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West Nile Virus

Health Care Provider Advisory

Transplants, Transfusions and West Nile Virus
September 9, 2002

The Rhode Island Department of Health brings you this advisory after consultation with the RI Blood Center and Infectious Disease Physicians.

Recent events raise questions concerning the possibility of transmitting West Nile Virus (WNV) by transfusion of blood products or solid-organ transplant. While CDC and other national health authorities continue to investigate, we give these recommendations for RI health care providers.

The US clearly faces an outbreak of WNV with 954 cases, 43 deaths in 42 states (as of September 8, 2002).

• Transmission of WNV infection appears probable through solid-organ transplantation, from an infected donor. CDC continues its investigation and will report findings as soon as available.
• Transmission of WNV infection by blood transfusion may be possible—CDC is currently investigating two possible transmission scenarios.
• Throughout the US, the risks for WNV transmission via transfusion or transplantation appear low, and are outweighed by the benefits of these lifesaving interventions.

The situation in Rhode Island differs markedly from many other states—particularly in the south and west.

• WNV is widely present in RI birds, but produced no positive mosquitoes in 2002. Cities and towns implemented an aggressive larvicide program with DEM.
• HEALTH tested 40 cases of meningo-encephalitis so far this season (2002)--all negative for WNV. We have yet to identify a confirmed human case in RI.
• Consequently, the risk of WNV transmission by transplantation and/or transfusion in RI appears to be especially low, and physicians are encouraged to reassure patients and their families of the same and encourage blood donations; it is a safe procedure and cannot cause WNV infection.
• Clinicians caring for patients with febrile illnesses, particularly those associated with unexplained meningitis or encephalitis, occurring in the weeks following organ transplant should consider West Nile virus infection as a possible cause of illness.

Physician Reporting Criteria for WNV Meningitis or Encephalitis:

All licensed medical providers are expected to report immediately, by telephone, any patient with a presumed diagnosis of: (1) Viral encephalitis (any age), or (2) Aseptic or suspect viral meningitis over the age of 17 years or (3) Guillain-Barré syndrome. The report should be phoned in immediately on suspicion of diagnosis to 222-2577 (8:30pm to 4:30pm) or to the after hours physician on call at 272-5952. The State Laboratory will perform laboratory testing for a panel of arboviral infections for persons meeting the above criteria.

HEALTH will continue to monitor the national and state situation and will keep RI health care providers informed through occasional advisories and the HEALTH website.