Monday, December 31, 2007

Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation

Monday, December 31, 2007 Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation

Nadège Bourvis1,2, Pierre-Yves Boelle1,2,3, Jean-Yves Cesbron4,5,6, Alain-Jacques Valleron1,2,3*

1 Université Pierre et Marie Curie-Paris6, Unité de Recherche Epidémiologie-Systèmes d'information-Modélisation, UMR S 707, Paris, France, 2 INSERM, U707, Paris, France, 3 Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Santé Publique, Hôpital St Antoine, Paris, France, 4 Laboratoire Adaptation et de Pathogénie des Micro-organismes, Université Joseph Fourier, UMR 5163, Grenoble, France, 5 Centre National de la Recherche Scientifique (CNRS), UMR 5163, Grenoble, France, 6 Centre hospitalier universitaire (CHU) de Grenoble, Laboratoire d'Immunologie, Grenoble, France

Abstract

Background

Experimental results evidenced the infectious potential of the dental pulp of animals infected with transmissible spongiform encephalopathies (TSE). This route of iatrogenic transmission of sporadic Creutzfeldt-Jakob disease (sCJD) may exist in humans via reused endodontic instruments if inadequate prion decontamination procedures are used.

Methodology/Principal Findings

To assess this risk, 10 critical parameters in the transmission process were identified, starting with contamination of an endodontic file during treatment of an infectious sCJD patient and ending with possible infection of a subsequent susceptible patient. It was assumed that a dose-risk response existed, with no-risk below threshold values. Plausible ranges of those parameters were obtained through literature search and expert opinions, and a sensitivity analysis was conducted. Without effective prion-deactivation procedures, the risk of being infected during endodontic treatment ranged between 3.4 and 13 per million procedures. The probability that more than one case was infected secondary to endodontic treatment of an infected sCJD patient ranged from 47% to 77% depending on the assumed quantity of infective material necessary for disease transmission. If current official recommendations on endodontic instrument decontamination were strictly followed, the risk of secondary infection would become quasi-null.

Conclusion

The risk of sCJD transmission through endodontic procedure compares with other health care risks of current concern such as death after liver biopsy or during general anaesthesia. These results show that single instrument use or adequate prion-decontamination procedures like those recently implemented in dental practice must be rigorously enforced.

snip...

Discussion

The results of this modelling approach show that the risk of sCJD transmission due to the reuse of instruments during ET may not be ignored in absence of effective prion-decontamination procedures.

How should our conclusions be used in a public health assessment? First note that this risk is already of concern to national health agencies as well as to health professionals [25]–[27]. Our work makes it possible to go beyond a qualitative assessment, towards more quantitative predictions where all hypotheses are clearly stated. The conclusions of this approach may easily be updated as new data accrue.

The details of ET were obtained from the latest official reports in France and UK or from experts. We conducted a literature search to collect the best estimates available of the possible quantities of infectious material left on the instruments, and subsequently partially removed by the classical disinfection procedures used until the last years of the 20th century. We obtained similarly estimates of the values of brain infectivity and of the ratio of brain infectivity to pulp infectivity. These parameters were obtained from animal experiments as they are clearly unknown in humans.

A comparable approach can be found in the HPA report on vCJD transmission in dentistry with two notable differences [25]. First, the route of instrument contamination and subsequent transmission considered in the HPA report was a very rare accidental process: the abrasion of tonsillar tissue during dental care. On the contrary, we considered the process of accessing the dental pulp during ET as certain, which obviously leads to a higher risk. Second, the HPA report considered infectivity of tonsils to be 106–107 i/c ID50 per gram, while we used dental pulp with a slightly lower range of infectivity from 104-106i/c ID50 per gram ( = BI* BPR).

The hypotheses we used concerning the relationship between the estimated inoculums and the probability of infection are obviously critical. In our assessment, we postulated that too small an inoculum (below 10-1 and 10-2 ID50 were considered with functions ?1 and ?2) would not lead to infection, and that there was a linear dose–response relationship above this threshold. This effectively complies with the “zero risk below a threshold” hypothesis rather than with the “single infectious particle” hypothesis. There is indeed experimental evidence that even very small quantities of infectious material may trigger infection in mice [13], [28], and this hypothesis was previously used in assessing decontamination procedures[29]. However, we adopted a more conservative risk estimate.

The duration of the infectious period of CJD is unknown but could be very long. We used as a reference the incubation period estimated from hGH iatrogenic cases [30]. To make comparison easier, and for want of better or more recent evidence, the duration of the infectious period relative to incubation was the same as in the HPA report, i.e. 40% of the incubation period [25].

Our risk assessment should have used the prevalence of infectious sCJD in those undergoing ET instead of that in the general population. Presumably, the former is the largest and the risk was therefore minimized. Indeed, children, who do not develop sCJD are taken into account in the general population estimate, when that in ET patients concerns only adults.

The ranges of values of risk assessment generated with our model were broad. They mirror the current lack of knowledge and the uncertainties concerning data and hypotheses. However, our model makes it clear that the ET of the 20th century were not risk-free in terms of CJD. Therefore, our model suggests that patients may well have been contaminated at the end of 20th century, and still be in the latency period and at risk of transmitting the disease.

The estimated individual risk of sCJD transmission during ET was low in our assessment. However, these values compared with the mortality rates in general anaesthesia [31], transcutaneous liver biopsy [32] or voluntary abortion [33] which are of concern in the modern health care.

We also studied the possible impact of ET at a population level and showed that there was a high probability that the reproduction rate R exceeded 1 in the absence of effective prion decontamination of the instruments: one of the conditions for the initiation of an epidemic process is fulfilled. To date, epidemiological surveillance data did not evidence such an epidemic process. However, would our hypothesis be true, the increase in incidence could remain modest and hard to identify for dozens of years because the incidence of sCJD is low, the incubation period long and in competition with all mortality causes present. CJD surveillance systems is too recent to show such trends.

***###***

Vacuum autoclaving and porous-load autoclaving for 18 min at 134°C are currently recognised as appropriate methods for prion decontamination, leading to a reduction of the infectivity load by of 3–5 log10 or more. According to our model, this decontamination would prevent CJD transmission in dental practice, even considering that the residual infectivity is not strictly reduced to zero. These methods are recommended in official reports in various countries. However, in a US study conducted in 1996 [34], only 53% of dentists used autoclaves to decontaminate root-canal files. In a survey conducted in France in 2004, only 79% of dentists used an autoclave [35]. The problem of correct use of the autoclaves and regular checking of their efficacy has also been raised by many authors in several countries [34]. A recent survey on dental practice also showed that other elementary precautionary measures against CJD transmission were not widely respected. For example, the vast majority of dentists did not actively seek out patients at-risk for any form of CJD (sporadic, iatrogenic or familial) [36]. Therefore, in the current situation and despite recommended decontamination procedures, the risk of sCJD transmission during dental care might still not be zero. In any case, our findings constitute a strong argument for the strict respect of the official recommendations on decontamination procedures in dentistry, and even suggest that the cost-benefit of single-use endodontic instruments should be re-evaluated.

The risk analysis approach we have used relies on a “problem dissection” in which all components to a risk are identified and linked to the available scientific data, knowledge, and expert opinion. It may be of help in other emerging diseases, when data on the natural history of the disease and transmission are still scarce and clinical events cannot be observed directly. In all these cases, the output of the work will always be questionable, because of the lack of data, but the strength of the method is that its results and final statements are refutable as data accrues.

snip... end... tss

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001330


http://www.plosone.org/article/fetchObjectAttachment.action;jsessionid=A92C286CBD5A9668069613D3CD070D90?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0001330&representation=PDF


Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob disease in the United States

http://cjdusa.blogspot.com/


BSE (Mad Cow) Update:

Do Reports of sCJD Clusters Matter?

snip... see full text ;

http://cjdtexas.blogspot.com/


10 January 1990

NOT FOR PUBLICATION

COMMITTEE ON SAFETY OF MEDICINES

WORKING PARTY ON BOVINE SPONGIFORM ENCEPHALOPATHY

SURGICAL CATGUT SUTURES

2.1 At the first meeting of the Working Party on Bovine Spongiform Encephalopathy on 6 September 1989, detailed consideration was given to XXXXX Surgical Catgut. This arose from the Company's response to the Letter to License Holders, indicating that the bovine small intestine source material was derived from UK cattle, unlike 8 other licensed catgut sutures. In contrast XXXXX Surgical Catgut was stated to hold over 90% share of the market for catgut sutures, and to constitute approximately 83% of all sutures used in U.K.

IMPORTS OF SUTURES FROM THE KNOWN BSE COUNTRY;

snip... see full text ;

http://creutzfeldt-jakob-disease.blogspot.com/


CJD QUESTIONNAIRE

http://cjdquestionnaire.blogspot.com/


SEAC 99th meeting on Friday 14th December 2007

Greetings,

AS one of them _lay_ folks, one must only ponder ;

"WITH the Nor-98 now documented in five different states so far in the USA in 2007, and with the TWO atypical BSE H-BASE cases in Texas and Alabama, with both scrapie and CWD running rampant in the USA, IS there any concern from SEAC with the rise of sporadic CJD in the USA from ''UNKNOWN PHENOTYPE'', and what concerns if any, in relations to blood donations, surgery, optical, and dental, do you have with these unknown atypical phenotypes in both humans and animals in the USA ???"

"Does it concern SEAC, or is it of no concern to SEAC?"

"Should it concern USA animal and human health officials?"

snip...

----- Original Message -----

From: xxxxxxxxxx

To: flounder9@verizon.net

Sent: Thursday, November 22, 2007 5:39 AM

Subject: QUESTION FOR SEAC

Mr Terry S Singeltary Sr., Bacliff, Texas 77518 USA.

Dear Mr Singeltary,

"Thank you for your e-mail of yesterday with the question for SEAC. I can confirm that this will be asked at the meeting on your behalf and the question and answer will appear in the minutes of the meeting which will be published on the SEAC Internet site."

snip...see full text ;

http://seac992007.blogspot.com/


NOR-98 ATYPICAL SCRAPIE CASES USA

snip...

In FY 2007, 331 scrapie cases have been confirmed and reported by the National Veterinary Services Laboratories (NVSL), including 59* Regulatory Scrapie Slaughter Surveillance (RSSS) cases (Figure 5 and Slide 16). In FY 2007, two field cases, one validation case, and two RSSS cases were consistent with Nor-98 scrapie. The Nor98-like cases originated from flocks in California, Minnesota, Colorado, Wyoming and Indiana respectively. Nineteen cases of scrapie in goats have been reported since 1990 (Figure 6). The last goat case was reported in September 2007.

snip...

see full report here ;

http://www.aphis.usda.gov/animal_health/animal_diseases/scrapie/downloads/yearly_report.pps


P03.141

Aspects of the Cerebellar Neuropathology in Nor98

Gavier-Widén, D1; Benestad, SL2; Ottander, L1; Westergren, E11National Veterinary Insitute, Sweden; 2National Veterinary Institute, Norway

Nor98 is a prion disease of old sheep and goats. This atypical form of scrapie was firstdescribed in Norway in 1998. Several features of Nor98 were shown to be differentfrom classical scrapie including the distribution of disease associated prion protein(PrPd) accumulation in the brain. The cerebellum is generally the most affected brainarea in Nor98. The study here presented aimed at adding information on theneuropathology in the cerebellum of Nor98 naturally affected sheep of variousgenotypes in Sweden and Norway. A panel of histochemical and immunohistochemical(IHC) stainings such as IHC for PrPd, synaptophysin, glial fibrillary acidic protein,amyloid, and cell markers for phagocytic cells were conducted. The type of histologicallesions and tissue reactions were evaluated. The types of PrPd deposition werecharacterized. The cerebellar cortex was regularly affected, even though there was avariation in the severity of the lesions from case to case. Neuropil vacuolation wasmore marked in the molecular layer, but affected also the granular cell layer. There wasa loss of granule cells. Punctate deposition of PrPd was characteristic. It wasmorphologically and in distribution identical with that of synaptophysin, suggestingthat PrPd accumulates in the synaptic structures. PrPd was also observed in thegranule cell layer and in the white matter. The pathology features of Nor98 in thecerebellum of the affected sheep showed similarities with those of sporadicCreutzfeldt-Jakob disease in humans.

http://www.prion2007.com/pdf/Prion%20Book%20of%20Abstracts.pdf


It will be critical to see whether the atypical BSE isolates behave similarly to typical BSE isolates in terms of transmissibility and disease pathogenesis. If transmission occurs, tissue distribution comparisons will be made between cattle infected with the atypical BSE isolate and the U.S. BSE isolate. Differences in tissue distribution could require new regulations regarding specific risk material (SRM) removal.

http://www.ars.usda.gov/research/projects/projects.htm?accn_no=408490


snip...

[/quote]

Terry S. Singeltary Sr. [flounder@wt.net]

Monday, January 08, 200l 3:03 PM

freas@CBS5055530.CBER.FDA.GOV CJDIBSE (aka madcow) Human/Animal TSE’s--U.S.--Submission To Scientific Advisors and Consultants Staff January 2001 Meeting (short version)

Greetings again Dr. Freas and Committee Members,

snip...

with same feeding and rendering practices as that of U.K. for years and years, same scrapie infected sheep used in feed, for years and years, 950 scrapie infect FLOCKS in the U.S. and over 20 different strains of scrapie known to date. (hmmm, i am thinking why there is not a variant scrapie, that is totally different than all the rest)? just being sarcastic. ...

snip...end... see full text Monday, January 08, 200l 3:03 PM ;

http://www.fda.gov/ohrms/dockets/ac/01/slides/3681s2_09.pdf


http://nor-98.blogspot.com/


Archive Number 20071105.3602 Published Date 05-NOV-2007 Subject PRO/AH/EDR> Prion disease update 2007 (07)

PRION DISEASE UPDATE 2007 (07) ****************************** A ProMED-mail post

snip...

[2] USA: National Prion Disease Pathology Surveillance Center Date: June 2007 Source: National Prion Disease Pathology Surveillance Center (USA) [edited]

CJD Cases examined ---------------------- Year / Referrals / Prion disease / Sporadic / Familial / Iatrogenic / vCJD

1996 / 42 / 32 / 26 / 4 / 0 / 0 1997 / 115 / 68 / 57 / 9 / 0 / 0 1998 / 93 / 53 / 45 / 7 / 1 / 0 1999 / 114 / 69 / 61 / 8 / 0 / 0 2000 / 151 / 103 / 89 / 14 / 0 / 0 2001 / 208 / 116 / 106 / 9 / 0 / 0 2002 / 255 / 143 / 118 / 23 / 2 / 0 2003 / 272 / 174 / 132 / 41 / 0 / 0 2004 / 334 / 183 / 157 / 21 / 0 / 1* 2005 / 352 / 195 / 152 / 37 / 1 / 0 2006 / 372 / 186 / 143 / 30 / 0 / 1** 2007 / 120 / 68 / 35 / 7 / 0 / 0 TOTAL / 2428*** / 1390**** / 1121 / 210 / 4 / 2

*Acquired in UK ** Acquired in Saudi Arabia *** Includes 17 inconclusive and 9 pending (1 from 2006, 8 from 2007. **** Includes 17 non-vCJD type unknown (2 from 1996, 2 from 1997, 1 from 2001, 1 from 2003, 4 from 2004, 3 from 2005, 4 from 2006) and 36 type pending (2 from 2005, 8 from 2006, 26 from 2007).

Notes:

-- Cases are listed based on the year of death when available. If the year of death is not available, the year of sample receipt is used.

-- Referrals: Cases with possible or probable prion disease from which brain tissue or blood in the case of familial disease were submitted.

-- Inconclusive: Cases in which the samples were not sufficient to make a diagnosis.

-- Non-vCJD type unknown are cases in which the tissue submitted was adequate to establish the presence but not the type; in all cases, vCJD could be excluded.

-- Communicated by: Terry S. Singeltary Sr.

[In submitting these data, Terry S. Singeltary Sr. draws attention to the steady increase in the "type unknown" category, which, according to their definition, comprises cases in which vCJD could be excluded. The total of 26 cases for the current year (2007) is disturbing, possibly symptomatic of the circulation of novel agents. Characterization of these agents should be given a high priority. - Mod.CP]

http://www.promedmail.org/pls/askus/f?p=2400:1001:6833194127530602005::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,39963


There is a growing number of human CJD cases, and they were presented last week in San Francisco by Luigi Gambatti(?) from his CJD surveillance collection.

He estimates that it may be up to 14 or 15 persons which display selectively SPRPSC and practically no detected RPRPSC proteins.

http://www.fda.gov/ohrms/dockets/ac/06/transcripts/1006-4240t1.htm


http://www.fda.gov/ohrms/dockets/ac/06/transcripts/2006-4240t1.pdf


JOURNAL OF NEUROLOGY

MARCH 26, 2003

RE-Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob

disease in the United States

Email Terry S. Singeltary:

flounder@wt.net

I lost my mother to hvCJD (Heidenhain Variant CJD). I would like to

comment on the CDC's attempts to monitor the occurrence of emerging

forms of CJD. Asante, Collinge et al [1] have reported that BSE

transmission to the 129-methionine genotype can lead to an alternate

phenotype that is indistinguishable from type 2 PrPSc, the commonest

sporadic CJD. However, CJD and all human TSEs are not reportable

nationally. CJD and all human TSEs must be made reportable in every

state and internationally. I hope that the CDC does not continue to

expect us to still believe that the 85%+ of all CJD cases which are

sporadic are all spontaneous, without route/source. We have many TSEs in

the USA in both animal and man. CWD in deer/elk is spreading rapidly and

CWD does transmit to mink, ferret, cattle, and squirrel monkey by

intracerebral inoculation. With the known incubation periods in other

TSEs, oral transmission studies of CWD may take much longer. Every

victim/family of CJD/TSEs should be asked about route and source of this

agent. To prolong this will only spread the agent and needlessly expose

others. In light of the findings of Asante and Collinge et al, there

should be drastic measures to safeguard the medical and surgical arena

from sporadic CJDs and all human TSEs. I only ponder how many sporadic

CJDs in the USA are type 2 PrPSc?

http://www.neurology.org/cgi/eletters/60/2/176#535


THE PATHOLOGICAL PROTEIN

Hardcover, 304 pages plus photos and illustrations. ISBN 0-387-95508-9

June 2003

BY Philip Yam

CHAPTER 14 LAYING ODDS

Answering critics like Terry Singeltary, who feels that the U.S. under- counts CJD, Schonberger conceded that the current surveillance system has errors but stated that most of the errors will be confined to the older population.

http://www.thepathologicalprotein.com/


doi:10.1016/S1473-3099(03)00715-1 Copyright © 2003 Published by Elsevier Ltd. Newsdesk

Tracking spongiform encephalopathies in North America

Xavier Bosch

Available online 29 July 2003. Volume 3, Issue 8, August 2003, Page 463

"My name is Terry S Singeltary Sr, and I live in Bacliff, Texas. I lost my mom to hvCJD (Heidenhain variant CJD) and have been searching for answers ever since. What I have found is that we have not been told the truth. CWD in deer and elk is a small portion of a much bigger problem." ...

http://www.thelancet.com/journals/laninf/article/PIIS1473309903007151/fulltext


http://download.thelancet.com/pdfs/journals/1473-3099/PIIS1473309903007151.pdf


Diagnosis and Reporting of Creutzfeldt-Jakob Disease

Singeltary, Sr et al. JAMA.2001; 285: 733-734.

JAMA.2001; 285: 733-734.Vol. 285 No. 6, February 14, 2001 JAMA

Diagnosis and Reporting of Creutzfeldt-Jakob Disease Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor:

In their Research Letter, Dr Gibbons and colleagues1 reported that the annual US death rate due to Creutzfeldt-Jakob disease (CJD) has been stable since 1985. These estimates, however, are based only on reported cases, and do not include misdiagnosed or preclinical cases. It seems to me that misdiagnosis alone would drastically change these figures. An unknown number of persons with a diagnosis of Alzheimer disease in fact may have CJD, although only a small number of these patients receive the postmortem examination necessary to make this diagnosis. Furthermore, only a few states have made CJD reportable. Human and animal transmissible spongiform encephalopathies should be reportable nationwide and internationally.

Terry S. Singeltary, SrBacliff, Tex1. Gibbons RV, Holman RC, Belay ED, Schonberger LB. Creutzfeldt-Jakobdisease in the United States: 1979-1998. JAMA. 2000;284:2322-2323.

FREE FULLTEXT

http://jama.ama-assn.org/cgi/content/extract/285/6/733?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=singeltary&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT


http://jama.ama-assn.org/cgi/content/full/285/6/733?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=singeltary&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT


Like lambs to the slaughter

31 March 2001 Debora MacKenzie Magazine issue 2284

FOUR years ago, Terry Singeltary watched his mother die horribly from a degenerative brain disease. Doctors told him it was Alzheimer's, but Singeltary was suspicious. The diagnosis didn't fit her violent symptoms, and he demanded an autopsy. It showed she had died of sporadic Creutzfeldt-Jakob disease.

Most doctors believe that sCJD is caused by a prion protein deforming by chance into a killer. But Singeltary thinks otherwise. He is one of a number of campaigners who say that some sCJD, like the variant CJD related to BSE, is caused by eating meat from infected animals. Their suspicions have focused on sheep carrying scrapie, a BSE-like disease that is widespread in flocks across Europe and North America.

Now scientists in France have stumbled across new evidence that adds weight to the campaigners' fears. To their complete surprise, the researchers found that one strain of scrapie causes the same brain damage in mice as sCJD.

"This means we cannot rule out that at least some sCJD may be caused by some strains of scrapie," says team member Jean-Philippe Deslys of the French Atomic Energy Commission's medical research laboratory in Fontenay-aux-Roses, south-west of Paris.

Hans Kretschmar of the University of Göttingen, who coordinates CJD surveillance in Germany, is so concerned by the findings that he now wants to trawl back through past sCJD cases to see if any might have been caused by eating infected mutton or lamb. ...

http://www.newscientist.com/article/mg16922840.300-like-lambs-to-the-slaughter.html


DER SPIEGEL (9/2001) - 24.02.2001 (9397 Zeichen) USA: Loch in der Mauer Die BSE-Angst erreicht Amerika: Trotz strikter Auflagen gelangte in Texas verbotenes Tiermehl ins Rinderfutter - die Kontrollen der Aufsichtsbehörden sind lax. Link auf diesen Artikel im Archiv: http://service.spiegel.de/digas/find?DID=18578755

"Its as full of holes as Swiss Cheese" says Terry Singeltary of the FDA regulations. ...

http://service.spiegel.de/digas/servlet/find/DID=18578755


Thu Dec 6, 2007 11:38

FDA IN CRISIS MODE, AMERICAN LIVES AT RISK

http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/dec0407fda.html


FDA SCIENCE AND MISSION AT RISK

http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4329b_02_01_FDA%20Report%20on%20Science%20and%20Technology.pdf


2 January 2000

British Medical Journal

U.S. Scientist should be concerned with a CJD epidemic in the U.S., as well

http://www.bmj.com/cgi/eletters/320/7226/8/b#6117


15 November 1999

British Medical Journal

vCJD in the USA * BSE in U.S.

http://www.bmj.com/cgi/eletters/319/7220/1312/b#5406


TSS

Sunday, December 16, 2007

Risk factors for sporadic Creutzfeldt-Jakob disease

Sunday, December 16, 2007 Risk factors for sporadic Creutzfeldt-Jakob disease Published Online: 11 Dec 2007

Copyright © 2007 American Neurological Association

Original Article

Risk factors for sporadic Creutzfeldt-Jakob disease

Hester J. T. Ward, FFPH 1 *, Dawn Everington, MSc 1, Simon N. Cousens, MA 2, Blaire Smith-Bathgate, RGN 1, Michelle Gillies, MRCP 1, Katy Murray, MRCP 1, Richard S. G. Knight, FRCPE 1, Peter G. Smith, DSc 2, Robert G. Will, FRCP 1 1National Creutzfeldt-Jakob Disease Surveillance Unit, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom 2Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

email: Hester J. T. Ward (h.ward@ed.ac.uk)

*Correspondence to Hester J. T. Ward, National CJD Surveillance Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, United Kingdom

Funded by: Department of Health; Grant Number: 121/7400 Scottish Executive Health Department; Grant Number: R39924

Abstract

Objective

Although surgical transmission of Creutzfeldt-Jakob disease (CJD) has been demonstrated, these iatrogenic cases account for only a small proportion of all CJD cases. The majority are sporadic CJD (sCJD) cases of unknown cause. This study investigated whether some cases classified as sCJD might have an unrecognized iatrogenic basis through surgical or other medical procedures

Methods

This study compared medical risk factors from 431 sCJD cases referred 1998 to 2006 with 454 population control subjects. Possible geographic and temporal links between neurological and gynecological operations in 857 sCJD cases referred from 1990 to 2006 were investigated

Results

A reported history of ever having undergone surgery was associated with increased risk for sCJD (odds ratio, 2.0; 95% confidence interval, 1.3-2.1; p = 0.003). Increased risk was not associated with surgical categories chosen a priori but was confined to the residual category other surgery, in which the increase in risk appeared most marked for three subcategories: skin stitches, nose/throat operations, and removal of growths/cysts/moles. No convincing evidence was found of links (same hospital, within 2 years) between cases undergoing neurosurgery or gynecological surgery

Interpretation

It is unlikely that a high proportion of UK sCJD cases are the result of transmission during surgery, but we cannot exclude the possibility that such transmission occurs occasionally. A study based on accurate surgical histories obtained from medical records is required to determine whether the increased risk associated with reported surgical history reflects a causal association or recall bias. Ann Neurol 2007

---------------------------------------------------------------------------- ---- Received: 24 May 2007; Revised: 5 September 2007; Accepted: 1 October 2007 Digital Object Identifier (DOI)

10.1002/ana.21294 About DOI

Additional Material

http://www3.interscience.wiley.com/cgi-bin/abstract/117861913/ABSTRACT?CRETRY=1&SRETRY=0


***

which the increase in risk appeared most marked for three subcategories:

skin stitches, nose/throat operations, and removal of growths/cysts/moles.

10 January 1990

Other US BSE risks: the imported products picture

24 Jul 00 Trade Statistics: UK to US

Compiled by Terry S.Singeltary Sr of Bacliff, Texas

[Opinion (webmaster): The US has focused for years on tracing, containing, and eradicating live animal imports from the UK or other countries with acknowledged BSE like Belgium, including some 499 cattle and the Vermont sheep. This strategy does not acknowledge imports of rendered bovine products from England during the BSE period nor secondary products such as surgical catgut, which is to say surgical cowgut, or dairy cattle embryos, vaccines for veterinarian and human medicines. What has become of these?

Mr. Singeltary, who lost his mother to CJD of unexplained origin a few years back and went on to became a well-known TSE activist, has tracked down voluminous pertinent import data through correspondence with UK officials and searches of government web sites. Imports of such products are frequently cited by Europeans in rating BSE risks in the US and in shutting out US exports.

Many people's eyes glaze over when reviewing reams of sometimes older trade statistics. There is no proof that any of the imported products was contaminated with BSE nor if so, any evidence that any BSE product lead to infection in US livestock, surgical patients, or what not. Nonetheless, the data obtained by Mr. Singeltary establish that an appalling variety and tonnage of products that were imported by the US from the UK and othr BSE-affected countries during the peak of the BSE epidemic years.]

10 January 1990

NOT FOR PUBLICATION

COMMITTEE ON SAFETY OF MEDICINES

WORKING PARTY ON BOVINE SPONGIFORM ENCEPHALOPATHY

SURGICAL CATGUT SUTURES

2.1 At the first meeting of the Working Party on Bovine Spongiform Encephalopathy on 6 September 1989, detailed consideration was given to XXXXX Surgical Catgut. This arose from the Company's response to the Letter to License Holders, indicating that the bovine small intestine source material was derived from UK cattle, unlike 8 other licensed catgut sutures. In contrast XXXXX Surgical Catgut was stated to hold over 90% share of the market for catgut sutures, and to constitute approximately 83% of all sutures used in U.K.

IMPORTS OF SUTURES FROM THE KNOWN BSE COUNTRY;

3006.10.0000: STERILE SURGICAL CATGUT, SIMILAR STERILE SUTURE MATERIALS AND STERILETISSUE ADHESIVES FOR SURGICAL WOUND CLOSURE; AND SIMILAR STERILE MATERIAL

U.S. Imports for Consumption: December 1998 and 1998 Year-to-Date (Customs Value, in Thousands of Dollars) (Units of Quantity: Kilograms)

<--- Dec 1998 ---> <--- 1998 YTD --->

Country Quantity Value Quantity Value

===================================================

WORLD TOTAL . . . . . . . 10,801 3,116 143,058 40,068

Belgium . . . . . . . . . --- --- 107 14

France . . . . . . . . . 81 49 2,727 1,132

Switzerland . . . . . . . --- --- 1,357 1,693

United Kingdom . . . . . 1,188 242 35,001 5,564

http://www.mad-cow.org/00/jul00_dont_eat_sheep.html#hhh


see url now available at ;

http://www.bseinquiry.gov.uk/files/yb/1990/01/10008001.pdf


2.1 Bovine Small Intestine

This is the largest single category, comprising 9 product licenses for surgical catgut, held by 3 Companies ;

http://www.bseinquiry.gov.uk/files/yb/1990/01/10010001.pdf


2.2 Skin

Bovine dermal collagen is present in 2 products for correction of tissue contour deformities by injection and 4 implantable haemostates.

Source USA, USA, W Germany, W. Germany, France. ...

http://www.bseinquiry.gov.uk/files/yb/1990/01/10010001.pdf


UPDATE ON SURGICAL CATGUT

MAY 1990

http://www.bseinquiry.gov.uk/files/yb/1990/05/00011001.pdf


40,000 human heart valves a year from BSE herds

Sun, 3 Sep 2000.

Unpublished Inquiry documents obtained by CJD activist Terry S. Singeltary Sr. of Bacliff, Texas

http://www.mad-cow.org/00/sep00_news.html#hhh


The documents below were provided by Terry S. Singeltary Sr on 8 May 2000. They are optically character read (scanned into computer) and so may contain typos and unreadable parts.

TIP740203/l 0424 CONFIDENTIAL

snip...

The responses by the companies were presented by Ms Turner and were categorised by MCA standards, the products that were discussed were all low volume usage products eg sutures, heart valves.

8. As the responses included some materials of human origin it was decided that more information should be sought about CJD. There had been 2 recent deaths reported associated with human growth hormone. These were being investigated.

snip...

http://www.mad-cow.org/00/may00_news.html#aaa


5.3.3 The greatest risk, in theory, would be from parenteral injection of material derived from bovine brain or lymphoid tissue. Medicinal products for injection or surgical implantation which are prepared from bovine tissues, or which utilise bovine serum albumin or similar agents in their manufacture, might also be capable of transmitting infectious agents. All medicinal products are licensed under the Medicines Act by the Licensing Authority following guidance, for example from the Committee on Safety of Medicines (CSM), the Committee on Dental and Surgical Materials (CDSM) and their subcommittees. The Licensing Authority have been alerted to potential concern about BSE in medicinal products and will ensure that scrutiny of source materials and manufacturing processes now takes account of BSE agent.

http://www.bseinquiry.gov.uk/files/ib/ibd1/tab02.pdf


EXPORT OF BRITISH BIOLOGICAL PHARMACEUTICALS

http://www.bseinquiry.gov.uk/files/yb/1990/03/13002001.pdf


http://www.bseinquiry.gov.uk/files/yb/1990/03/13008001.pdf


http://www.bseinquiry.gov.uk/files/yb/1990/03/13009001.pdf


No papers were presented by our American guests and none covered the subject of pharmaceuticals. ...

http://www.bseinquiry.gov.uk/files/yb/1990/04/02002001.pdf


http://www.bseinquiry.gov.uk/files/yb/1990/04/06002001.pdf


The documents below were provided by Terry S. Singeltary Sr on 8 May 2000. They are optically character read (scanned into computer) and so may contain typos and unreadable parts.

TIP740203/l 0424 CONFIDENTIAL

Mr Cunningham CMP3 From: D O Hagger MBI Dr Salisbury MED/IMCD3 Mr Burton PD/STB/PG1B B/17/2 Date: 15.02.1989 Mr Dudley PD/AD4

snip...

89/06.19/8.1 BSE3/1 0191 Hr J Maslin (MAFF) Ref: Maslin3g

From: Dr H Pickles Med SEB/B Date: 3 July 1989

CATTLE BY-PRODUCTS AND BSE

I was interested to see the list of by-products sent to the HSE. Those of particular concern included:

* small intestines: sutures (I thought the source was ovine but you are checking this)

* spinal cord: pharmaceuticals

* thymus: pharmaceuticals

Are you able to give me more information on which UK manufacturers use these materials? Our proposed ban on bovine offal for human consumption would not affect these uses, I assume.

snip...see full text ;

http://www.mad-cow.org/00/may00_news.html


http://www.javno.com/en/world/clanak.php?id=32047


Evidence For CJD/TSE Transmission Via Endoscopes From Terry S. Singletary, Sr flounder@wt.net

1-24-3

http://www.rense.com/general34/scopes.htm


Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob disease in the United States

http://cjdusa.blogspot.com/


CJD QUESTIONNAIRE

http://cjdquestionnaire.blogspot.com/


SCRAPIE USA

http://scrapie-usa.blogspot.com/


NOR-98 ATYPICAL SCRAPIE CASES USA

http://nor-98.blogspot.com/


CREUTZFELDT JAKOB DISEASE MAD COW BASE UPDATE USA

http://cjdmadcowbaseoct2007.blogspot.com/


Transmissible Mink Encephalopathy TME

http://transmissible-mink-encephalopathy.blogspot.com/


CHRONIC WASTING DISEASE

http://chronic-wasting-disease.blogspot.com/


ASSESSING THE RISK OF vCJD TRANSMISSION VIA SURGERY: AN INTERIM REVIEW

Economics, Statistics and Operational Research Department of Health Skipton House, 80 London Road, London SE1 6LW

March 2005

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4113542.pdf


British Medical Bulletin 66:255-265 (2003) © 2003 The British Council

Acquired prion disease: iatrogenic CJD, variant CJD, kuru Robert G Will National CJD Surveillance Unit, Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK

Abstract

Human prion diseases can be classified as sporadic, hereditary or acquired. The cause of sporadic Creutzfeldt-Jakob disease (CJD) is unknown, hereditary cases are associated with mutations of the prion protein gene (PRNP) and acquired forms are caused by the transmission of infection from human to human or, as a zoonosis, from cattle to human. Although acquired forms of human prion disease are rare, the transmission of a fatal and untreatable neurological disorder has had major implications for public health and public policy.

Iatrogenic CJD

Since the first evidence of iatrogenic transmission of CJD in 1974, via a corneal transplant, other mechanisms of iatrogenic transmission have been identified including neurosurgical instruments, depth electrodes, human pituitary hormones and human dura mater grafts. All these transmissions have involved cross-contamination with material in, or adjacent to, the brain where the expected levels of infectivity would be highest (Table 1). The route of inoculation has been parenteral, either by surgery or by intramuscular injection.

Corneal grafts and depth electrodes

Iatrogenic transmission of CJD was first suggested in 19741; CJD developed 18 months after transplantation of a cadaveric corneal graft, which had been obtained from a donor who had died of pathologically confirmed CJD. A second case was described in 19972 in which both donor and recipient died from pathologically confirmed CJD, although the delay between corneal transplant and the development of CJD was 30 years. These cases provide strong circumstantial evidence of transmission of CJD through cadaveric corneal grafts.

Two cases were reported in 1977 in which CJD developed 2 years after stereotactic EEG recordings3. The instruments had previously been used in a patient with rapidly progressive dementia and myoclonus, who was later confirmed as having died of CJD. The electrodes had been disinfected with ethanol and formaldehyde vapour. The possibility that CJD had been transmitted via the electrodes was subsequently supported by transmission of CJD to a chimpanzee 18 months after intradural implantation of the suspect electrodes4.

Neurosurgical transmission

The original publication by Nevin and co-workers5 suggested that CJD was transmitted via contaminated neurosurgical instruments in the 1950s. A small number of patients with CJD underwent invasive procedures, including brain biopsy, and concurrent in-patients underwent neurosurgery for other conditions (e.g. removal of meningioma or cortical undercut). The re-admission of three of these cases 18–24 months later to the same hospitals with CJD provides strong circumstantial evidence of transmission through contaminated neurosurgical instruments. A similar case has been described in France6, but there have subsequently been no further published cases implicating neurosurgical instruments. The clinical features in these cases were very similar to sporadic CJD.

Dura mater grafts

The transmission of CJD from patient to patient by cadaveric dura mater grafts was first recognised in 1987 and there have now been at least 136 cases world-wide, including 88 cases identified in Japan7. Almost all of these cases have involved the insertion of Lyodura grafts produced by B. Braun Melsungen AG and processed before May 1987. Exceptions to the use of Lyodura grafts include one case in which the source was unknown, one case in which locally produced dura was implanted and one case associated with Tutoplast dura. The risk of transmission of CJD through dura mater grafts had been thought to be low because only a small number of recipients would receive contaminated material from any individual infected donor. The large number of Lyodura-associated cases of CJD suggests that there may have been cross-contamination during the production process.

For dura mater-associated cases of CJD in Japan, the mean latency period from receipt of the graft to the onset of CJD was 8.2 years (range, 1.3–16.1 years)8 and for the 114 reported cases world-wide by the millennium, the interval from the implantation of the graft to the development of clinical disease ranged from 1.5–18 years with a mean of about 6 years9. The risk of developing CJD after exposure to a dura mater graft is difficult to estimate because of limited information on the number of recipients. The major risk, however, appears to be in those individuals who received grafts between 1981 and 1987 (Fig. 1) and in Japan the minimum risk has been estimated at approximately one case of CJD per 3000 Lyodura graft recipients.

The majority of patients with dura mater-related CJD present with symptoms and signs consistent with sporadic CJD, but in some cases the presentation is less typical. A cerebellar syndrome has been described occasionally, but this does not necessarily correlate with the anatomical site of the original graft.

Human pituitary hormones

The treatment of short stature in children with human pituitary-derived growth hormone (hGH) was initiated in the late 1950s, and about 30,000 children had been treated with hGH world-wide by 1985. Small numbers of women were treated for infertility with human pituitary gonadotrophin over a similar period. In 1985, the occurrence of CJD in two hGH recipients in the US10,11 and one case in the UK12 provided strong circumstantial evidence of transmission of CJD via hGH, not least because the young age of the patients contrasted with that usually observed in CJD. Since then, CJD has developed in over 160 hGH recipients in a number of countries including the US, UK, France, New Zealand, and The Netherlands (Table 2). The overall proportion of CJD cases in the recipient population is about 1 in 100, but this proportion varies between countries, with the highest rate in France. The contrasting inter-country incidence may relate to differences in the methods of sourcing of pituitary glands or variations in hormone production. hGH was withdrawn in most countries in 1985 and human pituitary gonadotrophin has also been withdrawn in many countries following the occurrence of CJD in four recipients in Australia13.

hGH production required the pooling of many thousands of glands and it is presumed that contamination of the hormone preparation occurred when pituitary glands derived from patients who died from or were incubating CJD were included in the production process. The circumstantial evidence suggesting a causal link between hGH and CJD has been supported by transmission studies in which a squirrel monkey developed prion disease following inoculation with 1 of 76 potentially contaminated lots of hGH14. The incubation period in hGH-related CJD is impossible to estimate precisely because the timing of infection is not known. However, the estimated mean incubation period is 12 years with a range of 4.5 to over 25 years, based on the latency from the mid-point of treatment to the onset of clinical illness. The clinical features of human pituitary hormone-related CJD are distinct from sporadic CJD. In the great majority of cases, the initial presentation involves a progressive cerebellar syndrome, and other features including dementia develop late, if at all. It is possible that the route of inoculation of the infectious agent may be an important determinant to clinical expression of disease. In kuru, presumed to be due to a peripheral route of infection, cerebellar signs predominate in the early stages as in human pituitary hormone recipients, whereas in iatrogenic CJD, due to central inoculation, the clinical features are similar to sCJD.

Variant CJD

snip... full text ;

http://bmb.oxfordjournals.org/cgi/content/full/66/1/255


TSEAC MEETING

----- Original Message -----

From: Terry S. Singeltary Sr.

To: FREAS@CBER.FDA.GOVCc: william.freas@fda.hhs.gov ; rosanna.harvey@fda.hhs.gov

Sent: Wednesday, November 29, 2006 1:24 PM

Subject: TSE advisory committee for the meeting December 15, 2006 [TSSSUBMISSION] November 29, 2006

Greetings FDA, DHH, Dr. Freas, and Dr. Harvey et al,

a kind and warm Holiday Greetings to you all. i kindly wish to submit the following to the TSE advisory committee for the meeting December 15, 2006, about the assessment for potential exposure to vCJD in human plasma-derived antihemophilic factor (FVIII) products manufactured from U.S. plasma donors and related communication material ;

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/E6-20251.htm


i see the media picked up on this as a 'low risk', from what the gov. agency perceived to be to them;

http://www.newsday.com/news/health/ats-ap_health14nov27,0,7955259.story?coll=ny-leadhealthnews-headlines


however, i seem to disagree. from my primitive ciphering, i see it anotherway. this is a huge catastrophic risk. 3 in 160 is 1.9%. so call that 2% which is 1 in 50 or twenty per thousand or 20,000 per million. also, what about the mixed genotypes/mixed susceptibility? what about the silent carriers that donated tainted blood? what about the sporadic CJDs of UNKNOWN strain or phenotype? this risk assessment is just more BSe to me. just another in a long line of ...

Greetings again Dr. Freas et al at FDA,

THIS was like closing the barn door after the mad cows got loose. not only the red cross, but the FDA has failed the public in protecting them from the TSE aka madcow agent. TSE agent i.e. bse, base, cwd, scrapie, tme, and any sub strains thereof. we do not know if these strains will or have transmitted to humans as subclinical TSE or clinical disease, and we do not know if they have or will transmit second, third, forth passage via friendly fire i.e. multiple potential routes via medical, surgical, pharmaceutical etc. IF you remember correctly Dr. Freas et al, i called this long ago, almost 6 years ago ;

PDF]Freas, William TSS SUBMISSION

Terry S. Singeltary Sr. [flounder@wt.net] Monday, January 08, 200l 3:03 PM freas ...Freas, William From: Terry S. Singeltary Sr. [flounder@wt.net] Sent: Monday, January 08,200l 3:03 PM

To: freas@CBS5055530.CBER.FDA.GOV

Subject: CJD/BSE (aka madcow) Human/Animal TSE?s--U.S.--Submission

To Scientific Advisors and Consultants Staff January 2001 Meeting (short version)

Greetings again Dr. Freas and Committee Members,

I wish to submit the following information to the Scientific Advisors and Consultants Staff 2001 Advisory Committee (short version). I understand the reason of having to shorten my submission, but only hope that you add it to a copy of the long version, for members to take and read at their pleasure, (if cost is problem, bill me, address below). So when they realize some time in the near future of the 'real' risks i speak of from human/animal TSEs and blood/surgical products.

snip...

I am beginning to think that the endless attempt to track down and ban, potential victims from known BSE Countries from giving blood will be futile. You would have to ban everyone on the Globe eventually? AS well, I think we MUST ACT SWIFTLY to find blood test for TSE's, whether it be blood test, urine test, eyelid test, anything at whatever cost, we need a test FAST. DO NOT let the incubation time period of these TSEs fool you. To think of Scrapie as the prime agent to compare CJD, but yet overlook the Louping-ill vaccine event in 1930's of which 1000's of sheep where infected by scrapie from a vaccine made of scrapie infected sheep brains, would be foolish. I acquired this full text version of the event which was recorded in the Annual Congress of 1946 National Vet. Med. Ass. of Great Britain and Ireland. From the BVA and the URL is posted in my (long version). ...

http://www.fda.gov/ohrms/dockets/ac/01/slides/3681s2_09.pdf


see full text ;

http://tseac.blogspot.com/


vCJD case study highlights blood transfusion risk

http://vcjdblood.blogspot.com/


Wednesday, October 24, 2007

MADCOW USDA the untold story

http://madcowusda.blogspot.com/


FOIA MAD SHEEP MAD RIVER VALLEY

DECLARATION OF EXTRAORDINARY EMERGENCY BECAUSE OF AN ATYPICAL T.S.E. (PRION DISEASE) OF FOREIGN ORIGIN IN THE UNITED STATES [Docket No. 00-072-1]

http://foiamadsheepmadrivervalley.blogspot.com/


[Docket No. 03-025IFA] FSIS Prohibition of the Use of Specified Risk Materials for Human Food and Requirement for the Disposition of Non-Ambulatory Disabled Cattle

9/13/2005

http://www.fsis.usda.gov/OPPDE/Comments/03-025IFA/03-025IFA-2.pdf


[Docket No. FSIS-2006-0011] FSIS Harvard Risk Assessment of Bovine Spongiform Encephalopathy (BSE)

http://www.fsis.usda.gov/OPPDE/Comments/2006-0011/2006-0011-1.pdf


SEAC 99 DECEMBER 14, 2007

Conclusions

14. Preliminary research findings suggest that the potential risk of transmission of vCJD via dental procedures may be greater than previously anticipated. Although this research is incomplete, uses an animal model exposed to relatively high doses of infectivity, and there are no data from infectivity studies on human oral tissues, these findings suggest an increased possibility that vCJD may be relatively efficiently transmitted via a range of dental procedures. Ongoing infectivity studies using human oral tissues and the other studies suggested here will enable more precise assessment of the risks of vCJD transmission through dental procedures.

15. Guidance was issued to dentists earlier this year recommending that endodontic files and reamers be treated as single use which, provided it is adhered to, will remove any risk of a self-sustaining epidemic arising from re-use of these instruments. To minimise risk it is critical that appropriate management and audit is in place, both for NHS and private dentistry.

16. It is also critical that a detailed and comprehensive assessment of the risks of all dental procedures be conducted as a matter of urgency. While taking into account the continuing scientific uncertainties, this will allow a more thorough consideration of the possible public health implications of vCJD transmission via dentistry and the identification of possible additional precautionary risk reduction measures. The assessment will require continued updating as more evidence becomes available on the transmissibility of vCJD by dental routes, and on the prevalence of infection within the population. A DH proposal to convene an expert group that includes dental professionals to expedite such an assessment is welcomed. Given the potential for transmission via dentistry, consideration should be given to the urgent assessment of new decontamination technologies which, if proved robust and effective, could significantly reduce transmission risks.

SEAC June 2007

27 SEAC Epidemiology Subgroup (2006) position statement of the vCJD epidemic. http://www.seac.gov.uk/statements/state260106subgroup.htm


28 DH (2007) Precautionary advice given to dentists on re-use of instruments http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=279256&NewsAreaID=2&NavigatedFromDepartment=False


see full text 17 pages ;

http://www.seac.gov.uk/papers/99-7.pdf


SEAC 99th meeting on Friday 14th December 2007

DECEMBER 14, 2007, 10 year Anniversary of my Moms death 'confirmed' from Heidenhain Variant Creutzfeldt Jakob Disease

Greetings,

AS one of them _lay_ folks, one must only ponder ;

"WITH the Nor-98 now documented in five different states so far in the USA in 2007, and with the TWO atypical BSE H-BASE cases in Texas and Alabama, with both scrapie and CWD running rampant in the USA, IS there any concern from SEAC with the rise of sporadic CJD in the USA from ''UNKNOWN PHENOTYPE'', and what concerns if any, in relations to blood donations, surgery, optical, and dental, do you have with these unknown atypical phenotypes in both humans and animals in the USA ???"

"Does it concern SEAC, or is it of no concern to SEAC?"

"Should it concern USA animal and human health officials?"

snip...

----- Original Message ----- From: xxxxxxxxxx To: flounder9@verizon.net Sent: Thursday, November 22, 2007 5:39 AM Subject: QUESTION FOR SEAC

Mr Terry S Singeltary Sr., Bacliff, Texas 77518 USA.

Dear Mr Singeltary,

"Thank you for your e-mail of yesterday with the question for SEAC. I can confirm that this will be asked at the meeting on your behalf and the question and answer will appear in the minutes of the meeting which will be published on the SEAC Internet site."

snip...end...TSS

Archive Number 20071105.3602 Published Date 05-NOV-2007 Subject PRO/AH/EDR> Prion disease update 2007 (07)

PRION DISEASE UPDATE 2007 (07) ****************************** A ProMED-mail post

snip...

[2] USA: National Prion Disease Pathology Surveillance Center Date: June 2007 Source: National Prion Disease Pathology Surveillance Center (USA) [edited]

CJD Cases examined ---------------------- Year / Referrals / Prion disease / Sporadic / Familial / Iatrogenic / vCJD

1996 / 42 / 32 / 26 / 4 / 0 / 0 1997 / 115 / 68 / 57 / 9 / 0 / 0 1998 / 93 / 53 / 45 / 7 / 1 / 0 1999 / 114 / 69 / 61 / 8 / 0 / 0 2000 / 151 / 103 / 89 / 14 / 0 / 0 2001 / 208 / 116 / 106 / 9 / 0 / 0 2002 / 255 / 143 / 118 / 23 / 2 / 0 2003 / 272 / 174 / 132 / 41 / 0 / 0 2004 / 334 / 183 / 157 / 21 / 0 / 1* 2005 / 352 / 195 / 152 / 37 / 1 / 0 2006 / 372 / 186 / 143 / 30 / 0 / 1** 2007 / 120 / 68 / 35 / 7 / 0 / 0 TOTAL / 2428*** / 1390**** / 1121 / 210 / 4 / 2

*Acquired in UK ** Acquired in Saudi Arabia *** Includes 17 inconclusive and 9 pending (1 from 2006, 8 from 2007. **** Includes 17 non-vCJD type unknown (2 from 1996, 2 from 1997, 1 from 2001, 1 from 2003, 4 from 2004, 3 from 2005, 4 from 2006) and 36 type pending (2 from 2005, 8 from 2006, 26 from 2007).

Notes:

-- Cases are listed based on the year of death when available. If the year of death is not available, the year of sample receipt is used.

-- Referrals: Cases with possible or probable prion disease from which brain tissue or blood in the case of familial disease were submitted.

-- Inconclusive: Cases in which the samples were not sufficient to make a diagnosis.

-- Non-vCJD type unknown are cases in which the tissue submitted was adequate to establish the presence but not the type; in all cases, vCJD could be excluded.

-- Communicated by: Terry S. Singeltary Sr.

[In submitting these data, Terry S. Singeltary Sr. draws attention to the steady increase in the "type unknown" category, which, according to their definition, comprises cases in which vCJD could be excluded. The total of 26 cases for the current year (2007) is disturbing, possibly symptomatic of the circulation of novel agents. Characterization of these agents should be given a high priority. - Mod.CP]

http://www.promedmail.org/pls/askus/f?p=2400:1001:6833194127530602005::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,39963


There is a growing number of human CJD cases, and they were presented last week in San Francisco by Luigi Gambatti(?) from his CJD surveillance collection.

He estimates that it may be up to 14 or 15 persons which display selectively SPRPSC and practically no detected RPRPSC proteins.

http://www.fda.gov/ohrms/dockets/ac/06/transcripts/1006-4240t1.htm


http://www.fda.gov/ohrms/dockets/ac/06/transcripts/2006-4240t1.pdf


snip...full text ;

http://seac992007.blogspot.com/


TSS