Rare human-to-human transmission
BALTIMORE, RALEIGH––Hunter, trapper, and fisher William Edward Small, 20, who died of an undiagnosed rabies infection in September 2011, transmitted rabies as an organ donor to a Maryland man who died of rabies in early March 2013––the first human rabies death in Maryland since 1976, and one of just a very few cases on record in which rabies was transmitted from human to human. There is only one other known case of rabies being transmitted in the U.S. via organ transplants.
The identity of the Maryland victim was not disclosed.
Centers for Disease Control and Prevention spokesperson Melissa Dankel told media that preserved brain tissue established that both Small and the Maryland man died from the raccoon rabies strain.
Multiple organs transplanted
The Maryland victim received a kidney from Small. His heart, liver, and his other kidney were transplanted into recipients in Florida, Georgia, and Illinois, who were given post-exposure rabies vaccination as soon as the source of the Maryland rabies case was identified.
Small was father of a child with Alecia Mercer, of Trenton, North Carolina, who disclosed his name on March 18, 2013 to Martha Waggoner of Associated Press.
“Military and state health officials visited Mercer at her home and told her that Small had died of rabies,” Waggoner wrote.
Small “did a lot of trapping and hunting and stuff,” Mercer told Waggoner. “He did the trapping, and he didn’t care what the animal looked like. He just picked it up.”
Pensacola Naval Air Station
In Florida to train as a U.S. Air Force aviation mechanic, Small was admitted to sick bay at the Pensacola Naval Air Station in August 2011, suffering from abdominal pain and vomiting. He was transferred four days later to the civilian hospital where he died. Before becoming too ill to talk, Small told his father he became ill after eating a fish he caught in the Gulf of Mexico.
Kathy Giery, director of donor program development for LifeQuest Organ Recovery Services, of Gainesville, Florida, told Waggoner that the diagnosis when Small died was that he had contracted ciguatera, “a toxin sometimes found in large saltwater fish, including grouper, red snapper and sea bass,” Waggoner summarized. “The Defense Department said he died of severe stomach and intestinal inflammation with complications including dehydration and seizure. The Florida Department of Health said he died from encephalitis of unknown origin.”
“Nobody suspected rabies”
“There was no testing done for rabies,” Giery told Waggoner, “because nobody suspected rabies.”
Visiting Small’s home, Waggoner noted that his room was “devoid of furniture, but the pelts of three raccoons, a beaver, and a grey fox he trapped or shot hang on the wall, along with an unframed baby photo of Small’s son.”
Raccoons are the species most commonly trapped for fur in the Carolinas and Florida. The region has had endemic raccoon rabies for as long as the raccoon rabies strain has been medically recognized. Infected raccoons trapped in Florida and released in West Virginia in 1976 touched off a 15-year raccoon rabies pandemic that spread as far west as Ohio and as far north as Maine, New Hampshire, and Vermont before being stopped by deployments of an oral vaccine.