Estimation of the Exposure of the UK Population to the Bovine Spongiform Encephalopathy Agent through Dietary Intake During the Period 1980 to 1996

Abstract

Although the incidence of variant Creutzfeldt-Jakob disease (vCJD) has declined to 1 since 2012 in the UK, uncertainty remains regarding possible future cases and the size of the subclinical population that may cause secondary transmission of the disease through blood transfusion. Estimating the number of individuals who were exposed to the bovine spongiform encephalopathy (BSE) infectious agent and may be susceptible to vCJD will help to clarify related public health concerns and plan strategies. In this paper, we explore this estimate by describing the probability of potential exposure due to dietary intake throughout the BSE epidemic period from 1980 to 1996 as a stochastic Poisson process. We estimate the age- and gender-specific exposure intensities in food categories of beef and beef-containing dishes, burgers and kebabs, pies, and sausages, separating the two periods of 1980–1989 and 1990–1996 due to the specified bovine offal legislation of 1989. The estimated total number of (living) exposed individuals during each period is 5,089,027 (95% confidence interval [CI] 4,514,963–6,410,317), which was obtained by multiplying the population size of different birth cohorts by the probability of exposure via dietary intake and the probability of survival until the end of 2013. The estimated number is approximately doubled, assuming a contamination rate of . Among those individuals estimated, 31,855 (95% CI 26,849–42,541) are susceptible to infection. We also examined the threshold hypothesis by fitting an extreme-value distribution to the estimated infectious dose of the exposed individuals and obtained a threshold estimate of 13.7 bID50 (95% CI 6.6–26.2 bID50) (Weibull). The results provide useful information on potential carriers of prion disease who may pose a threat of infection via blood transfusion and thus provide insight into the likelihood of new incidents of vCJD occurring in the future.

Transmission of scrapie prions to primate after an extended silent incubation period

“…Among old-world primates, which are closest to humans in terms of phylogeny, the cynomolgus macaque is the preferred current primate model for the study of human prion diseases 4 14 15 16 . Interestingly, the recent mathematical modeling of vCJD infection based on this model fits well with the current human epidemiology of vCJD 17 18 .…”

Experimental transfusion of variant CJD-infected blood reveals previously uncharacterised prion disorder in mice and macaque

“…Bovine spongiform encephalopathy (BSE) was widely distributed in Europe and most notably in the UK. Overall, more than 2 million undiagnosed infected cattle would have entered the human food chain 1 , implying an estimated exposure of 10 million consumers 2 . However, the fatal variant Creutzfeldt–Jakob disease (vCJD) in humans has fortunately remained rare, with 177 cases in the UK to date (51 in the rest of the world, including 27 in France); the majority of cases were detected between 1995 and 2005, and only three cases from 2012 to 2016.…”

Unexpected prion phenotypes in experimentally transfused animals: predictive models for humans?

“…Taken together with a recent publication that estimates that up to ten million people would have been exposed to BSE [10], those observations suggest thus that we are facing a Matryoshka situation towards v-CJD in UK:…”