Volume 199 - Issue 8
Updated Creutzfeldt–Jakob disease infection control guidelines: sifting facts from fiction
Authors: Steven J Collins, Eugene Athan and Ann P Koehler
Med J Aust 2013; 199 (8): 535-536. || doi: 10.5694/mja13.10475
Published online: 21 October 2013
Published online: 21 October 2013
In reply: We thank Hodgson for sharing his concerns, affording us the opportunity to reassure the medical and non-medical communities about the utility of recently revised infection control guidelines for Creutzfeldt-Jakob disease (CJD).1 We reiterate that sporadic CJD is already endemic in Australia, necessitating guidelines that are regularly updated to ensure relevant scientific developments are incorporated, and that variant CJD (a zoonosis related to “mad ...
In reply: We thank Hodgson for sharing his concerns, affording us the opportunity to reassure the medical and non-medical communities about the utility of recently revised infection control guidelines for Creutzfeldt–Jakob disease (CJD).1 We reiterate that sporadic CJD is already endemic in Australia, necessitating guidelines that are regularly updated to ensure relevant scientific developments are incorporated, and that variant CJD (a zoonosis related to “mad cow” disease) has not occurred in this country.
Stratification of transmission risk for organs and tissues2 has evolved and is based on considerable data. There are limitations, based on the translational relevance of animal models or occasional incompleteness, but it is a robust and valuable resource for guiding risk minimisation in health care settings.
Convincing epidemiological evidence supporting CJD transmission through major dental procedures is lacking.3 Although temporally remote surgery may pose a risk,3,4 heightened international surveillance efforts mean that direct CJD transmission through contaminated surgical instruments has not been clearly documented for 36 years.5 This encompasses concerns of first-degree relatives of people with possible genetic CJD. Such observations probably underscore improved routine hospital instrument cleaning and sterilisation, measures which reduce prion infectivity by ≥ 2–3 ID50 logs,6 levels aligning to those of low-risk or no-risk tissues.
Competing interests
No relevant disclosures.
References
- Australian Government Department of Health and Ageing. Creutzfeldt-Jakob disease infection control guidelines. Canberra: DoHA, 2013. http://www.health.gov.au/internet/main/publishing.nsf/content/icg-guidelines-index.htm (accessed Aug 2013).
- World Health Organization. WHO tables on tissue infectivity distribution in transmissible spongiform encephalopathies. Geneva: WHO, 2010. http://www.who.int/bloodproducts/tablestissueinfectivity.pdf (accessed Aug 2013).
- Collins S, Law M, Fletcher A, et al. Surgical treatment and risk of sporadic Creutzfeldt–Jakob disease: a case control study. Lancet 1999; 353: 693-697. 0_pgfId-2878442
- Mahillo-Fernandez I, de Pedro-Cuesta J, Bleda MJ, et al. Surgery and risk of sporadic Creutzfeldt–Jakob disease in Denmark and Sweden: registry-based case–control studies. Neuroepidemiology 2008; 31: 229-240. 0_CBBFBFDD
- Bernoulli C, Siegfried J, Baumgartner G, et al. Danger of accidental person-to-person transmission of Creutzfeldt–Jakob disease by surgery. Lancet 1977; 1: 478-479. 0_CBBBJIEB
- Taguchi F, Tamai Y, Uchida K, et al. Proposal for a procedure for complete inactivation of the Creutzfeldt–Jakob disease agent. Arch Virol 1991; 119: 297-301. 0_CBBHDEFA