Monday, March 27, 2023
| Patient or source of specimen | Outcome or status | HAV rRT -PCR | Serologic testing | Vaccination status | |
|---|---|---|---|---|---|
| IgM | IgG | ||||
| Donor | Deceased | Detected | Detected | Not detected | Unvaccinated |
| Multi–visceral organ recipient | Persistent infection | Detected | Detected | Detected | Vaccinated |
| Heart recipient | Immune | Not detected | Not detected | Detected | Vaccinated |
| Left kidney recipient | Immune | Not detected | Not detected | Detected | Vaccinated |
| Right kidney recipient | Immune | Not detected | Not detected | Detected | Vaccinated |
| Home health nurse A | Recovered | Detected | Detected | Not detected | Unvaccinated |
| Home health nurse B | Recovered | Detected | Detected | Not detected | Unvaccinated |
| Inpatient nurse | Recovered | No sample | Detected | Not detected | Unvaccinated |
Table 1. Laboratory results for case-patients and contacts related to HAV outbreak, Texas, 2015*
*HAV, hepatitis A virus; rRT-PCR, real-time reverse transcription PCR.
| Date collected | Liver HAV RNA, IU/mL | Small bowel HAV RNA, IU/mL | Serum HAV RNA, IU/mL | Fecal HAV RNA, IU/mL |
|---|---|---|---|---|
| 2014 Dec 18 | Native liver, none detected | |||
| 2014 Dec 23 | 34,000 | |||
| 2015 Jan 23 | 1,500,00 | |||
| 2015 Feb 10 | 7,000 | |||
| 2015 Mar 10 | 5,400 | |||
| 2015 Apr 16 | >90,000,000 | |||
| 2015 Sep 21 | >90,000,000 | >90,000,000 | ||
| 2015 Sep 29 | 746,000,000 | >90,000,000 | ||
| 2015 Oct 15 | 1,400,000 | 372,000 | ||
| 2015 Nov 9 | 27,900 | |||
| 2015 Nov 16 | 17,300 | |||
| 2015 Nov 23 | 13,000 | 1,500,000 | ||
| 2015 Dec 3 | 38,900 | 51,900 | ||
| 2016 Jan 11 | 68,000 | 22,600 | ||
| 2016 Mar 9 | 320 | |||
| 2016 Apr 6 | Not detected | 270 | ||
| 2016 May 4 | Not detected | Not detected |
Table 2. Pathologic, serum, and fecal HAV RNA quantification test results of multi–visceral organ recipient, Texas, 2014–2015*
*Blank cells indicate that no specimen was available for testing. HAV, hepatitis A virus.
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Health Sciences Clinical Professor of Family Medicine, University of California, Irvine, School of Medicine, Irvine, California
This activity is intended for infectious disease specialists and other physicians who care for organ transplant recipients.
The goal of this activity is to evaluate the potential parenteral transmission of hepatitis A virus infection through transplant and its subsequent effects.
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Health Sciences Clinical Professor of Family Medicine, University of California, Irvine, School of Medicine, Irvine, California
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Although transmission of hepatitis A virus (HAV) through blood transfusion has been documented, transmission through organ transplantation has not been reported. In August 2015, state health officials in Texas, USA, were notified of 2 home health nurses with HAV infection whose only common exposure was a child who had undergone multi–visceral organ transplantation 9 months earlier. Specimens from the nurses, organ donor, and all organ recipients were tested and medical records reviewed to determine a possible infection source. Identical HAV RNA sequences were detected from the serum of both nurses and the organ donor, as well as from the multi–visceral organ recipient’s serum and feces; this recipient’s posttransplant liver and intestine biopsy specimens also had detectable virus. The other organ recipients tested negative for HAV RNA. Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to the healthcare workers.
Hepatitis A virus (HAV), the most common cause of viral hepatitis, is a nonenveloped RNA virus belonging to the family Picornaviridae.[1,2] Approximately 1.5 million clinical cases of HAV occur worldwide annually; the virus is commonly spread person to person through the fecal–oral route.[2] Although rates of HAV infection have declined by 95% in the United States since a vaccine became available, infections continue to result from close personal contact with an infected household member or common-source outbreaks from contaminated food or water.[3] HAV can cause relapsing and fulminant hepatitis, but fatal infection is rare.
Parenteral transmission of HAV through contaminated blood products or needles is also rare, despite the presence of viremia up to 30 days before symptom onset.[4] No screening tests for HAV infection are required for blood, organ, or tissue donation in the United States.[5] HAV transmission through solid-organ transplantation has not been reported in the literature.
In August 2015, genetically identical HAV was recovered from 2 healthcare workers (HCWs) participating in the care of a child recipient of multiple visceral organs. To prevent infection in other organ recipients and contacts, the Centers for Disease Control and Prevention (CDC), along with state and local health departments, conducted an investigation to determine the source of the HCW infection and whether HAV was transmitted through the solid-organ transplantation.
