Monday, May 16, 2011

Does Poor Dental Health Have a Role in the Emergence of Variant Creutzfeldt Jakob Disease in the United Kingdom?

Does Poor Dental Health Have a Role in the Emergence of Variant Creutzfeldt Jakob Disease in the United Kingdom?


Robert Burnie, Roland L Salmon, Daniel R Thomas, Nigel Monaghan


Abstract


Introduction: Variant creutzfeldt jakob disease (vCJD) is the human neurological disease known to be caused by the same proteinaceous infectious agent (“prion”) that causes Bovine Spongiform Encephalopathy or "Mad Cow Disease". Two unusual and unexplained characteristics of the vCJD epidemic are its geographical distribution within the UK (about twice as frequent in Scotland and Northern England) and its median age of onset of 26 years that has remained unchanged over the fifteen years of the epidemic.

The hypothesis: Infection via the dental route as a consequence of poor dental health, most probably the presence of untreated decay may account for the geographical distribution of vCJD in the UK and offer an explanation for the constant median age of onset of the disease by representing a fixed stage in development.

Evaluation of the hypothesis: Analysis of existing data indicates that vCJD incidence by region and an index of dental health by region are positively correlated (r=0.737, p= 0.015). The hypothesis that infection via the dental route may explain the constant median age of onset and geographical distribution of vCJD could be investigated further with a case control study based on individual dental records and by further animal experiments to confirm the biological plausibility of this route.


Key words: Variant creutzfeldt jakob disease; Infection; Dental health; Epidemiology.


doi:10.5436/j.dehy.2011.2.00030


snip...




An alternative explanation for the asso-ciation between regional dental health and vCJD incidence is that the missing teeth(MT) and filled teeth(FT) components of DMFT scores represent a marker for the number of dental procedures, that is to say for dental treatment. Dental proce-dures, particularly dental extraction, root filling, or gum treatment, may represent a theoretical pathway of secondary trans-mission. The resistance of prions to stan-dard decontamination techniques [19], the potential for instruments to remain con-taminated with protein residue material after cleaning and the potential for endo-dontic instruments to come into intimate contact with peripheral branches of the trigeminal nerve [20] make transmission via this route biologically plausible. The UK National CJD Surveillance Unit re-ports that preliminary data from animal studies carried out by the Health Protec-tion Agency have indicated that the risk of

transmission of vCJD via dentistry may be higher than previously considered [21]. Whilst there is currently no evidence of vCJD having been spread by dentistry, even a very small risk of transmission has significant public health implications due to the considerable number of dental pro-cedures carried out each year [22].



Analysis of the variation in dental health and dental histories of those with vCJD in the UK and France could also be informative. Interestingly, in France the median age of death of 23 cases of vCJD is 36 years [23]. Could this be a reflection of better oral health among children or dif-ferences in treating dental decay in child-hood?





References


The National Creutzfeldt-Jakob Disease Research & Surveillance Unit (NCJDRSU). CJD Statistics [Accessed May 8, 2011]. Available from: http://www.cjd.ed.ac.uk/figures.htm

National CJD Surveillance Unit 2008, ‘Creutzfeldt-Jacob disease surveillance in the UK. Sixteenth Annual Report. Edin-burgh [Accessed May 8, 2011]. Available from: http://www.cjd.ed.ac.uk/scientificreport.pdf

Griffiths P. Variant CJD epidemiology: joining up the dots. Rev Med Virol 2001;1:203-4.

doi:10.1002/rmv.325

PMid:11479926

Ghani A, Ferguson N, Donnelly C, Ander-son R. Predicted vCJD mortality in Great Britain. Nature 2000;406:583-4.

doi:10.1038/35020688

PMid:10949288

Boëlle P, Cesbron J, Valleron A. Epidemio-logical evidence of higher susceptibility to vCJD in the young. BMC Infect Dis 2004;4:26.

doi:10.1186/1471-2334-4-26

PMid:15304199 PMCid:514608

Cousens, S, Smith, P, Ward, H, Everington, D, Knight, R, Zeidler et al. Geographical distribution of variant Creutzfeldt-Jakob disease in Great Britain, 1994-2000. Lancet 2001;357:1002.

doi:10.1016/S0140-6736(00)04236-7

Cousens, S, Everington, D, Ward, H, Huil-lard, J, Will, R & Smith, P. The geographi-cal distribution of variant Creutzfeldt-Jakob disease cases in the UK: what can we learn from it? Stat Methods Med Res 2003;12:235-46.

doi:10.1191/0962280203sm332ra

PMid:12828244

Jeffrey, M, González, L, Espenes, A, Press C, Martin, S, Chaplin, et al. Transportation of prion protein across the intestinal mucosa of scrapie-susceptible and scrapie-resistant sheep. J Pathol 2006;209:4-14.

doi:10.1002/path.1962

PMid:16575799

Sales, N. What can we learn from the oral intake of prions by sheep? J Pathol 2006;209:1-3.

doi:10.1002/path.1977

PMid:16575798

Bendheim, P, Bockman, J, McKinley, M, Kingsbury, D & Prusiner, S, Scrapie and Creutzfeldt-Jakob disease prion proteins share physical properties and antigenic de-terminants. Proc Natl Acad Sci USA 1985;82:997-1001.

doi:10.1073/pnas.82.4.997

Weissmann C, Enari M, Klöhn P, Rossi D, Flechsig E. Transmission of prions. Proc Natl Acad Sci U S A 2002;99 Suppl 4:16378-83.

doi:10.1073/pnas.172403799

PMid:12181490 PMCid:139897

Ingrosso, L, Pisani, F & Pocchiari, M. 'Transmission of the 263K scrapie strain by the dental route. J Gen Virol 1999;80:3043-7.

PMid:10580068

Pitts NB, Palmer, J. The dental caries ex-perience of 5-, 12-, and 14-year-old child-ren in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1991/92, 1992/93, and 1990-91. Community Denl Health 1994; 11, 42-52.

PMid:8193984

Office for National Statistics 2000, Na-tional Food Survey 1997-1999: Household consumption by Government Office Re-gion [Accessed May 8, 2011]. Available from: http://www.defra.gov.uk/evidence/statistics/foodfarm/food/familyfood/nationalfoodsurvey/index.htm

Census Dissemination Unit, 2006, Depri-vation Scores 1991 Census [Accessed May 8, 2011]. Available from: http://cdu.census.ac.uk/related/deprivation.htm

British Fluoridation Society. One in a mil-lion: water fluoridation and dental public health. 2nd edition. United Kingdom: British Fluoridation Society, 2004:55-79.

Everington D, Smith A, Ward H, Letters S, Will R, Bagg J. Dental treatment and risk of variant CJD--a case control study. Br Dent J 2007;202:E19; discussion 470-1.

Carp R. Transmission of scrapie by oral route: effect of gingival scarification. Lancet 1982;1:170-1.

doi:10.1016/S0140-6736(82)90421-4

Trevitt C, Singh P. Variant Creutzfeldt-Jakob disease: pathology, epidemiology, and public health implications. Am J Clin Nutr 2003;78:651S-56S.

PMid:12936961

Smith A, Dickson M, Aitken J, Bagg J. Contaminated dental instruments. J Hosp Infect 2002;51:233-5.

doi:10.1053/jhin.2002.1213

PMid:12144804

The National Creutzfeldt-Jakob Disease Research & Surveillance Unit (NCJDRSU). National CJD Surveillance Unit Scientific Report 2007/2008. Edin-burgh, 2008:39 [Accessed May 8, 2011]. Available from: http://www.cjd.ed.ac.uk/report17.pdf


UK Department of Health. Potential vCJD transmission risks via dentistry: an interim review, 2007 [Accessed May 8, 2011]. Available from: http://www.dh.gov.uk/en/Publicationsandstatis-tics/Publications/PublicationsPolicyAndGuidance/DH_081170

Institut de veille sanitaire. Maladie de Creutzfeldt-Jakob et maladies apparen-tées, 2009 [Accessed May 8, 2011]. Available from: http://www.invs.sante.fr/display/?doc=publications/mcj/donnees_mcj.html



http://www.dentalhypotheses.com/index.php/dhj/article/view/33




http://www.dentalhypotheses.com/index.php/dhj/article/download/33/31






Deadly vCJD may have a link to tooth decay

by Madeleine Brindley, Western Mail
May 16 2011

Dentists



A GROUP of Welsh experts believe cases of the human form of mad cow disease could be linked to simple tooth decay.



They have put forward an hypothesis, which suggests tooth decay may be the way in which people became infected with the incurable disease as a result of eating contaminated meat during the 1980s.



Dr Roland Salmon, one of the Public Health Wales professionals involved in developing the idea, said the hypothesis also helps to explain why there have been relatively few cases of variant Creutzfeldt-Jakob disease (vCJD).



It may also explain the geographical spread of the disease – cases are highest in Scotland and the North-East of England, where rates of dental decay are also high.



Between 1990 and the start of May 2011 there have been 171 confirmed and probable vCJD deaths reported to the National Creutzfeldt-Jakob Disease Research and Surveillance Unit in Edinburgh.



A further four people with either definite or probable vCJD are still alive.



Dr Salmon, director of Public Health Wales’ communicable disease surveillance centre, said: “There are three things that are difficult to explain given that, during the 1980s, we must have eaten tonnes of potentially infected meat.



“In many ways it’s remarkable that there have been so few cases, which may be because of the difficulty the disease had of crossing the species barrier and the genetics of humans.



“But given that we had taken all contaminated food out of the equation by 1996, we would have thought that the age of cases would be getting older – they aren’t.



“The median age of onset has remained at around 26.



“Another thing, which is not so widely known, is that it’s twice as common in Scotland and North-East England.”



The correlation between tooth decay and vCJD appeared after analysing regional data on vCJD incidence and historical regional dental health data from 1992-3 in 12-year-old children collected by British Association for the Study of Community Dentistry.



Dr Salmon, who devised the hypothesis with Daniel Thomas and Nigel Monaghan, also from Public Health Wales, and with Cardiff University medical student Robert Burnie, said it appears as if infection with vCJD was via the dental route – through minute gaps in the teeth caused by untreated decay – rather than through the stomach.



Variant Creutzfeldt-Jakob disease is known as the human form of mad cow disease because it is caused by the same prion responsible for bovine spongiform encephalitis – mad cow disease.



Dr Salmon said: “It looks like the relationship between dental health and the risk of getting vCJD has some mileage.



“Our research suggests that it’s not dental treatment but dental decay in the first place which is a risk factor.



“One particularly interesting thing is that the area with the lowest numbers of filled teeth and the lowest incidence of vCJD is the West Midlands, which is also the region with the highest levels of water fluoridation.”



The hypothesis has been published in the journal Dental Hypotheses in the hope that other researchers around the world will carry out further investigations to establish the link between vCJD and tooth decay.



“This does look like an explanation that has some mileage in it,” Dr Salmon added.





Read More http://www.walesonline.co.uk/news/wales-news/2011/05/16/deadly-vcjd-may-have-a-link-to-tooth-decay-91466-28697962/#ixzz1MWTYL43x






http://www.walesonline.co.uk/news/wales-news/2011/05/16/deadly-vcjd-may-have-a-link-to-tooth-decay-91466-28697962/






As We Said - Dental Visits Spread vCJD/Mad Cow By Jeff Rense 6-9-7


http://www.rense.com/general76/dent.htm







Subject: MASTER DENTIST FALLS VICTIM TO CJD
Date: March 31, 2007 at 1:27 pm PST



Subject: MASTER DENTIST FALLS VICTIM TO CJD Date: March 31, 2007 at 1:27 pm PST




''It was in the cards a long time ago,'' she says. ''We've put it in the hands of God.''



- Crystal Harmon can be reached at 894-9643 or by e-mail at charmon@bc-times.com.



http://www.mlive.com/news/bctimes/index.ssf?/base/news-9/1175181333132150.xml&coll=4




see full text ;



http://lists.ifas.ufl.edu/cgi-bin/wa.exe?A2=ind0703&L=sanet-mg&T=0&F=&S=&P=106052




Tuesday, August 12, 2008


Biosafety in Microbiological and Biomedical Laboratories Fifth Edition 2007 (occupational exposure to prion diseases)




http://creutzfeldt-jakob-disease.blogspot.com/2008/08/biosafety-in-microbiological-and.html






Thursday, July 08, 2010

GLOBAL CLUSTERS OF CREUTZFELDT JAKOB DISEASE - A REVIEW 2010


http://creutzfeldt-jakob-disease.blogspot.com/2010/07/global-clusters-of-creutzfeldt-jakob.html





SEAC
Position Statement

--------------------------------------------------------------------------------

Position Statement vCJD and Dentistry
Issue
1. The Department of Health (DH) asked SEAC to advise on the findings of preliminary research aimed at informing estimates of the risk of variant Creutzfeldt-Jakob Disease (vCJD) transmission via dentistry.

Background
2. Prions are more resistant than other types of infectious agent to the conventional cleaning and sterilisation practices used to decontaminate dental instruments1. Appreciable quantities of residual material may remain adherent to the surface after normal cleaning and sterilisation2. Therefore, if dental tissues are both infectious and susceptible to infection, then dental instruments are a potential mechanism for the secondary transmission of vCJD. Dentistry could be a particularly significant route of transmission for the population as a whole, due to the large number of routine procedures undertaken and also because dental patients have a normal life expectancy. This is in contrast with other transmission routes, such as blood transfusion and neurosurgery, where procedures are often carried out in response to some life-threatening condition. Additionally, the ubiquity of dental procedures and the lack of central records on dental procedures means that should such transmission occur, then it would be difficult to detect and control.

3. No cases of vCJD transmission arising from dental procedures have been reported to date 3 . Previous DH risk assessments4,5 have focused on two possible mechanisms for the transfer of vCJD infectivity via dental instruments; accidental abrasion of the lingual tonsil and endodontic procedures that involve contact with dental pulp. In considering these assessments, SEAC agreed that the risk of transmission via accidental abrasion of the lingual tonsil appears very low. However, the risk of transmission via endodontic procedures may be higher and give rise to a self sustaining vCJD epidemic under circumstances where (i) dental pulp is infective, (ii) transmission via endodontic instruments is efficient and (iii) a large proportion of vCJD infections remain in a subclinical carrier state (SEAC 91, February 2006). In light of this, SEAC advised that restricting endodontic files and reamers to single use be considered 6. SEAC recommended reassessment of these issues as new data emerge.

New research
4. Preliminary, unpublished results of research from the Health Protection Agency, aimed at addressing some of the uncertainties in the risk assessments, were reviewed by SEAC (SEAC 97, May 2007). The prion agent used in these studies is closely related to the vCJD agent. This research, using a mouse model, shows that following inoculation of mouse-adapted bovine spongiform encephalopathy (BSE) directly into the gut, infectivity subsequently becomes widespread in tissues of the oral cavity, including dental pulp, salivary glands and gingiva, during the preclinical as well as clinical stage of disease.

5. It is not known how closely the level and distribution of infectivity in the oral cavity of infected mice reflects those of humans infected with vCJD, as there are no comparable data from oral tissues, in particular dental pulp and gingiva, from human subclinical or clinical vCJD cases7. Although no abnormal prion protein was found in a study of human dental tissues, including dental pulp, salivary glands and gingiva from vCJD cases , the relationship between levels of infectivity and abnormal prion protein is unclear8. Infectivity studies underway using the mouse model and oral tissues that are presently available from human vCJD cases will provide some comparable data. On the basis of what is currently known, there is no reason to suppose that the mouse is not a good model for humans in respect to the distribution of infectivity in oral tissues. Furthermore, the new data are consistent with published results from experiments using a hamster scrapie model9 .

6. A second set of experiments using the same mouse model showed that non-invasive and transient contact between gingival tissue and fine dental files contaminated with mouse-adapted BSE brain homogenate transmits infection very efficiently. It is not known how efficient gingival transmission would be if dental files were contaminated with infectious oral tissues and then subsequently cleaned and sterilised, a situation which would more closely model human dental practice. Further studies using the mouse model that would be more representative of the human situation, comparing oral tissues with a range of doses of infectivity, cleaned and sterilised files and the kind of tissue contact with instruments that occurs during dentistry, should be considered.

7. SEAC considered that the experiments appear well designed and the conclusions justified and reliable, while recognising that the research is incomplete and confirmatory experiments have yet to be completed. It is recommended that the research be completed, submitted for peer-review and widely disseminated as soon as possible so others can consider the implications. Nevertheless, these preliminary data increase the possibility that some oral tissues of humans infected with vCJD may potentially become infective during the preclinical stage of the disease. In addition, they increase the possibility that infection could potentially be transmitted not only via accidental abrasion of the lingual tonsil or endodontic procedures but a variety of routine dental procedures. Implications for transmission risks

8. The new findings help refine assumptions made about the level of infectivity of dental pulp and the stage of incubation period when it becomes infective in the risk assessment of vCJD transmission from the reuse of endodontic files and reamers10. For example, if one patient in 10 000 were to be carrying infection (equivalent to about 6 000 people across the UK – the best current estimate11), the data suggest that in the worst case scenario envisaged in the risk assessment, re-use of endodontic files and reamers might lead to up to 150 new infections per annum. It is not known how many of those infected would go on to develop clinical vCJD. In addition, transmission via the re-use of endodontic files and reamers could be sufficiently efficient to cause a self-sustaining vCJD epidemic arising via this route.

9. These results increase the importance of obtaining reliable estimates of vCJD infection prevalence. Data that will soon be available from the National Anonymous Tonsil Archive may help refine this assessment and provide evidence of the existence and extent of subclinical vCJD infection in tonsillectomy patients. Further data, such as from post mortem tissue or blood donations, will be required to assess prevalence in the general UK population12.

10. Recent guidance issued by DH to dentists to ensure that endodontic files and reamers are treated as single use13 is welcomed and should, as long as it is effectively and quickly implemented, prevent transmission and a self-sustaining epidemic arising via this route. However, the extent and monitoring of compliance with this guidance in private and National Health Service dental practice is unclear.

11. The new research also suggests that dental procedures involving contact with other oral tissues, including gingiva, may also be capable of transmitting vCJD. In the absence of a detailed risk assessment examining the potential for transmission via all dental procedures, it is not possible to come to firm conclusions about the implications of these findings for transmission of vCJD. However, given the potential for transmission by this route serious consideration should be given to assessing the options for reducing transmission risks such as improving decontamination procedures and practice or the implementation of single use instruments.

12. The size of the potential risk from interactions between the dental and other routes of secondary transmission, such as blood transfusion and hospital surgery, to increase the likelihood of a self-sustaining epidemic is unclear.

13. It is likely to be difficult to distinguish clinical vCJD cases arising from dietary exposure to BSE from secondary transmissions via dental procedures, should they arise, as a large proportion of the population is likely both to have consumed contaminated meat and undergone dentistry. However, an analysis of dental procedures by patient age may provide an indication of the age group in which infections, if they occur, would be most likely to be observed. Should the incidence of clinical vCJD cases in this age group increase significantly, this may provide an indication that secondary transmission via dentistry is occurring. Investigation of the dental work for these cases may provide supporting data. There is no clear evidence, to date, based on surveillance or investigations of clinical vCJD cases, that any vCJD cases have been caused by dental procedures but this possibility cannot be excluded.

Conclusions
14. Preliminary research findings suggest that the potential risk of transmission of vCJD via dental procedures may be greater than previously anticipated. Although this research is incomplete, uses an animal model exposed to relatively high doses of infectivity, and there are no data from infectivity studies on human oral tissues, these findings suggest an increased possibility that vCJD may be relatively efficiently transmitted via a range of dental procedures. Ongoing infectivity studies using human oral tissues and the other studies suggested here will enable more precise assessment of the risks of vCJD transmission through dental procedures.

15. Guidance was issued to dentists earlier this year recommending that endodontic files and reamers be treated as single use which, provided it is adhered to, will remove any risk of a self-sustaining epidemic arising from re-use of these instruments. To minimise risk it is critical that appropriate management and audit is in place, both for NHS and private dentistry.

16. It is also critical that a detailed and comprehensive assessment of the risks of all dental procedures be conducted as a matter of urgency. While taking into account the continuing scientific uncertainties, this will allow a more thorough consideration of the possible public health implications of vCJD transmission via dentistry and the identification of possible additional precautionary risk reduction measures. The assessment will require continued updating as more evidence becomes available on the transmissibility of vCJD by dental routes, and on the prevalence of infection within the population. A DH proposal to convene an expert group that includes dental professionals to expedite such an assessment is welcomed. Given the potential for transmission via dentistry, consideration should be given to the urgent assessment of new decontamination technologies which, if proved robust and effective, could significantly reduce transmission risks.



SEAC
June 2007



References
1Smith et al. (2003) Prions and the oral cavity. J. Dent. Res. 82, 769-775.

2Smith et al. (2005) Residual protein levels on reprocessed dental instruments. J. Hosp. Infect. 61, 237-241.

3Everington et al. (2007) Dental treatment and risk of variant CJD – a case control study. Brit. Den. J. 202, 1-3.

4Department of Health. (2003) Risk assessment for vCJD and dentistry.

5 Department of Health (2006) Dentistry and vCJD: the implications of a carrier-state for a self-sustaining epidemic. Unpublished.

6SEAC (2006) Position statement on vCJD and endodontic dentistry. http://www.seac.gov.uk/statements/statement0506.htm

7Head et al. (2003) Investigation of PrPres in dental tissues in variant CJD. Br. Dent. J. 195, 339-343.

8SEAC 90 reserved business minutes.

9Ingrosso et al. (1999) Transmission of the 263K scrapie strain by the dental route. J. Gen. Virol. 80, 3043-3047.

10Department of Health (2006) Dentistry and vCJD: the implications of a carrier-state for a self-sustaining epidemic. Unpublished.

11Clarke & Ghani (2005) Projections of future course of the primary vCJD epidemic in the UK: inclusion of subclinical infection and the possibility of wider genetic susceptibility R. J. Soc. Interface. 2, 19-31.

12SEAC Epidemiology Subgroup (2006) position statement of the vCJD epidemic. http://www.seac.gov.uk/statements/state260106subgroup.htm



13DH (2007) Precautionary advice given to dentists on re-use of instruments http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=279256&NewsAreaID=2&NavigatedFromDepartment=False





Page updated: 8 June, 2007


http://www.seac.gov.uk/statements/state-vcjd-dentrstry.htm




Monday, December 31, 2007

Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation

http://creutzfeldt-jakob-disease.blogspot.com/2007_12_01_archive.html





Subject: CJD: update for dental staff Date: November 12, 2006 at 3:25 pm PST

1: Dent Update. 2006 Oct;33(8):454-6, 458-60.

CJD: update for dental staff.

http://seac992007.blogspot.com/2008/06/seac-2008-one-hundredth-meeting-of.html







Friday, February 19, 2010

Creutzfeldt-Jakob disease (CJD) biannual update (2010/1)


http://creutzfeldt-jakob-disease.blogspot.com/2010/02/creutzfeldt-jakob-disease-cjd-biannual.html





Tuesday, March 29, 2011

TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY EXPOSURE SPREADING VIA HOSPITALS AND SURGICAL PROCEDURES AROUND THE GLOBE

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/transmissible-spongiform-encephalopathy.html






Tuesday, April 26, 2011

sporadic CJD RISING Text and figures of the latest annual report of the NCJDRSU covering the period 1990-2009 (published 11th March 2011)

http://creutzfeldt-jakob-disease.blogspot.com/2011/04/sporadic-cjd-rising-text-and-figures-of.html





Friday, May 13,

2011 EFSA Joint Scientific Opinion on any possible epidemiological or molecular association between TSEs in animals and humans


http://transmissiblespongiformencephalopathy.blogspot.com/2011/05/efsa-joint-scientific-opinion-on-any.html






Sunday, May 01, 2011


STUDY OF ATYPICAL BSE 2010 Annual Report May 2011


http://bse-atypical.blogspot.com/2011/05/study-of-atypical-bse-2010-annual.html





CREUTZFELDT JAKOB DISEASE

Saturday, March 5, 2011


MAD COW ATYPICAL CJD PRION TSE CASES WITH CLASSIFICATIONS PENDING ON THE RISE IN NORTH AMERICA


http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/mad-cow-atypical-cjd-prion-tse-cases.html







TSS

Friday, May 13, 2011

EFSA Joint Scientific Opinion on any possible epidemiological or molecular association between TSEs in animals and humans

----- Original Message -----
From: Terry S. Singeltary Sr.
To: TERRY SINGELTARY
Sent: Thursday, May 12, 2011 10:46 PM
Subject: Joint Scientific Opinion on any possible epidemiological or molecular association between TSEs in animals and humans


SCIENTIFIC OPINION

Joint Scientific Opinion on any possible epidemiological or molecular association between TSEs in animals and humans1

EFSA Panel on Biological Hazards (BIOHAZ)2, 3

European Food Safety Authority (EFSA), Parma, Italy

European Centre for Disease Prevention and Control (ECDC)4, 5

Stockholm, Sweden

ABSTRACT

The existing scientific evidence that links animal and human TSEs is reviewed and discussed. The challenges involved in identifying TSEs as zoonoses are described and the example of the process that led to the establishment of a link between Bovine Spongiform Encephalopathy (BSE) and variant Creutzfeldt-Jakob Disease (vCJD) is reviewed. The strain diversity of animal and human TSE agents and the factors influencing the capacity of TSE agents to cross the species transmission barrier are also discussed. The scientific opinion critically assesses the tools and methodologies currently available to study and evaluate the possible association of animal and human TSEs, focussing on epidemiological and laboratory methods. The available scientific evidence on Classical BSE, Atypical BSE (H-type and L-type), Classical scrapie, Atypical scrapie, Chronic Wasting Disease (CWD), Transmissible Mink Encephalopathy (TME) and human TSEs is reviewed. The conclusions state that, at present, the only TSE agent demonstrated to be zoonotic is the Classical BSE agent. Active screening has allowed the identification of three new forms of animal TSEs (H-type Atypical BSE, L-type Atypical BSE and Atypical scrapie), but the information obtained has major limitations due to the unknown sensitivity of the current monitoring system for these TSEs. There is no epidemiological evidence to suggest that Classical scrapie is zoonotic. The epidemiological data are too limited to conclude whether the Atypical scrapie agent has a zoonotic potential. Transmission experiments to human PrP transgenic mice or primates suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE, Classical BSE in sheep, TME, CWD agents) might have zoonotic potential and indicate that that of the L-type Atypical BSE agent appears similar or even higher than that of the Classical BSE agent. A single study reported efficient transmission of a natural sheep Classical scrapie isolate to primates.

© European Food Safety Authority, 2011

KEY WORDS

Zoonosis, Transmissible Spongiform Encephalopathy, Bovine Spongiform Encephalopathy, Scrapie, Creutzfeldt-Jakob Disease

1 On request from the European Commission, Question No EFSA-Q-2009-00799, adopted on 9 December 2010.

2 Panel members: Olivier Andreoletti, Herbert Budka, Sava Buncic, John D Collins, John Griffin, Tine Hald, Arie Havelaar, James Hope, Günter Klein, James McLauchlin, Christine Müller-Graf, Christophe Nguyen-The, Birgit Noerrung, Luisa Peixe, Miguel Prieto Maradona, Antonia Ricci, John Sofos, John Threlfall, Ivar Vågsholm and Emmanuel Vanopdenbosch. Correspondence: biohaz@efsa.europa.eu

3 Acknowledgement: The Panel wishes to thank the members of the Working Group on Any possible epidemiological or molecular association between TSEs in animals and humans: Olivier Andreoletti, Vincent Béringue, Herbert Budka, Joaquín Castilla, Emmanuel Comoy, Martin Groschup, James Hope, Jean Manson, Giuseppe Ru, Glenn Telling, Juan Maria Torres, Emmanuel Vanopdenbosch and Robert Will for the preparatory work on this scientific opinion.

4 Advisory Forum (ECDC) members:

www.ecdc.europa.eu/en/aboutus/organisation/af/Pages/AboutUs_Organisation_AdvisoryForum.aspx


5 Acknowledgement: ECDC wishes to thank Daniel Palm and Johanna Takkinen for the support provided to this scientific opinion.


Association between TSEs in animals and humans


EFSA Journal 2011;9(1):1945 2

Association between TSEs in animals and humans

EFSA Journal 2011;9(1):1945 3

SUMMARY

Following to a request from the European Commission, the Panel on Biological Hazards (BIOHAZ) and the European Centre for Disease Prevention and Control (ECDC) were asked to deliver a scientific opinion on any possible epidemiological or molecular association between Transmissible Spongiform Encephalopathies (TSEs) in animals and humans. The opinion reviews and discusses the existing scientific evidence that links animal and human TSEs currently known.

The opinion first considers the definition of zoonoses and the principles for the identification of zoonotic diseases, which can be based on evidence gathered from both epidemiological and laboratory studies. The opinion describes the challenges involved in identifying TSEs as zoonoses, due to the specific characteristics of TSE infections/diseases, such as the nature of TSE agents, the occurrence of animal and human TSEs and the type of monitoring applied, the long incubation period of TSEs etc. The example of the process that led to establishing a link between Bovine Spongiform Encephalopathy (BSE) and variant Creutzfeldt-Jakob Disease (vCJD) is reviewed. The epidemiological and laboratory criteria that can be used to investigate such a link are described in detail, since those criteria might be useful for the identification of links between other animal and human TSEs.

The opinion discusses the strain diversity of the TSE agents described in sheep, goats, cattle, cervids and humans, based on the current knowledge, which highlights that multiple TSE agents exist in each species. The factors influencing the capacity of TSE agents to cross the species transmission barrier are then considered in detail, including the variability in host and donor PrP gene and protein, the TSE strain type involved and its interaction with the host PrP, and the route of infection.

The opinion critically assesses the tools and methodologies currently available to study and evaluate the possible association between animal and human TSEs. The use of epidemiology is discussed for TSEs in both animals and humans, and the possibility to compare the two sources of information is presented as a possible method to study the possible links.

Both in vivo and in vitro laboratory methods are considered and discussed, including neuropathology, transmission experiments involving different animal models (wild type and transgenic mice, primates and other species), biochemical methods, cell-free conversion assays, Protein Misfolding Cyclic Amplification (PMCA) and cell culture assays. Characteristics, advantages and disadvantages of the different methods are reviewed, including the opportunity to collate data from different types of experiments for the study of potential associations between animal and human TSEs.

The opinion then reviews the scientific evidence currently available for the different animal and human TSEs, including Classical BSE, Atypical BSE (H-type and L-type), Classical scrapie, Atypical scrapie, Chronic Wasting Disease (CWD), Transmissible Mink Encephalopathy (TME) and human TSEs. In particular, the following aspects are systematically discussed for each TSE agent: epidemiology, pathogenesis and in vivo and in vitro transmission experiments.

The opinion concludes that, at present, the only TSE agent demonstrated to be zoonotic is the Classical BSE agent. With regard to human TSEs, detected cases of sporadic CJD are randomly distributed in time and geographical location. These observations have been interpreted as a supportive argument that sporadic CJD is not environmentally acquired. However, the epidemiological evidence in relation to sporadic CJD cannot be regarded as definitive, and the possibility that a small proportion of cases are zoonotic cannot be excluded.

It also concludes that a series of uncertainties in relation to the epidemiological patterns of animal and human TSEs indicate that even a rough comparison of the present epidemiological patterns of human and animal TSEs other than Classical BSE is unlikely to be informative. Because of these uncertainties, it is an imperative to continue to carry out systematic surveillance of human TSE diseases, and to continue and improve the surveillance of animal TSE diseases.


Association between TSEs in animals and humans


EFSA Journal 2011;9(1):1945 4

The opinion highlights that the active screening has allowed the identification of three new forms of animal TSEs (L-type Atypical BSE, H-type Atypical BSE and Atypical scrapie), but that the information obtained has major limitations due to the unknown sensitivity of the current monitoring system for these TSEs. There is no epidemiological evidence to suggest that Classical scrapie is zoonotic. The epidemiological data are too limited to conclude whether the Atypical scrapie agent has a zoonotic potential.

Transmission experiments to human PrP transgenic mice suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE and Classical BSE in sheep agents) might have zoonotic potential, whereas for other agents there is no evidence provided of a zoonotic potential (H-type Atypical BSE and CWD), or no published studies are available (Classical and Atypical scrapie). In addition, transmission experiments to primates suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE, Classical BSE in sheep, TME, CWD agents) might have zoonotic potential. In particular, primates are highly permissive to L-type Atypical BSE, even by the oral route.

The opinion emphasizes that laboratory transmission experiments indicate that the L-type Atypical BSE agent has a significant zoonotic potential, which appears similar or even higher than that of the Classical BSE agent. While transmission data for evaluating the zoonotic potential of Classical scrapie in primates and human PrP transgenic mice are extremely limited or not yet available, a single study reported efficient transmission of a natural sheep Classical scrapie isolate to primates.

The opinion concludes that human PrP transgenic mice and primates are currently the most relevant models for investigating the human transmission barrier, but the extent to which such models are informative for measuring the zoonotic potential of an animal TSE under field exposure conditions is unknown. It is unpredictable whether a TSE agent will transmit to a new host, and if the transmission principally occurs, what the transmission rate will be.

Based on the results obtained with in vitro conversion assays, the opinion concludes that there is probably no absolute molecular barrier to transmission of TSE agents between mammalian species. Results also suggest that these assays may be developed as a tool for quantifying the transmission barriers between species for different TSE agent strains; however, there is no means at the moment to transpose in vitro results into the likelihood of in vivo interspecies transmission.

SNIP...


6. The uncertainty on “the origin of sCJD”.

There is speculation that sCJD is due to exposure to Atypical BSE, or is linked to Classical scrapie, Atypical scrapie etc. This uncertainty is the subject of this risk assessment.

SNIP...

6. Synopsis

The primary objective of this document is to assess potential associations between animal and human TSEs. An assessment of the potential causal links between animal and human TSEs according to the Bradford Hill’s guidelines (Bradford Hill, 1965) is shown in Table 5 below. One conclusion is that only the BSE/vCJD link is established. It is important to stress that future scientific information might result in changes to the assessment of one or more of the other animal TSEs.

Table 5: Assessment of Putative Links Between Animal and Human TSEs according to the criteria of the Bradford Hill guidelines.

TABLE 5 OMITTED, please see full text url link below for table 5...TSS

+: some scientific evidence is available for a positive interpretation

+/-: debatable or conflicting evidence is available

(a): Classical BSE has not been identified in sheep, but two cases of BSE in goat have been reported in France and UK

(b): there are multiple strains of the Classical scrapie agent

(c): a single study has reported transmission of a natural sheep Classical scrapie isolate to primates

SNIP...

CONCLUSIONS

• At present, the only TSE agent demonstrated to be zoonotic is the Classical BSE agent.

• In general, detected cases of sporadic CJD are randomly distributed in time and geographical location. These observations have been interpreted as a supportive argument that sporadic CJD is not environmentally acquired. However, the epidemiological evidence in relation to sporadic CJD cannot be regarded as definitive, and the possibility that a small proportion of cases are zoonotic cannot be excluded.

• Except for Classical BSE, there is limited epidemiological information on the prevalence and distribution of individual ruminant TSE agents.

• These uncertainties indicate that even a rough comparison of the present epidemiological patterns of human TSEs and animal TSEs other than Classical BSE is unlikely to be informative. Thus, it is an imperative to continue to carry out systematic surveillance of human TSEs, and to continue and improve the surveillance of animal TSEs.

• The active screening has allowed the identification of three new forms of animal TSEs (L-type Atypical BSE, H-type Atypical BSE, Atypical scrapie). However, the information obtained has major limitations due to the unknown sensitivity of the monitoring system for these TSEs.

• There is no epidemiological evidence provided to suggest that Classical scrapie is zoonotic.

• The epidemiological data are too limited to conclude whether the Atypical scrapie agent has a zoonotic potential.

• Transmission experiments to human PrP transgenic mice suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE and Classical BSE in sheep agents) might have zoonotic potential, whereas for other agents there is no evidence provided of zoonotic potential (H-type Atypical BSE and CWD agents) or no published studies are available (Classical and Atypical scrapie agents).

• Transmission experiments to primates suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE, Classical BSE in sheep, TME, CWD agents) might have zoonotic potential. In particular, primates are highly permissive to L-type Atypical BSE, even by the oral route.

• Laboratory transmission experiments indicate that the L-type Atypical BSE agent has a significant zoonotic potential, which appears similar or even higher than that of the Classical BSE agent.

• While transmission data for evaluating the zoonotic potential of Classical scrapie in primates and human PrP transgenic mice are extremely limited or not yet available, a single study reported efficient transmission of a natural sheep Classical scrapie isolate to primates.

• It is unpredictable whether a TSE agent will transmit to a new host and, if the transmission principally occurs, what the transmission rate will be.

• Human PrP transgenic mice and primates are the most relevant models for investigating the human transmission barrier. To which extent such models are informative for measuring the zoonotic potential of an animal TSE under field exposure conditions is unknown. The Classical BSE agent, as known zoonotic agent, might be used as a benchmark to evaluate the zoonotic potential of other animal TSE agents.

• The ability to create TSE agents by in vitro conversion assays with a novel or unprecedented host range (such as those that can infect rabbits) indicate that there is probably no absolute molecular barrier to transmission of TSE agents between mammalian species.

• The qualitative correlation between in vivo data and in vitro results suggests that in vitro conversion assays may be developed as a tool for quantifying the transmission barriers between diverse species and for different TSE agents. However, there is at the moment no means by which to calibrate and transpose the ease of heterologous conversion in vitro into the likelihood of transmission between species in vivo.

http://www.efsa.europa.eu/de/efsajournal/doc/1945.pdf



============================================================================



from the OPINION above ;

6. The uncertainty on “the origin of sCJD”.

There is speculation that sCJD is due to exposure to Atypical BSE, or is linked to Classical scrapie, Atypical scrapie etc. This uncertainty is the subject of this risk assessment.

snip...

• The epidemiological data are too limited to conclude whether the Atypical scrapie agent has a zoonotic potential.

• Transmission experiments to human PrP transgenic mice suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE and Classical BSE in sheep agents) might have zoonotic potential, whereas for other agents there is no evidence provided of zoonotic potential (H-type Atypical BSE and CWD agents) or no published studies are available (Classical and Atypical scrapie agents).

• Transmission experiments to primates suggest that some TSE agents other than the Classical BSE agent in cattle (namely L-type Atypical BSE, Classical BSE in sheep, TME, CWD agents) might have zoonotic potential. In particular, primates are highly permissive to L-type Atypical BSE, even by the oral route.

• Laboratory transmission experiments indicate that the L-type Atypical BSE agent has a significant zoonotic potential, which appears similar or even higher than that of the Classical BSE agent.

• While transmission data for evaluating the zoonotic potential of Classical scrapie in primates and human PrP transgenic mice are extremely limited or not yet available, a single study reported efficient transmission of a natural sheep Classical scrapie isolate to primates.

=============================================================================



let's look at some data shall we ;


Is Prion interspecies transmission barrier tissue-dependent?


Hubert Laude1 Laetitia Herzog1 Emilie Jaumain1 Fabienne Reine1 Annick Le Dur1 Jean-Luc Vilotte2 Vincent Beringue1

1. INRA, UR892, Virologie Immunologie Moléculaires, Jouy en Josas, France;

2. INRA, UMR1313, Génétique Animale et Biologie Intégrative, Jouy en Josas, France

The conformational selection model posits that prion interspecies transmission is essentially constrained by the degree of steric compatibility between the incoming PrPSc and the spectrum of conformations the exposed host PrP primary structure can adopt in the PrPSc state. However the question arises of whether the portfolio of PrPSc conformations allowed by PrPC might differ to a certain extent among brain and extraneural tissues due to different cellular environment or PrPC isoform variation. Of particular concern is the lymphoid tissue in which a number of prion strains can replicate at fairly high levels.

The issue of a possible tissue-dependence of prion interspecies transmission efficacy was examined in three different transgenic mouse models, all exhibiting a strong transmission barrier based on the absence of clear neurological signs and of PrPres in the brains of most inoculated animals. These models consisted in ovine PrP mice (VRQ allele; tg338 line) exposed to either elk CWD or hamster Sc237 prions sources, and in human PrP mice (Met129 allele; tg650 line) inoculated with cattle BSE. Mice inoculated intracerebrally were euthanized at regular intervals after exposure over the entire lifespan and analyzed for the presence of PrPres in brain and spleen tissues. As a common finding, ~75% to 100% of the inoculated mice scored positive for the presence of PrPres in the spleen from ~1 year post-infection onwards, while a minority (~5 %) accumulated PrPres in their brain even at very end of life. When PrPres negative brain and PrPres positive spleen tissues from the same mouse were further transmitted to ad hoc mice, disease was only observed with spleen tissue. Upon serial passaging of Sc237 prions to tg338 mice, a “mutant” strain exhibiting a 19kDa signature emerged in the brain but not the spleen. While the brain-derived agent failed to reinfect hamster PrP tg7mice, the spleen-passaged one did.

These data therefore demonstrate that prion transmission to a foreign host can exhibit a marked tissuedependence, with a much greater permissiveness of the lymphoid over the nervous tissue. This phenomenon did not seem to imply a preexisting lymphotropism of the infecting prion, since Sc237 agent is considered poorly lymphotropic compared to CWD agent.

Our data call for closer examination of extraneural PrPres in humanized or primate models when assessing any zoonotic potential of animal prions. Thus, as shown here, human species barrier to BSE prions may be much lower than previously anticipated according to brain PrPres detection-based studies.

2011 Pre-congress Workshop: TSEs in animals and their environment 13

http://www.prion2011.ca/files/2011TSEBookletV6Final.pdf


http://www.prion2011.ca/files/PRION_2011_-_Posters_(May_5-11).pdf


Wednesday, March 31, 2010

Atypical BSE in Cattle

To date the OIE/WAHO assumes that the human and animal health standards set out in the BSE chapter for classical BSE (C-Type) applies to all forms of BSE which include the H-type and L-type atypical forms. This assumption is scientifically not completely justified and accumulating evidence suggests that this may in fact not be the case. Molecular characterization and the spatial distribution pattern of histopathologic lesions and immunohistochemistry (IHC) signals are used to identify and characterize atypical BSE. Both the L-type and H-type atypical cases display significant differences in the conformation and spatial accumulation of the disease associated prion protein (PrPSc) in brains of afflicted cattle. Transmission studies in bovine transgenic and wild type mouse models support that the atypical BSE types might be unique strains because they have different incubation times and lesion profiles when compared to C-type BSE.

When L-type BSE was inoculated into ovine transgenic mice and Syrian hamster the resulting molecular fingerprint had changed, either in the first or a subsequent passage, from L-type into C-type BSE. In addition, non-human primates are specifically susceptible for atypical BSE as demonstrated by an approximately 50% shortened incubation time for L-type BSE as compared to C-type. Considering the current scientific information available, it cannot be assumed that these different BSE types pose the same human health risks as C-type BSE or that these risks are mitigated by the same protective measures.

This study will contribute to a correct definition of specified risk material (SRM) in atypical BSE. The incumbent of this position will develop new and transfer existing, ultra-sensitive methods for the detection of atypical BSE in tissue of experimentally infected cattle.

http://www.prionetcanada.ca/detail.aspx?menu=5&dt=293380&app=93&cat1=387&tp=20&lk=no&cat2


snip...

please see all seven threats listed in the USA, and more...FULL TEXT ;



Thursday, August 12, 2010

Seven main threats for the future linked to prions

First threat

The TSE road map defining the evolution of European policy for protection against prion diseases is based on a certain numbers of hypotheses some of which may turn out to be erroneous. In particular, a form of BSE (called atypical Bovine Spongiform Encephalopathy), recently identified by systematic testing in aged cattle without clinical signs, may be the origin of classical BSE and thus potentially constitute a reservoir, which may be impossible to eradicate if a sporadic origin is confirmed. ***Also, a link is suspected between atypical BSE and some apparently sporadic cases of Creutzfeldt-Jakob disease in humans. These atypical BSE cases constitute an unforeseen first threat that could sharply modify the European approach to prion diseases.

Second threat

snip...

http://www.neuroprion.org/en/np-neuroprion.html


http://prionpathy.blogspot.com/2010/08/seven-main-threats-for-future-linked-to.html


http://prionpathy.blogspot.com/





Diagnosis and Reporting of Creutzfeldt-Jakob Disease

Singeltary, Sr et al.

JAMA.2001; 285: 733-734. Vol. 285 No. 6, February 14, 2001 JAMA

Diagnosis and Reporting of Creutzfeldt-Jakob Disease

To the Editor:

In their Research Letter, Dr Gibbons and colleagues1 reported that the annual US death rate due to Creutzfeldt-Jakob disease (CJD) has been stable since 1985. These estimates, however, are based only on reported cases, and do not include misdiagnosed or preclinical cases. It seems to me that misdiagnosis alone would drastically change these figures. An unknown number of persons with a diagnosis of Alzheimer disease in fact may have CJD, although only a small number of these patients receive the postmortem examination necessary to make this diagnosis. Furthermore, only a few states have made CJD reportable. Human and animal transmissible spongiform encephalopathies should be reportable nationwide and internationally.

Terry S. Singeltary, Sr Bacliff, Tex

1. Gibbons RV, Holman RC, Belay ED, Schonberger LB. Creutzfeldt-Jakob disease in the United States: 1979-1998. JAMA. 2000;284:2322-2323.
FREE FULL TEXT


http://jama.ama-assn.org/cgi/content/extract/285/6/733?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=singeltary&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT




http://jama.ama-assn.org/cgi/content/full/285/6/733?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=singeltary&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT




Views ; Reviews


Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob disease in the United States


Ermias D. Belay, MD,

Ryan A. Maddox, MPH,

Pierluigi Gambetti, MD and

Lawrence B. Schonberger, MD

+ Author Affiliations


From the Division of Viral and Rickettsial Diseases (Drs. Belay and Schonberger and R.A. Maddox), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; and National Prion Disease Pathology Surveillance Center (Dr. Gambetti), Division of Neuropathology, Institute of Pathology, Case Western Reserve University, Cleveland, OH.


Address correspondence and reprint requests to Dr. Ermias D. Belay, 1600 Clifton Road, Mailstop A-39, Atlanta, GA 30333.


Abstract


Transmissible spongiform encephalopathies (TSEs) attracted increased attention in the mid-1980s because of the emergence among UK cattle of bovine spongiform encephalopathy (BSE), which has been shown to be transmitted to humans, causing a variant form of Creutzfeldt-Jakob disease (vCJD). The BSE outbreak has been reported in 19 European countries, Israel, and Japan, and human cases have so far been identified in four European countries, and more recently in a Canadian resident and a US resident who each lived in Britain during the BSE outbreak. To monitor the occurrence of emerging forms of CJD, such as vCJD, in the United States, the Centers for Disease Control and Prevention has been conducting surveillance for human TSEs through several mechanisms, including the establishment of the National Prion Disease Pathology Surveillance Center. Physicians are encouraged to maintain a high index of suspicion for vCJD and use the free services of the pathology center to assess the neuropathology of clinically diagnosed and suspected cases of CJD or other TSEs.


Received May 7, 2002.


Accepted August 28, 2002.


http://www.neurology.org/content/60/2/176.abstract



RE-Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob disease in the United States


Terry S. Singeltary, retired (medically) CJD WATCH

I lost my mother to hvCJD (Heidenhain Variant CJD). I would like to comment on the CDC's attempts to monitor the occurrence of emerging forms of CJD. Asante, Collinge et al [1] have reported that BSE transmission to the 129-methionine genotype can lead to an alternate phenotype that is indistinguishable from type 2 PrPSc, the commonest sporadic CJD. However, CJD and all human TSEs are not reportable nationally. CJD and all human TSEs must be made reportable in every state and internationally. I hope that the CDC does not continue to expect us to still believe that the 85%+ of all CJD cases which are sporadic are all spontaneous, without route/source. We have many TSEs in the USA in both animal and man. CWD in deer/elk is spreading rapidly and CWD does transmit to mink, ferret, cattle, and squirrel monkey by intracerebral inoculation. With the known incubation periods in other TSEs, oral transmission studies of CWD may take much longer. Every victim/family of CJD/TSEs should be asked about route and source of this agent. To prolong this will only spread the agent and needlessly expose others. In light of the findings of Asante and Collinge et al, there should be drastic measures to safeguard the medical and surgical arena from sporadic CJDs and all human TSEs. I only ponder how many sporadic CJDs in the USA are type 2 PrPSc?


Published March 26, 2003


http://www.neurology.org/content/60/2/176.abstract/reply#neurology_el_535




Reply to Singletary


Ryan A. Maddox, MPH Ermias D. Belay, MD, Lawrence B. Schonberger, MD Centers for Disease Control and Prevention Atlanta GA


Mr. Singletary raises several issues related to current Creutzfeldt- Jakob disease (CJD) surveillance activities. Although CJD is not a notifiable disease in most states, its unique characteristics, particularly its invariably fatal outcome within usually a year of onset, make routine mortality surveillance a useful surrogate for ongoing CJD

Mr. Singletary raises several issues related to current Creutzfeldt- Jakob disease (CJD) surveillance activities. Although CJD is not a notifiable disease in most states, its unique characteristics, particularly its invariably fatal outcome within usually a year of onset, make routine mortality surveillance a useful surrogate for ongoing CJD surveillance.[1] In addition, because CJD is least accurately diagnosed early in the course of illness, notifiable-disease surveillance could be less accurate than, if not duplicative of, current mortality surveillance.[1] However, in states where making CJD officially notifiable would meaningfully facilitate the collection of data to monitor for variant CJD (vCJD) or other emerging prion diseases, CDC encourages the designation of CJD as a notifiable disease.[1] Moreover, CDC encourages physicians to report any diagnosed or suspected CJD cases that may be of special public health importance (e.g., vCJD, iatrogenic CJD, unusual CJD clusters).

As noted in our article, strong evidence is lacking for a causal link between chronic wasting disease (CWD) of deer and elk and human disease,[2] but only limited data seeking such evidence exist. Overall, the previously published case-control studies that have evaluated environmental sources of infection for sporadic CJD have not consistently identified strong evidence for a common risk factor.[3] However, the power of a case-control study to detect a rare cause of CJD is limited, particularly given the relatively small number of subjects generally involved and its long incubation period, which may last for decades. Because only a very small proportion of the US population has been exposed to CWD, a targeted surveillance and investigation of unusual cases or case clusters of prion diseases among persons at increased risk of exposure to CWD is a more efficient approach to detecting the possible transmission of CWD to humans. In collaboration with appropriate local and state health departments and the National Prion Disease Pathology Surveillance Center, CDC is facilitating or conducting such surveillance and case- investigations, including related laboratory studies to characterize CJD and CWD prions.


Mr. Singletary also expresses concern over a recent publication by Asante and colleagues indicating the possibility that some sporadic CJD cases may be attributable to bovine spongiform encephalopathy (BSE).[4] The authors reported that transgenic mice expressing human prion protein homozygous for methionine at codon 129, when inoculated with BSE prions, developed a molecular phenotype consistent with a subtype of sporadic CJD. Although the authors implied that BSE might cause a sporadic CJD-like illness among persons homozygous for methionine, the results of their research with mice do not necessarily directly apply to the transmission of BSE to humans. If BSE causes a sporadic CJD-like illness in humans, an increase in sporadic CJD cases would be expected to first occur in the United Kingdom, where the vast majority of vCJD cases have been reported. In the United Kingdom during 1997 through 2002, however, the overall average annual mortality rate for sporadic CJD was not elevated; it was about 1 case per million population per year. In addition, during this most recent 6-year period following the first published description of vCJD in 1996, there was no increasing trend in the reported annual number of UK sporadic CJD deaths.[3, 5] Furthermore, surveillance in the UK has shown no increase in the proportion of sporadic CJD cases that are homozygous for methionine (Will RG, National CJD Surveillance Unit, United Kingdom, 2003; personal communication).


References


1. Gibbons RV, Holman RC, Belay ED, Schonberger LB. Diagnosis and reporting of Creutzfeldt-Jakob disease. JAMA 2001;285:733-734.


2. Belay ED, Maddox RA, Gambetti P, Schonberger LB. Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob disease in the United States. Neurology 2003;60:176-181.


3. Belay ED. Transmissible spongiform encephalopathies in humans. Annu Rev Microbiol 1999;53:283-314.


4. Asante EA, Linehan JM, Desbruslais M, et al. BSE prions propagate as either variant CJD-like or sporadic CJD-like prion strains in transgenic mice expressing human prion protein. EMBO J 2002;21:6358-6366.


5. The UK Creutzfeldt-Jakob Disease Surveillance Unit. CJD statistics.

Available at: http://www.cjd.ed.ac.uk/figures.htm.


Accessed February 18, 2003.

http://www.neurology.org/content/60/2/176.abstract/reply#neurology_el_582




THE PATHOLOGICAL PROTEIN


BY Philip Yam


Yam Philip Yam News Editor Scientific American www.sciam.com


Answering critics like Terry Singeltary, who feels that the U.S. under- counts CJD, Schonberger conceded that the current surveillance system has errors but stated that most of the errors will be confined to the older population.


CHAPTER 14

Laying Odds

Are prion diseases more prevalent than we thought?

Researchers and government officials badly underestimated the threat that mad cow disease posed when it first appeared in Britain. They didn't think bovine spongiform encephalopathy was a zoonosis-an animal disease that can sicken people. The 1996 news that BSE could infect humans with a new form of Creutzfeldt-Jakob disease stunned the world. It also got some biomedical researchers wondering whether sporadic CJD may really be a manifestation of a zoonotic sickness. Might it be caused by the ingestion of prions, as variant CJD is?

Revisiting Sporadic CJD

It's not hard to get Terry Singeltary going. "I have my conspiracy theories," admitted the 49-year-old Texan.1 Singeltary is probably the nation's most relentless consumer advocate when it comes to issues in prion diseases. He has helped families learn about the sickness and coordinated efforts with support groups such as CJD Voice and the CJD Foundation. He has also connected with others who are critical of the American way of handling the threat of prion diseases. Such critics include Consumers Union's Michael Hansen, journalist John Stauber, and Thomas Pringle, who used to run the voluminous


www.mad-cow.org/


Web site. These three lend their expertise to newspaper and magazine stories about prion diseases, and they usually argue that prions represent more of a threat than people realize, and that the government has responded poorly to the dangers because it is more concerned about protecting the beef industry than people's health.

Singeltary has similar inclinations. ...


snip...


THE PATHOLOGICAL PROTEIN


Hardcover, 304 pages plus photos and illustrations. ISBN 0-387-95508-9


June 2003


BY Philip Yam


CHAPTER 14 LAYING ODDS


Answering critics like Terry Singeltary, who feels that the U.S. under- counts CJD, Schonberger conceded that the current surveillance system has errors but stated that most of the errors will be confined to the older population.




http://www.thepathologicalprotein.com/



http://books.google.com/books?id=ePbrQNFrHtoC&pg=PA223&lpg=PA223&dq=the+pathological+protein+laying+odds+It%E2%80%99s+not+hard+to+get+Terry+Singeltary+going&source=bl&ots=um0PFAZSZD&sig=JWaGR7M7-1WeAr2qAXq8D6J_jak&hl=en&ei=MhtjS8jMJM2ztgeFoa2iBg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CAcQ6AEwAA#v=onepage&q=&f=false




http://www.springerlink.com/content/r2k2622661473336/fulltext.pdf?page=1




http://www.thepathologicalprotein.com/




http://prionunitusaupdate2008.blogspot.com/2009/04/national-prion-disease-pathology.html





14th ICID International Scientific Exchange Brochure -


Final Abstract Number: ISE.114


Session: International Scientific Exchange


Transmissible Spongiform encephalopathy (TSE) animal and human TSE in North America update October 2009


T. Singeltary


Bacliff, TX, USA


Background:


An update on atypical BSE and other TSE in North America. Please remember, the typical U.K. c-BSE, the atypical l-BSE (BASE), and h-BSE have all been documented in North America, along with the typical scrapie's, and atypical Nor-98 Scrapie, and to date, 2 different strains of CWD, and also TME. All these TSE in different species have been rendered and fed to food producing animals for humans and animals in North America (TSE in cats and dogs ?), and that the trading of these TSEs via animals and products via the USA and Canada has been immense over the years, decades.


Methods:


12 years independent research of available data


Results:


I propose that the current diagnostic criteria for human TSEs only enhances and helps the spreading of human TSE from the continued belief of the UKBSEnvCJD only theory in 2009. With all the science to date refuting it, to continue to validate this old myth, will only spread this TSE agent through a multitude of potential routes and sources i.e. consumption, medical i.e., surgical, blood, dental, endoscopy, optical, nutritional supplements, cosmetics etc.


Conclusion:


I would like to submit a review of past CJD surveillance in the USA, and the urgent need to make all human TSE in the USA a reportable disease, in every state, of every age group, and to make this mandatory immediately without further delay. The ramifications of not doing so will only allow this agent to spread further in the medical, dental, surgical arena's. Restricting the reporting of CJD and or any human TSE is NOT scientific. Iatrogenic CJD knows NO age group, TSE knows no boundaries. I propose as with Aguzzi, Asante, Collinge, Caughey, Deslys, Dormont, Gibbs, Gajdusek, Ironside, Manuelidis, Marsh, et al and many more, that the world of TSE Transmissible Spongiform Encephalopathy is far from an exact science, but there is enough proven science to date that this myth should be put to rest once and for all, and that we move forward with a new classification for human and animal TSE that would properly identify the infected species, the source species, and then the route.


http://ww2.isid.org/Downloads/14th_ICID_ISE_Abstracts.pdf




Human Prion Diseases in the United States


Article Metrics Related Content Comments: 1 .


Abstract Introduction Methods Results Discussion Acknowledgments Author Contributions References


Robert C. Holman1*, Ermias D. Belay1, Krista Y. Christensen1, Ryan A. Maddox1, Arialdi M. Minino2, Arianne M. Folkema1, Dana L. Haberling1, Teresa A. Hammett1, Kenneth D. Kochanek2, James J. Sejvar1, Lawrence B. Schonberger1


1 Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (USDHHS), Atlanta, Georgia, United States of America, 2 Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (USDHHS), Hyattsville, Maryland, United States of America


Abstract


Background


Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD), occurs worldwide. Variant CJD (vCJD), a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy.


This study describes the occurrence and epidemiology of CJD and vCJD in the United States.


Methodology/Principal Findings


Analysis of CJD and vCJD deaths using death certificates of US residents for 1979–2006, and those identified through other surveillance mechanisms during 1996–2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172–304 deaths). The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8%) of the CJD deaths occurred among persons =65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%); the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively). Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States.


Conclusion/Significance


Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.


Citation: Holman RC, Belay ED, Christensen KY, Maddox RA, Minino AM, et al. (2010) Human Prion Diseases in the United States. PLoS ONE 5(1): e8521. doi:10.1371/journal.pone.0008521


Editor: Mick F. Tuite, University of Kent, United Kingdom


Received: July 21, 2009; Accepted: October 30, 2009; Published: January 1, 2010


Holman et al. This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
Funding: The authors have no support or funding to report.


Competing interests: The authors have declared that no competing interests exist.


* E-mail: rholman@cdc.gov


http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0008521&annotationId=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd;jsessionid=6325F7DEEF9F972F91B273E1E90A1087.ambra02





re-Human Prion Diseases in the United States


Original Article

Human Prion Diseases in the United States


re-Human Prion Diseases in the United States


Posted by flounder on 01 Jan 2010 at 18:11 GMT


I kindly disagree with your synopsis for the following reasons ;


http://www.plosone.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd&root=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd





Saturday, March 5, 2011


MAD COW ATYPICAL CJD PRION TSE CASES WITH CLASSIFICATIONS PENDING ON THE RISE IN NORTH AMERICA


Greetings,


WITH more and more atypical Transmissible Spongiform Encephalopathy cases showing up in more and more species here in North America, and the enormous monumental amount of banned mad cow protein in commerce since the infamous partial and voluntary mad cow feed ban inked on paper, with tons and tons crossing back and forth between the USA, Canada, and Mexico, it just does not surprise me of all these "PENDING CLASSIFICATIONS" of human TSE in Canada, and the USA. UK c-BSE transmitted to humans became nvCJD. WE now have atypical strains of BSE in cattle. Mission Texas experiments long ago showed that transmitted USA sheep scrapie to USA bovine, produced a TSE much different than the UK typical c-BSE. SO why would human TSE in the USA look like UK human TSE ? The corruption is mind boggling. The UK saw a suspicious TSE in humans, and science linked it to cattle. North America is awash with human and animal TSE, CJD is rising in young and old, with the same pathology and same symptoms, and none of it is related to the other. isn't that nice. who, what, bestowed such miracles upon North America $


Archive Number 20100405.1091 Published Date 05-APR-2010

Subject PRO/AH/EDR> Prion disease update 1010 (04)


snip...


[Terry S. Singeltary Sr. has added the following comment:


"According to the World Health Organisation, the future public health threat of vCJD in the UK and Europe and potentially the rest of the world is of concern and currently unquantifiable. However, the possibility of a significant and geographically diverse vCJD epidemic occurring over the next few decades cannot be dismissed.


http://whqlibdoc.who.int/publications/2003/9241545887.pdf.



The key word here is diverse. What does diverse mean? If USA scrapie transmitted to USA bovine does not produce pathology as the UK c-BSE, then why would CJD from there look like UK vCJD?"


http://www.promedmail.org/pls/apex/f?p=2400:1001:568933508083034::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82101





CANADA CJD UPDATE 2011


CJD Deaths Reported by CJDSS1, 1994-20112 As of January 31, 2011


3. Final classification of 49 cases from 2009, 2010, 2011 is pending.


snip...


http://www.phac-aspc.gc.ca/hcai-iamss/cjd-mcj/cjdss-ssmcj/pdf/stats_0111-eng.pdf



USA 2011

USA

National Prion Disease Pathology Surveillance Center

Cases Examined1

(November 1, 2010)

Year Total Referrals2 Prion Disease Sporadic Familial Iatrogenic vCJD

1996 & earlier 51 33 28 5 0 0

1997 114 68 59 9 0 0

1998 87 51 43 7 1 0

1999 121 73 65 8 0 0

2000 146 103 89 14 0 0

2001 209 119 109 10 0 0

2002 248 149 125 22 2 0

2003 274 176 137 39 0 0

2004 325 186 164 21 0 13

2005 344 194 157 36 1 0

2006 383 197 166 29 0 24

2007 377 214 187 27 0 0

2008 394 231 205 25 0 0

2009 425 258 215 43 0 0

2010 333 213 158 33 0 0

TOTAL 38315 22656 1907 328 4 3


1 Listed based on the year of death or, if not available, on year of referral;

2 Cases with suspected prion disease for which brain tissue and/or blood (in familial cases) were submitted;

3 Disease acquired in the United Kingdom;

4 Disease was acquired in the United Kingdom in one case and in Saudi Arabia in the other case;

5 Includes 18 cases in which the diagnosis is pending, and 18 inconclusive cases;

6 Includes 23 (22 from 2010) cases with type determination pending in which the diagnosis of vCJD has been excluded.


http://www.cjdsurveillance.com/pdf/case-table.pdf




Please notice where sporadic CJD cases in 1996 went from 28 cases, to 215 cases in 2009, the highest recorded year to date. sporadic CJD is on a steady rise, and has been since 1996.


I also urge you to again notice these disturbing factors in lines 5 and 6 ;


5 Includes 18 cases in which the diagnosis is pending, and 18 inconclusive cases;


6 Includes 23 (22 from 2010) cases with type determination pending in which the diagnosis of vCJD has been excluded.


========end=====tss=====2011



Monday, August 9, 2010


National Prion Disease Pathology Surveillance Center Cases Examined (July 31, 2010)


(please watch and listen to the video and the scientist speaking about atypical BSE and sporadic CJD and listen to Professor Aguzzi)


http://prionunitusaupdate2008.blogspot.com/2010/08/national-prion-disease-pathology.html




please see full text here ;



Saturday, March 5, 2011


MAD COW ATYPICAL CJD PRION TSE CASES WITH CLASSIFICATIONS PENDING ON THE RISE IN NORTH AMERICA


http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/mad-cow-atypical-cjd-prion-tse-cases.html




Tuesday, April 26, 2011


sporadic CJD RISING Text and figures of the latest annual report of the NCJDRSU covering the period 1990-2009 (published 11th March 2011)


http://creutzfeldt-jakob-disease.blogspot.com/2011/04/sporadic-cjd-rising-text-and-figures-of.html




The statistical incidence of CJD cases in the United States has been revised to reflect that there is one case per 9000 in adults age 55 and older. Eighty-five percent of the cases are sporadic, meaning there is no known cause at present.


http://www.cjdfoundation.org/fact.html



http://cjdusa.blogspot.com/



http://transmissiblespongiformencephalopathy.blogspot.com/





Sunday, May 01, 2011

STUDY OF ATYPICAL BSE 2010 Annual Report May 2011

http://bse-atypical.blogspot.com/2011/05/study-of-atypical-bse-2010-annual.html





Thursday, April 28, 2011

Chronic Wasting Disease Testing and Prevalence Wisconsin April 2011

http://chronic-wasting-disease.blogspot.com/2011/04/chronic-wasting-disease-testing-and.html




UPDATED DATA ON 2ND CWD STRAIN

Wednesday, September 08, 2010

CWD PRION CONGRESS SEPTEMBER 8-11 2010

http://chronic-wasting-disease.blogspot.com/2010/09/cwd-prion-2010.html




Wednesday, January 5, 2011

ENLARGING SPECTRUM OF PRION-LIKE DISEASES Prusiner Colby et al 2011

Prions

David W. Colby1,* and Stanley B. Prusiner1,2

http://betaamyloidcjd.blogspot.com/2011/01/enlarging-spectrum-of-prion-like.html




Mother to Offspring Transmission of Chronic Wasting Disease

Candace K. Mathiason; Amy Nalls; Kelly Anderson; Jeanette Hayes-Klug; Jenny G. Powers; Nicholas J. Haley; Edward A. Hoover Colorado State University, Fort Collins, CO, USA

We have developed a new cervid model in small Asian muntjac deer (Muntiacus reevesi) to study potential modes of vertical transmission of chronic wasting disease (CWD) from mother to offspring. Eight of eight (8/8) muntjac doe orally infected with CWD tested PrPCWD lymphoid positive by 4 months post infection. Ten fawns were born to these CWD-infected doe— 4 of the fawns were viable, 5 were non-viable, and 1 was a first trimester fetus harvested from a CWD-infected doe euthanized at end-stage disease. The viable fawns have been monitored for CWD infection by immunohistochemistry and sPMCA performed on serial tonsil and rectal lymphoid tissue biopsies. PrPCWD has been detected in one fawn by IHC as early as 40 days of age. Moreover, sPMCA performed on rectal lymphoid tissue has yielded positive results on another fawn at 10 days of age. In addition, sPMCA assays have demonstrated amplifiable prions in fetal placental or spleen tissue of 3 non-viable fawns and mammary tissue of the dams. Additional pregnancy related fluids and tissues from the doe as well as tissue from the nonviable fawns are currently being probed for the presence of CWD. In summary, we have employed the muntjac deer model, to demonstrate for the first time the transmission of CWD from mother to offspring. These studies provide the foundation to investigate the mechanisms and pathways of maternal prion transfer.

2011 Pre-congress Workshop: TSEs in animals and their environment 9

http://www.prion2011.ca/files/2011TSEBookletV6Final.pdf



http://www.prion2011.ca/files/PRION_2011_-_Posters_(May_5-11).pdf



ENVT.11

Swine Are Susceptible to Chronic Wasting Disease by Intracerebral Inoculation

Justin Greenlee, Robert Kunkle, Jodi Smith

http://www.prion2011.ca/files/2011TSEBookletV6Final.pdf



http://www.prion2011.ca/files/PRION_2011_-_Posters_(May_5-11).pdf




RISK.21


Thirty-Year Review of Prion Disease Surveillance in the United States


Robert C. Holman, Ryan A. Maddox, Arianne M. Folkema, Arialdi M. Minino, Teresa A. Hammett, Kenneth D. Kochanek, James J. Sejvar, Ermias D. Belay, Lawrence B. Schonberger


http://www.prion2011.ca/files/2011TSEBookletV6Final.pdf



http://www.prion2011.ca/files/PRION_2011_-_Posters_(May_5-11).pdf




Saturday, January 2, 2010


Human Prion Diseases in the United States January 1, 2010 ***FINAL***


http://prionunitusaupdate2008.blogspot.com/2010/01/human-prion-diseases-in-united-states.html




Manuscript

Draft Manuscript Number:

Title: HUMAN and ANIMAL TSE Classifications i.e. mad cow disease and the UKBSEnvCJD only theory

Article Type: Personal View

Corresponding Author: Mr. Terry S. Singeltary,

Corresponding Author's Institution: na

First Author: Terry S Singeltary, none

Order of Authors: Terry S Singeltary, none; Terry S. Singeltary


Abstract: TSEs have been rampant in the USA for decades in many species, and they all have been rendered and fed back to animals for human/animal consumption. I propose that the current diagnostic criteria for human TSEs only enhances and helps the spreading of human TSE from the continued belief of the UKBSEnvCJD only theory in 2007.



http://www.regulations.gov/fdmspublic/ContentViewer?objectId=090000648027c28e&disposition=attachment&contentType=pdf




Monday, August 9, 2010

Variably protease-sensitive prionopathy: A new sporadic disease of the prion protein or just more PRIONBALONEY ?

http://prionunitusaupdate2008.blogspot.com/2010/08/variably-protease-sensitive-prionopathy.html



***+++***

Thursday, July 10, 2008


A Novel Human Disease with Abnormal Prion Protein Sensitive to Protease update July 10, 2008 Friday, June 20, 2008


http://cjdmadcowbaseoct2007.blogspot.com/2008/07/novel-human-disease-with-abnormal-prion.html



Wednesday, July 28, 2010

Atypical prion proteins and IBNC in cattle DEFRA project code SE1796 FOIA Final report

http://bse-atypical.blogspot.com/2010/07/atypical-prion-proteins-and-ibnc-in.html



IBNC

"All of the 15 cattle tested showed that the brains had abnormally accumulated prion protein."

Saturday, February 28, 2009

NEW RESULTS ON IDIOPATHIC BRAINSTEM NEURONAL CHROMATOLYSIS "All of the 15 cattle tested showed that the brains had abnormally accumulated PrP" 2009

SEAC 102/2

http://bse-atypical.blogspot.com/2009/02/new-results-on-idiopathic-brainstem.html



Saturday, January 29, 2011

Atypical L-Type Bovine Spongiform Encephalopathy (L-BSE) Transmission to Cynomolgus Macaques, a Non-Human Primate

Jpn. J. Infect. Dis., 64 (1), 81-84, 2011

http://transmissiblespongiformencephalopathy.blogspot.com/2011/01/atypical-l-type-bovine-spongiform.html



TSE


http://transmissiblespongiformencephalopathy.blogspot.com/



suppressed peer review of Harvard study October 31, 2002

http://www.fsis.usda.gov/oa/topics/BSE_Peer_Review.pdf



Harvard Risk Assessment of Bovine Spongiform Encephalopathy Update, October 31, 2005 INTRODUCTION The United States Department of Agriculture’s Food Safety and Inspection Service (FSIS) held a public meeting on July 25, 2006 in Washington, D.C. to present findings from the Harvard Risk Assessment of Bovine Spongiform Encephalopathy Update, October 31, 2005 (report and model located on the FSIS website: http://www.fsis.usda.gov/Science/Risk_Assessments/index.asp).


Comments on technical aspects of the risk assessment were then submitted to FSIS. Comments were received from Food and Water Watch, Food Animal Concerns Trust (FACT), Farm Sanctuary, R-CALF USA, Linda A Detwiler, and Terry S. Singeltary.


This document provides itemized replies to the public comments received on the 2005 updated Harvard BSE risk assessment. Please bear the following points in mind:


http://www.fsis.usda.gov/PDF/BSE_Risk_Assess_Response_Public_Comments.pdf



Friday, March 4, 2011

Alberta dairy cow found with mad cow disease

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/alberta-dairy-cow-found-with-mad-cow.html



Wednesday, August 11, 2010

REPORT ON THE INVESTIGATION OF THE SIXTEENTH CASE OF BOVINE SPONGIFORM ENCEPHALOPATHY (BSE) IN CANADA

http://bse-atypical.blogspot.com/2010/08/report-on-investigation-of-sixteenth.html



Thursday, August 19, 2010

REPORT ON THE INVESTIGATION OF THE SEVENTEENTH CASE OF BOVINE SPONGIFORM ENCEPHALOPATHY (BSE) IN CANADA

http://bseusa.blogspot.com/2010/08/report-on-investigation-of-seventeenth.html



Thursday, February 10, 2011

TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY REPORT UPDATE CANADA FEBRUARY 2011 a nd how to hide mad cow disease in Canada Current as of: 2011-01-31

http://madcowtesting.blogspot.com/2011/02/transmissible-spongiform-encephalopathy.html



Tuesday, November 02, 2010

BSE - ATYPICAL LESION DISTRIBUTION (RBSE 92-21367) statutory (obex only) diagnostic criteria CVL 1992

http://bse-atypical.blogspot.com/2010/11/bse-atypical-lesion-distribution-rbse.html



Wednesday, March 9, 2011

27 U.S. Senators want to force feed Japan Highly Potential North America Mad Cow Beef TSE PRION CJD

March 8, 2011

President Barack Obama The White House

1600 Pennsylvania Avenue, W Washington, DC 20500

Dear President Obama:

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/27-us-senators-want-to-force-feed-japan.html



http://madcowtesting.blogspot.com/



NOW FOR RISK FACTORS FOR CWD TRANSMISSION TO CATTLE ;

----- Original Message -----

From: David Colby

To: flounder9@verizon.net

Cc: stanley@XXXXXXXX

Sent: Tuesday, March 01, 2011 8:25 AM

Subject: Re: FW: re-Prions David W. Colby1,* and Stanley B. Prusiner1,2 + Author Affiliations

Dear Terry Singeltary,

Thank you for your correspondence regarding the review article Stanley Prusiner and I recently wrote for Cold Spring Harbor Perspectives. Dr. Prusiner asked that I reply to your message due to his busy schedule. We agree that the transmission of CWD prions to beef livestock would be a troubling development and assessing that risk is important. In our article, we cite a peer-reviewed publication reporting confirmed cases of laboratory transmission based on stringent criteria. The less stringent criteria for transmission described in the abstract you refer to lead to the discrepancy between your numbers and ours and thus the interpretation of the transmission rate. We stand by our assessment of the literature--namely that the transmission rate of CWD to bovines appears relatively low, but we recognize that even a low transmission rate could have important implications for public health and we thank you for bringing attention to this matter.

Warm Regards, David Colby

--

David Colby, PhDAssistant ProfessorDepartment of Chemical EngineeringUniversity of Delaware

PLEASE SEE FULL TEXT ;

Wednesday, January 5, 2011

ENLARGING SPECTRUM OF PRION-LIKE DISEASES Prusiner Colby et al 2011

Prions

David W. Colby1,* and Stanley B. Prusiner1,2

http://cshperspectives.cshlp.org/content/3/1/a006833.full.pdf+html



re-ENLARGING SPECTRUM OF PRION-LIKE DISEASES Prusiner Colby et al 2011 Prions

CWD to cattle figures CORRECTION

Greetings,

I believe the statement and quote below is incorrect ;

"CWD has been transmitted to cattle after intracerebral inoculation, although the infection rate was low (4 of 13 animals [Hamir et al. 2001]). This finding raised concerns that CWD prions might be transmitted to cattle grazing in contaminated pastures."

Please see ;

Within 26 months post inoculation, 12 inoculated animals had lost weight, revealed abnormal clinical signs, and were euthanatized. Laboratory tests revealed the presence of a unique pattern of the disease agent in tissues of these animals. These findings demonstrate that when CWD is directly inoculated into the brain of cattle, 86% of inoculated cattle develop clinical signs of the disease.

http://www.ars.usda.gov/research/publications/publications.htm?seq_no_115=194089



" although the infection rate was low (4 of 13 animals [Hamir et al. 2001]). "

shouldn't this be corrected, 86% is NOT a low rate. ...



kindest regards,


Terry S. Singeltary Sr. P.O. Box 42 Bacliff, Texas USA 77518



Thank you!

Thanks so much for your updates/comments. We intend to publish as rapidly as possible all updates/comments that contribute substantially to the topic under discussion.

http://cshperspectives.cshlp.org/letters/submit

please see full text of my submission here ;

Wednesday, January 5, 2011

ENLARGING SPECTRUM OF PRION-LIKE DISEASES Prusiner Colby et al 2011

Prions

David W. Colby1,* and Stanley B. Prusiner1,2

http://betaamyloidcjd.blogspot.com/2011/01/enlarging-spectrum-of-prion-like.html



Thursday, April 28, 2011

Chronic Wasting Disease Testing and Prevalence Wisconsin April 2011

http://chronic-wasting-disease.blogspot.com/2011/04/chronic-wasting-disease-testing-and.html



Sunday, March 27, 2011

SCRAPIE USA UPDATE FEBRUARY 2011

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/scrapie-usa-update-february-2011.html



Wednesday, February 16, 2011

IN CONFIDENCE SCRAPIE TRANSMISSION TO CHIMPANZEES

IN CONFIDENCE

http://scrapie-usa.blogspot.com/2011/02/in-confidence-scrapie-transmission-to.html



Sunday, April 18, 2010

SCRAPIE AND ATYPICAL SCRAPIE TRANSMISSION STUDIES A REVIEW 2010

http://scrapie-usa.blogspot.com/2010/04/scrapie-and-atypical-scrapie.html



Monday, April 25, 2011

Experimental Oral Transmission of Atypical Scrapie to Sheep

Volume 17, Number 5–May 2011

http://nor-98.blogspot.com/2011/04/experimental-oral-transmission-of.html



Saturday, December 01, 2007

Phenotypic Similarity of Transmissible Mink Encephalopathy in Cattle and L-type Bovine Spongiform Encephalopathy in a Mouse Model

Volume 13, Number 12–December 2007

Research

http://transmissible-mink-encephalopathy.blogspot.com/2007/12/phenotypic-similarity-of-transmissible.html




TRANSMISSIBLE MINK ENCEPHALOPATHY

http://transmissible-mink-encephalopathy.blogspot.com/



Saturday, March 5, 2011


MAD COW ATYPICAL CJD PRION TSE CASES WITH CLASSIFICATIONS PENDING ON THE RISE IN NORTH AMERICA


http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/mad-cow-atypical-cjd-prion-tse-cases.html



Wednesday, April 27, 2011



GENERATION ALZHEIMER'S: THE DEFINING DISEASE OF THE BABY BOOMERS


http://betaamyloidcjd.blogspot.com/2011/04/generation-alzheimers-defining-disease.html




All Other Emerging and Zoonotic Infectious Diseases CDC's FY 2012 request of $52,658,000 for all other emerging and zoonotic infectious disease activities is a decrease of $13,607,000 below the FY 2010 level,



which includes the elimination of Prion activities ($5,473,000),


a reduction for other cross-cutting infectious disease activities, and administrative savings. These funds support a range of critical emerging and zoonotic infectious disease programs such Lyme Disease, Chronic Fatigue Syndrome, and Special Pathogens, as well as other activities described below.



http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2012_CDC_CJ_Final.pdf




Friday, April 15, 2011


PRION TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY PROJECTS, RESEARCH FUNDING, BSE VOLUNTARY TESTING UPDATE IN NORTH AMERICA 2011


http://prionunitusaupdate2008.blogspot.com/2011/04/prion-transmissible-spongiform.html



Einstein once said, 'The definition of insanity is doing the same thing over and over again and expecting different results.' re-transmission studies on TSE's...TSS

Wednesday, May 11, 2011

House of Commons CJD May 2011 UPDATE

Jason McCartney: To ask the Secretary of State for Health how many people died from variant Creutzfeldt-Jakob disease in England in each of the last five years. [54620] Anne Milton: The National Creutzfeldt-Jakob disease Research and Surveillance Unit (NCJDRSU) has provided the following information about deaths from variant Creutzfeldt-Jakob disease (vCJD). This information is available on NCJDRSU website at:

http://www.cjd.ed.ac.uk/



United Kingdom definite and probable vCJD deaths 2005 to 2010

Number of Deaths

2005 5

2006 5

2007 5

2008 1

2009 3

2010 3

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110510/text/110510w0005.htm#11051093000106




CJD: Disease Control

Sir Paul Beresford: To ask the Secretary of State for Health what research his Department (a) has carried out and (b) is undertaking on cold sterilisation products for the prevention of cross infection of variant Creutzfeldt-Jakob disease prion from surgical instruments; what estimate has been made of the cost of such research in the last 12 months; when the results of the ongoing research are expected; who is carrying out the ongoing research; and where the results and conclusions of such research (i) are to be and (ii) have been published. [54483]

Mr Simon Burns: The Department has previously funded research on cold sterilisation products for the prevention of cross infection of variant Creutzfeldt-Jakob disease. The projects funded include research on enzymatic detergents, protein detection assays, physico-chemical technologies, and barrier and surface coatings. Findings have been published in peer-reviewed journals.

The Department is not currently funding any projects in this area, and there was no expenditure in 2010-11.

Sir Paul Beresford: To ask the Secretary of State for Health how much has been spent from the public purse on research studies on tonsils and the appendix to detect variant Creutzfeldt-Jakob disease; and when the results of such studies are expected. [54484]

Mr Simon Burns: To obtain an estimate of the prevalence of variant Creutzfeldt-Jakob disease (vCJD) in the population, the Department funds studies to detect vCJD in tonsils and appendices. From 1999-2000 to 2010-11, the Department spent £10.9 million on such studies from central research and development budgets.

Results have been published in peer reviewed journals. Further publication is expected at the end of the current projects.

9 May 2011 : Column 1041W

Sir Paul Beresford: To ask the Secretary of State for Health what estimate has been made of the cost to the public purse of importing blood products from non-UK sources for the purposes of prevention of transmission of variant Creutzfeldt-Jakob disease in each year since its commencement. [54485]

Anne Milton: Since 1998 a number of measures have been introduced by the UK Blood Services to reduce the risk of transfusion transmitted variant Creutzfeldt-Jakob disease. The cost of the importation of fresh frozen plasma for therapeutic use is shown in the following table:

Fresh frozen plasma: Cost of importation, 2004-11

£ million

2004-05 0.29

2005-06 0.51

2006-07 0.31

2007-08 0.32

2008-09 0.46

2009-10 0.93

2010-11 1.02

Total 3.84

Source: NHS Blood and Transplant.

NHS Blood and Transplant report that the increased costs shown from 2008-09 are in part a result of less favourable exchange rates.

Since 1999, plasma for the manufacture of fractionated plasma products, such as immunoglobulins and clotting factors, has been obtained from non-United Kingdom sources. There is a global market for the main plasma products and most companies were largely unaffected by the changes resulting from vCJD as they source plasma from non-UK donors.

Bio Products Laboratory Ltd (BPL) is the Department-owned fractionator which supplies part of the national health service demand but only a very small proportion of global product (2% to 4%). BPL historically used plasma from the UK blood services and was therefore directly affected by the change in policy. BPL's fractionated products are used in the UK, and are also sold abroad. A cost estimate for importing the plasma that is used to manufacture BPL products that are used in the UK is not readily available, but I will place an estimate in the Library by the end of June 2011.

Sir Paul Beresford: To ask the Secretary of State for Health pursuant to the contribution of the Minister of State of 28 April 2011, Official Report, column 426, on variant Creutzfeldt-Jakob disease, announcing funding for the development of cold plasma decontamination technology, whether this research will examine the removal or de-activation of vCJD prions. [54553]

Mr Simon Burns: The cold plasma decontamination project will use scrapie infected mouse brain homogenates, not variant Creutzfeldt-Jakob disease infected tissues and homogenates. Removal of the prion will be examined.

Sir Paul Beresford: To ask the Secretary of State for Health pursuant to the contribution of the Minister of State of 28 April 2011, Official Report, column 425W, and the answer of 12 July 2010, Official Report, column 475W on Creutzfeldt-Jakob disease, how many

9 May 2011 : Column 1042W

transmissions of variant Creutzfeldt-Jakob disease have been presumed to be associated with blood since 1999. [54597]

Anne Milton: There have been three cases of clinical variant Creutzfeldt-Jakob disease (vCJD) and one case of infection (without development of clinical disease) presumed to be associated with blood transfusion. These have occurred in people who have received blood transfusions from donors who themselves went on to develop clinical vCJD after they had made the blood donation. None of these patients were transfused since 1999. The vCJD infection in these four recipients only came to light in 2003 and later because of the incubation period of vCJD.

The Transfusion Medicine Epidemiology Review (TMER), a collaborative project between the United Kingdom National Creutzfeldt-Jakob Disease Research & Surveillance Unit (NCJDRSU) and the United Kingdom blood services, investigates evidence that CJD or vCJD may have been transmitted via the blood supply. Details are on the TMER website at:

www.cjd.ed.ac.uk/TMER/TMER.htm



Sir Paul Beresford: To ask the Secretary of State for Health whether his Department has conducted a cost analysis to compare the proposed use of prion filters and existing costs of risk reduction measures against the introduction of a variant Creutzfeldt-Jakob disease blood screening test which may replace or remove the need for these measures. [54816]

Anne Milton: There is currently no blood screening test that is proven to identify asymptomatic variant Creutzfeldt-Jakob disease infection. For this reason it is not possible to carry out a cost analysis to compare these measures.

Sir Paul Beresford: To ask the Secretary of State for Health pursuant to the contribution of the Minister of State for Health of 28 April 2011, Official Report, column 430 on variant Creutzfeldt-Jakob Disease (vCJD), what pathway his Department proposes to use to develop a prototype vCJD blood test in the event that no commercial company believes there is a business case to develop such a test. [54896]

Anne Milton: The Department is aware of a number of commercial organisations and academic institutions currently developing prototype blood tests for the abnormal prion protein associated with variant Creutzfeldt-Jakob Disease.

http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110509/text/110509w0004.htm#11050951000005




CJD

Paul Goggins: To ask the Secretary of State for Health in how many cases the presence of variant Creutzfeldt-Jakob disease has been evident in biopsies carried out following the death of a patient with haemophilia in the last 20 years. [52333]

Anne Milton: Abnormal prion protein associated with variant Creutzfeldt-Jakob disease has been found in a single spleen sample taken from one haemophilia patient at post mortem. Details can be found in “Peden A, McCardle L, Head MW et at. Variant CJD infection in the spleen of a neurologically asymptomatic UK adult patient with haemophilia. Haemophilia 2010; 16: 296-304”. The journal Haemophilia is available on line at:


www.wiley.com/bw/journal.asp?ref=1351-8216



http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110503/text/110503w0004.htm#11050342000011




Sunday, March 6, 2011

U.K. and U.S.A. vCJD, CJD, TSE screen (a) the blood supply and (b) blood donors Commons Hansard Written Answers and FDA March 2011

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/uk-and-usa-vcjd-cjd-tse-screen-the.html




Tuesday, April 26, 2011

sporadic CJD RISING Text and figures of the latest annual report of the NCJDRSU covering the period 1990-2009 (published 11th March 2011)

http://creutzfeldt-jakob-disease.blogspot.com/2011/04/sporadic-cjd-rising-text-and-figures-of.html




Saturday, March 5, 2011

MAD COW ATYPICAL CJD PRION TSE CASES WITH CLASSIFICATIONS PENDING ON THE RISE IN NORTH AMERICA

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/mad-cow-atypical-cjd-prion-tse-cases.html



Thursday, February 24, 2011

The risk of variant Creutzfeldt-Jakob disease among UK patients with bleeding disorders, known to have received potentially contaminated plasma products

http://vcjdtransfusion.blogspot.com/2011/02/risk-of-variant-creutzfeldt-jakob.html




Sunday, May 1, 2011

W.H.O. T.S.E. PRION Blood products and related biologicals May 2011

http://transmissiblespongiformencephalopathy.blogspot.com/2011/05/who-tse-prion-blood-products-and.html




Tuesday, March 29, 2011

TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY EXPOSURE SPREADING VIA HOSPITALS AND SURGICAL PROCEDURES AROUND THE GLOBE

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/transmissible-spongiform-encephalopathy.html



Tuesday, September 14, 2010

Transmissible Spongiform Encephalopathies Advisory Committee; Notice of Meeting October 28 and 29, 2010 (COMMENT SUBMISSION)

http://tseac.blogspot.com/2010/09/transmissible-spongiform_14.html



Sunday, May 10, 2009

Meeting of the Transmissible Spongiform Encephalopathies Committee On June 12, 2009 (Singeltary submission)

TO : william.freas@fda.hhs.gov

May 8, 2009

Greetings again Dr. Freas, TSEAC et al,

I would kindly, once again, wish to comment at this meeting about the urgent actions that need to be taken asap, to the Meeting of the Transmissible Spongiform Encephalopathies Committee On June 12, 2009. Due to my disability from my neck injury, I will not be attending this meeting either, however I hope for my submission to be read and submitted. ...

IN reply to ;

http://tseac.blogspot.com/2009/05/meeting-of-transmissible-spongiform.html



Harvard Risk Assessment of Bovine Spongiform Encephalopathy Update, October 31, 2005 INTRODUCTION The United States Department of Agriculture's Food Safety and Inspection Service (FSIS) held a public meeting on July 25, 2006 in Washington, D.C. to present findings from the Harvard Risk Assessment of Bovine Spongiform Encephalopathy Update, October 31, 2005 (report and model located on the FSIS website: http://www.fsis.usda.gov/Science/Risk_Assessments/index.asp).

Comments on technical aspects of the risk assessment were then submitted to FSIS. Comments were received from Food and Water Watch, Food Animal Concerns Trust (FACT), Farm Sanctuary, R-CALF USA, Linda A Detwiler, and Terry S. Singeltary. This document provides itemized replies to the public comments received on the 2005 updated Harvard BSE risk assessment. Please bear the following points in mind:

http://www.fsis.usda.gov/PDF/BSE_Risk_Assess_Response_Public_Comments.pdf



Wednesday, March 9, 2011

27 U.S. Senators want to force feed Japan Highly Potential North America Mad Cow Beef TSE PRION CJD

March 8, 2011

President Barack Obama The White House

1600 Pennsylvania Avenue, W Washington, DC 20500

Dear President Obama:

http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/27-us-senators-want-to-force-feed-japan.html



http://madcowtesting.blogspot.com/



Wednesday, March 31, 2010

Atypical BSE in Cattle

To date the OIE/WAHO assumes that the human and animal health standards set out in the BSE chapter for classical BSE (C-Type) applies to all forms of BSE which include the H-type and L-type atypical forms. This assumption is scientifically not completely justified and accumulating evidence suggests that this may in fact not be the case. Molecular characterization and the spatial distribution pattern of histopathologic lesions and immunohistochemistry (IHC) signals are used to identify and characterize atypical BSE. Both the L-type and H-type atypical cases display significant differences in the conformation and spatial accumulation of the disease associated prion protein (PrPSc) in brains of afflicted cattle. Transmission studies in bovine transgenic and wild type mouse models support that the atypical BSE types might be unique strains because they have different incubation times and lesion profiles when compared to C-type BSE. When L-type BSE was inoculated into ovine transgenic mice and Syrian hamster the resulting molecular fingerprint had changed, either in the first or a subsequent passage, from L-type into C-type BSE. In addition, non-human primates are specifically susceptible for atypical BSE as demonstrated by an approximately 50% shortened incubation time for L-type BSE as compared to C-type. Considering the current scientific information available, it cannot be assumed that these different BSE types pose the same human health risks as C-type BSE or that these risks are mitigated by the same protective measures.

This study will contribute to a correct definition of specified risk material (SRM) in atypical BSE. The incumbent of this position will develop new and transfer existing, ultra-sensitive methods for the detection of atypical BSE in tissue of experimentally infected cattle.

http://www.prionetcanada.ca/detail.aspx?menu=5&dt=293380&app=93&cat1=387&tp=20&lk=no&cat2



Thursday, August 12, 2010

Seven main threats for the future linked to prions

First threat

The TSE road map defining the evolution of European policy for protection against prion diseases is based on a certain numbers of hypotheses some of which may turn out to be erroneous. In particular, a form of BSE (called atypical Bovine Spongiform Encephalopathy), recently identified by systematic testing in aged cattle without clinical signs, may be the origin of classical BSE and thus potentially constitute a reservoir, which may be impossible to eradicate if a sporadic origin is confirmed. ***Also, a link is suspected between atypical BSE and some apparently sporadic cases of Creutzfeldt-Jakob disease in humans. These atypical BSE cases constitute an unforeseen first threat that could sharply modify the European approach to prion diseases.

Second threat

snip...


http://www.neuroprion.org/en/np-neuroprion.html



http://prionpathy.blogspot.com/2010/08/seven-main-threats-for-future-linked-to.html



All Other Emerging and Zoonotic Infectious Diseases CDC's FY 2012 request of $52,658,000 for all other emerging and zoonotic infectious disease activities is a decrease of $13,607,000 below the FY 2010 level,

which includes the elimination of Prion activities ($5,473,000),

a reduction for other cross-cutting infectious disease activities, and administrative savings. These funds support a range of critical emerging and zoonotic infectious disease programs such Lyme Disease, Chronic Fatigue Syndrome, and Special Pathogens, as well as other activities described below.

http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2012_CDC_CJ_Final.pdf



Friday, April 15, 2011

PRION TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY PROJECTS, RESEARCH FUNDING, BSE VOLUNTARY TESTING UPDATE IN NORTH AMERICA 2011

http://prionunitusaupdate2008.blogspot.com/2011/04/prion-transmissible-spongiform.html




TSS