NR ATYK
AU anonym
TI New case of transfusion-associated variant-CJD
QU Communicable Disease Report Weekly 2006 Feb 9; 16(6)
IA http://www.hpa.org.uk/cdr/archives/archive06/news/news0606.htm#vCJD
PT news
VT
A new case of probable variant Creutzfeldt-Jakob Disease (vCJD) has recently been diagnosed in a patient who received a blood transfusion from a donor who later developed vCJD (1). This is the third case of probable transfusion transmission of vCJD infection in the UK.
The first case of vCJD disease associated with blood transfusion was identified in December 2003. This individual developed vCJD six and a half years after transfusion of red cells donated by an individual who developed symptoms of vCJD three and a half years after donation (2). A case of vCJD 'infection' was identified a few months later in a recipient of red cells from a donor who developed symptoms of vCJD 18 months after donation. This second case died from causes unrelated to vCJD five years after transfusion. Post-mortem 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 (3). The new case developed vCJD nearly 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 United Kingdom. Of these, 23 are known to have donated blood prior to the diagnosis of vCJD. A collaborative study between the National Blood Services, the National CJD Surveillance Unit, and the Office for National Statistics has been underway since 1997 to collect evidence about transmission of CJD or vCJD via the blood supply (4). Blood donations have been traced for 18 of the 23 cases known to have donated blood, and 66 recipients of these vCJD-implicated blood donations have been identified. Forty of these 66 recipients have died, including the two known to have evidence of vCJD infection (2,3). 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/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 healthcare.
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 other groups being identified as 'at risk of vCJD for public health purposes' increased risk of vCJD, and being informed and asked to take public health precautions. These include certain recipients of plasma-products (5), individuals who have donated blood to vCJD cases (6), and certain recipients of blood from donors to vCJD cases (7). To date, there have been no vCJD cases associated with receipt of plasma-products, or among these other groups that have been categorises 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 (8).
References
1. Health Protection Agency. New case of variant CJD associated with blood transfusion (press release). London: HPA, 9 February 2006. Available at
2 Llewelyn CA, Hewitt PE, Knight RSG, Amar K, Cousens S, Mackenzie J, et al. Possible transmission of variant CJD disease by blood transfusion. 2004 Lancet 363;417-21.
3. Peden AH, Head MW, Ritchie DL, Bell JE, Ironside JW. Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient. 2004 Lancet 364;527-9.
4. Transfusion medicine epidemiology review (TMER) [online] 2005 [cited 9 February 2006]. Available at
5. DH announcement: Plasma product recipients; Patient Notification Exercise Begins Reference number: 2004/0329. London: Department of Health, 9 September 2004. Available at
6.DH announcement: Notification exercise begins to reduce risk of vCJD transmission Reference number: 2005/0256. London: Department of Health, 20 July 2004. Available at
7. DH announcement: Next stage of notification exercise to reduce risk of variant CJD transmission begins. Reference number: 2005/0404. London: Department of Health, 17 November 2005. Available at
8. DH announcement: Further precautions to protect blood supply Reference number: 2004/0104. London: Department of Health, 16 March 2004. Available at
SP englisch
PO England