Incidents of Potential iatrogenic Creutzfeldt-Jakob disease (CJD) biannual update (July 2012)
Infection report/CJD
Creutzfeldt-Jakob disease (CJD) biannual update (July 2012)
This six-monthly report provides an update on reports of incidents of
potential iatrogenic (healthcare-acquired) exposure to CJD. The data are correct
as of 27 July 2012.
For numbers of CJD case reports, readers should consult data provided by
the National CJD Research and Surveillance Unit (NCJDRSU), Edinburgh [1]. The
latest yearly analysis of vCJD reports (onsets and deaths) is also available
from the NCJDRSU website [2].
Reports of incidents of potential iatrogenic exposure to CJD via surgery:
2000 to 30 June 2012 A surgical incident occurs when a patient with or at
increased risk of CJD has undergone surgery without the appropriate infection
control guidance being followed [3]. This could happen if a patient undergoes
surgery during the incubation period of CJD, or because information about CJD
risk factors is not available at the time of surgery. If this happens, surgical
instruments that may be contaminated with the infectious agent that causes CJD,
could pose a transmission risk when they are re-used on other patients.
In June 2010 the CJD Incidents Panel changed its protocol for reporting
surgical incidents, and a new reporting algorithm was published on the HPA CJD
Section website. Under the new protocol only CJD cases (or patients at increased
risk of CJD) who have undergone surgical procedures which are thought to pose a
possible transmission risk (i.e. within the likely infectious incubation period,
and involving medium or high risk procedures) are categorised as ‘surgical
incidents'. Other procedures, either outside the incubation period, or involving
low infectivity tissues, are categorised as ‘CJD Reports'.
Table 1 shows the number of CJD surgical incidents reported to the CJD
Incidents Panel from 2000 to 30 June 2012 by the diagnosis of the index patient.
As shown in the table, 44% of surgical incidents and 64% of reports result from
surgery on index cases diagnosed with sporadic CJD. Advice has been issued for 4
surgical incidents and 17 CJD surgical reports that have been reported to the
CJD Incidents Panel in the first six months of 2012. Information about the CJD
Incidents Panel can be found on the HPA website [4].
Table 1. CJD surgical incidents (n=452) and reports (n=59) reported to the
CJD Incidents Panel (which have been closed, or where advice has been issued) by
diagnosis of index patient: 2000 to 30 June 2012
snip...see url link for table...tss
TOTAL 16 38 56 50 45 56 63 27 33 29 23 4 12 38 4 17 452 59
Notes: I = Incidents; R = Reports; Prior to 2010, all reports were recorded
as incidents.
Health Protection Report Vol 6 No. 32 - 10 August 2012
If the investigation of a surgical incident identifies any instruments that
are considered to be potentially contaminated with the infectious agent, and
that could still pose an infection risk to other patients, the Panel advises
that these instruments should be removed from general use or refurbished. These
instruments may be quarantined, kept for exclusive use on the index patient,
refurbished (endoscopes only) or destroyed. Since 2000 there have been 90
incidents in which instruments have been permanently removed from general use or
refurbished (endoscopes only).
Surgical incidents resulting in ‘at risk’ patients
The Panel may advise contacting and informing patients of their possible
exposure to CJD following a surgical incident. These patients should be
considered 'at risk of CJD for public health purposes' and are asked to take
certain precautions (i.e. not to donate blood, other tissues or organs, and to
inform their medical and dental carers prior to any invasive procedures) in
order to reduce the risk of transmitting the CJD agent.
The diagnosis of the index patient; the timing of the procedure relative to
the development of clinical CJD; the tissue that instruments were in contact
with during the procedure on the index patient; and the number of cycles of
re-use and decontamination the instruments have been through following the
procedure on the index case – all influence the possible risk to subsequent
patients.
The threshold level of risk at which patients are considered to be ‘at
increased risk’ of CJD is 1%, in addition to the background risk in the UK
population. This risk threshold is based on risk assessment models, using
precautionary assumptions. The 1% threshold level is used as a cut off for
implementing public health precautions and is not intended to be a precise
measure of an individual patient's risk. A similar threshold is used for
identifying other patients who have been exposed to possible CJD risks following
surgical, blood, plasma and tissue incidents.
From 2000 to 30 June 2012, there have been 28 surgical incidents in which
the Panel has advised that 192 patients should be considered to have an
increased risk of CJD.
Patient denotifications
Following changes in the assessment of tissue infectivity, the Panel has
advised that 38 patients in 14 surgical incidents who were originally considered
(and notified) as being ‘at risk' of CJD should no longer be considered ‘at
risk', and should be denotified. In November 2005, gastrointestinal endoscopies
without invasive procedures were reclassified as low risk procedures, and advice
was issued to denotify two patients in one surgical incident. In 2006, anterior
eye was reclassified as a ‘medium low' infectivity tissue. This led to a change
in advice as only the first patient on whom instruments were used following an
anterior eye procedure was to be considered as having an increased risk of CJD.
Previously this had applied to the first two patients exposed to such
instruments. This resulted in the Panel advising that 16 patients in seven
incidents should be denotified. In 2009, the anterior eye was further
reclassified as a low infectivity tissue. Following this change, the Panel
advised that another 20 patients should be denotified.
As of 30 June 2012, the Panel has received confirmation that of the 34
patients originally notified of their exposure (out of the 38 originally
considered to be ‘at risk'), 26 patients have been informed that they are no
longer considered ‘at risk' and eight patients died before they could be
denotified.
Current 'at risk' patients resulting from surgical instruments
There are 15 surgical incidents in which 154 patients are still considered
to be at increased risk of CJD. Currently, 125 of these 'at risk' patients have
been notified and a further four notified by proxy, that they are at increased
risk of CJD. Local decisions have been taken not to notify four patients and 21
patients have died before notification in these incidents.
Health Protection Report Vol 6 No. 32 - 10 August 2012
Table 2. Surgical ‘at risk’ patients still identified as being ‘at
increased risk of CJD’ by the Panel by procedure on the index patient
Diagnosis of index patient
Procedure on index patient
Number of incidents
Patients identified as 'at risk'
Patients who died before being notified
Local decision not to notify patient Notified patients
Sporadic Brain biopsy 2 28 2 1 25a
Sporadic Ophthalmic surgery 1 11 2 – 9
Sporadic ENT 1 1 - - 1
Variant Appendectomy 1 2 - 2 -
Variant Endoscopy 1 1 - 1 -
Asymptomatic infected vCJD Endoscopy 1 4 1 – 3b
At risk variant Endoscopy 6 37 5 – 32
At risk familial Neurosurgery 1 31 10 – 21
At risk familial Ophthalmic surgery 1 39 1 – 38
Total 15 154 21 4 129c
Notes
a. Three of these patients were notified by proxy
b. One of these patients was notified by proxy
c. Four of these patients were notified by proxy
Monitoring of patients 'at increased risk' of CJD
The CJD Incidents Panel and the Advisory Committee on Dangerous Pathogens
Transmissible Spongiform Encephalopathy Risk Management Subgroup (formerly the
ACDP TSE Working Group) have identified a range of individuals and groups who
may have been exposed to an increased risk of CJD as a consequence of their
medical care (see table 3 below).
It is important to follow up these individuals to help determine the risks
of CJD spreading to patients through different routes. Follow up involves a
range of activities and is carried out by different organisations. At core,
follow up aims to ascertain whether any people who may have been exposed to
increased CJD risks go on to develop CJD.
Health Protection Report Vol 6 No. 32 - 10 August 2012
Table 3. Summary of health status of individuals at increased risk of
CJD/vCJD (as at 30 June 2012)
'At risk' Group
Identified as 'at risk'
Ever notified as being 'at risk'
Alive and Notified
CJD/vCJD cases
Asymptomatic vCJD infections d
Recipients of blood from vCJD cases 67 27 18 3 1
Blood donors to vCJD cases 112 107 104 - - Other recipients from blood
donors to vCJD cases 34 32 22 - -
Plasma product recipients (all except one have non-bleeding disorders) 11
10 4 - -
Surgical contacts of all CJD cases 154 129 119 - -
Highly transfused patients (recipients of blood from ≥80 donors identified
at pre-surgical assessment) 10 9 8 - -
Total for at risk groups where HPA holds data 388 310 273 3 1
Patients with bleeding disorders who received UK sourced plasma products a
3,872 n/a n/a – 1
Recipients of human derived growth hormone b 1,883 1,883 1,513 71 -
Total for all 'at risk' groups c 6,143 >2,193 >1,786 74 2
a. Data provided by the UK Haemophilia Centre Doctors' Organisation
(UKHCDO). These are minimum figures. Central reporting for bleeding disorder
patients is incomplete, and seven patients have opted out of the central UKHCDO
database. Individual haemophilia centres were asked to send out standardised
letters of notification to all their ‘at risk’ patients, but the exact number of
patients who received these letters and are therefore aware of their risk is not
known.
b. Data provided by the Institute for Child Health. A small number of ‘at
risk' growth hormone recipients are not included in the Institute of Child
Health study so the true number ‘at risk’ will be greater. The exact number of
growth hormone recipients in the ICH study currently aware of their risk is not
known, as given their age at the original notification many were informed
indirectly, by their parents.
c. These are minimum figures given the comments made above.
d. An asymptomatic infection is when an individual does not exhibit any of
the signs and symptoms of CJD in life but abnormal prion protein indicative of
CJD infection has been found in tissue obtained from them. In these cases the
abnormal prion protein was identified during post mortem after the individuals
had died of other causes.
References
1. The National Creutzfeldt-Jakob Disease Research and Surveillance Unit,
The University of Edinburgh. CJD statistics. Available at: http://www.cjd.ed.ac.uk/figures.htm.
2. The National Creutzfeldt-Jakob Disease Research and Surveillance Unit,
The University of Edinburgh. Incidence of variant Creutzfeldt-Jakob disease
onsets and deaths in the UK January 1994 - May 2011. Edinburgh: NCJDSU, 18 May
2011. Available at: http://www.cjd.ed.ac.uk/cjdq68.pdf.
3. Transmissible spongiform encephalopathy agents: safe working and the
prevention of infection. The ACDP TSE Risk Management Subgroup. http://www.dh.gov.uk/ab/ACDP/TSEguidance/index.htm
4. HPA CJD Incidents Panel [online].
Available at: http://www.hpa.org.uk/web/
CJDIncidentsPanel.
Health Protection Report Vol 6 No. 32 - 10 August 2012
Tuesday, June 26, 2012
Creutzfeldt Jakob Disease Human TSE report update North America, Canada,
Mexico, and USDA PRION UNIT as of May 18, 2012
type determination pending Creutzfeldt Jakob Disease (tdpCJD), is on the
rise in Canada and the USA
Wednesday, August 01, 2012
Behavioural and Psychiatric Features of the Human Prion Diseases:
Experience in 368 Prospectively Studied Patients
Monday, August 06, 2012
Atypical neuropathological sCJD-MM phenotype with abundant white matter
Kuru-type plaques sparing the cerebellar cortex
Saturday, July 07, 2012
Class II, Blood products, collected from a donor who was at risk for
variant Creutzfeldt-Jakob disease ( vCJD) USA
Enforcement Report
Monday, August 6, 2012
TAFS
BSE Final report in USA August 6, 2012
Monday, July 23, 2012
The National Prion Disease Pathology Surveillance Center July 2012
North America has NO surveillance system for iatrogenic CJD. a few mishaps
of late ;
Tuesday, July 31, 2012
11 patients may have been exposed to fatal disease Creutzfeldt-Jakob
Disease CJD Greenville Memorial Hospital
Thursday, August 02, 2012
CJD case in Saint John prompts letter to patients Canada CJD case in Saint
John prompts letter to patients
Wednesday, May 16, 2012
Alzheimer’s disease and Transmissible Spongiform Encephalopathy prion
disease, Iatrogenic, what if ?
Proposal ID: 29403
Tuesday, May 29, 2012
Transmissible Proteins: Expanding the Prion Heresy
Friday, May 11, 2012
ProMetic Life Sciences Inc.: P-Capt® Filtration Prevents Transmission of
Endogenous Blood-Borne Infectivity in Primates
Wednesday, August 24, 2011
All Clinically-Relevant Blood Components Transmit Prion Disease following a
Single Blood Transfusion: A Sheep Model of vCJD
http://transmissiblespongiformencephalopathy.blogspot.com/2011/08/all-clinically-relevant-blood.html
Wednesday, August 24, 2011
There Is No Safe Dose of Prions
Sunday, May 1, 2011
W.H.O. T.S.E. PRION Blood products and related biologicals May 2011
Monday, February 7, 2011
FDA’s Currently-Recommended Policies to Reduce the Possible Risk of
Transmission of CJD and vCJD by Blood and Blood Products 2011 ???
Friday, February 10, 2012
Creutzfeldt-Jakob disease (CJD) biannual update (2012/1) potential
iatrogenic (healthcare-acquired) exposure to CJD, and on the National Anonymous
Tonsil Archive
Thursday, December 29, 2011
Aerosols An underestimated vehicle for transmission of prion diseases?
PRION www.landesbioscience.com
please see more on Aerosols and TSE prion disease here ;
Saturday, February 12, 2011
Another Pathologists dies from CJD, another potential occupational death ?
another happenstance of bad luck, a spontaneous event from nothing, or
friendly fire ???
2011 TO 2012 UPDATE
Saturday, December 3, 2011
Candidate Cell Substrates, Vaccine Production, and Transmissible Spongiform
Encephalopathies
Volume 17, Number 12—December 2011
Tuesday, December 14, 2010
Infection control of CJD, vCJD and other human prion diseases in healthcare
and community settings part 4, Annex A1, Annex J,
UPDATE DECEMBER 2010
Sunday, August 01, 2010
Blood product, collected from a donors possibly at increased risk for vCJD
only, was distributed USA JULY 2010
Tuesday, September 14, 2010
Transmissible Spongiform Encephalopathies Advisory Committee; Notice of
Meeting October 28 and 29, 2010 (COMMENT SUBMISSION)
Thursday, September 02, 2010
NEUROSURGERY AND CREUTZFELDT-JAKOB DISEASE Health Law, Ethics, and Human
Rights The Disclosure Dilemma
Thursday, July 08, 2010
GLOBAL CLUSTERS OF CREUTZFELDT JAKOB DISEASE - A REVIEW 2010
Wednesday, June 02, 2010
CJD Annex H UPDATE AFTER DEATH PRECAUTIONS Published: 2 June 2003 Updated:
May 2010
Tuesday, May 11, 2010
Current risk of iatrogenic Creutzfeld–Jakob disease in the UK: efficacy of
available cleaning chemistries and reusability of neurosurgical instruments
Saturday, January 16, 2010
Evidence For CJD TSE Transmission Via Endoscopes 1-24-3 re-Singeltary to
Bramble et al
Evidence For CJD/TSE Transmission Via Endoscopes
From Terry S. Singletary, Sr flounder@wt.net 1-24-3
Monday, July 20, 2009
Pre-surgical risk assessment for variant Creutzfeldt-Jakob disease (vCJD)
risk in neurosurgery and eye surgery units
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
Sunday, May 10, 2009
Meeting of the Transmissible Spongiform Encephalopathies Committee On June
12, 2009 (Singeltary submission)
Thursday, January 29, 2009
Medical Procedures and Risk for Sporadic Creutzfeldt-Jakob Disease, Japan,
1999-2008 (WARNING TO Neurosurgeons and Ophthalmologists) Volume 15, Number
2-February 2009 Research
Sunday, July 20, 2008
Red Cross told to fix blood collection or face charges 15 years after
warnings issued, few changes made to ensure safety
Monday, December 31, 2007
Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in
Endodontic Practice in Absence of Adequate Prion Inactivation
Saturday, December 08, 2007
Transfusion Transmission of Human Prion Diseases
Tuesday, October 09, 2007
nvCJD TSE BLOOD UPDATE
Saturday, December 08, 2007
Transfusion Transmission of Human Prion Diseases
Saturday, January 20, 2007
Fourth case of transfusion-associated vCJD infection in the United Kingdom
vCJD case study highlights blood transfusion risk 9 Dec 2006 by Terry S.
Singeltary Sr.
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 mad cow agent. TSE agent ie bse, base, cwd, scrapie, tme, ...
vCJD case study highlights blood transfusion risk -
Subject: CJD: update for dental staff
Date: November 12, 2006 at 3:25 pm PST
1: Dent Update. 2006 Oct;33(8):454-6, 458-60.
CJD: update for dental staff.
layperson
Terry S. Singeltary Sr.
P.O. Box 42
Bacliff, Texas USA 77518
flounder9@verizon.net
posted by Terry S. Singeltary Sr. at
11:34 AM
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