METHODS: In 2015, cases of Chagas disease in SOT recipients were investigated to determine if the infections were donor-derived or the result of reactivation, and to identify other potentially at-risk recipients. Detailed histories were collected for the recipients and donors and included information on potential risk factors, such as birth or residence in Latin or South America. Determinations of source of infection relied on evaluation of risk histories for recipients and donors, and laboratory testing of pre- and post-transplant samples. SOT recipients, at risk of either donor-derived infection or reactivation, were monitored post-transplant by PCR and microscopy to identify early signs of infection and allow for prompt treatment.
RESULTS: CDC was notified of 9 SOT recipients at risk of reactivation in 2015; 3 (33%) of whom had laboratory evidence of reactivation and were treated with benznidazole. CDC was also notified of 2 seropositive organ donors, resulting in post-transplant monitoring for 5 recipients at risk of donor-derived infection; none developed infection. Health departments led or contributed to investigations in their jurisdictions. Upon identification of at-risk recipients, health departments ensured timely submission of samples for post-transplant monitoring which led to the prompt identification of 3 cases of reactivation. Despite instructions on appropriate monitoring, several transplant centers failed to adhere to monitoring schedules putting patients at greater risk for disease related to T. cruzi. Health department involvement was required to ensure specimen submission.
CONCLUSIONS: Public health plays a key role in the prevention and control of Chagas disease in at-risk transplant patients. Currently, not all at-risk donors or recipients are screened for Chagas disease. As additional OPOs initiate donor screening programs, public health may have a larger number of cases to manage to ensure the health and safety of this patient population.