There have been more than 400 patients who contracted
Creutzfeldt-Jakob disease (CJD) via a medical procedure, that is, through the use of neurosurgical instruments, intracerebral electroencephalographic
electrodes (EEG), human pituitary
hormone, dura mater grafts, corneal transplant, and
blood transfusion. The number of new patients with iatrogenic CJD has decreased; however, cases of variant CJD that was transmitted via
blood transfusion have been reported since 2004. Clearly, iatrogenic transmission of CJD remains a serious problem. Recently, we investigated medical procedures (any surgery, neurosurgery, ophthalmic surgery, and
blood transfusion) performed on patients registered by the CJD Surveillance Committee in Japan during a recent 9-year period. In a case-control study comprising 753
sporadic CJD (sCJD) patients and 210 control subjects, we found no evidence that
prion disease was transmitted via the investigated medical procedures before onset of sCJD. In a review of previously reported case-control studies,
blood transfusion was never shown to be a significant risk factor for CJD; our study yielded the same result. Some case-control studies reported that surgery was a significant risk factor for sCJD. However, when
surgical procedures were categorized by type of surgery, the results were conflicting, which suggests that there is little possibility of
prion transmission via
surgical procedures. In our study, 4.5% of sCJD patients underwent surgery after onset of sCJD, including neurosurgeries in 0.8% and ophthalmic surgeries in 1.9%. The fact that some patients underwent surgery, including neurosurgery, even after the onset of sCJD indicates that we cannot exclude the possibility of
prion transmission via medical procedures. We must remain vigilant against
prion diseases to reduce the risk of iatrogenesis.