vCJD and blood transfusion: risk assessment in the United Kingdom

The risk of vCJD transmission via blood transfusion depends on potential levels of infectivity, recipients' exposure to infected donors and individual susceptibility. On infectivity, SEAC (the UK's main scientific advisory committee on TSEs), has published an updated position statement. Based on animal models, this suggests that infectivity is split roughly equally between leucocytes and plasma, with negligible levels directly associated with red cells or platelets. Risk assessments are now therefore based on the amounts of plasma and leucocytes within each component as transfused. Recipients' exposure to infection depends critically on the prevalence of infection in the population. This remains unknown, so a range of assumptions must still be considered. A further consideration is the likelihood of any infected donors' blood being infective. Those infected in the primary outbreak will now have been incubating vCJD for 10-25 years. Current thinking is that blood may be more infective later in the incubation period. This reinforces the case for a precautionary approach to transmission risks, despite the small number of incidents seen so far. Exposure will also depend on how many donors contributed components to a given individual. Recent work has shown that more patients receive large numbers of units than previously thought. These highly-transfused patients are a particular cause for concern. The current precautionary assumption is of all recipients being susceptible to infection by transfusion, though incubation periods may differ markedly.