Table 2.
Global incidence of iatrogenic prion and prion-like transmission and disease in relation to medical treatment and indication
| Medical treatment (site of administration) | Medical indication | Product or mode of transmission | Known or suspected infectious source | Estimated CJD transmission risk and, or number of known cases (geographical location of affected patients) | Unexpected finding of Aβ accumulation in the brain and, or cerebral blood vessels of indicated patient groups (geographical location of affected patients) |
|---|---|---|---|---|---|
| Growth hormone therapy (intramuscular) | Primary and secondary pituitary insufficiency | Hormone batches prepared from pooled human cadaveric pituitary glands | Inclusion of tissue(s) from sporadic CJD case(s) | 1–10% of treated groups > 230 cases worldwide (Europe, USA) [8] |
26/72 growth hormone-associated CJD cases examined (aggregate numbers from four studies conducted in Europe and the USA) [9, 42, 70] 5/12 growth hormone treated patients without CJD (UK) [70] |
| Dura mater grafting (CNS) | Repair or replacement of dura during neurosurgery | Batches prepared from pooled dura mater tissue from human cadaveric brain | Inclusion of tissue(s) from sporadic CJD case(s) | < 1% of grafted patients (Japan) > 228 cases world-wide (Japan, Europe, USA) [8] |
26/36 dura mater-associated CJD cases examined (aggregate numbers from four studies conducted in Japan, Europe and the USA) [9, 26, 34, 46] Case report of dura mater recipient without CJD (Europe) [38] |
| Neurosurgery, electro-encephalography (CNS) | Neurological disease, and electrophysiological recording | Re-use of contaminated instruments and depth electrodes | Prior use on a patient with sporadic CJD | Six cases world-wide (UK, France, Switzerland) [8] | Eight patients < 55 years of age, without CJD, with a severe cerebral amyloid angiopathy and a history of childhood neurosurgery (Europe, Japan) [43] |
| Corneal transplantation (eye) | Replacement of damaged or diseased cornea | Individual donated cadaveric human eyes | Donation from unrecognised sporadic CJD case | One definite (USA) and four suspected cases (Japan, Europe, USA) [84] | Not reported |
| Blood transfusion (intravenous) | Symptomatic anaemia, acute blood loss | Individual units of donated human packed red blood cells | Unrecognised preclinical variant CJD blood donor | Four infections linked to 67 recipients of implicated components from 18 donors (UK). Three cases of typical clinical variant CJD and one asymptomatic case with evidence of infection in the spleen (UK) [62] | Not reported |
| Factor VIII treatment (intravenous) | Haemophilia | Batches of fractionated and purified pooled blood donations | Inclusion of preclinical variant CJD donor bloods | One out of 17 at risk asymptomatic haemophiliacs tested positive in spleen (UK) [62] | Not reported |