama, Arkansas, Oklahoma, and Laboratory Test(s) Available: Texas, 2004. Morb Mortal Wkly Rep MMWR 2004;53: • No FDA-licensed blood donor screening test exists. 586-9. • Antemortem: 3. Centers for Disease Control and Prevention. Rabies. ᭺ Skin biopsy from nape of neck [cited 2009 May]. Available from: http://www. ᭺ Fluorescent microscopy cdc.gov/ncidod/dvrd/rabies/ ᭺ Virus isolation or NAT from saliva 4. Helmick CG, Tauxe RV, Vernon AA. Is there a risk to ᭺ Viral antibody in serum or cerebrospinal fluid contacts of patients with rabies? Rev Infect Dis 1987; 9:511-8. Currently Recommended Donor Deferral Period: 5. Houff SA, Burton RC, Wilson RW, Henson TE, London • No FDA Guidance or AABB Standard exists. WT, Baer GM, Anderson LJ, Winkler WG, Madden DL, • No deferral after possible rabies exposure is required. Sever JL. Human-to-human transmission of rabies Some facilities may require temporary deferral for virus by corneal transplant. N Engl J Med 1979;300: prophylaxis because of confusing infectious disease 603-4. test serologies that may occur following receipt of 6. Srinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, hyperimmune globulin (e.g., anti-HBc). Sutker WL, Ksiazek TG, Paddock CD, Guarner J, Shieh WJ, Goldsmith C, Hanlon CA, Zoretic J, Fischbach B, Impact on Blood Availability: Niezgoda M, El-FekyWH, Orciari L, Sanchez EQ, Likos • Agent-specific screening question(s): Not applicable A, Klintmalm GB, Cardo D, LeDuc J, Chamberland • Laboratory test(s) available: Not applicable ME, Jernigan DB, Zaki SR; Rabies in Transplant Recipients Investigation Team.Transmission of rabies Impact on Blood Safety: virus from an organ donor to four transplant recipi- • Agent-specific screening question(s): Not applicable ents. N Engl J Med 2005;352:1103-11. • Laboratory test(s) available: Not applicable 7. Willoughby RE Jr, Tieves KS, Hoffman GM, Ghanayem NS, Amlie-Lefond CM, Schwabe MJ, Chusid MJ, Rup- Leukoreduction Efficacy: precht CE. Survival after treatment of rabies with • Unknown induction of coma. N Engl J Med 2005;352:2508-14. Pathogen Reduction Efficacy for Plasma Derivatives: • Multiple pathogen reduction steps used in the frac- tionation process have been shown to be robust in removal of enveloped viruses.

Volume 49, August 2009 Supplement TRANSFUSION 147S