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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. World Health Organization Consultation on Public Health Issues Related to Bovine Spongiform Encephalopathy and the Emergence of a New Variant of Creutzfeldt-Jakob DiseaseAt a World Health Organization (WHO) Consultation organized in Geneva on April 2-3, 1996, a group of international experts reviewed the public health issues related to bovine spongiform encephalopathy (BSE) and the emergence of a new variant of Creutzfeldt-Jakob Disease (V-CJD), as officially reported by the United Kingdom on March 20, 1996. The Consultation made recommendations, based on the latest scientific information, to minimize transmission of BSE among animals and to reduce as completely as possible any exposure of humans to the BSE agent. FINDINGS Bovine Spongiform Encephalopathy BSE is a transmissible spongiform encephalopathy (TSE) in cattle, which was first identified in the United Kingdom in 1986. It is one of a group of similar degenerative diseases that occur in several animal species. Transmission of BSE to cattle appears to have occurred by contaminated meat and bone meal in concentrate feed, sheep or cattle being the original source. The United Kingdom is the only country with a high incidence of the disease, and the epidemic there appears to have been due mainly to recycling of affected bovine material back to cattle before the ruminant (cattle, sheep, and goats) feed ban in July 1988 took effect. There is no evidence of either maternal or horizontal transmission of BSE. The incidence of the disease is declining significantly in the United Kingdom, although the measures introduced have not thus far halted the epidemic. The worldwide distribution of BSE is not known precisely, but it has been reported at a much lower incidence than in the United Kingdom in native cattle in other European countries. In these latter countries only part of the BSE cases could be related to consumption of feed that might have been contaminated with the BSE agent. Variant of Creutzfeldt-Jakob Disease The group reviewed the clinical and pathologic data from the 10 cases in the United Kingdom. The disease has occurred at younger ages than is usual for classical CJD and shows several clinical and pathologic differences. Based on findings in these 10 cases, the group established a case definition to facilitate better surveillance, which is necessary to determine the incidence and distribution of this syndrome. The group concluded that there is no definite link between BSE and V-CJD but that circumstantial evidence suggests exposure to BSE may be the most likely explanation. Further research on both diseases is urgently required. Exposure to BSE has already been greatly reduced by measures taken in the United Kingdom. RECOMMENDATIONS Bovine Spongiform Encephalopathy
Variant of Creutzfeldt-Jakob Disease
As surveillance worldwide is increased for both BSE and V-CJD, more information will become available in the coming months. WHO will keep these developments under review and update the recommendations as appropriate. Adapted from Weekly Epidemiological Record 1996;71(no.15) (in press). Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC. Editorial NoteEditorial Note: In the United States, the U.S. Department of Agriculture (USDA) has conducted active surveillance for BSE in cattle since 1990 and has not detected any cases. Nonetheless, because of the concern that V-CJD in the United Kingdom might possibly be linked to BSE, additional safety measures are being instituted, including discontinuation of the use of ruminant tissue in ruminant feeds. CDC conducts surveillance for CJD through examination of death certificate data for U.S. residents for whom CJD was listed as one of the multiple causes of death (1). Based on this surveillance, during 1979-1993, the annual incidence of CJD remained stable at approximately one case per million persons. In the United Kingdom, five of eight patients who died with V-CJD since May 1995 were aged less than 30 years; in comparison, in the United States, CJD deaths in this age group remain extremely rare ( less than 5 cases per billion per year). CDC is working with the Council of State and Territorial Epidemiologists to consider expansion of current CJD surveillance. On April 8, an interagency meeting including representatives from CDC, the National Institutes of Health, the Food and Drug Administration, USDA, and the U.S. Department of Defense was held to disseminate conclusions from the WHO consultation and to coordinate preventive activities for BSE and CJD. CDC is working with its four established Emerging Infections Disease Programs (Minnesota; Oregon; New Haven, Connecticut; and the San Francisco Bay area, California), the Georgia Department of Human Resources, and the Atlanta Metropolitan Active Surveillance Program to pilot enhanced surveillance efforts for CJD, including an active search for V-CJD as described in the United Kingdom (2). References
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