title: Managing the risk of iatrogenic transmission of Creutzfeldt-Jakob disease in the UK.
abstract: BACKGROUND
  With the emergence of bovine spongiform encephalopathy (BSE) and variant Creutzfeldt-Jakob disease (CJD) in the UK, there is concern about iatrogenic transmission, and the approach to managing this risk is unique.
  
  
  OBJECTIVE
  To describe and review CJD incident management and the notification of individuals 'at increased risk' as a strategy for reducing iatrogenic transmission.
  
  
  METHODS
  A description of iatrogenic CJD transmission, the CJD Incidents Panel's role, the number and nature of CJD incidents reported and the individuals considered 'at increased risk' by mid-2012.
  
  
  RESULTS
  Seventy-seven UK cases of CJD are likely to have resulted from iatrogenic transmission, among recipients of human-derived growth hormone (64 cases), dura mater grafts (eight cases), blood transfusions (four cases) and plasma products (one case). To limit transmission, the Panel reviewed 490 incidents and advised on look-backs, recalls of blood and plasma products, and quarantining and disposing of surgical instruments. Additionally, on Panel advice, around 6000 asymptomatic individuals have been informed they are at increased risk of CJD and have been asked to follow public health precautions.
  
  
  CONCLUSIONS
  The strategy to reduce iatrogenic transmission of CJD has been developed in a context of scientific uncertainty. The rarity of transmission events could indicate that incident-related exposures present negligible transmission risks, or--given the prolonged incubation and subclinical phenotypes of CJD--infections could be yet to occur or have been undetected. Scientific developments, including better estimates of infection prevalence, a screening test, or improvements in decontaminating surgical instruments, may change future risk management.
authors.affiliation: CJD Section, Health Protection Services, Public Health England, London, UK. Electronic address: victoria.hall4@nhs.net.
authors.forename: V
authors.initials: V
authors.lastname: Hall
authors.affiliation: CJD Section, Health Protection Services, Public Health England, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Brookes
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Nacul
authors.affiliation: CJD Section, Health Protection Services, Public Health England, London, UK.
authors.forename: O N
authors.initials: ON
authors.lastname: Gill
authors.affiliation: CJD Section, Health Protection Services, Public Health England, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Connor
mesh_terms: D007562:Creutzfeldt-Jakob Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D017053:Infection Control / Q000379:methods*; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology
keywords: Bovine spongiform encephalopathy; Creutzfeldt–Jakob disease; Infection prevention; Management; Transmission