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The perceived risk of variant Creutzfeld-Jakob disease and the effect of additional delay in tonsillectomy: a
S Loughran1, C B Alves, N K Geddes
1Department of Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK. sean@ihr.gla.ac.uk
Insights
Parents are aware of variant Creutzfeldt-Jakob disease (vCJD) risks associated with tonsillectomy instrument reuse. However, extended waiting times negatively impacted children
Area of Science:
- Otolaryngology
- Public Health
- Infectious Disease Epidemiology
Background:
- UK Department of Health mandated disposable instruments for tonsillectomies in 2001 due to vCJD transmission risk.
- This policy led to instrument supply delays and increased surgical waiting times for children.
Purpose of the Study:
- To assess parental attitudes towards the risk of vCJD transmission via surgical instruments.
- To evaluate the impact of extended waiting times on children awaiting tonsillectomy.
Main Methods:
- A questionnaire was distributed to parents of 249 children on the tonsillectomy waiting list.
- Follow-up questions were posed to parents of children waiting over 6 months.
Main Results:
- 70% of parents responded; 37% perceived a risk of instrument reuse, while 53% were unsure.
- 41% of parents would have accepted surgery with non-disposable instruments.
- 68% of parents reported negative health effects on their child due to prolonged waiting, with only 7% seeing symptom improvement.
Conclusions:
- Parents exhibit awareness of vCJD risks, though the perceived level of risk varies.
- The rate of spontaneous symptom resolution during the extended tonsillectomy waiting period is minimal.
Objectives:
In February 2001 the United Kingdom Department of Health in conjunction with the British Association of Otolaryngology, Head and Neck Surgeons decreed that all non-emergency tonsillectomies should be performed using disposable instruments because of the theoretical risk of transmission of variant Creutzfeld-Jakob disease (vCJD). There was an understandable delay in the provision of these instruments by the various manufacturers, leading to an increase in waiting time for surgery. It was decided to assess parental attitudes to the risk of vCJD, and assess the effect the additional delay had on their child.
Method:
A questionnaire was sent to the parents of all 249 children on the waiting list for tonsillectomy.
Results:
Seventy percent replied, and of these, 37% felt there was a risk of reusing instruments, only 10% felt there was no risk, and the remaining 53% did not know if there was any risk. Nevertheless 41% of parents would have gone ahead using old instruments if allowed. All parents of the 73 children waiting greater than 6 months were questioned on the effect of the additional delay. Only 7% reported improvement in symptoms, and 68% felt the additional delay had badly affected their child's health and wellbeing. Ninety percent of parents felt their child's symptoms still warranted tonsillectomy.
Conclusion:
There is an awareness of risk of vCJD among parents whose children await tonsillectomy, although understandably the level of risk they feel is hard to quantify. The rate of symptom resolution whilst on the waiting list was very low.
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