@article {1276,
	title = {Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: report of an investigation},
	journal = {The Lancet Microbe},
	year = {2023},
	month = {08/2023},
	abstract = {<p>In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2{\textendash}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>
},
	issn = {2666-5247},
	doi = {https://doi.org/10.1016/S2666-5247(23)00170-2},
	author = {Gould, Carolyn V. and Free, Rebecca J. and Bhatnagar, Julu and Soto, Raymond A. and Royer, Tricia L. and Maley, Warren R. and Moss, Sean and Berk, Matthew A. and Craig-Shapiro, Rebecca and Kodiyanplakkal, Rosy Priya L. and Westblade, Lars F. and Muthukumar, Thangamani and Puius, Yoram A. and Raina, Amresh and Hadi, Azam and Gyure, Kymberly A. and Trief, Danielle and Pereira, Marcus and Kuehnert, Matthew J. and Ballen, Vennus and Kessler, Debra A. and Dailey, Kimberly and Omura, Charles and Doan, Thuy and Miller, Steve and Wilson, Michael R. and Lehman, Jennifer A. and Ritter, Jana M. and Lee, Elizabeth and Silva-Flannery, Luciana and Reagan-Steiner, Sarah and Velez, Jason O. and Laven, Janeen J. and Fitzpatrick, Kelly A. and Panella, Amanda and Davis, Emily H. and Hughes, Holly R. and Brault, Aaron C. and St George, Kirsten and Dean, Amy B. and Ackelsberg, Joel and Basavaraju, Sridhar V. and Chiu, Charles Y. and Staples, J. Erin and Ajaimy, Maria and Al Azzi, Yorg and Annambhotla, Pallavi and Backenson, Bryon and Belden, Katherine and Colovai, Adriana and Coppock, Dagan and Du, Lydia and Estetter, Lindsey and Le, Marie and Martines, Roosecelis B. and Pettengill, Matthew and Szymczak, Wendy and Vareechon, Chairut}
}
