Volume 22-17
1 September 1996

[Table of Contents]

Infection Control

ADVISORY NOTICE: INFECTION CONTROL FOR CREUTZFELDT-JAKOB DISEASE

The Division of Nosocomial and Occupational Infections and the Division of Blood-borne Pathogens, Bureau of Infectious Diseases, LCDC, has received enquiries related to updated infection control (IC) methods for patients with Creutzfeldt-Jakob Disease (CJD). The 1992 Health Canada Infection Control Guidelines: Isolation and Precaution Techniques provide some recommendations. These Guidelines are currently being revised, including the recommendations for CJD. Other jurisdictions and organizations have published IC guidelines for CJD (1-6) and these provide pertinent information.

Human infection with the CJD agent is known to occur. All cases have resulted from either direct exposure of the brain to the CJD agent (e.g., dura mater graft) or peripheral injection of a CJD agent-contaminated product derived from human brain (pituitary hormone).

Cases of CJD have been reported in health care workers, but there is no epidemiologic evidence to indicate that health care workers are at increased occupational risk for CJD. However, practices to minimize the exposure of health care workers should be in place.

Special CJD-specific IC precautions are recommended for patients who have, are suspected of having, or are at substantially increased risk of developing CJD [i.e., persons who have received human pituitary hormone (growth hormone and gonadotrophin) or dura mater grafts or members of a family where CJD is recognized as being familial].

There is no human evidence of CJD transmission from patients who are asymptomatic for CJD and not at increased risk of developing CJD (as defined in the previous paragraph). Therefore, such patients do not need special CJD-specific IC precautions.

The clinical diagnosis of CJD can be difficult, especially in the early clinical phase or if the presentation is atypical. It is problematic as to what IC practices should be recommended for patients who have undiagnosed neurologic illness, especially dementing illness. Credible guidelines from other jurisdictions are not consistent. The United Kingdom guidelines (1) do not consider these patients to be a risk group that needs special CJD-specific IC precautions. Australian guidelines (2) classify any patient with undiagnosed progressive neurologic illness with or without dementia as at increased but not high risk for having CJD and some special CJD-specific IC precautions are recommended. LCDC, in consultation with external advisors, is examining this issue in detail.

Health care organizations or professionals needing to discuss IC precautions for CJD may contact LCDC staff at 613-952-9875.

References

1. Advisory Committee on Dangerous Pathogens. Precautions for work with human and animal spongiform encephalopathies. London: HMSO, 1994.

2. National Health and Medical Research Council. Creutzfeldt-Jakob disease and other human spongiform encephalopathies: guidelines on patient management and infection control. Australia: Australian Government Publishing Service, 1995.

3. Budka H, Aguzzi A, Brown P et al. Tissue handling in suspected Creutzfeldt-Jakob disease (CJD) and other human spongiform encephalopathies (prion diseases). Brain Pathol 1995;5:319-22.

4. Bell JE, Ironside JW. How to tackle a possible Creutzfeldt-Jakob disease necropsy. J Clin Pathol 1993;46:193-97.

5. Committee on Health Care Issues, American Neurological Association. Precautions in handling tissues, fluids, and other contaminated materials from patients with documented or suspected Creutzfeldt-Jakob disease. Ann Neurol 1986;19:75-7.

6. Steelman VM. Creutzfeldt-Jakob disease: recommendations for infection control. Am J Infect Control 1994;22:312-18.

Source:

Blood-borne Pathogens Division and Nosocomial and Occupational Infections Division, Bureau of Infectious Diseases, LCDC, Ottawa.

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