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Cows
Variant CJD - the facts and the fears

The announcement in March 1996 that meat from cattle with BSE could cause a fatal brain disease in humans confirmed the worst fears of scientists and the public.

And just as no-one could be sure in the 1980's that mad cow disease was a risk to people who ate contaminated beef, now it's impossible to know whether vCJD can be passed on between people through surgery or blood products.

Stephen Churchill
Stephen Churchill: first to be diagnosed with vCJD
Now that more than 100 people have died from this terrible illness - known as variant CJD or vCJD - the priority is to try to prevent the disease spreading from those already infected. But doctors and medical researchers are working in the dark.

Scientists say there may be a danger of developing vCJD through blood transfusions or through surgical instruments which are re-used after operations on an infected person.

So far no-one's known to have contracted vCJD this way.

But if there is a risk, it could be years before people become ill - so the authorities are taking precautions which may not even be necessary.

Despite the costs involved, many believe the mistakes made during the BSE outbreak, prove it's better to be safe than sorry.

The Science

BSE and vCJD are both caused by abnormal prions - which change the brain chemistry and destroy nerve cells. As more cells die, the victim loses control of movement, speech and other functions of the central nervous system. So far, there is no cure.

Scientists say the most likely cause of vCJD is eating contaminated meat from cattle infected with BSE. The most dangerous parts of the animal - brain and central nervous system - should be removed, but during the 1980s, it's known some did make it into the food chain.

The concern now centres on whether people with vCJD can pass it on. It's clear that they can't through normal contact - but no-one knows if operations or blood transfusions carry a risk.

And because vCJD may take 10 or more years to develop, it would be too late to take action by the time any evidence started showing up.

Assessing the risks

Laboratory testing for BSE
The science is uncertain
Teams of scientists have been looking at the risks from surgery and blood transfusions since 1998.

For surgery, the dangers would depend a number of factors. Only certain body tissues, like the brain, spleen or tonsils, are likely to contain infectious materials, so operations in these areas would carry the highest risks.

If surgical instruments can become infected with prions, then the risks depend on whether they can be decontaminated, what operations they're used on in future, and how susceptible future patients may be to infection.

The same complex questions apply to blood and organ donations. So the Government has had to take preventative measures, without knowing if there is a danger or not.

Prevention

The concerns over blood transfusion were the first to be addressed. In 1997, the government announced that:

  • white blood cells would be removed from donated blood and blood products. These may prevent more of a risk because they come are linked to the lymphatic system, which is known to harbour prion infectivity.
  • blood products made from pooled plasma donations like Factor VIII - needed by patients with disorders like haemophilia - will be sourced from countries outside the UK.
  • these measures were due to be completed by 1999
Surgical Instruments
Standards for decontaminating surgical instruments were raised
In January 2001, the government announced new measures to address surgical concerns. Measures included:
  • 200 million to improve standards of decontamination of surgical instruments across the NHS
  • single-use instruments for all tonsillectomies in the future - tonsils have been shown to harbour high levels of prion infectivity in vCJD patients.
The risk list

The other big question, which the Government has not yet resolved, is whether to tell people who MAY have been put at risk.

Since the disease has no cure, this raises huge moral questions. Should people be burdened with such information? Do they have a right to know? Should people's names be kept on database for scientific purposes?

And the practical implications for hospital authorities are no less significant: patients might have to be traced who may have come into contact with potentially contaminated equipment.

New record keeping systems are being set up for the future, but for incidents in the past the numbers could run into thousands.

All these issues have been considered by the CJD Incidents Panel which has now put its recommendations into the public domain for consultation.

See also:

23 Oct 01 | Wales
Surgery flaws pose CJD risk
10 Oct 01 | Health
CJD risk database proposed
06 Sep 01 | Sci/Tech
Q&A: What is CJD?
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