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From: TSS ()
Subject: Re: New case (3rd) of variant CJD associated with blood transfusion
Date: February 9, 2006 at 10:13 am PST

In Reply to: Re: New case (3rd) of variant CJD associated with blood transfusion posted by TSS on February 9, 2006 at 6:52 am:

New case of transfusion-associated vCJD in the United Kingdom

Editorial team (eurosurveillance.weekly@hpa.org.uk), Eurosurveillance
editorial office
A new case of probable variant Creutzfeldt-Jakob disease (vCJD) has recently
been diagnosed in a patient in the United Kingdom (UK) who received a blood
transfusion from a donor who later developed vCJD [1]. This patient, who is
still alive and is under the care of doctors at the National Prion Clinic,
is the third case of vCJD infection in the UK associated with transfusion
[2].

The first case of vCJD disease associated with blood transfusion was
identified in December 2003 [3]. This patient developed vCJD six and a half
years after receiving a transfusion of red blood cells donated by an
individual who developed symptoms of vCJD three and a half years after
donation [4].

Another case of vCJD 'infection' was identified a few months later in a
recipient of red blood cells from a donor who developed symptoms of vCJD 18
months after the donation [5]. This second patient died from causes
unrelated to vCJD five years after transfusion. Postmortem investigations
found abnormal prion protein in the spleen and a cervical lymph node, but
not in the brain, and no pathological features of vCJD were found [6].

The most recent patient developed vCJD almost eight years after receiving a
transfusion of red blood cells from a donor who developed vCJD about 20
months after donating this blood [1]. Each of the three infected recipients
received blood from different donors.

To date, 160 cases of vCJD have been identified in the UK. Of these, 23 are
known to have donated blood before the diagnosis of vCJD. A collaborative
study (the Transfusion Medicine Epidemiology Review) between the National
Blood Services, the National CJD Surveillance Unit and the Office for
National Statistics has been conducted since 1997 to collect evidence about
transmission of CJD or vCJD via the blood supply [7]. Blood donations have
been traced for 18 of the 23 known donors, and 66 recipients of these
vCJD-implicated blood donations have been identified. Forty of these 66
recipients have died, including the two previous patients with probable
transfusion-associated vCJD [4,6]. The small group of living recipients of
vCJD-implicated blood transfusion have been informed of their potential
exposure to vCJD by blood transfusion. Some were contacted in late 2003 and
early 2004, and some in 2005. They were asked to take certain precautions to
reduce the risk of onward person-to-person transmission of vCJD during
medical procedures.

All three infected recipients identified to date received non-leucodepleted
red blood cells. Since October 1999, leucocytes have been removed from all
blood used for transfusion in the UK. The effect of leucodepletion on the
reduction of the risk of transmission of vCJD from an infected donor is
uncertain.

The risk of vCJD infectivity in blood has also resulted in certain other
groups of individuals being categorised as ‘at risk of vCJD for public
health purposes’. These groups have been informed and asked to take public
health precautions. The groups include certain recipients of plasma products
[8], individuals who have donated blood to patients who developed vCJD [9]
and certain recipients of blood from donors to patients who developed vCJD
[10]. To date, there have been no vCJD cases associated with receipt of
plasma products, or in these other groups of individuals that have been
categorised as ‘at risk’.

This third case of vCJD infection associated with blood transfusion provides
further evidence that vCJD can be transmitted between humans by blood
transfusion, although much remains unknown. This reinforces the importance
of the existing precautions that have been introduced to reduce the risk of
transmission of vCJD infection by blood and blood products [11].

Numbers of vCJD cases countries other than the UK remain small: by January
2006, there had been 15 cases reported in France, 4 in Ireland, 2 in the
United States, and 1 each in Canada, Italy, Japan, the Netherlands,
Portugal, Saudi Arabia and Spain [12].

This article has been adapted from reference 2

References:

1. Health Protection Agency. New case of variant CJD associated with blood
transfusion. Press release 9 February 2006.
(http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060209_cjd.htm)
2. HPA. New case of transfusion-associated variant-CJD. Commun Dis Rep CDR
Wkly [serial online] 2006; 16(6): News. (http://www.hpa.org.uk/cdr)
3. CDR editorial team. Possible case of transfusion-associated variant CJD
in the United Kingdom. Eurosurveillance Weekly 2003; 7(51): 030128.
(http://www.eurosurveillance.org/ew/2003/031218.asp#2)
4. Llewelyn CA, Hewitt PE, Knight RSG, Amar K, Cousens S, Mackenzie J, Will
RG. Possible transmission of variant CJD disease by blood transfusion.
Lancet 2004; 363:417-421.
5. Eurosurveillance. Possible second case of variant CJD prion protein
transmission from blood transfusion in the UK. Eurosurveillance Weekly 2004;
8(31): 040729. (http://www.eurosurveillance.org/ew/2004/040729.asp#2)
6. Peden AH, Head MW, Ritchie DL, Bell JE, Ironside JW. Preclinical vCJD
after blood transfusion in a PRNP codon 129 heterozygous patient. Lancet
2004; 364:527-529.
7. Transfusion Medicine Epidemiology Review (TMER) website.
(http://www.cjd.ed.ac.uk/TMER/TMER.htm)
8. Department of Health [London].Patient Notification Exercise Begins. Press
release 2004/0329, 9 September 2004.
(http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesN
otices/fs/en?CONTENT_ID=4088953&chk=4BSn4F)
9. Department of Health [London]. Notification exercise begins to reduce
risk of vCJD transmission. Press release 2005/0256, 20 July 2005.tss
(http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesN
otices/fs/en?CONTENT_ID=4116206&chk=4YsTe9)
10. Department of Health [London]. Next stage of notification exercise to
reduce risk of variant CJD transmission begins. Press release 2005/0404, 17
November 2005.
(http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesN
otices/fs/en?CONTENT_ID=4123496&chk=UnGWvb)
11. Department of Health [London]. Further precautions to protect blood
supply. Press release 2004/0104, 16 March 2004.
(http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesN
otices/fs/en?CONTENT_ID=4076608&chk=MTwE%2Bl)
12. Molesworth AM, Andrews NJ. Variant Creutzfeldt-Jakob disease in the
United Kingdom and elsewhere: situation at the end of 2005. Eurosurveillance
2006; 11(1): 060126. (http://www.eurosurveillance.org/ew/2006/060126.asp#5)


http://www.eurosurveillance.org/ew/2006/060209.asp#2


TSS



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