Updated Creutzfeldt–Jakob disease infection control guidelines: sifting facts from fiction

To the Editor: The editorial by Koehler and colleagues on the updated Australian Creutzfeldt–Jakob disease (CJD) guidelines has left me confused.1 I believe that adherence to the guidelines could contribute to CJD and variant CJD changing from sporadic to endemic diseases.

My concerns relate to the tables of criteria used to assess patient and tissue risk, and the sterilisation recommendations associated with them.2 Consider a patient presenting for a dental procedure involving bone. The patient’s mother is the only relative with proven CJD or a diagnosis that could be confused with it. There are no genetic tests available. The guidelines assess this patient as having “background” risk (ie, no increased risk), the tissue is considered low or no risk, and no special precautions are required with sterilisation.2

The CJD support network provides the following data about patient risk:3 10%–15% of CJD is genetic with an autosomal dominant inheritance, and 40% of families have no history of dementia or CJD. This equates to this patient having a genetic risk of CJD of 2%–3%; considerably more than one in one million per head of population per year.4

The guidelines indicate that the tissue risk criteria table data are from many animal models with varying prion diseases.2 This information differs markedly from data on infective spongiform encephalopathies available from the World Health Organization.5

There is abundant evidence of infection and inoculation within the distribution of the trigeminal nerve.5 This is relevant to dental procedures, where amplification of the disease may occur.

Experimental methods of sterilisation give no assurance that a hospital is delivering equipment free of prions. The guidelines offer no suggestion on how to confirm that no prions are present. I trust my fears are unfounded.