West Nile Virus RNA in Tissues from Donor Associated with Transmission to Organ Transplant Recipients

Dianna M. Blau

, Ingrid B. Rabe, Julu Bhatnagar, Rachel Civen, Kavita K. Trivedi, Dominique Rollin, Susan N. Hocevar, Matthew Kuehnert, J. Erin Staples, Sherif R. Zaki, Marc Fischer, and the West Nile Virus Transplant-Associated Transmission Investigation Team

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D.M. Blau, J. Bhatnagar, D. Rollin, S.N. Hocevar, M. Kuehnert, S.R. Zaki); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (I.B. Rabe, J.E. Staples, M. Fischer); Los Angeles County Department of Public Health, Los Angeles, California, USA (R. Civen); California Department of Public Health, Richmond, California, USA (K. Trivedi)

Abstract

We identified West Nile virus (WNV) RNA in skin, fat, muscle, tendon, and bone marrow from a deceased donor associated with WNV transmission through solid organ transplantation. WNV could not be cultured from the RNA-positive tissues. Further studies are needed to determine if WNV can be transmitted from postmortem tissues.

West Nile virus (WNV), a mosquito-borne flavivirus, was detected in North America in 1999 and has since become endemic to the United States, where it causes annual seasonal outbreaks. An estimated 70%–80% of human WNV infections are asymptomatic (1). Most symptomatic persons experience acute systemic febrile illness; West Nile neurologic disease develops in < 1% of infected persons but has a case-fatality rate of 9% (2).
Most WNV infections are acquired through bites from infected mosquitoes. However, the virus can also be transmitted by transfusion of infected blood products or by solid organ transplantation (3,4). In 6 clusters of organ transplant–transmitted WNV infections reported to public health agencies in the United States, 12 (75%) of 16 recipients were infected (5). Encephalitis developed in 9 (75%) of those recipients; 4 of those 9 died.
WNV transmission through tissue transplantation (i.e., skin, muscle, or connective tissues) has not been identified, and the risk for transmission by this route is not known. We evaluated tissues collected from a deceased donor who was associated with transmission of WNV through solid organ transplantation to determine if WNV RNA, viral antigen, or infectious viral particles could be detected in postmortem tissues.