Abstract
Iatrogenic Creutzfeldt-Jakob Disease from Commercial Cadaveric Human Growth Hormone
Highlights
Sweden) during 1984–1985 [3]
To the Editor: Iatrogenic Creutzfeldt-Jakob disease is an acquired form of prion disease that has been declining in incidence since the mid-1990s [1]
Produced cadaveric human growth hormone (hGH) has been associated with only 1 previously reported case of Iatrogenic Creutzfeldt-Jakob disease (iCJD): CJD developed in a 39-yearold Austrian man ≈22 years after he received commercial cadaveric hGH
Summary
To the Editor: Iatrogenic Creutzfeldt-Jakob disease (iCJD) is an acquired form of prion disease that has been declining in incidence since the mid-1990s [1]. Despite an ongoing active surveillance program that identified ≈3,500 of ≈4,500 post-1977 cadaveric hGH recipients in the US NHPP, all 29 CJD infections in NHPP recipients occurred among the estimated ≈2,700 pre-1977 recipients [1,2] This significant reduction in iCJD was attributed to the 1977 introduction of a highly selective, column chromatography step in the hormone purification protocol that can markedly reduce prion infectivity [1,2]. Identification through passive surveillance of 2 CJD cases among recipients of such hGH further supports a causal, rather than chance, association between commercial hormone and CJD It suggests a difference in iCJD risk between post-1977 NHPP-distributed hGH and commercial cadaveric hGH. Limitations of this report include the lack of neuropathologic confirmation and insufficient information to strongly implicate a single commercial cadaveric hGH product as infection source The report of another iCJD case-patient who received Crescormon during the same period provides some evidence that the product was the source of prion contamination. We recommend that when a clinical diagnosis of CJD is suspected, but before the patient’s death, the local caregivers, with the family, should initiate arrangements for a postmortem examination to confirm diagnosis (e.g., www. cjdsurveillance.com)
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