Mad Cow Fears Rise
Over Prion-Contaminated
Reusable Surgical Instruments
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. - Ed
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 small".
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 has CJD.
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 those tissues."
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 Procedures
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 Each Use
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 confirmed.
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? -ed
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 Infection
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 surgical equipment.
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 5 Live.
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 said.
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 disaster.
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.
In future therefore it may be necessary to introduce disposable instruments for certain procedures. A special committee of experts advising the Government is already looking at this issue.
Animal studies have shown that spongiform encephalopathy diseases, which include different forms of CJD, BSE in cattle and the sheep infection scrapie, tend to reside in the lymph system before attacking the brain. Tonsils are linked to the lymph system.
The new research by Professor Collinge's team showed this also appeared to be the way new variant CJD behaved in humans.
But only the new variant form of CJD, which is effectively mad cow disease transferred to humans through infected beef, was detected in tonsils. The "classical" form of CJD, which appears for no known reason in one person in a million, was not seen in the tissue samples.



This Site Served by TheHostPros