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Creutzfeldt-Jakob disease (CJD) biannual update (February 2013) Infection report/CJD

Posted Feb 10 2013 12:06pm
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



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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



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please see more on Aerosols and TSE prion disease here ;













Saturday, February 12, 2011



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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)














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NEUROSURGERY AND CREUTZFELDT-JAKOB DISEASE Health Law, Ethics, and Human Rights The Disclosure Dilemma














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USA Blood products, collected from a donor who was at risk for vCJD, were distributed July-August 2010













Sunday, August 01, 2010



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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



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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



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Friday, July 17, 2009



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Sunday, May 10, 2009



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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



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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



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Monday, December 31, 2012



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Tuesday, December 25, 2012



CREUTZFELDT JAKOB TSE PRION DISEASE HUMANS END OF YEAR REVIEW DECEMBER 25, 2012














Tuesday, June 26, 2012


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Wednesday, June 13, 2012


MEXICO IS UNDER or MIS DIAGNOSING CREUTZFELDT JAKOB DISEASE AND OTHER PRION DISEASE SOME WITH POSSIBLE nvCJD












TSS


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