Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan.
Neuroepidemiology. 2010;34(4):232-7. doi: 10.1159/000297747. Epub 2010 Mar 18.
Ongoing surveillance following the 1996 Japanese nationwide survey on dural-graft-associated Creutzfeldt-Jakob disease (d-CJD) has found that, of all d-CJD cases occurring globally, most patients were identified in Japan. Despite wide recognition that the epidemic is the consequence of shortcomings in the regulation of organ transplantation and the tardy decision-making by the Japanese health ministry, the size of the d-CJD epidemic remains unknown.
To estimate the overall size of the d-CJD epidemic, a mathematical model was constructed using data on 132 d-CJD patients from the Japanese nationwide surveillance system from 1996 to 2008.
Our bayesian model predicted the size of the epidemic to be 163 patients (95% bayesian credible set: 147-183), suggesting that the probability of observing a total of 200 d-CJD patients in the future is low. Further, using a model which included a hypothetical 1987 ban on the use of dura mater, we estimated that the number of patients developing d-CJD would have been between 82 and 122, had Japan acted sooner to counteract the influx of tainted grafts.
From a public health point of view, minimizing the number of patients exposed should be the highest priority in stemming future epidemics.
自 1996 年日本全国范围内针对硬脑膜移植物相关克雅氏病（d-CJD）的调查以来，持续进行的监测发现，在全球所有发生的 d-CJD 病例中，大多数患者都在日本被发现。尽管人们普遍认识到，这一流行病是器官移植监管不善和日本卫生部决策迟缓的结果，但 d-CJD 疫情的规模仍不得而知。
为了估计 d-CJD 疫情的总体规模，我们使用了 1996 年至 2008 年日本全国监测系统中 132 例 d-CJD 患者的数据，构建了一个数学模型。
我们的贝叶斯模型预测疫情规模为 163 例（95%贝叶斯可信区间：147-183），这表明未来观察到总共 200 例 d-CJD 患者的可能性较低。此外，使用一个包含假设的 1987 年禁止使用硬脑膜的模型，我们估计，如果日本更早采取行动来阻止受污染移植物的涌入，那么 d-CJD 患者的数量将在 82 到 122 之间。
从公共卫生的角度来看，减少接触患者的人数应是遏制未来疫情的最高优先事项。
