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From: TSS (pool143-218.dial-u2.hou.wt.net)
Subject: POSITION STATEMENT MATERNAL TRANSMISSION OF vCJD SEAC
Date: February 4, 2005 at 7:52 am PST

-------- Original Message --------
Subject: POSITION STATEMENT MATERNAL TRANSMISSION OF vCJD SEAC
Date: Fri, 04 Feb 2005 09:54:58 -0600
From: "Terry S. Singeltary Sr."
To: Bovine Spongiform Encephalopathy
CC: cjdvoice@yahoogroups.com, Agriculture@mail.house.gov


1

POSITION STATEMENT
MATERNAL TRANSMISSION OF vCJD
Issue

1. The Chief Medical Officer for England asked SEAC to consider
current evidence and comment on the potential transmission of
vCJD from mother to child via human breast milk. In utero
transmission was also considered. The committee also
commented on the scientific basis of a risk reduction measure for
possible transmission of vCJD via banked breast milk.

Background

2. No diagnostic test is currently available for the detection of
abnormal PrP in milk. Research is under way to develop tests to
screen for the possible presence of abnormal prion protein (PrP) in
milk samples from cattle experimentally infected with BSE1. These
modified tests may also be applicable to human milk. However, it is
not yet clear when/if a reliable test will be available.

3. A small number of breast milk banks in the UK supply highly
vulnerable premature babies for whom no milk may be available
from the mother. A model developed by the Department of Health
to assess the effect of pooling breast milk from multiple donors on
the possible risks of transmission of vCJD via breast milk banks
was considered.

4. There is some, albeit limited, published epidemiological and
experimental research on maternal transmission of prion diseases.
There are also unpublished surveillance data of children born to
vCJD cases from the National CJD Surveillance Unit and UK
surveillance of neurological illness in children which might inform on
potential risks of maternal transmission.
1 A joint FSA/SEAC milk working group is monitoring and providing advice
on this research
carried out at the Veterinary Laboratories Agency.
2
Breast milk banks

5. There is no evidence that vCJD infectivity has ever been
transmitted through breast milk. However, a theoretical risk exists.
Modelling studies clearly show that the practice of pooling breast
milk increases the number of donors to which a recipient is
exposed and thereby increases the potential risk of an infant
receiving milk contaminated with vCJD infectivity. The theoretical
risk of infection can be minimised by not pooling the milk, by the
use of individual hand operated breast milk pumps for single
donors, and by the use of single-use sterilised bottles for collection.
In addition, available evidence suggests that infection/inflammation
of the breast results in increased lymphocytes in milk and therefore
increased risk of infectivity. This risk would be minimised if milk
from donors showing signs of infection is not used.

6. The committee suggested that, if practicable, milk could be stored
for an appropriate period of time to allow the health status of donors
to be monitored, before it is released. However, information was
not available to the committee on whether long-term storage of
human milk is detrimental to its nutritional quality.
Maternal transmission

7. There is evidence from animal studies for low level maternal
transmission of prions in cattle and sheep. This transmission may
occur in utero, via milk and/or perinatally. However, the possibility
that this putative maternal transmission might have been due to
another mode of transmission, for example through a contaminated
environment or feed, cannot be ruled out.

8. In contrast, in humans there is no evidence for maternal
transmission in cases of familial prion disease, other than the
transfer of a mutant form of the PrP gene, and there is no evidence
of maternal transmission of Kuru. However, compared with other
human prion diseases vCJD may pose a greater risk because of
the greater involvement of the lymphoreticular system in vCJD
pathogenesis. Although, breast tissue (and placenta) from a single
vCJD case tested negative for PrPvCJD, transfer of infectivity to
breast milk may depend on the physiological status of the
mammary gland. Similar tests or infectivity bioassays have not
been conducted on breast tissue from lactating patients with vCJD.
3

9. A published study suggesting transmission of sCJD in colostrum2
was considered unreliable because tissues not normally associated
with high levels of infectivity (blood and placenta) showed
equivalent infectivity to that of the brain in this study.

10. Analysis of prospective surveillance data of UK children born to
mothers with, or that had subsequently developed clinical vCJD,
provide no evidence for maternal transmission of vCJD. However,
the number of cases is very small and the incubation period of
vCJD, if transmitted from mother to child, is unknown and so the
children may yet be too young to have developed symptoms.

11. The phenotype of BSE infection in humans expressing PrP
genotypes other than M/M at codon 129 is not known. Given
recently published studies in mice expressing the human PrP
gene3, which suggest that the human PrP genotype may affect
disease phenotype, the committee considered it very important that
undiagnosed neurological diseases be carefully monitored. In this
respect, amongst others, it is recommended that the careful
monitoring of neurological illnesses through the PIND surveillance
of children4 continue.

Conclusions

12. In summary, there is currently no epidemiological evidence for
maternal transmission of vCJD, including transmission via breast
milk. However, there is a hypothetical risk. Although available
evidence is limited and mostly indirect rather than direct, this risk, if
any, appears to be low. As a risk cannot be excluded, a watching
brief should be maintained.

SEAC

January 2005

2 Tamai Y et al. Demonstration of the transmissible agent in tissue from
a pregnant woman
with CJD. New Eng J Med 1992 327, 649.
3 Wadsworth et al. Human prion protein with valine 129 prevents
expression of variant CJD
phenotype. Science. 2004 306, 1793-1796.
4 Devereux G et al. Variations in neurodegenerative disease across the
UK: findings from the
national study of Progressive Intellectual and Neurological
Deterioration (PIND). Arch Dis
Child. 2004 89, 8-12.

http://www.seac.gov.uk/statements/cjdtransmissionfinal.pdf

-------- Original Message --------
Subject: re-Mother passes on CJD to unborn baby SUNDAY TELEGRAPH Sun, 17
Sep 2000 10:09:01 -0700
Date: Sun, 26 Dec 2004 11:32:26 -0600
From: "Terry S. Singeltary Sr."
Reply-To: BSE-L


Greetings list members,

> re-Mother passes on CJD to unborn baby SUNDAY TELEGRAPH Sun, 17 Sep
> 2000 10:09:01 -0700

WHY is it we have heard nothing else about this case?

WHAT is the latest about this child that was supposedly to have
been infected with nvCJD via his mother from birth, after which
the mother passed on with confirmed nvCJD ???

thank you,
kind regards,

Terry


Date: Sun, 17 Sep 2000 10:09:01 -0700
Reply-To: BSE-L

Sender: BSE-L

From: "Terry S. Singeltary Sr."

Subject: Mother passes on CJD to unborn baby SUNDAY TELEGRAPH

Bovine Spongiform Encephalopathy

ISSUE 1941 Sunday 17 September 2000 Mother passes on CJD to unborn baby
By Rajeev Syal, Jenny Booth and Chris Hastings Scientists shocked as
disease reveals new deadly traits Tragic inheritance of baby 'born with
CJD' BSE report DOCTORS believe that a baby girl has been born with new
variant Creutzfeldt-Jakob disease, the human form of mad cow disease.
Her mother died of the illness earlier this year. Four specialists who
have examined the 11-month-old girl believe that she is exhibiting the
symptoms of vCJD and that she contracted the condition in the womb. The
Telegraph knows the identity of the child, but cannot name her for legal
reasons. The specialists have passed on their findings to the child's
grandmother after tests failed to detect any other ailment in the girl.
Only a post-mortem examination, however, can offer conclusive proof of
vCJD. If confirmed, this would be the first known example of vCJD being
transmitted from mother to child, and will heighten fears that the
disease can be transmitted through blood. One leading microbiologist
believes that some of the 67 people who have already died of vCJD may
have inherited it from their mothers, rather than contracting it from
eating infected meat. The baby's 50-year-old grandmother, who is now her
legal guardian, said the doctors suspected that prions - the infectious
agents believed to cause the disease - had been passed on to the baby in
the womb and had given her brain damage. She said: "They don't know if
it's gone into incubation. If so, it could be years before we can
finally confirm the disease." The health of the child has been the
subject of speculation since her mother died of vCJD in May, seven
months after giving birth. The girl was found to have brain damage and
has been suffering from fits and convulsions. Doctors have said that she
is growing at half the normal rate for a child of her age and suffers
from poor sight and abnormally stiff limbs. Her appendix has been
examined by doctors looking for signs of vCJD, but the tests proved
inconclusive. She will undergo further brain scans later this year. On
Friday, The Lancet reported research by scientists at the Institute for
Animal Health confirming for the first time that BSE can be transmitted
in sheep by infected blood transfusions. The finding increases the
likelihood that a vCJD-infected mother could pass on the disease to her
baby. Richard Lacey, the emeritus professor of medical microbiology at
Leeds University, said that it was "inevitable" that infected mothers
would pass on vCJD through the placenta. He said: "The only thing that
is uncertain is the scale on which it is happening." New variant CJD, a
fatal disease of the brain and nervous system, is believed to have been
transmitted to humans through eating beef infected with bovine
spongiform encephalopathy. The Ministry of Agriculture admitted in 1996
that a pregnant cow could pass BSE to its unborn calf. Maternal
transmission also occurs in sheep, rats and mice. Scientists have
observed that offspring often develop the disease more virulently than
the parent and after a much shorter incubation period. Until now,
researchers have been baffled at the youth of the 67 people known to
have died of vCJD. Their average age is 27. Most victims were aged 18 to
40. Dr Rob Will, of the National CJD Surveillance Unit in Edinburgh, has
suggested that the victims caught the disease through eating cheap
mechanically recovered meat used in school meals or even baby food. Dr
Lacey however suspects that some may have contracted the illness from
their mothers. The Telegraph has also learnt that the Department of
Health is now considering the use of disposable surgical instruments
throughout the NHS because of growing concern that blood and tissue from
vCJD carriers could remain infectious even after sterilisation. As this
newspaper revealed four years ago, tissue from such patients is capable
of passing ordinary CJD to healthy patients, yet current standards for
sterilising equipment are not adequate to destroy the prions.

http://www.telegraph.co.uk:80/et?ac=003472652334058&rtmo=fqV0Nsvs&atmo=rrrrrrvs&pg=/et/00/9/17/ncjd17.html

SSUE 1941 Sunday 17 September 2000 Tragic inheritance of baby 'born with
CJD' By Rajeev Syal, Chris Hastings and Jenny Booth Mother passes on CJD
to unborn baby THE dark-haired baby attracts admiring glances wherever
she goes. She has her mother's striking blue eyes, says her adoring
grandmother. Medical experts believe, however, that she is the first
child to inherit the disease which killed her mother, variant
Creutzfeldt-Jakob disease, while still in the womb. The child's
50-year-old grandmother, who has to feed the 11-month-old girl through a
tube, said: "Every time I look at her, I see the agony that my daughter
endured in her last days. Seeing my own child die in agony nearly killed
me and now I am terrified that I will also see my grandchild die in the
same way." For months she suspected that her granddaughter was suffering
from the symptoms of vCJD. Over recent weeks, her worst fears have been
confirmed by doctors from the leading London hospital that is treating
her grandchild. The tragedy began in July 1998, when the woman's
22-year-old daughter - who ran her own catering business - became moody,
tired and constantly tearful. Her daughter's frequent outbursts of
temper were untypical; the two normally lived harmoniously together in a
semi-detatched home in a Warwickshire village. By February last year,
the young woman had become pregnant. She developed severe back trouble
and, five months into her pregnancy, had to give up work. She could
hardly move her arms and legs and had to be helped around the house.
Other symptoms included pins and needles in her legs and swollen and
sore lips. Doctors were mystified as to the cause of the illness. In
October, to try to protect mother and child, the baby girl was delivered
by Caesarean section weighing 6lb 4oz. Immediately, however, the doctors
were aware that the little girl had difficulties swallowing and she was
placed in a special baby care unit. The family was told by doctors two
days after the birth that the baby probably had brain damage. The
specialists decided to conduct a series of tests on the child. The
family had begun to guess the truth. The dead woman's mother recalled:
"I had spoken to someone who told me that their relative had died of
CJD, and I had seen the news reports on television about cows. Then it
dawned on me; my daughter's moods and the jerky movements she had begun
to suffer were similar. It was an awful moment." By January, vCJD was
confirmed in the mother by a biopsy on her tonsils - a procedure that is
98 per cent accurate.After this she was warned that her baby may also
have contracted the disease.The young woman was virtually confined to a
wheelchair and her memory was so bad that she sometimes failed to
recognise her mother and her child. The baby's father had moved away
from the area. Doctors tried to discover if her baby also had vCJD, but
because the case was unique, and hampered by the poor health of the
child, they were not sure how to reach a diagnosis. In May, the child's
mother died after months of suffering. In the same month, doctors
removed the little girl's appendix and took samples of her lymph tissue
in the hope that an analysis would show whether she was carrying the
prions - aberrant proteins - that caused the disease that killed her
mother. According to the baby's grandmother, the tests carried out by
the doctors were necessarily inconclusive because vCJD infection can
only be finally confirmed after death through a post-mortem. They
nevertheless believe that her granddaughter has been suffering from the
effects of vCJD from the time of her conception. Caring for her dead
daughter's child has now become the focus of the woman's life, and it is
proving to be a daunting task. Her granddaughter's eyesight has been
affected, and it is impossible to know how much she can see. Her limbs
are stiff and she needs physiotherapy. She sleeps a lot of the time, as
her mother did when she was ill. Last week she was suffering fits and
convulsions, and doctors have said that she is growing at half the
normal rate. She is to undergo further examinations by vCJD specialists
later this year. Her grandmother said: "The appalling thing is that I am
watching my granddaughter die while the Government fails to warn others
that they may be passing the disease on. I want this baby's case
highlighted because no other family should go through what we have been
through,"

http://www.telegraph.co.uk:80/et?ac=003472652334058&rtmo=a2e3JspL&atmo=gggggg3K&pg=/et/00/9/17/ncjd217.html

ISSUE 1941 Sunday 17 September 2000 Scientists shocked as disease
reveals new deadly traits By Robert Matthews THE growing concern over
the health of the baby born to a mother with variant CJD and the new
evidence, announced last week, that the disease may have spread through
blood transfusions, highlight the disturbing ability of vCJD to surprise
the experts. A conclusive diagnosis of vCJD in the 11-month-old child
would imply a far shorter incubation period than many scientists thought
possible. It would also mean that the disease can be passed down the
generations, not merely acquired through contact with infected tissue.
Scientists have yet to pin down the likely size of the vCJD epidemic,
with estimates for Britain ranging from about 100 cases to more than
100,000; so far there have been only 82 probable or confirmed cases. The
case of the baby girl means that scientists are now admitting that many
predictions may have to be rethought. According to Dr Neil Ferguson of
the University of Oxford, a leading expert on the mathematics of
epidemics, so-called vertical transmission down the generations has, at
least until now, been thought to be relatively unimportant. Dr Ferguson
said: "It very much depends on the probability of it taking place. If a
woman has to be very sick and symptomatic in order to give it to her
baby, then the number of cases it creates are going to be very small,
because she is unlikely to get pregnant." The mother of the baby at the
centre of the current concern is, however, understood to have been
showing only minor symptoms of the disease at the time of conception;
only later in her pregnancy did she develop the classic symptoms of vCJD
from which she died in May this year. Richard Lacey, an emeritus
professor of medical microbiology at Leeds University, said that the
Telegraph story had wider implications than its obvious medical
significance. Prof Lacey said: "The only thing that is certain is the
scale on which it is happening. That will take decades to find out. I am
aware of other cases where maternal transmission could be an issue; this
isn't the only one. "This poses difficult ethical problems: to what
extent should individuals be told of the risk? Should such a person be
told not to give blood when he or she is old enough to do so? What
effect will this knowledge have on that person's way of life, on their
emotions? There needs to be some sort of discussion about how we cope
with it, but at the moment there is nothing." Epidemiologists are
puzzled by the fact that vCJD is predominantly affecting young people,
while classic CJD is a disease of the old. Prof Lacey suggested that one
possible explanation is that the teenagers and young people who have
died from vCJD may have contracted the disease from their mothers while
in the womb. He added that it is a recognised clinical syndrome that
infectivity accumulates when it is passed on from one generation to the
next. Dr Stephen Dealler, an expert on BSE and vCJD at Burnley Hospital,
said that it had been believed that mother-to-offspring infection could
take place in cows, but only with a considerable incubation period. "The
thinking is that it may take place in cows, but the incubation period is
still three to five years," he said. "This would lead us to expect an
incubation period of around seven years in humans. If the baby does have
vCJD, that's a very fast incubation period." Last week's revelation
resulting from animal experiments that the disease may be transferred
through blood transfusions from infected people with no symptoms was
being played down by government scientists, who said that all British
blood is screened to remove cells that may harbour vCJD. The Telegraph
has learnt, however, that the Department of Health is seriously
considering the use of disposable surgical instruments throughout the
National Health Service. This follows growing concern that blood and
tissue from asymptomatic carriers of the disease could remain infectious
even after sterilisations.

http://www.telegraph.co.uk:80/et?ac=003472652334058&rtmo=a2e3JspL&atmo=gggggg3K&pg=/et/00/9/17/ncjd117.html


TSS

Terry S. Singeltary Sr.
P.O. Box 42
Bacliff, Texas USA 77518






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