건강과 대안 » RISK ASSESSMENT

[광우병] 영국인 2000명 중 1명 수혈로 인간광우병 감염됐을 것(영국정부 보고서)

건강과대안 — Wed, 15 May 2013 20:00:02 +0000

Policy paper vCJD and transfusion of blood components: updated risk assessment

Organisation:: Department of Health
Published:: 15 April 2013
Applies to:: England

https://www.gov.uk/government/publications/vcjd-and-transfusion-of-blood-components-updated-risk-assessment

vCJD AND TRANSFUSION OF BLOOD COMPONENTS:
AN UPDATED RISK ASSESSMENT
Peter Bennett and Maren Daraktchiev
Health Protection Analytical Team
Department of Health
Wellington House
133-155 Waterloo Road, London SE1 8UG
February 14th 2013
CONTENTS
SUMMARY 1
1. INTRODUCTION 2
2. CASE EVIDENCE, PREVIOUS SCENARIOS AND MODEL CALIBRATION 4
3. INPUTS AND ASSUMPTIONS REVISITED 9
4. MODELLING METHODS 17
5. RESULTS AND DISCUSSION 29
6. CONCLUDING COMMENTS AND CAVEATS 32
ANNEXES
A. BACKGROUND EVIDENCE AND DATA
1. Total usage of components
2. Distribution of units by age of recipients
3. Post-transfusion survival
4. Transfusion-related vCJD infections and follow-up of recipients
B. ESTIMATING THE RISK OF vCJD INFECTION FROM PAST RECEIPT OF
BLOOD COMPONENTS
C. PAST AND FUTURE SECONDARY CASES: ILLUSTRATIVE SCENARIOS
D. SUMMARY OF “CALIBRATED” MODEL RUNS

================================

영국의 병원에서 인간광우병에 감염된 혈액의 수혈로 인한 인간광우병으로
사망한 사람이 1000명에 이를 수 있다는 영국 정부 보고서가 2013년 4월
15일 발표되었습니다.

영국 정부의 전문가들은 3만명 정도의 영국 국민들이 수혈로 인해서 인간광우병에
감염되었을 것으로 추정했습니다.(이 추정치는 이전 추정치의 2배)

Frank Dobson 전 보건부장관은 총리에게 장래 수혈을 통한 인간광우병 사망을
막기 위해 헌혈자들을 위한 전국적 검사 프로그램을 시행할 것을 촉구했습니다.

영국 정부의 조치로 지금은 쇠고기에 의해 인간광우병에 감염될 가능성은 거의
없지만, 영국 국민 2000명 중 1명(즉 3만명)은 이미 수혈에 의해 변형 프리온에
감염된 채 증상이 나타나지 않는 채 다른 사람에게 변형 프리온을 전염시키는
침묵의 매개자(“silent” carriers)을 하고 있다고 볼 수 있습니다.

======================================================

Mad cow infected blood ‘to kill 1,000’

By Rowena Mason, Political Correspondent

10:00PM BST 28 Apr 2013

http://www.telegraph.co.uk/health/healthnews/10024078/Mad-cow-infected-blood-to-kill-1000.html

The Government continues to encourage ‘people of all ages to give blood’ Photo: AFP

Up to 1,000 people could die of the human form of “mad cow” disease through infected blood given to them in British hospitals, ministers have been told.

Government experts believe there is still a risk of people contracting variant Creutzfeldt-Jakob Disease (vCJD) through blood transfusions, as about 30,000 Britons are likely to be carrying the brain-wasting illness in a dormant form — double the previous estimate.

They warn the current total death toll of 176 from vCJD could rise more than five-fold as the infection has not been wiped out of the blood supply like it has been in the food chain.

Frank Dobson, a former health secretary, tonight urged ministers to develop a nationwide screening programme for blood donors to stop future infections of vCJD, which has the potential to cause “horrendous deaths”.

People are no longer in danger of getting vCJD from eating British beef, after ministers ordered the slaughter of millions of cows when the “mad cow” disease scandal broke in 1989. Fears that hundreds of thousands of people could contract the human form of bovine spongiform encephalopathy (BSE) proved unfounded.

However, the Government acknowledges that one in 2,000 Britons – or approximately 30,000 people- are already “silent” carriers of infectious proteins that lead some people to develop vCJD.

A little-reported study last summer concluded the prevalence of this “silent” vCJD is likely to be twice as high as previously thought.

These 30,000 carriers can unknowingly pass on the infectious proteins – known as prions – to new potential sufferers through donated blood.

Because so little is known about vCJD, there is no telling which carriers will go on to develop the disease or whether any new cases will actually materialise at all.

There have been no new cases for two years and there are thought to be no surviving sufferers of vCJD, which has always historically proved fatal.

However a new risk assessment published this month by the Government’s Health Protection Analytical team reveals that infected blood donations could cause up to 1,000 deaths in a high case scenario.

About half of the cases could develop in people who have already received blood transfusions and up to 580 cases from people who are yet to be infected with the disease. The central estimate of infections yet to occur is 205.

It suggests ministers could consider recruiting young blood donors born after 1996 once they become eligible, as they will not have eaten infected beef.

“The number of “silent” vCJD infections associated with transfusion would be much higher than the number of clinical cases,” it said. “It is therefore important to maintain, and if possible enhance, measures to prevent onward transmission of infection, notably the exclusion of recipients from donating blood.”

Mr Dobson, the former Labour Health Secretary, said “everything humanly possible should be done to develop a blood test”.

“There is no room at all for complacency,” he told The Daily Telegraph. “With a blood test, you would be able to screen every potential donor. If that screening showed the incidence was higher than thought then maybe you would do it for the whole population.”

Professor John Collinge, an expert from University College London, whose research unit has developed a blood test for vCJD, said there is an element of “wishful thinking” within the Government, with officials hoping the problem has gone away.

He said he is “sceptical of guesstimates” of future cases and believes ministers need to start a study of vCJD in blood, rather than appendices, to get a proper grip on the risk of infection through transfusions.

“The figure of one in 2,000 in the appendix study was pretty worrying,” he said. “I was pretty alarmed by that. It’s clear there is a very substantial pool of infection in the community. There needs to be blood testing to answer this question of prevalance properly.”

Sir Paul Beresford, an MP and former Conservative environment minister, also believes the Government must wake up to the potential for future vCJD infections and is campaigning for more filtering of donated blood.

“If we’ve got it wrong our grandchildren are going to potentially have an epidemic of vCJD that we can do nothing about but we can prevent it if we act now,” he said.

“There’s some quite simple things they can do. For example, there’s a new system that’s being developed that will filter red blood cells before transfusion.

“[The system] is not adequate at the moment but the Government’s argument is that there’s no sign of a risk because the number of people turning up with vCJD is going down. But it can take 10, 15, 20, 25 years for this to pop up.”

A spokesman for the Department of Health said the Government continues to encourage “people of all ages to give blood”, adding “we have one of the safest blood supplies in the world”.

“Independent experts from the Advisory Committee on the Safety of Blood, Tissues and Organs have used this study during their considerations of measures to reduce the potential risk of transmission through blood transfusions,” she said. “There is no evidence of any UK clinical cases of vCJD being linked to a blood transfusion given after 1999.

“In fact there have been no new cases in the UK for more than two years.”

She said the study relates to people’s future potential to develop vCJD, not actual new cases that have occured.

======================
영국서 인간광우병 수혈 감염으로 1천 명 사망 우려”

SBS 최종편집 : 2013-04-29 17:46
http://news.sbs.co.kr/section_news/news_read.jsp?news_id=N1001760657

영국에서 인간광우병인 변종 크로이츠펠트-야콥병(vCJD)의 수혈을 통한 감염으로 1천여 명이 사망할 수 있다는 보고서가 나왔습니다.

영국 일간지인 텔레그래프에 따르면 영국 정부의 보건 분석팀은 수혈로 인간광우병 사망자가 1천여 명이 될 것으로 예측했습니다.

이 가운데 절반은 현재 수혈을 받은 사람들이지만 나머지는 앞으로 받을 수혈로 발병할 거라고 분석팀은 보고 있습니다.

이에 따라 보고서는 광우병에 걸린 소를 먹지 않은 1996년 이후 출생자만 헌혈할 수 있게 하는 방안을 제안했습니다.

이에 대해 영국 보건부 대변인은 이번 연구는 혈액·조직·기관 안전 자문위원회의 전문가들이 수혈을 통한 vCJD 감염 위험을 줄이는 방안을 검토하는 과정에서 나온 것이라며, 1999년 이후 영국에서 발병한 어떠한 vCJD도 수혈과 연관됐다는 증거가 없고 특히 지난 2년간은 신규 발병자가 아예 없다고 밝혔습니다.

또, 영국정부는 앞으로도 모든 연령의 사람들에게 헌혈을 계속 장려할 것이라고 덧붙였습니다.

영국에서는 지금까지 176명이 vCJD로 사망했으며 대부분 광우병에 걸린 소고기를 먹고 발병한 것으로 조사됐습니다.

===============

Risk assessments for CJD

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/CreutzfeldtJakobDisease/CJDIncidentsPanel/RiskAssessmentsForCJD/
Risk Assessments

Panel advice is based on risk assessments commissioned by the Department of Health:

Risk Assessment of Exposure to vCJD Infectivity in Blood and Blood Products February 2003 [external link]
Risk Assessment for vCJD and Dentistry July 2003 [external link]
Assessing the risk of vCJD transmission via surgery: an interim review March 2005 [external link]
vCJD risk assessment calculations for a patient with multiple routes of exposure June 2009 [external link]
The risk of secondary vCJD Infection of patients receiving a high number of blood transfusions. July 2009 [external link]
vCJD in blood recipients with a possible donor in common: coincidence versus causality February 2010 [external link]

The first version of the Framework document was based on the following risk assessment:

Risk Assessment for transmission of vCJD via surgical instruments: a modelling approach and numerical scenarios March 2001 [external link]

Last reviewed: 3 April 2013

[조류독감] 중국 H7N9 AI에 대한 유럽질병관리본부 위험평가

건강과대안 — Thu, 04 Apr 2013 15:15:22 +0000

중국에서 발생한 신종 플루 A(H7N9)에 대한 ECDC의 위험평가

3월 31일 중국 보건당국은 신종 조류인플루엔자 바이러스 A(H7N9)에 3명이 감염되어 질병이
발생했으며, 2명이 사망했따고 발표했음. 감염자에게서 A(H7N9) 및 A(H9N2) viruses를 검출하였음. (이것은 신종 조류인플루엔자 A 바이러스라는 사실을 의미함)

발병 사례들 간의 역학적 연관 관계는 전혀 나타나지 않았음. 바이러스에 감염된 상하이의 젊은 남성이 도축장에서 일하였음에도 불구하고 해당 인플루엔자 바이러스에 감염되어 사망한 조류 및 동물은 전혀 보고되지 않았음.

신종플루 바이러스의 haemagglutinin 및 neuraminidase 유전자는 A(H7N9)에서 유래한
재조합 인플루엔자A 바이러스이며, A(H9N2)에서 유래한 다른 6개의 유전자 조각이 섞였음.
(이것은 기존 유럽에서 발생한 A(H7N9)와 차이가 있음) 조류의 고병원성과 연관된 유전적 마커는 없는 것으로 밝혀졌음.(추가적인 실험실 검사가 필요함)

M 유전자에서 adamantane 저항성이 있는 마커인 S31N가 존재하므로 이 바이러스는
adamantanes (amantadine and rimantadine)에 대한 저항성(내성)이 있을 것으로 추정됨.
따라서 이 제제에 대한 약물투여는 소용없음. 비록 H3N2 바이러스에서oseltamivir와 zanamivir
의 저항성 (내성)을 갖는 neuraminidase의 R292K 아미노산에 대해 현재 세계보건기구 협력
연구소에서 phenotypic test를 사용한 확정 검사를 진행 중에 있지만, neuraminidase 저해제
구성성분에 대한 감수성 있는 것으로 결과가 나올 것으로 예상됨.

표 1. 신종플루 A(H7N9) 확정진단 정보 (3명의 사례)

역학적 특징

현재 중국의 조사로 바이러스가 유래한 동물이나 전염 경로, 인간대 인간 전염 가능성, 잠복기,
감염 위험을 평가하기엔 너무 이른 상황임. 불현성 감염(보균자) 및 인간 전염 경로는 중국
보건당국에서 조사가 진행 중이며, 아직 결과가 나오지 않았음.

대유행 위험

현재 어떤 의미있는 방식으로도 대유행 위험이 결정된 바 없음. 유럽의 조류에서 A(H7N9)는
낮은 병원성을 보였지만, 병원성이 낮은 바이러스에 대한 공식적인 조사가 이루어진 바가
없으므로 그 분포에 대한 정보가 불확실함.

과거 네덜란드에서 고병원성 A(H7N7)에 감염되어 사망한 사례가 1건 발생한 바 있으며,
당시 H7 바이러스의 PB2의 구성성분 중 E627K와 관련이 있었음.

A(H7N9)-A(H9N2) 재조합 바이러스 및 동물에서 A(H9N2) 바이러스에 대한 실험실 연구결과
는 대유행 가능성이 있다고 나온 바 있으므로 A(H7) 바이러스의 인간 전염 가능성에 대한
우려는 합리적 타당성이 있음.

그러나 신종플루 바이러스의 대유행에 대한 결정은 WHO, 미국 CDC, ECDC 등의 국제기구의
감시 및 연구가 필요함.

ECDC risk assessment on novel influenza A virus in China

03 Apr 2013

http://www.ecdc.europa.eu/en/press/news/Lists/News/ECDC_DispForm.aspx?List=32e43ee8%2De230%2D4424%2Da783%2D85742124029a&ID=876&RootFolder=%2Fen%2Fpress%2Fnews%2FLists%2FNews

파일 : http://www.ecdc.europa.eu/en/publications/Publications/AH7N9-China-rapid-risk-assessment.pdf

ECDC

On 31 March 2013, the Chinese authorities announced the identification of a novel influenza A virus, A(H7H9), in three seriously ill people from two provinces presenting with respiratory infections. So far, no epidemiological link has been identified between those three patients.

When testing for the influenza virus, the Chinese Center for Disease Control and Prevention identified genes from both A(H7N9) and A(H9N2) viruses, thus indicating a novel reassortant avian influenza A virus.

In its initial assessment of the situation, the ECDC rapid risk assessment concludes that the risk of the spread of the virus in Europe can be considered low at this stage. However, individual patients coming from China cannot be ruled out. It is thus important to further investigate the source of infection and the mode of transmission to develop ECDC’s assessment further.

This event stresses the importance of considering the possibility of zoonotic influenza due to novel influenza A viruses in persons presenting with severe acute respiratory disease. Especially when patients have recently been in countries where animal influenza A viruses circulate and these viruses have recently caused severe respiratory disease in humans. This includes China.

ECDC is working closely with WHO and the European Commission and will continue to monitor the situation.

ECDC Rapid Risk Assessment Severe respiratory disease associated with a novel influenza A virus, A(H7N9) China, 2 April 2013

[참고 논문]

Pathogenesis and transmissibility of highly (H7N1) and low (H7N9) pathogenic avian influenza virus infection in red-legged partridge (Alectoris rufa).

Bertran K, Pérez-Ramírez E, Busquets N, Dolz R, Ramis A, Darji A, Abad FX, Valle R, Chaves A, Vergara-Alert J, Barral M, Höfle U, Majó N.

Vet Res. 2011 Feb 7;42(1):24. doi: 10.1186/1297-9716-42-24.

================

Pathogenesis, transmissibility, and ocular tropism of a highly pathogenic avian influenza A (H7N3) virus associated with human conjunctivitis.

Belser JA, Davis CT, Balish A, Edwards LE, Zeng H, Maines TR, Gustin KM, Martínez IL, Fasce R, Cox NJ, Katz JM, Tumpey TM.

J Virol. 2013 Mar 13. [Epub ahead of print]

[돼지독감] ECDC의 11월 6일자 위험평가(Version 6)

건강과대안 — Wed, 11 Nov 2009 15:12:38 +0000

ECDC RISK ASSESSMENT

Pandemic H1N1 2009

Version 6 – 6 November 2009

출처 : http://www.ecdc.europa.eu/en/healthtopics/Documents/0908_Influenza_AH1N1_Risk_Assessment.pdf

What’s new or different in this update?

This update is informed by the first experiences from this autumn in Europe and North America as well as further analyses from the Southern Hemisphere’s temperate countries during their winter season.

It also includes:
 details of the clinical experience of people who are becoming severely ill;
 the first adjusted planning assumptions for European countries not significantly affected by the earlier
wave;
 the basic parameters of the pandemic, drawing on work undertaken with WHO and ECDC Advisory Forum;
 confirmation that many older people possess prior immunity, but that those who are not immune are more
at risk of severe disease than any other age group;
 more information on the extent of asymptomatic and very mild cases and;
 first estimates of the relative risk for those who, if they have certain risk factors, become severely ill with
this infection (pregnant women, people with asthma and other chronic respiratory diseases and massively
obese people).