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From: TSS ()
Subject: Surgical or Endoscopic patients to be screened for CJD risk Sun 20 Aug 2006
Date: August 19, 2006 at 6:09 pm PST

----- Original Message -----
From: "Terry S. Singeltary Sr."
Sent: Saturday, August 19, 2006 8:29 PM
Subject: Surgical or Endoscopic patients to be screened for CJD risk Sun 20 Aug 2006

##################### Bovine Spongiform Encephalopathy #####################

Sun 20 Aug 2006

Surgical patients to be screened for CJD risk


PATIENTS undergoing surgery or endoscopic tests are to be screened for their risk of having the deadly human form of mad cow disease following a series of infection scares last year.

The Chief Medical Officer for Scotland Dr Harry Burns has written to all health boards ordering doctors to identify patients who may have previously been exposed to Creutzfeldt-Jakob Disease (CJD).

Surgeons must now carry out a strict assessment before patients undergo surgical procedures on tissues such as the brain, spinal cord, eye, spleen and tonsils.

The new guidelines come after a series of incidents last year that saw patients who potentially carried CJD undergoing surgery without the proper infection control precautions.

Doctors must now ensure they identify whether patients are at risk of carrying the deadly disease through family contacts, previous surgery or from receiving infected tissues, organs and hormone products.

All patients undergoing procedures on tissues considered to be susceptible to CJD will be asked a series of questions about their potential exposure before elective and emergency surgery.

If they are found to be "at risk" of CJD, extra infection control measures including decontamination of surgical instruments and their disposal will be put in place.

Burns said: "The need for additional advice on pre-procedure assessment was identified by the CJD Incidents Panel following a number of CJD cases in 2005 in which patients underwent surgery without prior knowledge of the need for infection control precautions relating to their special CJD status."

The new guidelines come amid fears that vCJD can be transmitted to patients via infected surgical instruments.

Researchers have called for better logging of the number of times equipment is used and on whom to ensure instruments used on patients later diagnosed with CJD could be taken out of use.

The latest figures show that so far in 2006 there have been 62 suspected cases of CJD in the UK and three people have died from the form caused by eating BSE-infected beef, vCJD.

Since 1995, 156 people have died of vCJD, with 28 dying at the height of the epidemic in 2000. There are currently six living individuals who are suffering from vCJD.

But experts at the National CJD Surveillance Unit at the Western General Hospital in Edinburgh have warned that hundreds more people could die in the next 20 years as a result of contracting vCJD during surgery. Of the 161 people diagnosed with vCJD by the end of 2005, 130 had undergone surgery in the years preceding the start of symptoms.

The government has now allocated £200m to improve sterilisation and tracking of reusable surgical equipment.

Scientists also hope to develop better tests for CJD - which currently requires a tissue sample for analysis - to screen patients when they arrive in hospital.

Dr Ian Stansfield, a CJD researcher at Aberdeen University, said: "Recent research has suggested there may be different types of vCJD that have different incubation times.

"This means we could see waves of epidemics as the other types begin to harm people. As the moment we can only identify patients with CJD if their tissue is found to have the misfolded protein responsible. The trouble is this misfolded protein acts as a catalyst and causes healthy forms of the protein to misfold also, which is what allows the disease to be infectious."

Evidence For CJD/TSE
Transmission Via Endoscopes
From Terry S. Singletary, Sr



Greetings List Members,

This is _very_ disturbing to me:


The distribution of PrPSc in the body is different in sporadic and
variant CJD, reflecting the different pathogenesis of the two forms. In
the case ot sporadic CJD, prion infectivity is largely limited to the
CNS (including the retina) and only operations involving the brain and
eye have resulted in iatrogenic transmission of the disease.
Gastro-intestinal endoscopy is unlikely to be a vector for the
transmission of sporadic CJD as infected tissue is not encountered
during the procedure. No special precautions are necessary during or
after the procedure and the endoscope should be cleaned and disinfected
in the normal thorough way.4


i personally believe it is irresponsible for anyone to state in this day
and time, that sporadic CJDs (now at 6 variants) will not transmit the
disease by this route. considering infective dose cannot be quantified,
only speculated, such a statement is thus, irresponsible. to hypothosize
that sporadic CJD just happens spontaneously (with no scientific proof),
that the PrPSc distribution in tissues of all sporadic CJDs is entirely
different than that of vCJD, without being able to quantify the titre of
infection, or even confirm all the different variants yet, again is
_not_ based on all scientific data, then it's only a hypothosis. who is
to say that some of these variants of sporadic CJD were not obtained

also stated:


Although thorough cleaning of flexible endoscopes ensures patient safety
for ''normal'' pathogens, the same process may not be adequate for the


The sporadic form of CJD affects approximately one person per mil-lion
per annum in the population on a worldwide basis.

who is to say how much infectivity are in some of these variants of
sporadic CJDs, without confirming this? if we look at the 6 different
variants of sporadic CJDs, has the infective dose for all 6 _documented_
variants been quantified, and documented as being 'measurable'?

will there be more variants of sporadic CJDs, and what of the
ramifications from them?

what of other strains/variants of TSE in cattle, BSE in sheep, CWD in
cattle, or any of the 20+ strains of Scrapies in deer/elk? i get dizzy
thinking of the different scenerio's. what would the human TSEs from
these species look like and how can anyone quantify any tissue
infectivity from these potential TSE transmissions to humans, and the
risk scenerio described here from this potential route? could not some
of these sporadic CJDs have derived directly or indirectly from one of
these species, and if so, pose a risk by the route described here?

something else to consider, in the recent finding of the incubation
period of 38 years from a _small_ dose of human growth hormone;


> We describe the second patient with hGH related CJD in the
Netherlands. The patient developed the disease 38 years after hGH
injections. To our knowledge, this is the longest incubation period
described for any form of iatrogentic CJD. Furthermore, our patient was
_not_ treated with hGH, but only received a _low_ dose as part of a
diagnostic procedure. (see full text below).


so my quesion is, how low is 'low' in quantifing the infectious dose in
vCJD, comparing to _all_ sporadic CJDs, from the different potential
routes, sources, and infectivity dose?

will the titre of infectivity in every tissue and organ of all sporadic
CJDs stay exact or constant, no matter what the infective dose, route
and species may be? this is considering you don't buy the fact that
sporadic CJDs 85%+ of _all_ CJDs, are a happen stance of bad luck,
happen spontaneously without cause, and are one-in-a-million world wide,
with no substantial surveillance to confirm this.

Diagnosis and Reporting of Creutzfeldt-Jakob Disease T. S. Singeltary,
Sr; D. E. Kraemer; R. V. Gibbons, R. C. Holman, E. D. Belay, L. B.

and what of Dr. Prusiner et al recent work about tissue infectivity;

Prions in skeletal muscle


Our data demonstrate that factors in addition to the amount of PrP
expressed determine the tropism of prions for certain tissues. That some
muscles are intrinsically capable of accumulating substantial titers of
prions is of particular concern. Because significant dietary exposure to
prions might occur through the consumption of meat, even if it is
largely free of neural and lymphatic tissue, a comprehensive effort to
map the distribution of prions in the muscle of infected livestock is
needed. Furthermore, muscle may provide a readily biopsied tissue from
which to diagnose prion disease in asymptomatic animals and even humans.


can the science/diagnostic measures used to date, measure this, and at
the same time guarantee that no titre of infectivity exists from
sporadic CJDs (all of the variants), from this potential mode and route
of transmission?

i don't think so, this is just my opinion. this is why i get paid
nothing, and these scientists get the big bucks. i just hope i am wrong
and the big bucks are correct in their _hypothisis_ of this potential
mode/route of transmission with endoscopy equipment, from _all_ human TSEs.

i understand we have to weigh the risks of what we know to what we don't
know, to the disease we _may_ catch to what we are having the procedure
for, but to categorically state at this present time of scientific


"Gastro-intestinal endoscopy is unlikely to be a vector for the
transmission of sporadic CJD as infected tissue is not encountered
during the procedure. No special precautions are necessary during or
after the procedure and the endoscope should be cleaned and disinfected
in the normal thorough way.4"


but, to categorically state this, in my opinion, is not only wrong, but
potentially very dangerous to the future of human health...TSS


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