title: Uncertainty in the tail of the variant Creutzfeldt-Jakob disease epidemic in the UK.
abstract: Despite low case numbers the variant Creutzfeldt-Jakob disease epidemic poses many challenges for public health planning due to remaining uncertainties in disease biology and transmission routes. We develop a stochastic model for variant CJD transmission, taking into account the known transmission routes (food and red-cell transfusion) to assess the remaining uncertainty in the epidemic. We use Bayesian methods to obtain scenarios consistent with current data. Our results show a potentially long but uncertain tail in the epidemic, with a peak annual incidence of around 11 cases, but the 95% credibility interval between 1 and 65 cases. These cases are predicted to be due to past food-borne transmissions occurring in previously mostly unaffected genotypes and to transmissions via blood transfusion in all genotypes. However, we also show that the latter are unlikely to be identifiable as transfusion-associated cases by case-linking. Regardless of the numbers of future cases, even in the absence of any further control measures, we do not find any self-sustaining epidemics.
authors.affiliation: Department of Infectious Disease Epidemiology, Medical Research Council Centre of Outbreak Analysis and Modelling, Imperial College London, London, United Kingdom. t.garske@imperial.ac.uk
authors.forename: Tini
authors.initials: T
authors.lastname: Garske
authors.forename: Azra C
authors.initials: AC
authors.lastname: Ghani
mesh_terms: D001499:Bayes Theorem; D003062:Codon; D015331:Cohort Studies; D007562:Creutzfeldt-Jakob Syndrome / Q000453:epidemiology* / Q000235:genetics*; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D015233:Models, Statistical; D008962:Models, Theoretical; D013269:Stochastic Processes; D065227:Transfusion Reaction; D006113:United Kingdom
chemical_list: D003062:Codon