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West Nile Is Linked to Transplants


West Nile virus infections have been confirmed in three transplant patients in Florida and Georgia--one of whom died of encephalitis--and a similar infection is suspected in a fourth patient.

All received organs from a Georgia woman who died from injuries suffered in an automobile accident in late July, and federal officials now think it is likely that her organs transmitted the virus to the four patients.

What they do not know is whether the woman was infected by a mosquito bite or a blood transfusion. In the two days before she died, she received several transfusions and other blood products from as many as 60 donors.

"There is clear evidence that organ transplantation was the source" of the infections, said Dr. James Hughes of the Centers for Disease Control and Prevention in Atlanta. "We have to aggressively pursue the possibility that a blood product is responsible for this."

Federal authorities have blocked the further use of blood products from the approximately 60 donors, but "roughly 12 people" have already received blood from them, Hughes said. Those recipients, the remaining blood collected from the original donors and the donors themselves will be tested for exposure to the virus, officials said during a news conference Tuesday.

If no evidence of an infection is found in any of the donors, officials will presume that the female donor who died was infected by a mosquito, Hughes said.

Health authorities are releasing little information about the organ recipients because of patient confidentiality. But all received their donor organs around the beginning of August and developed symptoms within 2 to 2 1/2 weeks.

One patient in Georgia died of encephalitis and a second was hospitalized but is now recovering. A 63-year-old man in Florida was hospitalized with encephalitis and is also recovering. A 71-year-old woman in Florida developed a severe fever but is recuperating at home. Officials suspect that she had a West Nile virus infection, but it has not yet been confirmed by laboratory tests, said Dr. Steven Wiersma of the Florida health department.

Dr. Jesse Goodman of the Food and Drug Administration said that potential blood donors and recipients should not be overly concerned about the findings. He noted that more than 4.5 million Americans receive blood products each year, but that this cluster of cases represents the only instance in which West Nile transmission is suspected.

All four organ recipients were taking immune-suppressing drugs, which vastly increased their chances of developing a severe illness when exposed to the virus, Hughes said.

Hughes also noted that there has never been any evidence of West Nile virus transmission by blood in Israel, where the virus has been present for much longer than in the United States.

Transmission of other viruses in the same family--including the dengue and St. Louis encephalitis viruses--is also exceptionally rare, he added.

The first cases of human West Nile virus infection were observed in the U.S. three years ago. By now, the virus has been observed in every state east of the Rockies. As of Tuesday, there have been 673 confirmed human infections so far this year, with 32 deaths.

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