title: Can a second wave of new variant of the CJD be discarded in absence of observation of clinical non Met-Met cases?
abstract: BACKGROUND
  Presently, all patients with clinical variant Creutzfeldt-Jakob disease in the United Kingdom have been Met-Met at codon 129 of the PrP gene. There is much worry about the possibility of a second wave of the epidemic in the 60% of the United Kingdom population which are not Met-Met.
  
  
  METHODS
  A mathematical model of a putative United Kingdom variant Creutzfeldt-Jakob disease epidemic that could occur in non Met-Met is derived. The risk of infection is assumed to parallel the Met-Met risk which has been previously modelled. The reason for the present absence of clinical non Met-Met cases is assumed to be a longer incubation period in these subjects than in others. The incubation period is assumed to be lognormally distributed. The means and coefficients of variation compatible with the present absence of clinical cases are systematically searched.
  
  
  RESULTS
  We show that the present absence of clinical cases of variant Creutzfeldt-Jakob disease in the Met-Val or Val-Val population can be compatible with a second wave only if the mean incubation period is more than 25 years. The best estimates of the size of the second wave are always below 250. A fraction of these cases however will never be observed, as they will die from other causes before the onset of the new variant.
  
  
  CONCLUSIONS
  The mean incubation period values compatible with the absence of non Met-Met clinical cases that we found are not implausible, and the possibility of a second wave cannot yet be ruled out. However, should this second wave occur, it would be below 250 in the worst hypothesis.
authors.affiliation: Unité 707 Epidémiologie, Systèmes d'information et Modélisation, INSERM et Université Pierre-et-Marie-Curie, Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12. alain-jacques.valleron@upmc.fr
authors.forename: A J
authors.initials: AJ
authors.lastname: Valleron
authors.forename: P Y
authors.initials: PY
authors.lastname: Boelle
authors.forename: E
authors.initials: E
authors.lastname: Chatignoux
authors.forename: J Y
authors.initials: JY
authors.lastname: Cesbron
mesh_terms: D007562:Creutzfeldt-Jakob Syndrome / Q000453:epidemiology*; D006801:Humans; D008715:Methionine; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D008715:Methionine