Creutzfeldt-Jakob disease (CJD) biannual update (February 2013) Infection report/CJD
Infection report/CJD
Creutzfeldt-Jakob disease (CJD) biannual update (February 2013)
This six-monthly report provides an update on reports of incidents of
potential iatrogenic (healthcare-acquired) exposures to CJD. The data is correct
as of 31st December 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 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 occur if an asymptomatic patient undergoes
surgery during the incubation period of CJD, or because information for those
potentially at risk of CJD is not available at the time of surgery. If this
happens, surgical instruments may be contaminated with the infectious agent that
causes CJD. These instruments could then pose a transmission risk when they are
re-used on other patients.
In June 2010 a distinction was made between surgical incidents and CJD
reports. 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 earlier in the incubation period, or involving low
infectivity tissues, are categorised as 'CJD reports'. 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 92 incidents in which instruments have been
permanently removed from general use or refurbished (endoscopes only).
Table 1 shows the number of CJD surgical incidents and reports notified to
the CJD Incidents Panel by the diagnosis of the index patient from 2000 to 2012.
Advice has been issued for 7 surgical incidents and 25 surgical reports that
were notified to the CJD Incidents Panel in 2012.
Health Protection Report Vol 7 No. 6 - 8 February 2013
Table 1. Number of CJD Surgical Incidents/Reports Notified to the CJD
Incidents Panel:
2000- 2012
Index patient
status
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Total I
snip...
TOTAL 16 38 56 50 45 56 63 27 33 29 23 4 13 40 7 25 456 59
Health Protection Report Vol 7 No. 6 - 8 February 2013
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 31st December 2012, there have been 29 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 and procedural
risks in 2005 and 2009, 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.
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.
Relating to surgical instruments there are 15 surgical incidents in which
154 patients are still considered to be at increased risk of CJD. Currently, 119
of these 'at risk' patients are alive and notified of their increased risk of
CJD. Local decisions have been taken not to notify two patients in these
incidents.
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 2 below). The risks of iatrogenic CJD transmission to
these different individuals are very uncertain, but potentially devastating. The
CJD Incidents Panel has advised that these individuals should be informed of
their risk and asked to follow public health precautions to avoid transmitting
the infection to others.
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 7 No. 6 - 8 February 2013
Table 2. Summary of the Health Status of All Individuals ‘At Increased
Risk’ of CJD/vCJD,
2000-2012
Source: CJD Panel Secretariat
*Data for recipients of human derived growth hormone as at 30/06/2012
a These are minimum figures. Central reporting for bleeding disorder
patients is incomplete, and seven patients have opted out of the central UKHCDO
database. A small number of ‘at risk’ growth hormone recipients are not included
in the Institute of Child Health study. Not all of ‘at risk’ growth hormone
recipients have been notified. There is no central record of who has been
informed.
b 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.
c One patient was notified by proxy.
d Four of these were notified by proxy.
e Two of these were notified by proxy.
e Includes patients who were notified by proxy.
snip...
Total for all ‘at risk’ groups a 6,143 >2,198 >1,788 74 2
Health Protection Report Vol 7 No. 6 - 8 February 2013
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/data.html
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/documents/report20.pdf
3. Transmissible spongiform encephalopathy agents: safe working and the
prevention of infection. The ACDP TSE Risk Management Subgroup.
Thursday, January 17, 2013
TSE guidance, surgical, dental, blood risk factors, Part 4 Infection
control of CJD, vCJD and other human prion diseases in healthcare and community
settings (updated January 2013)
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
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
Monday, November 26, 2012
Aerosol Transmission of Chronic Wasting Disease in White-tailed Deer
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 ???
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
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, August 12, 2010
USA Blood products, collected from a donor who was at risk for vCJD, were
distributed July-August 2010
Sunday, August 01, 2010
Blood product, collected from a donors possibly at increased risk for vCJD
only, was distributed USA JULY 2010
Thursday, July 08, 2010
Nosocomial transmission of sporadic Creutzfeldt–Jakob disease: results from
a risk-based assessment of surgical interventions Public release date:
8-Jul-2010
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
Tuesday, May 04, 2010
Review of the Human Pituitary Trust Account and CJD Issue 20 January 2010
Tuesday, March 16, 2010
Transmissible Spongiform Encephalopathy Agents: Safe Working and the
Prevention of Infection: Part 4 REVISED FEB. 2010
Monday, August 17, 2009
Transmissible Spongiform Encephalopathy Agents: Safe Working and the
Prevention of Infection: Annex J,K, AND D Published: 2009
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
Wednesday, August 20, 2008
Tonometer disinfection practice in the United Kingdom: A national survey
Tuesday, August 12, 2008
Biosafety in Microbiological and Biomedical Laboratories Fifth Edition 2007
(occupational exposure to prion diseases)
Monday, December 31, 2007
Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in
Endodontic Practice in Absence of Adequate Prion Inactivation
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.
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
Thursday, October 25, 2012
Current limitations about the cleaning of luminal endoscopes and TSE prion risk factors there from
Article in Press
2011 TO 2012 UPDATE
Saturday, December 3, 2011
Candidate Cell Substrates, Vaccine Production, and Transmissible Spongiform
Encephalopathies
Volume 17, Number 12—December 2011
Sunday, June 26, 2011
Risk Analysis of Low-Dose Prion Exposures in Cynomolgus Macaque
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 ???
Terry S. Singeltary Sr. on the Creutzfeldt-Jakob Disease Public Health
Crisis
full text with source references ;
Are some commoner types of neurodegenerative disease (including Alzheimer's
disease and Parkinson's disease) also transmissible? Some recent scientific
research has suggested this possibility
Singeltary submission ;
Wednesday, May 16, 2012
Alzheimer’s disease and Transmissible Spongiform Encephalopathy prion
disease, Iatrogenic, what if ?
Proposal ID: 29403
Wednesday, January 5, 2011
ENLARGING SPECTRUM OF PRION-LIKE DISEASES Prusiner Colby et al 2011 Prions
David W. Colby1,* and Stanley B. Prusiner1,2
U.S.A. 50 STATE BSE MAD COW CONFERENCE CALL Jan. 9, 2001
Monday, January 14, 2013
Gambetti et al USA Prion Unit change another highly suspect USA mad cow
victim to another fake name i.e. sporadic FFI at age 16 CJD Foundation goes
along with this BSe
Monday, December 31, 2012
Creutzfeldt Jakob Disease and Human TSE Prion Disease in Washington State,
2006–2011-2012
Tuesday, December 25, 2012
CREUTZFELDT JAKOB TSE PRION DISEASE HUMANS END OF YEAR REVIEW DECEMBER 25,
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, June 13, 2012
MEXICO IS UNDER or MIS DIAGNOSING CREUTZFELDT JAKOB DISEASE AND OTHER PRION
DISEASE SOME WITH POSSIBLE nvCJD
TSS
posted by Terry S. Singeltary Sr. at
11:06 AM
<< Home