HIV and STI Department, and CJD Section, National Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
BMJ. 2013 Oct 15;347:f5675. doi: 10.1136/bmj.f5675.
To carry out a further survey of archived appendix samples to understand better the differences between existing estimates of the prevalence of subclinical infection with prions after the bovine spongiform encephalopathy epizootic and to see whether a broader birth cohort was affected, and to understand better the implications for the management of blood and blood products and for the handling of surgical instruments.
Irreversibly unlinked and anonymised large scale survey of archived appendix samples.
Archived appendix samples from the pathology departments of 41 UK hospitals participating in the earlier survey, and additional hospitals in regions with lower levels of participation in that survey.
32,441 archived appendix samples fixed in formalin and embedded in paraffin and tested for the presence of abnormal prion protein (PrP).
Of the 32,441 appendix samples 16 were positive for abnormal PrP, indicating an overall prevalence of 493 per million population (95% confidence interval 282 to 801 per million). The prevalence in those born in 1941-60 (733 per million, 269 to 1596 per million) did not differ significantly from those born between 1961 and 1985 (412 per million, 198 to 758 per million) and was similar in both sexes and across the three broad geographical areas sampled. Genetic testing of the positive specimens for the genotype at PRNP codon 129 revealed a high proportion that were valine homozygous compared with the frequency in the normal population, and in stark contrast with confirmed clinical cases of vCJD, all of which were methionine homozygous at PRNP codon 129.
This study corroborates previous studies and suggests a high prevalence of infection with abnormal PrP, indicating vCJD carrier status in the population compared with the 177 vCJD cases to date. These findings have important implications for the management of blood and blood products and for the handling of surgical instruments.
进一步调查存档的阑尾样本，以更好地了解在牛海绵状脑病流行后，目前对朊病毒亚临床感染流行率的估计之间的差异，以及是否更广泛的出生队列受到影响，并更好地了解这对血液和血液制品管理以及手术器械处理的影响。
对存档的阑尾样本进行不可逆转的非关联和匿名大规模调查。
来自 41 家英国医院病理科的存档阑尾样本，这些医院参与了早期调查，以及该调查参与度较低的地区的其他医院。
32441 个存档的阑尾样本，固定在福尔马林中，嵌入石蜡中，并检测是否存在异常朊病毒蛋白（PrP）。
在 32441 个阑尾样本中，有 16 个样本的异常 PrP 呈阳性，表明总体流行率为每百万人口 493 例（95%置信区间为每百万 282 至 801 例）。出生于 1941-1960 年（每百万 733 例，每百万 269-1596 例）的人群与出生于 1961-1985 年的人群（每百万 412 例，每百万 198-758 例）的流行率无显著差异，且在两性和三个抽样的广泛地理区域中相似。对阳性标本的 PRNP 密码子 129 基因型进行基因检测显示，与正常人群相比，高比例为缬氨酸纯合子，与 PRNP 密码子 129 处确认的临床 vCJD 病例的甲硫氨酸纯合子形成鲜明对比。
本研究证实了先前的研究结果，表明人群中存在异常 PrP 感染的高流行率，表明存在 vCJD 携带者状态，而迄今为止，仅报告了 177 例 vCJD 病例。这些发现对血液和血液制品管理以及手术器械处理具有重要意义。
