UK Medicine Yields To vCJD -
All Tonsillectomy Instruments
Now Disposable
From Patricia Doyle <>
From ProMED-mail <>

The National Heath Service (NHS) is to spend millions of pounds to prevent any risk of people contracting the human form of BSE [variant CJD] during surgery. From now on, surgeons will have to use disposable instruments when they carry out tonsil surgery, at a cost to the NHS of £25 million a year.
As part of the program, the government is giving hospitals a further £200 million to modernize NHS decontamination and sterilization facilities to prevent transmission of variant CJD. The Department of Health stresses that the risk of contracting variant CJD during surgery is only theoretical. Disposable equipment for other types of surgery may be introduced at a later date.
Deputy Chief Medical Officer for England and Wales, Dr. Pat Troop, said: "We still do not know how many people might be incubating variant CJD. There is a theoretical risk that it could be passed on through surgical operations from those who have yet to show symptoms of the disease. The highest standards of decontamination are the cornerstone of our strategy to reduce the risks." She said the government was following advice from the Spongiform Encephalopathy Advisory Committee (SEAC) in addressing tonsillectomy operations at this stage.
Health minister John Denham said: "We have no evidence of any patient being infected with variant CJD in hospital. But while we are still learning about the progress of variant CJD, we should take precautions to reduce the theoretical risk of transmission to patients. He said there were no moves as yet to extend single-use instruments to other types of [surgery]. "SEAC said tonsils were an area where practical steps could be made and that's what we're doing. In other areas of surgery, it would be some time before it was practical to introduce single-use instruments. By that time, we will know more about the process of transmission and be able to take a sensible decision then."
The Royal College of Surgeons backed the measures, and said it would work with the Department of Health and instrument manufacturers to ensure single use instruments are available as soon as possible for tonsil surgery. In 1996, almost 59 000 patients had tonsillectomies.
Dr. John Collinge, a Medical Research Council Scientist, has been calling for action from the government for the last 3 years. He said it was known that [variant CJD] prions, in addition to being found in tonsils, were concentrated in the brain and the spinal column, the spleen, and probably also in the eye. He told the BBC: "Operations involving those kinds of areas are the ones we're most concerned about." But he added: "Tonsillectomy, which is a common procedure carried out on young people, particularly children, is a wise place to start."
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