Is There the Potential for an Epidemic of Variant Creutzfeldt-Jakob Disease Via Blood Transfusion in the UK?

Overview

Journal J R Soc Interface

Specialties Biology
Biomedical Engineering
Biophysics

Date 2007 Feb 9

PMID 17287181

Citations 10

Authors

Paul Clarke

Robert G Will

Azra C Ghani

Affiliations

Soon will be listed here.

Abstract

The discovery of three individuals suspected to have contracted variant Creutzfeldt-Jakob disease (vCJD) through blood transfusions has heightened concerns that a secondary epidemic via human-to-human transmission could occur in the UK. The Department of Health responded immediately to this threat by banning those who had received blood transfusions since 1980 from donating blood. In this paper, we conduct a sensitivity analysis to explore the potential size of a blood-borne vCJD epidemic and investigate the effectiveness of public health interventions. A mathematical model was developed together with an expression for the basic reproduction number (R0). The sensitivity of model predictions to unknown parameters determining the transmission of vCJD via infected blood was assessed under pessimistic modelling assumptions. We found that the size of the epidemic (up until 2080) was bounded above by 900 cases, with self-sustaining epidemics (R0>1) also possible; but the scenarios under which such epidemics could arise were found to be biologically implausible. Under optimistic assumptions, public health interventions reduced the upper bound to 250 and further still when only biologically plausible scenarios were considered. Our results support the belief that scenarios leading to large or self-sustaining epidemics are possible but unlikely, and that public health interventions were effective.

Citing Articles

The importance of ongoing international surveillance for Creutzfeldt-Jakob disease.

Watson N, Brandel J, Green A, Hermann P, Ladogana A, Lindsay T Nat Rev Neurol. 2021; 17(6):362-379.

PMID: 33972773 PMC: 8109225. DOI: 10.1038/s41582-021-00488-7.

PMCA Applications for Prion Detection in Peripheral Tissues of Patients with Variant Creutzfeldt-Jakob Disease.

Giaccone G, Moda F Biomolecules. 2020; 10(3).

PMID: 32151109 PMC: 7175161. DOI: 10.3390/biom10030405.

Initial Results of a Prospective Study and Identification of New Strategies to Increase Traceability of Plasma-derived Medicines.

Najafi S, Farahani A, Keshavarz-Bahaghighat H Iran J Pharm Res. 2018; 17(Suppl):145-150.

PMID: 29796039 PMC: 5958334.

Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use.

Cicchetti A, Berrino A, Casini M, Codella P, Facco G, Fiore A Blood Transfus. 2016; 14(4):287-386.

PMID: 27403740 PMC: 4942318. DOI: 10.2450/2016.0065-16.

Prion infectivity in the spleen of a PRNP heterozygous individual with subclinical variant Creutzfeldt-Jakob disease.

Bishop M, Diack A, Ritchie D, Ironside J, Will R, Manson J Brain. 2013; 136(Pt 4):1139-45.

PMID: 23449776 PMC: 3613713. DOI: 10.1093/brain/awt032.

References

Peden A, Head M, Ritchie D, Bell J, Ironside J . Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient. Lancet. 2004; 364(9433):527-9. DOI: 10.1016/S0140-6736(04)16811-6. View

Gregori L, McCombie N, Palmer D, Birch P, Sowemimo-Coker S, Giulivi A . Effectiveness of leucoreduction for removal of infectivity of transmissible spongiform encephalopathies from blood. Lancet. 2004; 364(9433):529-31. DOI: 10.1016/S0140-6736(04)16812-8. View

Kimberlin R, Walker C . Pathogenesis of mouse scrapie: effect of route of inoculation on infectivity titres and dose-response curves. J Comp Pathol. 1978; 88(1):39-47. DOI: 10.1016/0021-9975(78)90059-2. View

Diekmann O, Heesterbeek J, Metz J . On the definition and the computation of the basic reproduction ratio R0 in models for infectious diseases in heterogeneous populations. J Math Biol. 1990; 28(4):365-82. DOI: 10.1007/BF00178324. View

Bruce M, Chree A, McConnell I, Foster J, Pearson G, Fraser H . Transmission of bovine spongiform encephalopathy and scrapie to mice: strain variation and the species barrier. Philos Trans R Soc Lond B Biol Sci. 1994; 343(1306):405-11. DOI: 10.1098/rstb.1994.0036. View

Hill A, Desbruslais M, Joiner S, Sidle K, Gowland I, Collinge J . The same prion strain causes vCJD and BSE. Nature. 1997; 389(6650):448-50, 526. DOI: 10.1038/38925. View

Bruce M, Will R, Ironside J, McConnell I, Drummond D, Suttie A . Transmissions to mice indicate that 'new variant' CJD is caused by the BSE agent. Nature. 1997; 389(6650):498-501. DOI: 10.1038/39057. View

Ghani A, Ferguson N, Donnelly C, Hagenaars T, Anderson R . Epidemiological determinants of the pattern and magnitude of the vCJD epidemic in Great Britain. Proc Biol Sci. 1999; 265(1413):2443-52. PMC: 1689535. DOI: 10.1098/rspb.1998.0596. View

Farrugia A, Ironside J, Giangrande P . Variant Creutzfeldt-Jakob disease transmission by plasma products: assessing and communicating risk in an era of scientific uncertainty. Vox Sang. 2005; 89(4):186-92. DOI: 10.1111/j.1423-0410.2005.00702.x. View

10.

Hilton D . Pathogenesis and prevalence of variant Creutzfeldt-Jakob disease. J Pathol. 2005; 208(2):134-41. DOI: 10.1002/path.1880. View

11.

Ironside J . Variant Creutzfeldt-Jakob disease: risk of transmission by blood transfusion and blood therapies. Haemophilia. 2006; 12 Suppl 1:8-15. DOI: 10.1111/j.1365-2516.2006.01195.x. View

12.

Dolan G . Clinical implications of emerging pathogens in haemophilia: the variant Creutzfeldt-Jakob disease experience. Haemophilia. 2006; 12 Suppl 1:16-20. DOI: 10.1111/j.1365-2516.2006.01196.x. View

13.

Bishop M, Hart P, Aitchison L, Baybutt H, Plinston C, Thomson V . Predicting susceptibility and incubation time of human-to-human transmission of vCJD. Lancet Neurol. 2006; 5(5):393-8. DOI: 10.1016/S1474-4422(06)70413-6. View

14.

Ironside J, Bishop M, Connolly K, Hegazy D, Lowrie S, Le Grice M . Variant Creutzfeldt-Jakob disease: prion protein genotype analysis of positive appendix tissue samples from a retrospective prevalence study. BMJ. 2006; 332(7551):1186-8. PMC: 1463905. DOI: 10.1136/bmj.38804.511644.55. View

15.

Clarke P, Ghani A . Projections of the future course of the primary vCJD epidemic in the UK: inclusion of subclinical infection and the possibility of wider genetic susceptibility. J R Soc Interface. 2006; 2(2):19-31. PMC: 1578257. DOI: 10.1098/rsif.2004.0017. View

16.

Hewitt P, Llewelyn C, Mackenzie J, Will R . Creutzfeldt-Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study. Vox Sang. 2006; 91(3):221-30. DOI: 10.1111/j.1423-0410.2006.00833.x. View

17.

Garske T, Ward H, Clarke P, Will R, Ghani A . Factors determining the potential for onward transmission of variant Creutzfeldt-Jakob disease via surgical instruments. J R Soc Interface. 2006; 3(11):757-66. PMC: 1885367. DOI: 10.1098/rsif.2006.0142. View

18.

Scott M, Will R, Ironside J, Nguyen H, Tremblay P, DeArmond S . Compelling transgenetic evidence for transmission of bovine spongiform encephalopathy prions to humans. Proc Natl Acad Sci U S A. 1999; 96(26):15137-42. PMC: 24786. DOI: 10.1073/pnas.96.26.15137. View

19.

Ghani A, Ferguson N, Donnelly C, Anderson R . Predicted vCJD mortality in Great Britain. Nature. 2000; 406(6796):583-4. DOI: 10.1038/35020688. View

20.

Wells A, Mounter P, Chapman C, Stainsby D, Wallis J . Where does blood go? Prospective observational study of red cell transfusion in north England. BMJ. 2002; 325(7368):803. PMC: 128945. DOI: 10.1136/bmj.325.7368.803. View