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From: TSS ()
Subject: Re: TSE ADVISORY COMMITTEE OCTOBER 31, 2005 AND DON'T NEED TO KNOW POLICY PER CJD FOUNDATION ?
Date: December 16, 2005 at 6:52 am PST

In Reply to: TSE ADVISORY COMMITTEE OCTOBER 31, 2005 AND DON'T NEED TO KNOW POLICY PER CJD FOUNDATION ? posted by TSS on December 15, 2005 at 1:41 pm:

CJD WATCH MESSAGE BOARD
TSS
CJD UPDATE REPORT iCJD healthcare-acquired
Fri Dec 16, 2005 09:04
70.110.88.73

Creutzfeldt-Jakob disease (CJD) update report


This six-monthly report provides an update on reports of incidents of potential iatrogenic (healthcare-acquired) exposure to CJD, and on the National Anonymous Tonsil Archive.

For numbers of CJD case reports, readers should consult data provided by the national CJD Surveillance Unit (NCJDSU), Edinburgh (1). The latest quarterly analysis of vCJD reports (onsets and deaths) is also available from the NCJDSU website (2).


Reports of incidents of potential iatrogenic exposure to CJD (September 2004 to February 2005)

During the half-year September 2004 to February 2005, 38 incidents of potential exposure to CJD via surgical instruments were reported to the CJD Incidents Panel (3). Surgical incidents occur when instruments that are considered potentially contaminated with the CJD agent during use on an index patient have been subsequently re-used on other patients. Table 1 shows the number of CJD surgical incidents reported to the CJD Incidents Panel during the four years to August 2004 (4) and between September 2004 and February 2005 by the diagnosis of the index patient (ie, the patient whose healthcare resulted in potential contamination of instruments with the CJD agent).


Table 1 CJD Surgical Incidents reported to the CJD Incidents Panel, between August 2000 and August 2005 and 1 September 2004 and 28 February 2005 by diagnosis of index patient

Final diagnosis of index patient Year 1 to 4 First half
year 5 Total
28/08/00-
01/09/04 (4) 01/09/04-
28/02/05 Aug 00-
Feb 05
Sporadic CJD (possible,
probable or definite) 86 7 93
Variant CJD
(possible, probable or definite) 51 2 53
Other types of CJD, or 'at risk'
of CJD, or CJD type unclear 34 28 62
Not CJD 12 1 13
Total 183 38 221

Investigation of past surgical incidents occasionally resulted in advice to remove from use for other patients (to quarantine or destroy, or donate for research) surgical instruments considered to be potentially contaminated with the CJD agent. For reports received between September 2004 and February 2005, the Panel has (to date) advised that instruments should be permanently removed from use on other patients following use in other patients in four incidents. Hospitals are asked to consider sending any instruments to be destroyed to the Surgical Instrument Store (held by the Health Protection Agecny, Porton Down) to be used for research purposes. None of the reported incidents during this half-year, have yet resulted in advice to contact and inform patients of their potential exposure to CJD via surgical instruments.

The National Anonymous Tonsil Archive

The National Anonymous Tonsil Archive (NATA) is a national unlinked anonymous survey of tonsil tissue that will be used to undertake studies on the prevalence of abnormal prion protein, the agent believed to be responsible for infection with variant Creutzfeldt-Jakob Disease (vCJD) (5). NATA began at the end of 2003 and aims to collect 100,000 pairs of tonsils. Tonsils are being collected from people of all ages during routine tonsillectomies. Only tissue not required for patient care, that normally would be discarded, is included and patients are given an opportunity to object to their tissues being used in the archive.

Figure 1 and figure 2 show the number of tonsil pairs received per month between January 2004 and October 2005. The accumulating total number of tonsil pairs in the archive by the end of October 2005 was 17,840. The number of collection forms that have been completed but no tonsil tissue collected is 889 (610 due to patient objection and 279 due to clinical pathology being requested on the specimen as part of the patient's care).


Figure 1 Number of tonsil pairs collected for NATA monthly: January 2004 to October 2005


Figure 2 Cumulative number of tonsil pairs collected monthly: January 2004 to October 2005


By October 2005, 70 of the 100 NHS hospital trusts that perform over 200 tonsillectomies per year in England were regularly sending tonsil pairs to NATA. A further 30 hospitals trusts had had a recruitment visit and were expected to begin collecting tonsils shortly. Recruitment of hospitals continues, with the expectation that the target recruitment rate of 500 tonsil pairs per week will be met. Currently approximately 50,000 tonsillectomies are performed annually in England.

The project has recently started in Scotland where just over 5000 tonsillectomies are performed each year. There are 14 hospitals in Scotland which carry out more than 200 tonsillectomies per year and these hospitals are being visited by a team of liaison officers so that procedures for the collection of tonsil tissue after tonsillectomies are successfully adopted. Tonsil tissue collected in Scotland will be transported to Colindale for inclusion in the archive.

Figure 3 NHS hospital trusts currently sending tonsils to the HPA Centre for Infections

References

1. The National Creutzfeldt-Jakob Disease Surveillance Unit, The University of Edinburgh. CJD statistics. CJD figures. Edinburgh: NCJDSU, 4 November May 2005. Available at .


2.The National Creutzfeldt-Jakob Disease Surveillance Unit, The University of Edinburgh. Incidence of variant Creutzfeldt-Jakob Disease Onsets and Deaths in the UK January 1994 – September 2005.Edinburgh: NCJDSU, 14 April 2005. Available at .


3. Health Protection Agency [online]. CJD Incidents Panel. London: HPA, 27 April 2005. Available at
.


4.HPA. Emerging Infections update: November 2004 to January 2005. Commun Dis Rep CDR Wkly [serial online] 12 May 2005 [cited 10 November 2005]; 15(19): News. Available at:
.


5. HPA. The National Anonymous Tonsil Archive: a resource for Creutzfeldt-Jakob disease studies. Commun Dis Rep CDR Wkly [serial online] 30 October 2003 [cited 10 November 2005]; 13(44): News. Available at: .

http://www.hpa.org.uk/cdr/pages/emerg_inf_cjd.htm#cjd

TSS




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