title: Estimation of the size of the iatrogenic Creutzfeldt-Jakob disease outbreak associated with cadaveric dura mater grafts in Korea.
abstract: OBJECTIVE
  This study estimated the overall incidence of iatrogenic Creutzfeldt-Jakob disease (iCJD) based on dura graft cases in Korea using a mathematical model.
  
  
  METHODS
  We estimated the number of annual dura grafts performed between 1980 and 1995 by applying the proportion of dura grafts recorded by the Health Insurance Review Agency claim dataset in Korea to the number of nationwide neurosurgery cases. The distribution of the incubation period was assumed to fall under a Weibull distribution with density function or a log-logistic distribution with density function.
  
  
  RESULTS
  The total number of neurosurgery procedures performed from 1980 to 1995 was estimated to be 263,945, and among those operations, 37% used dura graft products. Between the years of 1980 and 2020, our model predicted that the total number of iCJD cases would be between 14.9 and 33.2 (95% confidence interval [CI], 13.4 to 50.9). Notably, we estimated that the cumulative number of iCJD cases caused by dura grafts between 1980 and 2011 was approximately 13.3 to 27.3 (95% CI, 12.2 to 40.6).
  
  
  CONCLUSIONS
  Based on our model, we postulate that the incidence of iCJD will sharply decline from 2012 to 2020. However, additional new cases are still expected, which necessitates a strong national surveillance system.
authors.affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
authors.forename: Byoung-Hak
authors.initials: BH
authors.lastname: Jeon
authors.affiliation: Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea.
authors.forename: Jinseob
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, National Medical Center, Seoul, Korea.
authors.forename: Ganghyun
authors.initials: G
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yonsei University of College of Medicine, Seoul, Korea.
authors.forename: Soochul
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: SangYun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
authors.forename: Hae-Kwan
authors.initials: HK
authors.lastname: Cheong
keywords: Creutzfeldt-Jakob disease; Dura mater; Incubation period; Modeling; Prediction; Prion diseases; Surveillance