Annex J - Assessment to be carried out before surgery and/or endoscopy to identify patients with, or at risk of, CJD or vCJD Revised and updated 16 July 2009
Summary of advice (revised July 2009)
Annex J provides a clear and pragmatic way of assessing CJD and vCJD risk prior to surgery or endoscopy. Growing numbers of patients have been informed that they are at increased risk of CJD or vCJD. Therefore it is recommended that all patients about to undergo any surgery or endoscopy should be asked if they have ever been notified as at increased risk of CJD or vCJD. This recommendation is outlined in paragraphs J1 and J2.
In addition, patients undergoing surgery or neuro-endoscopy which may involve contact with tissues of potentially high level TSE infectivity (“high risk tissues”) should, through a set of detailed questions, be assessed for their possible CJD/vCJD risk exposure. These questions are outlined in Table J1 and paragraphs J3 to J6.
Annex J has been revised (July 2009) to include a new question to be asked of all patients about to undergo surgery or neuro-endoscopy on high risk tissues. This new question (question 4 in Table J1) has been added to identify those patients who have received blood or blood components from 80 or more blood donors. These patients are now designated as at increased risk of vCJD by the CJD Incidents Panel. Table J1 and paragraph J6 provide guidance on how to identify those patients who have received multiple blood transfusions. An algorithm, included as Appendix A, guides health professionals through the process.
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Additional recommendations for surgery and neuro-endoscopy which may involve contact with high risk tissue only N.B. These additional recommendations are only applicable to those assessing patients in neurosurgical and ophthalmic surgical departments for neurosurgical and posterior ophthalmic surgical procedures. With regards to endoscopy, these additional recommendations are only applicable to those assessing patients for intradural neuro-endoscopic procedures. Procedures should not be delayed whilst information is being collected, and clinicians should be careful not to prejudice overall patient care. J3. As well as asking all patients whether they have been notified as being at increased risk of CJD/vCJD, clinicians assessing patients for procedures that involve contact with high risk tissues should ask supplementary questions (as outlined in Table J1) to assess further their CJD/vCJD risk. If a patient has answered ‘yes’ to the question in paragraph J1 there is no additional need to ask the questions in Table J1 – the patient’s risk status has been established. J4. Tissues assumed or proven to have high level infectivity for CJD or vCJD are:
• Brain
• Spinal cord
• Dura mater
• Cranial nerves, specifically:
• the entire optic nerve
• only the intracranial components of the other cranial nerves
• Cranial nerve ganglia
• Posterior eye, specifically:
• posterior hyaloid face
• retina
• retinal pigment epithelium
• choroid
• subretinal fluid
• optic nerve
• Pituitary gland
Annex A1 gives further advice on CJD/vCJD tissue infectivity
J5. Table J1 outlines recommended questions to assess CJD/vCJD risk. It is recommended that patients are asked these questions prior to elective or emergency surgical or neuro-endoscopic procedures likely to involve contact with tissues of potentially high infectivity. Paragraph J6 and the algorithm in Appendix A outlines the steps to take based on the patient’s responses. Appendix B is an information sheet for pre-surgical patients undergoing surgery or neuro-endoscopy on high risk tissues about the questions they will be asked.
Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection: Annex K 1 Published: March 2009
Annex K
Guidelines for pathologists and pathology laboratories for the handling of tissues from patients with, or at risk of, CJD or vCJD
K9. Table K1 outlines those tissues either assumed or proven to have medium or high level infectivity for CJD other than vCJD. This table is based on Table A1 in Annex A1 of this guidance, which is updated regularly in accordance with international guidelines. Tissues assumed or proven to have either low level, or no, infectivity have not been included in this table, e.g. liver, kidney, muscle. Table K1 – tissues either assumed or proven to have medium or high level infectivity for CJD other than vCJD
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Table J1 – CJD risk questions for patients about to undergo elective or emergency surgical or neuro-endoscopic procedures likely to involve contact with tissues of potentially high level infectivity Question to Patient Notes to clinician
1 Have you a history of CJD or other prion disease in your family? If yes, please specify. Patients should be considered to be at risk from genetic forms of CJD if they have or have had: i) Genetic testing, which has indicated that they are at significant risk of developing CJD or other prion disease; ii) A blood relative known to have a genetic mutation indicative of genetic CJD or other prion disease; iii) 2 or more blood relatives affected by CJD or other prion disease
2 Have you ever received growth hormone or gonadotrophin treatment? If yes, please specify: i) whether the hormone was derived from human pituitary glands ii) the year of treatment iii) whether the treatment was received in the UK or in another country Recipients of hormone derived from human pituitary glands, e.g. growth hormone or gonadotrophin, have been identified as at increased risk of sporadic CJD. In the UK, the use of human-derived growth hormone was discontinued in 1985 but human-derived products may have continued to be used in other countries. In the UK, the use of human-derived gonadotrophin was discontinued in 1973 but may have continued in other countries after this time.
3 Have you ever had surgery on your brain or spinal cord?
(a) Patients who underwent intradural neurosurgical or spinal procedures before August 1992 may have received a graft of human-derived dura mater and should be treated as at increased risk, unless evidence can be provided that human-derived dura mater was not used. Patients who received a graft of human-derived dura mater before 1980 are at increased risk of sporadic CJD. Patients who received a graft of human-derived dura mater between 1980 and August 1992 are at increased risk of both sporadic CJD and vCJD. This difference in risk has implications for patient management, in particular gastrointestinal endoscopy. See Annex F for more information.
(b) NICE guidance emphasises the need for a separate pool of new neuroendoscopes and reusable surgical instruments for high risk procedures on children born since 1st January 1997 and who have not previously undergone high risk procedures. These instruments and neuroendoscopes should not be used for patients born before 1st January 1997 or those who underwent high risk procedures using reusable instruments before the implementation of this guidance.
4 Published: 31 July 2006 Revised and updated: 16 July 2009
4 Since 1980, have you had any transfusions of blood or blood components (red cells, plasma, cryoprecipitate or platelets*)? If yes, have you either:
i) received more than 50 units of blood or blood components? or
ii) received blood or blood components on more than 20 occasions?
Where possible, please provide the names of all the hospitals where you received blood or blood components.
Patients who have received blood from more than 80 donors have been identified as at increased risk of vCJD. Information on this is available from the HPA:
http://www.hpa.org.uk/vCJDpresurgicalassessment
* This does not include:
• Autologous transfusion
• Plasma products such as IVIG, albumin, coagulation factors and anti-D J6. The actions to be taken following the patient’s response to the above questions are: Patient’s response
Action
No to all questions
Surgery or neuro-endoscopy can proceed using normal infection control procedures.
Yes to any of questions 1, 2 or 3
Further investigation into the nature of the patient’s CJD risk should be undertaken, and the patient’s CJD risk assessed. This assessment of CJD risk should be recorded in the patient’s medical notes for future reference. If the patient is found to be at increased risk of CJD or vCJD following investigation, or the risk status is unknown at the time of the procedure, special infection control precautions should be taken for the patient’s procedure including quarantining of instruments, and the local infection control team should be consulted for advice. Part 4 of this guidance provides advice for the precautions to be taken during the treatment of patients with or at increased risk of CJD or vCJD, and Annex F provides information on neuro-endoscopic procedures.
If the patient is found to be at increased risk of CJD or vCJD they should also be referred to their GP, who will need to inform them of their increased risk of CJD or vCJD and provide them with further information and advice. This is available from the CJD Incidents Panel:
http://www.hpa.org.uk/CJDIncidentsPanel
Patients who are at increased risk of genetic forms of CJD should be offered the opportunity of referral to the National Prion Clinic, based at the National Hospital for Neurology and Neurosurgery, Queen Square, London:
http://www.nationalprionclinic.org/
Patients who are at increased risk of sporadic CJD due to receipt of human-derived growth hormone or gonadotrophin should be offered the opportunity of referral to the UCL Institute of Child Health, London. Contact: L.Davidson@ich.ucl.ac.uk, 020 7404 0536
5 Published: 31 July 2006 Revised and updated: 16 July 2009
Yes to question 4
The algorithm in Appendix A of this document outlines the steps to be taken following a patient’s response to question 4. The algorithm in Appendix C gives the recommended roles and responsibilities of healthcare staff during this process. A highly transfused vCJD risk assessment form (Appendix D) should be completed if:
• the patient has received more than 50 units of blood or blood components or
• the patient has received blood or blood components on more than 20 occasions
The patient should be asked to provide the names of all the hospitals where they received blood or blood components, where possible, to assist the risk assessment. Appendix E contains a letter to send to blood laboratories in other hospitals if additional information from them is required. Word versions of Appendix D and Appendix E are available from the HPA at:
http://www.hpa.org.uk/vCJDpresurgicalassessment
The highly transfused risk assessment form will allow further investigation of the patient’s transfusion history, and assessment of their potential for exposure to blood or blood components from 80 or more donors (their ‘donor exposure’). If the patient has received fewer than 80 donor exposures, the patient is not considered to be at increased risk of vCJD. Surgery or neuro-endoscopy can proceed using normal infection control procedures. If the patient has received 80 or more donor exposures, the patient is confirmed as at increased risk of vCJD. Special infection control precautions should be taken for the patient’s procedure including quarantining of instruments, and the local infection control team should be consulted for advice. Part 4 of this guidance provides advice for the precautions to be taken during the treatment of patients with or at increased risk of CJD or vCJD, and Annex F provides information on neuro-endoscopic procedures.
If it is unclear from the patient’s transfusion history whether they have received 80 or more donor exposures, the instruments used in the patient’s surgery should be quarantined and further information on the patient’s donor exposures should be sought.
If the patient’s donor exposure remains uncertain, a local risk assessment should be conducted to determine how likely the patient is to have received blood from 80 or more donors. A local decision should be taken on whether the patient is at increased risk of vCJD and on how to manage the quarantined instruments.
• If the local risk assessment concludes that the patient received 80 or more donor exposures then the patient is at increased risk of vCJD and the instruments should be destroyed. Alternatively, instruments destined for disposal may instead be retained for research – refer to Annex E for details
• If the local risk assessment concludes that the patient received fewer than 80 donor exposures then the patient is not considered to be at increased risk of vCJD and the instruments can be returned to routine use after undergoing normal decontamination processes
[continues overleaf] 6 Published: 31 July 2006 Revised and updated: 16 July 2009
to answer any questions, a family member, or someone close to the patient (in the case of a child, a person with parental responsibility), should be asked the CJD risk questions as set out in Table J1 prior to the surgery or neuro-endoscopy. J8. If the family member, or someone close to the patient, is not able to provide a definitive answer to the CJD risk questions, the surgery or neuro-endoscopy should proceed but all instruments should be quarantined following the procedure (see Annex E of this guidance for details on quarantining). The patient’s GP should be contacted after the surgery or neuro-endoscopy, and enquiries made as to whether the patient is at increased risk of CJD/vCJD according to the questions as set out in Table J1.
J9. The actions to be taken following the GP’s response to the questions in Table J1 are:
GP’s response
Action
No to all questions
The instruments can be returned to routine use after undergoing normal decontamination processes.
Yes to any of questions 1, 2 or 3
Further investigation into the nature of the patient’s CJD risk should be undertaken, and the patient’s CJD risk confirmed or rejected. Confirmation or rejection of CJD risk should be recorded in the patient’s medical notes for future reference. If the patient is found to be at increased risk of CJD or vCJD following investigation then the quarantined instruments should be destroyed. Alternatively, instruments destined for disposal may instead be retained for research – refer to Annex E for details.
The patient’s GP should inform the patient that they are at increased risk of CJD or vCJD and provide them with further information and advice. This is available from:
http://www.hpa.org.uk/CJDIncidentsPanel
Patients who are at increased risk of genetic forms of CJD may benefit from discussions with the National Prion Clinic, based at the National Hospital for Neurology and Neurosurgery, Queen Square, London:
http://www.nationalprionclinic.org/
[continues overleaf]
7 Published: 31 July 2006 Revised and updated: 16 July 2009
Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection: Annex J
Patients who are at increased risk of sporadic CJD due to receipt of human derived growth hormone or gonadotrophin may benefit from discussions with the UCL Institute of Child Health, London. Contact: L.Davidson@ich.ucl.ac.uk, 020 7404 0536.
Yes or uncertain to question 4
A highly transfused vCJD assessment form (Appendix D) should be completed if:
• the patient has received more than 50 units of blood or blood components
or • the patient has received blood or blood components on more than 20 occasions The GP should be asked to provide the names of all the hospitals where the patient has received blood or blood components, to assist the risk assessment. Appendix E contains a letter to send to blood laboratories in other hospitals if additional information from them is required. Word versions of Appendix D and Appendix E are available from the HPA at:
http://www.hpa.org.uk/vCJDpresurgicalassessment
The highly transfused risk assessment form will allow further investigation of the patient’s transfusion history, and assessment of their potential for exposure to blood or blood components from 80 or more donors (their ‘donor exposure’). If the patient has received fewer than 80 donor exposures, the patient is not considered to be at increased risk of vCJD. The instruments can be returned to routine use after undergoing normal decontamination processes. If the patient has received 80 or more donor exposures, the patient is confirmed as at increased risk of vCJD and the instruments should be destroyed. Alternatively, instruments destined for disposal may instead be retained for research – refer to Annex E for details.
If it is unclear from the patient’s transfusion history whether they have received 80 or more donor exposures, the instruments used in the patient’s surgery should remain in quarantine and further information on the patient’s donor exposures should be sought.
If the patient’s donor exposure remains uncertain, a local risk assessment should be conducted to determine how likely the patient is to have received blood from 80 or more donors. A local decision should be taken on whether the patient is at increased risk of vCJD and on how to manage the quarantined instruments.
?? If the local risk assessment concludes that the patient received 80 or more donor exposures then the patient is at increased risk of vCJD and the instruments should be destroyed. Alternatively, instruments destined for disposal may instead be retained for research – refer to Annex E for details
?? If the local risk assessment concludes that the patient received fewer than 80 donor exposures then the patient is not considered to be at increased risk of vCJD and the instruments can returned to routine use after undergoing normal decontamination processes
If the patient is found to be at increased risk of vCJD the highly transfused risk assessment form should be forwarded to the HPA CJD section. The HPA will contact the patient’s GP to request that they inform the patient of their increased risk of vCJD and provide them with further information and advice. The HPA will also inform the local HPU. More information for clinicians and patients can be found at:
http://www.hpa.org.uk/vCJDpresurgicalassessment
[continues overleaf]
8 Published: 31 July 2006
Revised and updated: 16 July 2009 Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection: Annex J
The results of the risk assessment, including the number of transfusions to date, and confirmation or rejection of vCJD risk, should be recorded in the patient’s medical notes for future reference. Uncertain about any of questions 1, 2 or 3
The instruments should be kept in quarantine. The local infection control team should carry out a risk assessment, and they may wish to involve the local Control of Communicable Disease Consultant in this process. The outcome of the risk assessment should determine whether or not to return the instruments to routine use.
Additional actions to be taken during pre-surgery assessment for CJD risk
J10. In addition to asking the patient CJD/vCJD risk questions, the following actions should also be carried out before any surgical or endoscopic procedure involving contact with high risk tissue. The clinician undertaking the pre-surgery assessment should:
• Check the patient’s medical notes and/ or referral letter for any mention of CJD or vCJD status
• Consider whether there is a risk that the patient may be showing the early signs of CJD or vCJD, i.e. consider whether the patient may have an undiagnosed neurological disease involving cognitive impairment or ataxia J11. These actions, in conjunction with the CJD/vCJD risk questions, will minimise the chance of a CJD incident occurring and therefore reduce the risk of transmission of CJD or vCJD to subsequent patients. Infection control guidance
J12. Part 4 of this Guidance provides advice on the special infection control precautions that should be taken for patients with, or at increased risk of, CJD or vCJD, and Annex F provides information on endoscopic procedures. Patients at increased risk of CJD or vCJD
J13. As outlined in Table 4A in Part 4, a number of patients have been identified as at increased risk of CJD or vCJD on the recommendation of the CJD Incidents Panel. Paragraphs J15 to J17 provide some further information on these individuals and the steps taken to ensure that health care staff are informed of their risk status.
J14. Patients identified to be at increased risk include:
Related to blood transfusions
• People who have received blood from 80 or more donors who have been identified prior to high risk surgery
• People who have received blood from someone who went on to develop vCJD
• People who have given blood to someone who went on to develop vCJD
• People who have received blood from someone who has also given blood to a patient who went to develop vCJD
9 Published: 31 July 2006 Revised and updated: 16 July 2009
Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection: Annex J Related to surgery
• People who have had surgery using instruments that had been used on someone who developed CJD
• People who have had an intradural neurosurgical or spinal procedure before August 1992
• People who have received an organ or tissue from a donor infected with CJD or at increased risk of CJD Related to other medical care
• People who have been treated with certain UK sourced plasma products between 1980 and 2001
• People who have been treated with growth hormone sourced from humans (before 1985)
• People who have been treated with gonadotrophin sourced from humans (before 1973)
• People who have been told by a specialist that they have a risk of developing the genetic form of CJD J15. When someone is notified that they are at increased risk of CJD or vCJD, they are asked to take certain precautions to reduce the risk of spreading the infection to others. These include:
• Not donating blood, tissue or organs;
• Informing healthcare staff if they need to undergo an invasive surgical, medical or dental procedure;
• Informing a family member or someone close to them, in case they need emergency surgery or endoscopy in the future J16. The individual’s GP is asked to record the patient’s CJD risk status in their primary care records. The GP should also include this information in any referral letter should the patient require invasive surgical, medical or dental procedures. J17. Further information on the work of the CJD Incidents Panel is available on the HPA website:
http://www.hpa.org.uk/CJDIncidentsPanel
Training
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Part of your routine assessment before surgery includes some questions to find out whether you could have an increased risk of Creutzfeldt-Jakob disease (CJD). We will ask you:
Have you ever been notified that you are at risk of CJD or vCJD for public health purposes?
Have you any history of CJD or other prion disease in your family?
Have you ever received growth hormone or gonadotrophin treatment?
Have you had surgery on your brain or spinal cord at any time in the past?
Since 1980, have you had any transfusions of blood or blood components (red cells, plasma or platelets)?
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also see ;
Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection: Annex J
ANNEX J
Assessment to be carried out before surgery and/or endoscopy to identify patients with, or at increased risk of, CJD or vCJD
Summary of advice (revised July 2009)
Annex J provides a clear and pragmatic way of assessing CJD and vCJD risk prior to surgery or endoscopy. Growing numbers of patients have been informed that they are at increased risk of CJD or vCJD. Therefore it is recommended that all patients about to undergo any surgery or endoscopy should be asked if they have ever been notified as at increased risk of CJD or vCJD. This recommendation is outlined in paragraphs J1 and J2.
In addition, patients undergoing surgery or neuro-endoscopy which may involve contact with tissues of potentially high level TSE infectivity (“high risk tissues”) should, through a set of detailed questions, be assessed for their possible CJD/vCJD risk exposure. These questions are outlined in Table J1 and paragraphs J3 to J6.
Annex J has been revised (July 2009) to include a new question to be asked of all patients about to undergo surgery or neuro-endoscopy on high risk tissues. This new question (question 4 in Table J1) has been added to identify those patients who have received blood or blood components from 80 or more blood donors. These patients are now designated as at increased risk of vCJD by the CJD Incidents Panel. Table J1 and paragraph J6 provide guidance on how to identify those patients who have received multiple blood transfusions. An algorithm, included as Appendix A, guides health professionals through the process.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_102856.pdf
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_096930.pdf
Annex D - Transport of TSE-infected material Published: December 2003, updated: 23 January 2009
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_087484.pdf
Friday, July 17, 2009
Revision to pre-surgical assessment of risk for vCJD in neurosurgery and eye surgery units Volume 3 No 28; 17 July 2009
http://creutzfeldt-jakob-disease.blogspot.com/2009/07/revision-to-pre-surgical-assessment-of.html
Tuesday, August 12, 2008
Biosafety in Microbiological and Biomedical Laboratories Fifth Edition 2007 (occupational exposure to prion diseases)
http://creutzfeldt-jakob-disease.blogspot.com/2008/08/biosafety-in-microbiological-and.html
Thursday, July 23, 2009
UW Hospital warning 53 patients about possible exposure to rare brain disease
http://creutzfeldt-jakob-disease.blogspot.com/2009/07/uw-hospital-warning-53-patients-about.html
Tuesday, April 21, 2009
Doctor Antonio Ruiz Villaespesa, pathologist and CJD researcher deceased because of Creutzfeldt-Jakob Disease SPAIN
http://cjdusa.blogspot.com/2009/04/doctor-antonio-ruiz-villaespesa.html
Br J Ophthalmol 2005;89:1131-1138 doi:10.1136/bjo.2004.063495 Clinical science Scientific reports Abnormal prion protein in the retina of the most commonly occurring subtype of sporadic Creutzfeldt-Jakob disease M W Head1, A H Peden1, H M Yull1, D L Ritchie1, R E Bonshek2, A B Tullo2 and J W Ironside1 + Author Affiliations
1National CJD Surveillance Unit, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK 2Academic Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester M13 9WH, UK Correspondence to: Dr M W Head National CJD Surveillance Unit, Bryan Matthews Building, Western General Hospital, Edinburgh EH4 2XU, UK; m.w.head@ed.ac.uk Accepted 7 March 2005 Abstract Background: Involvement of the eye has been reported in patients with variant Creutzfeldt-Jakob disease (vCJD), but there is disagreement on whether retinal involvement occurs in sporadic Creutzfeldt-Jakob disease (sCJD).
Methods: Western blotting, paraffin embedded tissue blotting, and immunohistochemistry were used to test whether the abnormal form of the prion protein (PrPSc) accumulates to detectable levels in the eye in a case of the most common subtype of sCJD (MM1).
Results: Low levels of PrPSc were detectable in the retina, localised to the plexiform layers of the central retina. PrPSc was not detectable in other ocular tissues.
Conclusions: The abnormal form of the prion protein is present in the retina in the most common sCJD subtype (MM1), albeit at levels lower than those found previously in vCJD and in sCJD of the VV2 subtype.
http://bjo.bmj.com/content/89/9/1131.abstract
Friday, August 07, 2009
CJD Human Cornea Tissue, Recall END OF ENFORCEMENT REPORT FOR AUGUST 5, 2009
http://creutzfeldt-jakob-disease.blogspot.com/2009/08/cjd-human-cornea-tissue-recall-end-of.html
Tuesday, August 11, 2009
Characteristics of Established and Proposed Sporadic Creutzfeldt-Jakob Disease Variants
http://creutzfeldt-jakob-disease.blogspot.com/2009/08/characteristics-of-established-and.html
Monday, July 27, 2009
U.S.A. HIDING MAD COW DISEASE VICTIMS AS SPORADIC CJD ?
WHY DID THIS VIDEO NOT SHOW ON EVERY NEWS CHANNEL IN THE U.S.A. $$$
IT IS A DAMNING VIDEO !!!
I WATCHED THIS RECENTLY, and had never seen it. i was so mad, i was spitting nails out faster than a framing gun.
WHY DID THE CANADIAN MEDIA ONLY PRESENT THIS TO THE U.S.A. PUBLIC (thank you very much though), and why has the U.S.A. MEDIA FAILED US ???
SNIP...
SEE DAMNING VIDEO AT BOTTOM OF BLOG HERE ;
Monday, July 27, 2009
U.S.A. HIDING MAD COW DISEASE VICTIMS AS SPORADIC CJD ?
http://creutzfeldt-jakob-disease.blogspot.com/2009/07/usa-hiding-mad-cow-disease-victims-as.html
NOW, AFTER SEEING THAT VIDEO, (first watch the video) lets go back in mad cow time here in the USA, shall we.
THERE must be an independent review of this cover-up, and the infamous ENHANCED BSE SURVEILLANCE AND TESTING OF 2004, that was nothing but a cover-up, and blundered at that, and plus a REDO of the testing of no less than 1 million head of cattle tested each year, for five years, with scientist from the EU overseeing the testing protocols, surveillance, and confirmation of all cases.
this video states the 'USA had to _admit_ a home grown case of mad cow in TEXAS." fact was, they did not finally admit anything, IT TOOK AN ACT OF CONGRESS, THE HONORABLE PHYLISS FONG AND THE O.I.G., TO MAKE THEM RETEST AND CONFIRM! that my friend is fact. and only after Prof. Aguzzi, Dr. Jean-Philippe Deslys, Dr. Collinge et al slammed them over the testing of that animal. and then we had the mad cow in Texas that they just refused to test, and was sent to a pet food rendering plant. NO TEST AT ALL. you must realize, when other officials, doctors, and such from other country's confront issues about things in the USA, they must walk on ice when doing so. read inbetween the lines here ;
i wrote all these scientist and doctors and the OIG about that damn texas cow, gave them the evidence i had from TAHC. so did others, but finally fong et al did something.
a bit of history for you mel. file this away. ...
Tuesday, July 28, 2009
MAD COW COVER-UP USA MASKED AS SPORADIC CJD
http://madcowtesting.blogspot.com/2009/07/mad-cow-cover-up-usa-masked-as-sporadic.html
TSS