The North Carolina man had been in the military for 17 weeks and completed basic training. He had moved on to training in Pensacola, Fla., to become an aviation mechanic when he got sick. He died at a civilian hospital. The cause of death was listed as encephalitis. Officials in North Carolina say several family members visited him in the hospital before he died and they have recommended that at least one relative be treated as a preventative measure.
The patient who died in late February was a Maryland man who was an Army veteran. He had received a kidney in 2011 at the Walter Reed National Military Medical Center in Bethesda, Md.
The other recipients received the donor's heart, liver and other kidney. One transplant took place at Northwestern Memorial Hospital in Chicago. The other transplants occurred in Florida and Georgia. All the transplant recipients are getting treatment to prevent rabies.
People who may have been exposed to rabies can receive injections of a vaccine to protect them.
Rodney Willoughby, a Milwaukee doctor who in 2004 successfully treated a teenage girl with rabies, said the prognosis for the organ recipients is strong, given that they are receiving efficient vaccines and haven't shown rabies symptoms nearly 18 months after the transplants.
Rabies is diagnosed as the cause of just one to three deaths per year in the United States.
The raccoon virus in this case has a typical incubation period of one to three months, although there have been other cases of longer incubation periods.
Willoughby said the rabies virus remains "statistically, for all intents and purposes, a 100 percent fatal illness." The virus enters the body at the site of a bite—or, in this case, a transplant—and remains there for a long incubation period before attacking the brain and spinal cord. Rabies replicates slowly inside the tissue, becoming difficult, if not impossible, to detect or screen for in a prospective donor.
He said there is not an efficient test for it.
The Centers for Disease Control says there has been just one other reported instance of rabies transmission by transplanted solid organs, a 2004 case in which all four recipients died after receiving tissue from an infected donor. There have been at least eight instances of rabies transmission through transplanted corneas.