Creutzfeldt–Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study

Abstract

Background and Objectives This paper reports the results to 1 March 2006 of an ongoing UK study, the Transfusion Medicine Epidemiological Review (TMER), by the National CJD Surveillance Unit (NCJDSU) and the UK Blood Services (UKBS) to determine whether there is any evidence that Creutzfeldt-Jakob disease (CJD), including sporadic CJD (sCJD), familial CJD (fCJD), and variant CJD (vCJD) is transmissible via blood transfusion. Materials and MethodsSporadic CJD and fCJD cases with a history of blood donation or transfusion are notified to UKBS. All vCJD cases aged > 17 years are notified to UKBS on diagnosis. A search for donation records is instigated and the fate of all donations is identified by lookback. For cases with a history of blood transfusion, hospital and UKBS records are searched to identify blood donors. Details of identified recipients and donors are checked against the NCJDSU register to establish if there are any matches.Results CJD cases with donation history: 18/31 vCJD, 3/93 sCJD, and 3/5 fCJD cases reported as blood donors were confirmed to have donated labile components transfused to 66, 20, and 11 recipients respectively. Two vCJD recipients have appeared on the NCJDSU register as confirmed and probable vCJD cases. The latter developed symptoms of vCJD 6.5 years and 7.8 years respectively after receiving non-leucodepleted red blood cells (RBCs) from two different donors who developed clinical symptoms approximately 40 and 21 months after donating. A third recipient, given RBC donated by a further vCJD case approximately 18 months before onset of clinical symptoms, had abnormal prion protein in lymphoid tissue at post-mortem (5-years post-transfusion) but had no clinical symptoms of vCJD. CJD cases with history of transfusion: Hospital records for 7/11 vCJD and 7/52 sCJD cases included a history of transfusion of labile blood components donated by 125 and 24 donors respectively. Two recipients who developed vCJD were linked to donors who had already appeared on the NCJDSU register as vCJD cases (see above). No further links were established. ConclusionThis study has identified three instances of probable transfusion transmission of vCJD infection, including two confirmed clinical cases and one pre-or sub-clinical infection. This study has not provided evidence, to date, of transmission of sCJD or fCJD by blood transfusion, but data on these forms of diseases are limited.

Excretion of Transmissible Spongiform Encephalopathy Infectivity in Urine

“…TSE infectivity and pathologic changes are concentrated in the nervous system; however, much of the transmission risk results from parenteral exposure to the much lower concentrations of infectivity found in tissues outside the nervous system. Thus, despite the very low concentration of TSE infectivity in blood (1,2), 4 human cases of transmission of variant Creutzfeldt-Jakob disease through blood transfusions have been documented (3,4). If TSE infectivity were excreted, human urine, which is a source of injectible fertility hormones and other drugs (5,6), could also pose a risk for transmission.…”

The Canadian Management of Bovine Spongiform Encephalopathy in Historical and Scientific Perspective, 1990-2014

“…71 However, an ongoing study has not been able to demonstrate blood transfusion as a cause for vCJD development in any individuals who have succumbed to the disease in Canada or elsewhere. 72 …”

Transmissible spongiform encephalopathies: a current perpective for public health

“…Ekonomiyi büyük miktarda zarara uğrattığını göz önünde bulundurarak, bu hastalıkların etiyolojisini araştırmak ve hastalıktan korunma yollarını belirlemek amacıyla büyük miktarlarda fonlar ayrıldı. [23][24][25] , bu da infeksiyonun daha da tehlikeli hal aldığının kanıtıdır.…”