- Because Mad Cow/CJD prions can withstand temperatures
of approximately 1,000 F, the era of being able to adequately sterilize
reusable medical/dental surgical instruments with current technology such
as an autoclave is now past. We are calling for new universal sterile health
precautions and policies requiring that ALL invasive medical, surgical,
and dental instruments and devices may be used one time, and one time only,
after which they must be discarded safely and appropriately. The current
data suggest highest priority consideration of such a new policy at the
federal, state, and local levels to appropriately protect individuals who
entrust the medical and dental profession with their health and safety.
- British Women Fear CJD/Mad Cow
Infection From Unsterile Instruments
- LONDON (Reuters) - Seven
women in western England may have been infected with the human form of
mad cow disease while giving birth, but it is wrong to warn them because
they would only ``worry,'' a regional health authority said on Monday.
- Instruments used last year in a Caesarean section on
a woman who was later found to be suffering from a new variant of Creutzfeld-Jakob
Disease (CJD), were repeatedly reused after the October birth. It is now
believed the germ can survive the sterilization of surgical instruments.
- The woman's baby has since been found to suffer from
a neurological condition, sparking fears she may be the first British child
to inherit the illness from its mother.
- ``They (the instruments) had been used seven times,''
West Midlands Director of Health Dr Rod Griffiths told BBC radio. ''We
know who the patients are, but no (we haven't got in touch with them) because
ethically it's not at all clear whether that's the right thing to do,''
he said. Any risk was ''vanishingly small.''
- Griffiths said the fact there was as yet no clear proof
CJD could survive sterilization on the instruments -- used between October
26 last year and January 29 this year -- meant it would be irresponsible
to warn the women who may potentially have contracted it.
- ``If...I say to you, you may have been exposed to a germ,
we don't know whether there was any left on the kit or not, it might be
enough to give you the disease it might not, because we've no idea what
the effective dose is,'' he said, ``It doesn't seem to me to be the sensible
thing to do.''
- ``Once I've told you, you can forget getting life insurance
and you can worry about it for the rest of your life. Of course it may
never affect you at all,'' he added.
- While the hospital has not been named for legal reasons,
Griffiths said General Practitioners (GPs) in the West Midlands had been
told they can tell patients who fear they have been infected as long as
they ask first.
- ``I don't want to tell people unless they ask, because
if they ask it's a quite different game. But if I go out and give the bad
news it ruins their lives, when it need not,'' he said.
- Scientists say CJD is caused by eating meat from cows
infected with the fatal brain-wasting illness bovine spongiform encephalopathy
(BSE), or mad cow disease.
- Statistics show that nine people died last year from
the new variant of CJD, which occurs when a brain protein called a prion
changes and folds in an unusual way.
- Fear For Others Over CJD Mother's
Caesarean Surgical Instruments
- A Department of Health investigation is under way after
surgical instruments used to deliver a baby whose mother was suffering
from the human form of mad cow disease were unwittingly used by maternity
ward staff for two months after the birth.
- The instruments, which may have been contaminated with
the agent which causes new variant Creutzfeld Jakob Disease, were re-used
in a small number of Caesarean sections before the mother was diagnosed
as having the disease.
- Dr Rod Griffiths, the West Midlands' Director of Public
Health, said the risk that the women, thought to number less than 10, had
been infected with CJD during the subsequent births was "vanishingly
- Dr Griffiths added that staff at the hospital where the
baby was born had followed proper procedure, removing the surgical instruments
from use as soon as the mother's condition was known.
- The doctor added that it was theoretically possible for
the prion which causes CJD to remain on instruments after operations, but
it was usually removed simply by washing prior to sterilisation.
- The equipment which was re-used was properly washed and
sterilised between operations, Dr Griffiths added.
- The mother diagnosed as having CJD gave birth last autumn
at a Midlands hospital. Neither the mother nor the hospital can be named
for legal reasons.
- Her daughter is also thought to be suffering from a neurological
condition and doctors are awaiting the result of tests to see if she also
- The women involved in subsequent operations have not
been contacted by health officials, which is normal procedure where a level
of risk is not known, he added.
- The mother and baby were transferred to a second Midlands
hospital after the birth and staff at the other hospital acted within hours
of learning of the CJD diagnosis. Doctors believe the baby girl may be
the first child to be infected with CJD by her mother.
- Mad Cow/CJD May Be Transmitted Through Surgery
- By Steve Connor
- Science Editor - The Independent UK
- Scientists have found new evidence to suggest that the
human version of "mad cow" disease might be transmitted during
surgery via contaminated surgical instruments.
- A test for the new variant form of Creutzfeldt-Jakob
disease (nvCJD) shows the infectious agent responsible for the brain disorder
is present in tonsils and certain other tissues handled in thousands of
routine operations. Experts fear the nvCJD agent could survive the sterilisation
procedures for surgical instruments and bepassed from person to person
during hospital treatment.
- Government experts are drawing up a set of new guidelines
on the use of disposable scalpels, forceps and other surgical instruments
to limit the risks to patients. An anonymous mass screening programme is
also planned for later this year to detect people incubating nvCJD.
- Thousands of tonsils are to be tested at random over
the next few years to try to determine how many in the general population
are infected with the human form of bovine spongiform encephalopathy (BSE).
At present there are 35 confirmed cases of nvCJD, which scientists believe
developed as a result of people eating beef contaminated with BSE, but
there are fears that this might be the first signs of an epidemic. Attempts
to estimate the future course of the disease have been hampered by a lack
of knowledge and a suitable test for early diagnosis.
- Professor John Collinge, a consultant neurologist at
the Imperial College School of Medicine at St Mary's hospital in London,
said yesterday he has developed a tonsil test for nvCJD which will be used
in the mass screening programme to diagnose the infectious agent, believed
to be a rogue "prion" protein. Previously, doctors could only
reliably confirm nvCJD with an examination of the brain after death. "[The
prion] is present in every tissue of every case of nvCJD [we studied] and
it's present at quite considerable levels," Professor Collinge said.
"This has implications for the risk of the infection passing from
one person to anothers. We don't know yet the level of infectiousness in
- This raised the prospect of using disposable instruments
wherever possible because "there is no means of sterilising surgical
instruments adequately against prions".
- Research funded by the Medical Research Council and the
Wellcome Trust, published in The Lancet, shows that although the tonsil
test could detect the infectious prion protein in nvCJD cases, this was
not the case for "classical" CJD. Professor Collinge said this
shows how the rogue prion protein behaves quite differently to CJD.
- Professor Liam Donaldson, the Chief Medical Officer,
said last night: "Current policy based on advice from the Advisory
Committee on Dangerous Pathogens published in April 1998 is that when any
patient with symptoms of nvCJD, or suspected of having nvCJD, undergoes
surgical operation, the instruments must be removed so that they cannot
be used again."
- Mad Cow/CJD Warning Over Routine Surgical
- Australian researchers studying the risk factors linked
to sporadic CJD have found that the greatest is surgery for conditions
like hysterectomies and heart surgery.
- They think their findings could have implications for
"new variant CJD" caused by eating beef infected with bovine
spongiform encephalopathy (BSE).
- CJD - a degenerative, fatal brain disorder that leads
to progressive dementia and other conditions - comes in several forms.
The most common is sporadic CJD that mainly affects elderly people and
accounts for between 85 and 95% of cases worldwide.
- Risk Factors
- Scientists do not know what causes it, but researchers
from the Australian National Creutzfeldt-Jakob Disease Registry sought
to isolate some risk factors.
- They studied 241 definite and probable cases of CJD and
compared them with 784 healthy volunteers.
- The information on the CJD cases came from the registry's
records of cases between 1970 and 1993.
- The greatest risk factor was for people who had had three
or more operations, including hysterectomies, heart surgery, haemorrhoid
removal, cataracts, varicose veins and carpel tunnel syndrome.
- But people who had organ transplants, blood transfusions
and major dental work were at no increased risk.
- Other risk factors included living or working on a farm
or in a market garden for more than 10 years.
- However, people who worked in butchers shops or abattoirs
were not at any greater risk.
- Hospital Infection
- The researchers say their findings suggest that CJD could
be linked to infections transmitted during operations.
- Writing in the Lancet, they say they shoud "reinforce
the heightened vigilance about infection control at all levels of care
in hospital settings".
- Last year, there were some 39 cases of sporadic CJD in
the UK and 12 cases of new variant CJD.
- Recent UK research has suggested a link between new variant
CJD and surgical instruments.
- Some doctors have called for the introduction of disposable
instruments to prevent infection being spread.
- CJD - Opticians Ordered To Toss Contacts After
- By Adam Tanner
- Opticians have been ordered to throw away test contact
lenses after each use amid fears that they could transmit Creutzfeldt-Jakob
disease, the Department of Health has said.
- The Health Secretary Frank Dobson made the order in a
bid to prevent the fatal brain condition after receiving advice from experts
on the Spongiform Encephalopathy Advisory Committee (SEAC), a spokeswoman
- The move will mean that lenses intended for multiple
use are discarded after just one test.
- Outrageous - Single-Use Medical Devices Commonly
Re-Used In US
- The Daily News - UK
- Note - This is a criminally-negligent practice which
must be stopped. CJD/Mad Cow, HIV, Hep-C, and many other potentially fatal
viral and bacterial diseases can be spread this way. Additionally, routine
sterilization procedures are NOT always applied and performed properly
in the medical and dental professions. Even if they were, temperatures
in excess of 1,000 degrees F are needed to destroy CJD/Mad Cow prions.
In other words, no normal sterilization procedure, even if done letter-perfectly,
can destroy CJD prions. And how many prions does it take to become infected?
- Also, keep in mind the long incubation periods of these
diseases. If you have a procedure done with a non-sterile, contaminated
and/or re-used needle, catheter, or other invasive medical or dental device...and
you become ill a year or several years later with CJD, AIDS, or Hep C...who
would know, or who could prove that a tainted medical device was responsible?
- NEW YORK (Reuters) - In hospitals and clinics around
the United States, biopsy needles, catheters and other internal medical
devices frequently are being reused despite labeling that stipulates ``single-use
only,'' the New York Times reported Wednesday.
- The practice of reusing such devices is not necessarily
dangerous, experts told the Times, but it generally violates federal regulations.
- So far, the federal government has not asked the companies
that reprocess the devices to show evidence that they are safe and effective,
but under pressure from device makers it is now reconsidering its approach,
the Times said.
- ``We have used what we call enforcement discretion not
to go after them,'' Larry Kessler, director of the office of surveillance
and biometrics at the Food and Drug Administration, told the Times. One
reason is that the agency has little evidence of a safety problem, Kessler
said, although it is believed that research is urgently needed.
- Some doctors and federal officials say the issue is more
about economics than safety, as device makers make less money when single-use
devices are cleaned, sterilized and reused, the Times said.
- Doctors say the devices cost so much that they often
cannot afford to use devices just once, but device makers contend that
hospitals are putting patients at risk to save money, the Times said.
- The FDA is considering requiring the device-reprocessing
companies to show safety and effectiveness of the resold products, and
requiring that device makers label their products with the risks from reprocessing.
The agency is posting the proposal on its Web site, and will hold a satellite
teleconference Wednesday in which the device makers, reprocessing companies,
doctors, hospitals and ethicists can comment, the paper said.
- Thousands Face New Tonsil Test For Mad Cow/CJD
- ITV Teletext Service UK
- Thousands of people are to be tested for CJD after scientists
discovered evidence of the human form of cow disease in people's tonsils.
- The find means it may be possible in the next three years
to establish if a CJD time bomb is ticking within Britain's population.
- It also raises concerns about the rise of infection from
- Scientists have developed a test for CJD which could
show the extent of the disease in the population.
- Until now it has only been possible to diagnose cases
of new variant CJD, the disease linked to BSE in cattle, after death.
- The test involves taking tissue from the tonsils and
can be conducted on living people.
- The findings could eventually mean scientists will be
able to develop a test which could diagnose people with nvCJD as soon as
they are infected.
- Research can now be done on material from tonsillectomies
to estimate the extent of nvCJD - which has a long incubation period -
in the general population.
- But the findings also raise concern about infection caused
by the rogue proteins that spread the disease and cannot be cleaned from
surgical instruments no matter how thoroughly they are sterilised.
- Writing in The Lancet, the scientists led by Professor
John Collinge at the Imperial College School of Medicine at St Mary's Hospital
in London, say they tested tonsil tissue from 20 patients in the late stages
of suspected prion disease.
- An abnormal form of the protease-resistant prion protein
is thought to cause the breakdown of brain cells associated with nvCJD.
- Prions reproduce in the tissues of the immune system,
including the tonsils.
- Because of the theoretical possibility that the disease
could be spread by surgery to the infected organs Professor Collinge recommends
that for such operations only disposable surgical instruments be used.
- The infection can withstand high temperatures which make
the usual sterilisation procedures ineffective.
- Dr Stephen Dealer, from the BSE Research Campaign, said
the findings would help to assess the risk from surgical instruments.
- "This is one of the reasons why John Collinge's
test may be so wonderful. It will give use some insight into just how big
that risk is. This is a very important finding," he told BBC Radio
- Thirty-three cases of nvCJD in the UK and one case in
France have been confirmed since 1996.
- The researchers also tested tonsil, spleen and lymph
node tissues from patients who had died of the disease.
- They found that all immune system tissue obtained from
dead patients whose CJD had been confirmed by brain biopsies contained
the rogue prion.
- Different progression
- Tonsil biopsies of living patients found the tissue was
positive for the prion in the three cases which were confirmed on death
to have the disease.
- The research also showed that nvCJD has a different progression
from normal CJD and may spend longer in the immune system.
- This suggests it could present greater dangers of infecting
people through blood tranfusions, organ transplants and tissue-sharing.
- They believe the difference in progression may be due
to the suspected root of exposure - through eating BSE-infected meat.
- This could suggest that the people who have developed
nvCJD have immune systems which are particularly susceptible to nvCJD.
- The scientists believe they may eventually be able to
develop a test which is sensitive enough to detect prion infection at an
early stage of infection.
- Definite diagnosis
- Professor Collinge, whose research is funded by the Wellcome
Trust and the Medical Research Council, said: "This new test has already
proven very helpful in the diagnosis of new variant CJD.
- "While, unfortunately, we have at present no means
to treat this dreadful disease, we can at least now provide a definite
diagnosis at an earlier stage."
- He said research needed to continue to identify whether
it would be possible to detect the disease through a simple blood test.
- Excite UK Channels News New CJD Fears
After Test Finds Disease In Tonsils
- Scientists have discovered evidence of CJD, the human
form of mad cow disease, in people's tonsils.
- The find means it may be possible in the next three years
to establish if a CJD time bomb is ticking within Britain's population.
- But it also raises renewed concerns about the risk of
infection from surgical equipment in hospitals, the expert behind the discovery
- Scientists plan to screen thousands of people using the
new test. A significant positive result would provide early warning of
a major epidemic to come and allow time for action aimed at averting the
- Professor John Collinge, from St Mary's Hospital, London,
said: "If we were to screen several thousand tonsils and found that
several were positive that would be a real cause for concern."
- The concern about infection raised by the new findings
centres on rogue prion proteins that spread the disease and cannot be cleaned
from surgical instruments no matter how thoroughly they are sterilised.