UK Won't Ban Reusable
Surgical Instruments In
Tonsil Removal Despite
vCJD Concerns
By Andy Coghlan
Britain's Department of Health has ruled out a ban on reusable surgical instruments for tonsil removal, despite fears they could pass the human form of mad cow disease from patient to patient.
John Collinge, a senior adviser to the British government on BSE, warned on Wednesday that up to half the tonsilectomy kits used in British hospitals might now be infected with the infectious agent which causes BSE in cows and variant Creutzfeldt-Jakob Disease (vCJD) in humans (details here).
Collinge, at Imperial College School of Medicine, London, is a member of the government's Spongiform Encephalopathies Advisory Committee (SEAC). He says that tonsils from people who have contracted vCJD contain large amounts of the infectious agent, a mutant protein called the PrPSC prion.
Prions are extremely difficult to destroy by conventional sterilisation, so Collinge fears that instruments used in tonsilectomies might be especially prone to contamination. If an infected person is operated on, the prions might remain on the instruments and infect the next patient.
"Theoretical risk"
The Department of Health says that if Collinge has new evidence to support his arguments, he should present them to SEAC. "Our advice to health authorities and trusts continues to be that they should sterilise all equipment thoroughly," says a spokesman.
"If Collinge is raising a specific warning on tonsils, it's likely SEAC would want to consider the evidence he's put forward in the same way they did on dental instruments," says the spokesman.
SEAC concluded that there is a theoretical risk that prions could survive on dental instruments, particularly after invasive procedures such as root canal work. "But it remains theoretical," says the spokesman.
"All we can say is that the advice from SEAC and the CJD Surveillance Unit in Edinburgh is that there's a surgical risk, but that there's no instance anywhere in the world of CJD being passed on through surgical instruments," says the spokesman.
Work to investigate tonsils is under way, however. "There are two tonsil studies commissioned by the department looking at thousands of tonsils to find the instance of prion proteins in them," the spokesman says. "The whole issue of reusable instruments is one that SEAC is due to consider at some point."