Human-to-Human Rabies Transmission via Solid Organ Transplantation from a Donor with Undiagnosed Rabies - United States, October 2024-February 2025.

Although rabies virus is typically transmitted through mammalian animal bites or scratches, human-to-human transmission has occurred through organ and tissue transplantation. From 1978 to 2013, three transplant-transmitted rabies events in the United States affected nine tissue or organ recipients. Rabies is almost always fatal without timely receipt of postexposure prophylaxis (PEP). In January 2025, clinicians in Ohio notified the Ohio Department of Health and CDC of a suspected case of rabies in a kidney transplant recipient who died 51 days after receiving the transplant. CDC confirmed the recipient's rabies diagnosis. Investigation revealed that the deceased donor had been scratched by a skunk approximately 6 weeks before death. No other organs from that donor were transplanted; however, three persons received cornea tissue grafts. While investigation of the donor's rabies status was ongoing, the cornea recipients underwent precautionary graft removal and received PEP. None developed signs or symptoms compatible with rabies. CDC detected rabies virus RNA in an archived sample of the donor's kidney, confirming organ-derived transmission. Investigation identified 370 persons with possible exposures to the donor or kidney recipient; 357 (96%) completed risk assessments. Among those who completed risk assessments, 46 (13%) were recommended to receive PEP. Early consultation with public health officials might prevent rabies-infected organ and tissue donation or lead to prompt PEP for transplant recipients. The risk for rabies should be considered among donors who have received rabies-susceptible animal bites or scratches within the previous year, particularly those donors with acute encephalopathy.