RALEIGH, N.C. (AP) — Health officials are recommending vaccine for at least one North Carolina relative of a rabies-infected man who died in Florida in 2011 and whose transplanted kidney fatally infected a Maryland man, the state's top public health veterinarian said Friday.

Fewer than five family members from North Carolina visited the rabies-infected man while he was hospitalized in Florida, Dr. Carl Williams said. Local and state health departments have contacted the relatives and are evaluating their rabies risks.

Vaccine injections and the rest of a protective treatment against the fatal disease costing thousands of dollars are "going to be recommended for at least one of them," Williams said.

The Centers for Disease Control and Prevention said Friday that a Maryland man died after receiving a transplanted, rabies-infected kidney that came from a donor who wasn't known to have the disease. The donor died in Florida after moving there from North Carolina. Rabies was only recently confirmed as his cause of death after the Maryland investigation began, the CDC said.

The recipients of the donor's other kidney, heart and liver are getting anti-rabies shots. Those patients live in Florida, Georgia and Illinois.

Williams wouldn't describe where the donor lived before moving to Florida, saying even naming the county could identify the rabies victim. Rabies is common in wildlife statewide. How the donor may have gotten the raccoon rabies virus is under investigation, the CDC said.

He was infectious for a period that began a few days before he showed rabies symptoms and likely lasted through the time of death, Williams said. Once symptoms show, there's no cure for the fatal disease, he said.

"What generally happens in human rabies patients that are hospitalized is that there is a lot of close contact, not only from health care workers but from close family because the patient is going to die," Williams said.

The disease could, in rare cases, be transmitted by saliva from a kiss on the lips or tears being wiped away by a visiting mother, Williams said.

"Anybody who may have been exposed to this donor's saliva while he was alive may be at risk of rabies. Admittedly he didn't bite anyone so we're talking about a low-risk situation," Williams said.

Typically, one to three cases of human rabies are diagnosed annually in the United States, the CDC said. North Carolina hasn't had a human death from rabies since the 1950s, state Department of Health and Human Services spokeswoman Julie Henry said.

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Emery Dalesio can be reached at http://twitter.com/emerydalesio