PubMed · 12555721
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Marimargaret Reichert, Janet K Schultz. 2003. Thinking about eye instruments and CJD.. https://pubmed.ncbi.nlm.nih.gov/12555721/
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The emergence of variant CJD (vCJD) in the last decade has heightened awareness of the need for rigorous infection control precautions in all healthcare environments. It has also raised particular problems in relation to the clinical management of patients who are either suffering from prion diseases or who are perceived as being 'at risk'. From the healthcare perspective CJD is of concern because at present it is an incurable, fatal disease and the causative agent, abnormal prion protein, is resistant to conventional inactivation procedures. Many healthcare workers are concerned about the risks of cross-infection when treating such patients. There are a number of guidelines for the management of CJD patients, though the information they provide sometimes appears contradictory and may require some interpretation in the clinical setting. This paper is based on real-life case scenarios and the advice given to dentists for the management of a group of patients with different manifestations of prion diseases.
Amongst fears about iatrogenic transmission of new variant Creutzfeldt-Jakob disease (vCJD), last year the Department of Health of the U.K. advised that all adenotonsillectomies be performed using disposable instruments. Following implementation of these guidelines, many consultants reported an increase in post-tonsillectomy haemorrhage in association with the use of disposable instruments. We have undertaken a retrospective study of tonsillectomy and have confirmed a significant increase in the incidence of return to the theatre for arrest of postoperative haemorrhage (5.32% vs. 2.18%) during the period when disposable instruments were used.
BACKGROUND: Past projections of the future course of the vCJD epidemic in the UK have shown considerable uncertainty, with wide confidence bounds. However, recent vCJD case data have indicated a decrease in the annual incidence of deaths over the past two years. METHODS: A detailed survival model is fitted to the 121 vCJD deaths reported by the end of 2002 stratified by age and calendar time to obtain projections of future incidence. The model is additionally fitted to recent results from a survey of appendix tissues. RESULTS: Our results show a substantial decrease in the uncertainty of the future course of the primary epidemic in the susceptible genotype (MM-homozygous at codon 129 of the prion protein gene), with a best estimate of 40 future deaths (95% prediction interval 9-540) based on fitting to the vCJD case data alone. Additional fitting of the appendix data increases these estimates (best estimate 100, 95% prediction interval 10-2,600) but remains lower than previous projections. CONCLUSIONS: The primary vCJD epidemic in the known susceptible genotype in the UK appears to be in decline.