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Final Issue: Volume 16 Number 51

Published on: 21 December 2006

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News Archives

Last updated: Volume 14, No.24 (PDF file, KB)

Archives | News Archives 2004: Page 1| News 10 June

News Archives: | 2006 | 2005 | 2004 | 2003

Tonsil study provides estimate of the number of people in the UK who could be incubating vCJD

 

A study has recently been published in the Journal of Pathology that aimed to provide an estimate of the number of individuals in the United Kingdom (UK) who may be incubating variant Creutzfeldt-Jakob disease (vCJD) (1).  A distinctive feature of this disease is the distribution of abnormal prion protein in the peripheral lymphatic system, particularly tonsil tissue, which may be detected during the pre-clinical phase when there is a risk of iatrogenic transmission. Immunohistochemistry was used to demonstrate the presense of abnormal prion protein in 12,674 appendix and tonsil samples collected from histopathology departments across the UK and anonymised prior to testing.  Three of the samples showed evidence of the abnormal prion protein associated with vCJD and, after extrapolation, this provided an estimate of approximately 3800 individuals within the UK population who could be incubating this disease. 

The Department of Health and Medical Research Council steering group has recommended that a much larger study should be undertaken. The Health Protection Agency recently began this large-scale project to collect 100,000 samples of leftover tonsil tissue removed during routine operations. Once anonymised, these specimens will be tested for the presence of the abnormal prion that causes CJD, and the larger scale of the study should provide better estimates of the number of people who may be affected.

The National Anonymous Tonsil Archive (NATA) is collecting tonsils from people of all ages following routine tonsillectomies (2).  Only tissue not required for patient care, that normally would be discarded, is to be included and patients are given an opportunity to object to their tissues being used in the archive.  Improved estimates of the prevalence of abnormal prion protein should help plan interventions to limit the impact of infection and to plan care provision for those who may develop the disease.  The scientific co-ordinator of NATA, Carol Kelly, is based at the Health Protection Agency Communicable Disease Surveillance Centre (tel: 020 327 6727  email: <carole.kelly@hpa.org.uk>.

 

References

1.Hilton DA, Ghani AC, Conyers L, Edwards P, McCardle L, Richie D.  Prevalence of lymphoreticular prion protein accumulation in UK tissue samples. J Pathol  2004: 203 [online] May 2004 [cited 10 June 2004].

2.HPA.  The National Anonymous Tonsil Archive: a resource for Creutzfeldt-Jakob disease studies.  Commun Dis Rep CDR Wkly [serial online] 2003 [cited 9 June 2004]; 13(44): News.  Available at <http://wwww.hpa.org.uk/cdr/archives/2003/cdr4403.pdf>.

 

Study recommends use of antibiotics for chemoprophylaxis after a case of meningococcal disease

 

Results of a study which looked at the effectiveness of antibiotics in preventing meningococcal disease through chemoprophylaxis given to the index patient, household contacts, and children in day care settings after a single case has been published in the British Medical Journal (1).

The paper is a meta-analysis of studies that looked at no fewer than ten cases in which outcomes were compared between treated and untreated groups. The paper concludes that the risk of meningococcal disease in household contacts of a patient can be reduced by an estimated 89% if they take antibiotics known to eradicate meningococcal carriage, and that chemoprophylaxis should be recommended for the index patient and all household contacts.

References

1.Purcell B, Samuelsson S, Hahne SJM, Ehrhard I, Heuberger S, Camaroni I, et al.  Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review.  BMJ  2004; 328 (7452):1339-43.  Available at http://bmj.bmjjournals.com/cgi/content/full/328/7452/1339>.

 

Exercise East Civet

 

On 21 May 2004, a one-day table-top exercise (East Civet) was held in Cambridge, with the support of the Regional Director of Public Health, the Regional Director for Health Protection Agency's (HPA) East of England, and the HPA's Emergency Response Division.  It was designed to evaluate, and subsequently inform, the SARS contingency plan for the East of England Region. This was the first SARS exercise to be held in the East of England and participants included public health specialists, infection control staff, emergency planners, GPs primary care staff,and microbiologists.

Objectives included assessing how the region would manage an outbreak of SARS and ,the interaction and communication between multi-disciplinary groups, and how .  The exercise also examined how contact tracing would be carried out and managed. the management of Primary Care Trusts.

The syndicates were from Bedfordshire and Hertfordshire, Cambridgeshire, Norfolk, Suffolk, North Essex, South and West Essex, and East region as well as the exercise control syndicate.   The syndicates looked in detail at the existing regional SARS plan to assess how well it would work in practice and made many constructive suggestions, particularly about the actions required at each level of escalation.  They also explored how communications would be handled in the event of an outbreak and worked on clarifying roles and responsibilities across the board, as well as the general infection policy.

Key action points

Observations from this exercise are being used to develop both the national and regional SARS plans and lessons identified will be disseminated to the relevant agencies.