Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: Results from a risk-based assessment of surgical interventions
Résumé
Objectives: Evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case-control study, we applied a risk-based classification of surgical interventions to determine the association between a history of surgery and sCJD Design: Case-control study, allowing for detailed analysis according to time since exposure. Setting: National populations of Denmark and Sweden. Participants: From national registries of Denmark and Sweden we included 167 definite and probable sCJD cases with onset during the period 1987-2003, 835 age-, sex- and residence-matched controls and 2,224 unmatched. Surgical procedures were categorized by anatomic structure and presumed risk of transmission level. We used logistic regression to determine odds ratio (OR) for sCJD by surgical interventions in specified time-windows before disease-onset. Results: From comparisons with matched controls, procedures involving retina and optic nerve were associated with an increased risk at a latency of ≥1 year OR (95%CI) 5.53 (1.08-28.0). At latencies of 10 to 19 years, interventions on peripheral nerves 4.41 (1.17-16.6) and skeletal muscle 1.58 (1.01-2.48) were directly associated. Interventions on blood vessels 4.54 (1.01-20.0), peritoneum 2.38 (1.14-4.96), and skeletal muscle 2.04 (1.06-3.92), interventions conducted by vaginal approach 2.26 (1.14-4.47) and a pooled category of Lower-risk procedures 2.81 (1.62-4.88) had an increased risk after ≥20 years. Similar results were found when comparing with unmatched controls. Interpretation: This observation is in concordance with animal models of prion neuroinvasion and is likely to represent a causal relation of surgery with a non-negligible proportion of sCJD cases.
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