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From: TSS (216-119-144-39.ipset24.wt.net)
Subject: Variant Creutzfeldt-Jakob disease 'NEW practicable decontamination procedures are urgently needed' LANCET BLOOD ARTICLES August 2004
Date: August 6, 2004 at 8:49 am PST

-------- Original Message --------
Subject: Variant Creutzfeldt-Jakob disease 'NEW practicable decontamination procedures are urgently needed' LANCET BLOOD ARTICLES Volume 364, Number 9433 07 August 2004
Date: Fri, 6 Aug 2004 08:51:36 -0500
From: "Terry S. Singeltary Sr."
Reply-To: Bovine Spongiform Encephalopathy
To: BSE-L@uni-karlsruhe.de


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

Variant Creutzfeldt-Jakob disease

'In view of the widespread tissue distribution of the variant
Creutzfeldt-Jakob disease agent in human beings, new practicable
decontamination procedures are urgently needed' Prions are uniquely
resistant to decontamination, and prion diseases can be transmitted
iatrogenically by medical devices. Guillaume Fichet and colleagues

investigated the effectiveness of innovative physical and chemical
methods of prion inactivation using in-vitro and in-vivo models of prion
contamination. They found that three novel decontamination methods were
more effective than standard chemical methods for decontaminating
fragile surgical instruments. In a Research Letter, Alexander H Peden
and colleagues

describe a case of preclinical variant Creutzfeldt-Jakob disease (vCJD)
detected at autopsy in a patient who had received a blood transfusion
from a donor who subsequently developed the disease. In a second
Research Letter, Luisa Gregori and colleagues

investigate the effectiveness of leucoreduction for removal of
infectivity of transmissible spongiform encephalopathies from donated
blood, and suggest that this procedure alone is not sufficient to remove
all such infectivity. In a Comment paper, Kumanan Wilson and Maura N
Ricketts

discuss the possible transmission of vCJD through blood transfusion, and
state that lack of definitive evidence should not preclude action to
prevent such transmission.

http://www.thelancet.com/journal/vol364/iss9433/full/llan.364.9433.talking_points.30447.2

Transfusion transmission of vCJD: a crisis avoided?

In this issue of The Lancet, three reports examine issues about the
iatrogenic transmission of variant Creutzfeldt-Jakob disease (vCJD).

*Kumanan Wilson, Maura N Ricketts

------------------------------------------------------------------------
Toronto General Hospital, University Health Network, Toronto, Ontario,
Canada M5G 2C4 (KW); and Blood Safety Surveillance and Health Care
Acquired Infections Division, Population and Public Health Branch,
Health Canada, Ottawa, Ontario, Canada (MNR)
------------------------------------------------------------------------
Kumanan.Wilson@uhn.on.ca

http://www.thelancet.com/journal/vol364/iss9433/full/llan.364.9433.analysis_and_interpretation.30437.1

Effectiveness of leucoreduction for removal of infectivity of
transmissible spongiform encephalopathies from blood

Luisa Gregori, Nancy McCombie, Douglas Palmer, Paul Birch, Samuel O
Sowemimo-Coker, Antonio Giulivi, Robert G Rohwer

------------------------------------------------------------------------
Lancet 2004; 264: 529-31
------------------------------------------------------------------------
Veterans Affairs Maryland Health Care System, VA Medical Center,
University of Maryland at Baltimore, 10 North Greene Street, Baltimore,
MD 21201, USA (L Gregori PhD, R G Rohwer PhD); Health Canada, Center for
Infectious Disease Prevention and Control, Ottawa, ON, Canada (N
McCombie RN, A Giulivi MD); Canadian Blood Services, Ottawa, ON, Canada
(D Palmer MSc, P Birch MLT); Pall Corporation, Port Washington, NY, USA
(S O Sowemimo-Coker PhD)
------------------------------------------------------------------------
Correspondence to: Dr Robert G Rohwer
rrohwer@umaryland.edu

http://www.thelancet.com/journal/vol364/iss9433/full/llan.364.9433.primary_research.30433.1

Preclinical vCJD after blood transfusion in a PRNP codon 129
heterozygous patient

Alexander H Peden, Mark W Head, Diane L Ritchie, Jeanne E Bell, James W
Ironside

------------------------------------------------------------------------
Lancet 2004; 264: 527-29
------------------------------------------------------------------------
National Creutzfeldt-Jakob Disease Surveillance Unit, Division of
Pathology, School of Molecular and Clinical Medicine, University of
Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK (A H Peden
PhD, M W Head PhD, D L Ritchie BSc, Prof J E Bell FRCPath, Prof J W
Ironside FRCPath)
------------------------------------------------------------------------
Correspondence to: Prof James W Ironside
james.ironside@ed.ac.uk

http://www.thelancet.com/journal/vol364/iss9433/full/llan.364.9433.primary_research.30432.1

Novel methods for disinfection of prion-contaminated medical devices

Guillaume Fichet, Emmanuel Comoy, Christelle Duval, Kathleen Antloga,
Capucine Dehen, Aurore Charbonnier, Gerald McDonnell, Paul Brown,
Corinne Ida Lasmézas, Jean-Philippe Deslys

------------------------------------------------------------------------
Lancet 2004; 364: 521-26
------------------------------------------------------------------------
See Comment


------------------------------------------------------------------------
CEA/DSV/DRM/GIDTIP, Route du Panorama, 92265 Fontenay-aux-Roses, France
(G Fichet DipBiol, E Comoy PhD, C Duval, C Dehen, A Charbonnier, C
Lasmézas PhD, J-P Deslys PhD); Anjou Recherche/Veolia water, 1 place de
Turenne, 94417 Saint-Maurice Cedex, France (G Fichet); Steris, Viables,
Basingstoke, UK (G McDonnell PhD, K Antloga MD); EFS-Nord de France,
59800 Lille, France (C Duval); and Bethesda, Maryland, USA (P Brown PhD).
------------------------------------------------------------------------
Correspondence to: Dr Emmanuel Comoy, Groupe d'Innovation Diagnostique
et Thérapeutique sur les Infections à Prions, CEA/DSV/DRM, 18 Route du
Panorama, 92265 Fontenay-aux-Roses, France.
emmanuel.comoy@cea.fr

Summary

Background The unique resistance of prions to classic methods of
decontamination, and evidence that prion diseases can be transmitted
iatrogenically by medical devices pose a serious infection control
challenge to health-care facilities. In view of the widespread tissue
distribution of the variant Creutzfeldt-Jakob disease agent in human
beings, new practicable decontamination procedures are urgently needed.
Methods We adapted an in-vivo method using stainless steel wires
contaminated with prions to the hamster-adapted scrapie strain 263K. A
new in-vitro protocol of surface contamination compatible with
subsequent biochemical detection of PrPres (protease-resistant form of
the prion protein) from the treated surface was developed to explore the
mechanisms of action of methods of decontamination under test. These
models were used to investigate the effectiveness of innovative physical
and chemical methods of prion inactivation. Findings Standard chemical
decontamination methods (NaOH 1N, NaOCl 20 000 ppm) and autoclaving in
water at 134°C reduced infectivity by >5·6 log10 lethal doses;
autoclaving without immersion was somewhat less effective (4-4·5 log
reduction). Three milder treatments, including a phenolic disinfectant,
an alkaline cleaner, and the combination of an enzymatic cleaner and
vaporised hydrogen peroxide (VHP) were also effective. VHP alone, which
can be compatible with electronic components, achieved an approximately
4·5 log reduction in infectivity (equivalent to autoclaving without
water immersion). Interpretation New decontamination procedures are
proposed to ensure the safety of medical and surgical instruments as
well as surfaces that cannot withstand the currently recommended prion
inactivation procedures.

http://www.thelancet.com/journal/vol364/iss9433/full/llan.364.9433.primary_research.30425.1

TSS

######### http://mailhost-alt.rz.uni-karlsruhe.de/warc/bse-l.html ##########






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