USA CREUTZFELDT-JAKOB DISEASE

CREUTZFELDT-JAKOB DISEASE - USA (NORTH CAROLINA), POTENTIAL SURGICAL EXPOSURE ***************************************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Tue 11 Feb 2014 Source: The Piedmont News Station [edited] Novant Health Forsyth Medical Center announced Monday [10 Feb 2014] they are reaching out to 18 neurosurgery patients exposed to Creutzfeldt-Jakob disease, a degenerative neurological disorder that is incurable and invariably fatal. "Today [11 Feb 2014], we are reaching out to 18 neurosurgery patients who were exposed to Creutzfeldt-Jakob disease over the last 3 weeks at Forsyth Medical Center," said Jeff Lindsay, President of Forsyth Medical Center. According to the National Institute of Neurological Disorders and Stroke, Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, invariably fatal brain disorder. CJD affects about one person in every one million people per year worldwide. "While the CDC categorizes such risks as very low, any risk of transmission is simply unacceptable," said Lindsay. "On behalf of the entire team, I apologize to the patients and their families for this anxiety. We are committed to providing support to patients and their families." CJD [variant CJC] has been closely associated with mad cow disease (bovine spongiform encephalopathy), however Dr. Jim Lederer said this particular strain is not associated with mad cow disease. "The patient had sporadic CJD. This is important to note, because it is often incorrectly associated with mad cow disease [variant CJD]. It is not," said Dr. Jim Lederer. "On 18 Jan 2014, an operation was performed on a patient with symptoms that could have been attributed to CJD. There were reasons to suspect this patient may have CJD. As such, extra precautions to clean equipment should have been taken, but [were] not," said Dr. Jim Lederer. Forsyth Medical said the exposure occurred through surgical instruments that were not properly sterilized. The surgical instruments used during the surgery were sterilized using standard hospital procedures, however they were not subjected to the enhanced sterilization procedures necessary on instruments used in confirmed or suspected cases of CJD. A patient who had entered Forsyth Medical Center last month [January 2014] for back surgery said a hospital staff member contacted her on Monday [10 Feb 2014] saying she is one of 18 patients who may have been exposed to the disease. A [staff member] says that it's not the hospital's fault, but they are taking full responsibility." Doctors say it is rare that the exposed patients will develop the disease, but if the disease surfaces in patients, it likely won't happen for 20 to 30 years. Novant Health says they will keep tabs on the health of the 18 patients, watching for any signs of the disease for the rest of their lives. According to the CDC, prions, the infectious agents of CJD, may not be inactivated by means of routine surgical instrument sterilization procedures. The World Health Organization and the US Centers for Disease Control and Prevention recommend that instruments used in confirmed or suspected CJD cases be immediately destroyed after use; short of destruction, it is recommended that heat and chemical decontamination be used in combination to process instruments that come in contact with high-infectivity tissues. According to the CDC, no cases of iatrogenic transmission of CJD have been reported since 1976, when current sterilization procedures were adopted. "We believe the chances of transmission to another person [are] very, very low," said Dr. Jim Lederer. The operation at Forsyth Medical was performed on a patient who was "suspected and later confirmed" to have sporadic CJD. In a news conference, Forsyth Medical officials said the disease has no cure and may not show up in exposed patients for decades. CJD usually appears later in life and runs a rapid course. Typically, onset of symptoms occurs about age 60, and about 90 percent of individuals die within one year. In the early stages of disease, people may have failing memory, behavioral changes, lack of coordination, and visual disturbances. As the illness progresses, mental deterioration becomes pronounced, and involuntary movements, blindness, weakness of extremities, and coma may occur. The Department of Health and Human Services issued [the following] statement on Monday [10 Feb 2014]: "DHHS officials are aware of the incident at Novant Health Forsyth Medical Center and have been in contact with the facility. Our primary concern is the health, safety, and welfare of patients, and we will continue to closely monitor the situation," said Kevin Howell, DHHS spokesperson.

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