Use of modelling to inform public health policy: a case study on the blood-borne transmission of variant-CJD

Since the identification of variant Creutzfeldt–Jacob Disease in the late 1980s, the possibility that this disease might be passed on via blood transfusion has presented challenging policy questions for Government and blood services in the UK. This paper discusses the use of mathematical modelling to inform policy in this area of health protection. We focus on the use of a relatively simple analytical model to explore how many such infections might eventually be expected to result in clinical cases under a range of alternative scenarios of interest to policy, and on the potential impact of possible additional counter measures. We comment on the value of triangulating between findings generated using distinct modelling approaches and observational data.

[1]  C. Chapman,et al.  Long‐term survival after blood transfusion: a population based study in the North of England , 2004, Transfusion.

[2]  Jean Maccario,et al.  The Incubation Period of Kuru , 2002, Epidemiology.

[3]  J. Ironside,et al.  Predicting susceptibility and incubation time of human-to-human transmission of vCJD , 2005, The Lancet Neurology.

[4]  J. Lefrère,et al.  From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France , 2009, Transfusion.

[5]  M. Bishop,et al.  Pathological investigation of the first blood donor and recipient pair linked by transfusion‐associated variant Creutzfeldt–Jakob disease transmission , 2009, Neuropathology and applied neurobiology.

[6]  N. Hunter,et al.  Prion diseases are efficiently transmitted by blood transfusion in sheep. , 2008, Blood.

[7]  Hong Yang,et al.  Estimation of variant Creutzfeldt‐Jakob disease infectivity titers in human blood , 2011, Transfusion.

[8]  Richard Knight,et al.  The risk of transmitting prion disease by blood or plasma products. , 2010, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[9]  Suvankar Pal,et al.  Clinical presentation and pre-mortem diagnosis of variant Creutzfeldt-Jakob disease associated with blood transfusion: a case report , 2006, The Lancet.

[10]  J Mackenzie,et al.  Creutzfeldt-Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study. , 2006, Vox sanguinis.

[11]  John Collinge,et al.  Kuru in the 21st century—an acquired human prion disease with very long incubation periods , 2006, The Lancet.

[12]  Antonio Giulivi,et al.  Effectiveness of leucoreduction for removal of infectivity of transmissible spongiform encephalopathies from blood , 2004, The Lancet.

[13]  N M Ferguson,et al.  Epidemiological determinants of the pattern and magnitude of the vCJD epidemic in Great Britain , 1998, Proceedings of the Royal Society of London. Series B: Biological Sciences.

[14]  George E. P. Box,et al.  The Royal Society of London , 2013 .

[15]  S. Cousens,et al.  Transmissions to mice indicate that ‘new variant’ CJD is caused by the BSE agent , 1997, Nature.

[16]  M. Head,et al.  Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient , 2004, The Lancet.

[17]  J. Collinge Prion diseases of humans and animals: their causes and molecular basis. , 2001, Annual review of neuroscience.

[18]  Mark Penney,et al.  Prevalence of lymphoreticular prion protein accumulation in UK tissue samples , 2004, The Journal of pathology.

[19]  Roger Y Dodd Prions and precautions: be careful for what you ask , 2010, Transfusion.

[20]  Peter Rudge,et al.  Variant CJD in an individual heterozygous for PRNP codon 129 , 2009, The Lancet.

[21]  James W Ironside,et al.  Variant Creutzfeldt-Jakob disease: prion protein genotype analysis of positive appendix tissue samples from a retrospective prevalence study , 2006, BMJ : British Medical Journal.

[22]  Bob Will,et al.  Variant CJD: where has it gone, or has it? , 2010, Practical Neurology.

[23]  S. Love,et al.  Variant CJD infection in the spleen of a neurologically asymptomatic UK adult patient with haemophilia , 2010, Haemophilia : the official journal of the World Federation of Hemophilia.

[24]  Christl A. Donnelly,et al.  Predicted vCJD mortality in Great Britain , 2000, Nature.

[25]  Andrew F. Hill,et al.  The same prion strain causes vCJD and BSE , 1997, Nature.

[26]  P. Bennett,et al.  Assessing the risk of vCJD transmission via surgery: models for uncertainty and complexity , 2005, J. Oper. Res. Soc..

[27]  Azra C. Ghani,et al.  Uncertainty in the Tail of the Variant Creutzfeldt-Jakob Disease Epidemic in the UK , 2010, PloS one.

[28]  J P Wallis,et al.  Strategies to reduce transfusion acquired vCJD , 2011, Transfusion medicine.

[29]  A. Casbard,et al.  The EASTR Study: indications for transfusion and estimates of transfusion recipient numbers in hospitals supplied by the National Blood Service , 2009, Transfusion medicine.

[30]  John Cairns,et al.  The management of blood safety in the presence of uncertain risk: a United kingdom perspective. , 2012, Transfusion medicine reviews.

[31]  J Mackenzie,et al.  Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion , 2004, The Lancet.

[32]  John O'Sullivan,et al.  The single-ventricle patient population: a current and future concern a population-based study in the North of England , 2014, Heart.

[33]  Jeremy E. Oakley,et al.  The cost-effectiveness of surgical instrument management policies to reduce the risk of vCJD transmission to humans , 2009, J. Oper. Res. Soc..

[34]  Paul Clarke,et al.  Projections of the future course of the primary vCJD epidemic in the UK: inclusion of subclinical infection and the possibility of wider genetic susceptibility , 2005, Journal of The Royal Society Interface.

[35]  R. Will,et al.  Creutzfeldt–Jakob disease and blood transfusion: results of the UK Transfusion Medicine Epidemiological Review study , 2006, BMJ.