Blood Transfusion and Spread of Variant Creutzfeldt-Jakob Disease

Dietz, Klaus; Raddatz, Günter; Wallis, Jonathan P.; Müller, Norbert; Zerr, Inga; Duerr, Hans-Peter; Lefèvre, Hans; Seifried, Erhard; Löwer, Johannes

doi:10.3201/eid1301.060396

Cited by 19 publications

(10 citation statements)

References 18 publications

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“…One can perceive to what extent the deferral of transfused patients from giving blood is an essential measure in breaking a “contamination cycle” between the donor population and that of recipients. Implemented several years ago, this precaution has probably avoided several transfusion transmissions of vCJD, even if a German study, based on a mathematical model, has concluded that the effect of this strategy is minimal: arguing that the majority of donors were infected from dietary sources and, having never been transfused, would not be excluded from blood donation 99 How many donors and recipients will develop vCJD during the next few years, each time leading to transfusion lookbacks and investigations?…”

Section: Uncertaintiesmentioning

confidence: 99%

From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France

Lefrère

Hewitt

2009

Transfusion

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Transfusion transmission of the prion, the agent of variant Creutzfeldt-Jakob disease (vCJD), is now established. Subjects infected through food may transmit the disease through blood donations. The two nations most affected to date by this threat are the United Kingdom (UK) and France. The first transfusion cases have been observed in the UK over the past 5 years. In France, a few individuals who developed vCJD had a history of blood donation, leading to a risk of transmission to recipients, some of whom could be incubating the disease. In the absence of a large-scale screening test, it is impossible to establish the prevalence of infection in the blood donor population and transfused patients. This lack of a test also prevents specific screening of blood donations. Thus, prevention of transfusion transmission essentially relies at present on deferral of "at-risk" individuals. Because prions are present in both white blood cells and plasma, leukoreduction is probably insufficient to totally eliminate the transfusion risk. In the absence of a screening test for blood donations, recently developed prion-specific filters could be a solution. Furthermore, while the dietary spread of vCJD seems efficiently controlled, uncertainty remains as to the extent of the spread of prions through blood transfusion and other secondary routes.

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Section: Uncertaintiesmentioning

confidence: 99%

From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France

Lefrère

Hewitt

2009

Transfusion

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“…The estimated mortality of blood recipients is high, with 24% mortality in the first year, 6% in the second year, 4% in the third year and 3% in the next 4 years, and 2% in the next 3 years. [64][65][66] Then in the 11th year the cohort moved to a mortality rate using the distribution from the U.S. life tables corresponding to the aging of the cohort from age 71 to 100. 58 Chagas-related mortality.…”

Section: Samplementioning

confidence: 99%

Cost-effectiveness of Implementation Methods for ELISA Serology Testing of Trypanosoma cruzi in California Blood Banks

Wilson

Ramsey²,

Koplowicz³

et al. 2008

The American Journal of Tropical Medicine and Hygiene

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The first U.S. ELISA test for T. cruzi antibodies was licensed by the Food and Drug Administration (FDA) on December 13, 2006. Blood banks have begun screening in absence of FDA recommendations for best implementation methods. We surveyed 2,029 blood donors at five California sites with three risk-based Chagas risk-screening questions. Semi-Markov models compared the cost-effectiveness of three testing strategies. 30% of donors screened positively. Screening all dominated doing nothing, being less costly, and saving more lives. The choice to "screen and test" compared with "testing all" varied by Chagas prevalence, "screening and testing" being cost-effective for high (0.004) and low (0.00004) prevalences, and "testing all" cost-effective for moderate risk (0.0004). It is cost-effective to screen by ELISA rather than do nothing. The best strategy depends on site-specific risk. Census estimates of Hispanics do not predict donor risk well. We suggest using our screening questions to determine risk level and most cost-effective testing strategy.

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“…2004). The risk of vCJD through blood transfusion is currently of concern with recent reports of three cases arising from a single individual donor (Dietz et al. 2007).…”

Section: Introductionmentioning

confidence: 99%

The prion/lipid hypothesis - further evidence to support the molecular basis for transmissible spongiform encephalopathy risk assessment

Gale

2007

Journal of Applied Microbiology

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Summary Defining the molecular structure of the transmissible spongiform encephalopathy (TSE) agent is important both for underpinning risk assessments and for developing and understanding decontamination strategies. Recent studies have shown that oligomeric particles comprising 14–28 prion protein (PrP) molecules are much more infectious than larger fibrils (prion rods) or indeed smaller oligomers (trimers) and PrP monomers. Here, results from deactivation studies (with alkali, heat, hexane or formaldehyde) are interpreted in terms of the infectious nucleation seed comprising 14–28 PrP molecules held together by interactions with amphipathic phospholipid (PL) or more probably sphingolipid (SL) from the host. According to the PrP/lipid hypothesis, the strength of the protein/lipid interactions accounts for the high thermostability of TSE infectivity and for differences in thermostability between strains. The implications of the molecular biophysics data for environmental TSE risk assessments are discussed with respect to behaviour in soil. While formaldehyde appears to cause inactivation of scrapie infectivity by increasing the ID50, the dose–response is complicated by apparent heterogeneity between hamster subpopulations in susceptibility. The process of inactivation by formaldehyde may be due to cross‐linking the highly infectious 14–28 PrP oligomers into larger, but less infectious aggregates. This process appears more reversible in some hamster subpopulations than others.

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Blood Transfusion and Spread of Variant Creutzfeldt-Jakob Disease

Abstract: The effect of reducing vCJD transmission by excluding potential blood donors who have received a blood transfusion can be quantified and depends on the absolute number of cases observed or expected.

Cited by 19 publications

References 18 publications

From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France

From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France

Cost-effectiveness of Implementation Methods for ELISA Serology Testing of Trypanosoma cruzi in California Blood Banks

The prion/lipid hypothesis - further evidence to support the molecular basis for transmissible spongiform encephalopathy risk assessment

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