Nosocomial transmission of sporadic Creutzfeldt–Jakob disease: results from a risk-based assessment of surgical interventions
OPEN ACCESS- Jesús de Pedro-Cuesta1,2,
- Ignacio Mahillo-Fernández1,2,
- Alberto Rábano3,
- Miguel Calero2,4,
- Mabel Cruz5,
- Åke Siden5,
- Henning Laursen6,
- Gerhard Falkenhorst7,
- Kåre Mølbak7,
- EUROSURGYCJD Research Group
- 1Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- 2Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED),Madrid, Spain
- 3Pathology Unit, Fundación Alcorcón University Teaching Hospital, Alcorcon, Spain
- 4Department of Spongiform Encephalopathies, National Microbiology Center, Carlos III Institute of Health, Ctra. Majadahonda-Pozuelo, Majadahonda, Spain
- 5Department of Clinical Neurosciences, Neurology Division, Karolinska Institutet, Stockholm, Sweden
- 6Neuropathology Laboratory, Copenhagen, Denmark
- 7Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
- Correspondence to Dr Jesús de Pedro Cuesta, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Calle Monforte de Lemos 5, Madrid 28029, Spain; jpedro{at}isciii.es
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Contributors JdP-C has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Preliminary results were presented at the EUROCJD/NEUROCJD Public Health EU Meeting, held in Paris on 5 December 2006.
- Received 9 July 2009
- Revised 3 March 2010
- Accepted 12 April 2010
- Published Online First 14 June 2010
Abstract
Objectives Evidence of surgical transmission of sporadic Creutzfeldt–Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case–control study, the authors applied a risk-based classification of surgical interventions to determine the association between a history of surgery and sCJD.
Design Case–control study, allowing for detailed analysis according to time since exposure.
Setting National populations of Denmark and Sweden.
Participants From national registries of Denmark and Sweden, the authors included 167 definite and probable sCJD cases with onset during the period 1987–2003, 835 age-, sex- and residence-matched controls and 2224 unmatched. Surgical procedures were categorised by anatomical structure and presumed risk of transmission level. The authors used logistic regression to determine the odds ratio (OR) for sCJD by surgical interventions in specified time-windows before disease-onset.
Results From comparisons with matched controls, procedures involving retina and optic nerve were associated with an increased risk at a latency of ≥1 year OR (95% CI) 5.53 (1.08 to 28.0). At latencies of 10 to 19 years, interventions on peripheral nerves 4.41 (1.17 to 16.6) and skeletal muscle 1.58 (1.01 to 2.48) were directly associated. Interventions on blood vessels 4.54 (1.01 to 20.0), peritoneum 2.38 (1.14 to 4.96) and skeletal muscle 2.04 (1.06 to 3.92), interventions conducted by vaginal approach 2.26 (1.14 to 4.47) and a pooled category of lower-risk procedures 2.81 (1.62 to 4.88) had an increased risk after ≥20 years. Similar results were found when comparing with unmatched controls.
Interpretation This observation is in concordance with animal models of prion neuroinvasion and is likely to represent a causal relation of surgery with a non-negligible proportion of sCJD cases.
Footnotes
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Funding Funding was obtained from The Research Commission EU, Concerted Action QLRG3-CT-2002-81223, NEUROPRION, and the Spanish RECSP C03-09, CIEN C03-06 and CIBERNED networks.
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Competing interests None.
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Ethics approval Ethics approval was provided by the Danish Data Protection Agency (record No 2003-41-3104) and Karolinska Institute Ethics Committee (South; report No 452/02).
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Provenance and peer review Not commissioned; externally peer reviewed.
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