Rabies Transplant Case, Screwworm Threat, and Hep B Vaccine Rollback

In this episode of Thermometer HQ, I sit down with my colleague Dr. Jon Epstein to talk about three stories that, on the surface, seem very different: a tragic rabies transplant case, a parasitic fly threatening cattle, and a political rollback of hepatitis B vaccination for newborns. Together, they tell a single story: infectious diseases are not “behind us,” and when we ignore science or dismantle public health systems, the consequences are both predictable and preventable.

A deadly reminder: rabies through organ transplantation

We start with a case that is rare, but chilling.

In Ohio, a kidney transplant recipient died 51 days after surgery. The cause wasn’t a surgical complication, rejection, or a common infection—it was rabies. Investigators traced the infection back to the organ donor, who had been scratched by a skunk about six weeks before dying of an unrelated cause. That “minor” animal scratch turned out to be the source of a fatal infection passed from one human to another through a life-saving procedure.

A few key points are important here:

• Rabies is 100% fatal once symptoms begin. In the United States, we only see one to three human cases per year, which makes it easy to forget how deadly it is.
• Scratches matter. We often associate rabies with obvious, vicious bites. But saliva on an animal’s claws—especially bats, skunks, raccoons, foxes—can be enough if it breaks the skin.
• Exposure isn’t always obvious. A classic example: waking up in a room with a bat and no visible bite. Medical guidance is to treat that as a potential exposure and give post-exposure prophylaxis (PEP), because the bite or scratch may be too small to notice.

In this case, there was no routine screening test done for rabies on the donor organs—because there isn’t a practical, rapid test we can apply to every unexpected death, and rabies is so rare that it’s not part of standard donor screening. Only after the transplant recipient died did CDC go back, test preserved kidney tissue, and confirm rabies viral RNA in the donor organ.

The takeaway isn’t that organ donation is unsafe—far from it. It’s that rare infections still matter, and we underestimate animal exposures at our own risk. If you’re scratched or bitten by a wild mammal, or you wake up with a bat in your room, that’s not something to “walk off.” It’s something to discuss urgently with a medical professional.

Screwworm: a cattle parasite with national consequences

Next, we turn to a very different outbreak, one that primarily affects animals but poses real risks to our food system and economy.

Screwworm is not a metaphor; it’s a fly. The adult fly lays eggs on warm-blooded animals—particularly cattle. The larvae burrow into living tissue, feeding and expanding the wound. Untreated, it can kill animals, devastate herds, and impose enormous economic losses on ranchers.

The United States successfully eradicated screwworm decades ago using an elegant strategy: release massive numbers of sterile flies. When sterile males mate with wild females, the result is no viable offspring, and the population collapses.

But climate, trade, and animal movement mean we’re never permanently “done” with pests and pathogens. Screwworm is now spreading through Central America and southern Mexico, pushing steadily north toward the U.S. border. For states like Texas, with enormous beef and cattle industries, this is a serious threat layered on top of existing concerns like avian influenza in dairy cattle.

The response, however, is a model of what good public health and One Health cooperation can look like:

• USDA has ramped up surveillance and created a centralized hub for data and response.
• The U.S. is partnering with Mexico and Central American countries to expand sterile fly production and release.
• FDA has fast-tracked a topical preventive treatment that can be applied to cattle to protect them from infestation.
• Multiple agencies—USDA, CDC, Interior, Defense, State—are coordinating across borders, recognizing that animals, pathogens, and insects don’t care about immigration politics.

This is what it looks like when we treat infectious threats as real, present, and solvable: coordinated action, scientific tools, and international cooperation.

Rolling back hepatitis B birth-dose vaccination: politics over evidence

The third topic brings us squarely into the collision between science and politics.

For decades, the CDC’s Advisory Committee on Immunization Practices (ACIP) has been the gold standard for vaccine policy. It was composed of experts in infectious diseases, epidemiology, pediatrics, and public health who used rigorous methods to weigh evidence on safety, effectiveness, and equity before making recommendations.

Recently, the current administration removed the existing ACIP members and replaced them with individuals who, in many cases, lack expertise in vaccines and infectious disease but share a contrarian, politically aligned stance on COVID and vaccination more broadly. One of their first major decisions: rolling back the universal recommendation that all newborns in the United States receive a hepatitis B vaccine dose at birth.

To understand why this is so dangerous, you have to understand hepatitis B:

• It’s a highly infectious virus spread through blood, sexual contact, and from mother to baby during birth.
• In infants and young children, infection is very likely to become chronic, silently damaging the liver over years or decades.
• Chronic hepatitis B infection can lead to cirrhosis and liver cancer.
• There is no cure. Only long-term antiviral therapy to suppress the virus.

Before universal newborn vaccination, more than 30,000 U.S. children under 10 were infected with hepatitis B every year, about half during birth. Many pregnant people never got tested, or their tests were false-negative. Universal birth-dose vaccination created a safety net that didn’t depend on a perfect health system or perfect prenatal care.

And that’s the crucial point: the United States does not have a universal, equitable, well-functioning health system. We are a large, diverse country with significant gaps in access to prenatal care, testing, and follow-up. That’s exactly why the birth dose is so important here, even if countries with universal health care and smaller, more homogeneous populations can safely delay vaccination.

By moving from a universal recommendation to a “risk-based” approach, we’re doing three things:

1. Reinserting inequity into vaccine protection—families with the least access to care will be the ones whose children remain at risk.
2. Undermining coverage by making it easier for insurers and federal programs (like Vaccines for Children) to reduce support.
3. Signaling that political ideology, not evidence, is now guiding vaccine policy.

The anti-vaccine movement has long targeted the hepatitis B birth dose with emotional narratives and false claims—especially around autism—despite decades of data showing the vaccine is extraordinarily safe. Instead of countering misinformation, this policy change rewards it.

The common thread: progress is reversible

Rabies in a transplant recipient. A parasitic fly edging toward Texas. A birth-dose vaccine quietly protecting babies, now rolled back for political reasons.

All three stories underscore the same reality: infectious diseases don’t vanish just because we’re tired of thinking about them. They exploit every weakness: biological, social, or political. When we underfund surveillance, ignore animal health, or dismantle evidence-based vaccine policy, we’re not “liberating” people from public health. We’re setting them up for preventable harm.

👉 Watch the full episode on YouTube: https://youtu.be/RQl3_IC6Kts