@article{501,
  author = {Carolyn Gould and Rebecca Free and Julu Bhatnagar and Raymond Soto and Tricia Royer and Warren Maley and Sean Moss and Matthew Berk and Rebecca Craig-Shapiro and Rosy Kodiyanplakkal and Lars Westblade and Thangamani Muthukumar and Yoram Puius and Amresh Raina and Azam Hadi and Kymberly Gyure and Danielle Trief and Marcus Pereira and Matthew Kuehnert and Vennus Ballen and Debra Kessler and Kimberly Dailey and Charles Omura and Thuy Doan and Steve Miller and Michael Wilson and Jennifer Lehman and Jana Ritter and Elizabeth Lee and Luciana Silva-Flannery and Sarah Reagan-Steiner and Jason Velez and Janeen Laven and Kelly Fitzpatrick and Amanda Panella and Emily Davis and Holly Hughes and Aaron Brault and Kirsten St George and Amy Dean and Joel Ackelsberg and Sridhar Basavaraju and Charles Chiu and Erin Staples and Maria Ajaimy and Yorg Azzi and Pallavi Annambhotla and Bryon Backenson and Katherine Belden and Adriana Colovai and Dagan Coppock and Lydia Du and Lindsey Estetter and Marie Le and Roosecelis Martines and Matthew Pettengill and Wendy Szymczak and Chairut Vareechon},
  title = {Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: report of an investigation},
  abstract = {<p>In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2–6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. Methods From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. Findings We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. Interpretation This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains.</p>
},
  year = {2023},
  journal = {The Lancet Microbe},
  month = {08/2023},
  issn = {2666-5247},
  doi = {https://doi.org/10.1016/S2666-5247(23)00170-2},
  language = {eng},
}