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Canadian Medical Association Journal
March 24'98

Can CJD be transmitted through the blood supply?

CMAJ 1998;158:714

See response from: J. Hoey
In the editorial "Human rights, ethics and the Krever inquiry" (CMAJ 1997;157[9]:1231 [full text / texte complet]), Dr. John Hoey states that "there is evidence that variant Creutzfeldt­Jakob disease (vCJD) can be spread through the blood supply." This statement contrasts sharply with information given to the Canadian Red Cross Society by experts in the North London Blood Transfusion Service, who have stated that "there is absolutely no evidence that vCJD can be spread through the blood supply."

There has been conjecture based on tentative evidence that a staining procedure for tonsillar tissues may demonstrate vCJD, as well as a report from Switzerland that the receptor for vCJD may occur on B cells. In addition, studies from the National Institutes of Health have shown that only under certain controlled conditions can the vCJD prion occur in the blood of mice and furthermore that the prion can be transmitted and cause CJD only if the blood is injected into the brain of the mouse; transmission does not occur through the blood­brain barrier. The inaccurate statement in the editorial is disturbing to physicians charged with counselling patients who may have received blood components from donors in whom CJD was subsequently diagnosed. It also stands in stark contrast to the article "Is Creutzfeldt­Jakob disease transmitted in blood? Is the absence of evidence of risk evidence of the absence of risk?" (CMAJ 1997;157[10]:1367-70 [full text / résumé]), by Dr. Maura N. Ricketts, who concludes, "Evidence indicates that the risk of transmission of CJD through blood and blood products is not simply rare or even exceedingly rare. It is theoretical."

My experience with CMAJ is that it often includes unqualified statements in reports of new medical developments in Canada and the rest of the world. Such statements have the potential to set up a chain reaction among physicians, who will worry and arrive at the wrong conclusions.

Antonio Giulivi, MD
Associate National Director
Medical and Scientific Affairs
Canadian Red Cross Society
Ottawa, Ont.

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