Re: CJD cases

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From:"Tim Morken" <>
Content-Type:text/plain; format=flowed


In the past there has been interest on the histonet for information about 
Creutzfeldt-Jakob Disease (CJD). Below are some sites I got together from 
CDC and other sources.

For really good information about the practicalities of dealing with CJD lab 
work contact:
Jennifer Hofecker, HT, Dept of Pathology, Univ. of Rochester Medical center, 
Box 626, Rochester, NY, 14642.  PH(W): 716-275-3196, email:

Jennifer has put on workshops at the NSH meetings and has a lot of printed 
material on how to set up a lab for CJD work.

Journal article:
Handling Creutzveldt-Jakcob disease Tissues in the Histology Laboratory, 
Titford, M. and Bastian, F.O., J Histotech, V12, No.3 Sept 1989

If you have access to the internet you can go to these sites:

Search Altavista for "CJD" at
there are many articles concerning CJD and V-CJD from Britain.

CAP: Detailed information on handling CJD in the autopsy suite and the lab, 
with references.

For all CDC information on CJD, go to to the main CDC web page and search 
for "CJD" :

CJD Epidemiology, risk factors and decontamination:

Media facts:

Udatated  info at (reproduced below)

AGENT: Transmissible Spongiform Encephalopathies (Creutzfeldt-Jakob, kuru
     and related agents)

     Laboratory-associated infections with the transmissible spongiform 
encephalopathies (prion
     diseases) have not been documented. However, there is evidence that 
     disease (CJD) has been transmitted iatrogenically to patients by 
corneal transplants, dura
     mater grafts and growth hormone extracted from human pituitary glands, 
and by exposure
     to contaminated electroencephalographic electrodes (99). Infection is 
always fatal. There is
     no known nonhuman reservoir for CJD or kuru. Nonhuman primates and 
other laboratory
     animals have been infected by inoculation, but there is no evidence of 
     transmission. Scrapie of sheep and goats, bovine spongiform 
encephalopathy and mink
     encephalopathy are transmissible spongiform encephalopathies of animals 
that are similar to
     the human transmissible diseases. However, there is no evidence that 
the animal diseases
     can be transmitted to man.

     LABORATORY HAZARDS: High titers of a transmissible agent have been 
demonstrated in
     the brain and spinal cord of persons with kuru. In persons with 
Creutzfeldt-Jakob disease
     and its Gerstmann-Straussler-Schenker Syndrome variants, a similar 
transmissible agent has
     been demonstrated in the brain, spleen, liver, lymph nodes, lungs, 
spinal cord, kidneys,
     cornea and lens, and in spinal fluid and blood. Accidental parenteral 
inoculation, especially
     of nerve tissues, including formalin-fixed specimens, is extremely 
hazardous. Although
     non-nerve tissues are less often infectious, all tissues of humans and 
animals infected with
     these agents should be considered potentially hazardous. The risk of 
infection from aerosols,
     droplets, and exposure to intact skin, gastric and mucous membranes is 
not known;
     however, there is no evidence of contact or aerosol transmission. These 
agents are
     characterized by extreme resistance to conventional inactivation 
procedures including
     irradiation, boiling, dry heat and chemicals (formalin, 
betapropiolactone, alcohols);
     however, they are inactivated by 1 N NaOH, sodium hypochlorite (>2% 
free chlorine
     concentration) and steam autoclaving at 134 degrees C for 1 hour.

     RECOMMENDED PRECAUTIONS: Biosafety Level 2 practices and facilities are 
     for all activities utilizing known or potentially infectious tissues 
and fluids from
     naturally-infected humans and from experimentally infected animals. 
Extreme care must be
     taken to avoid accidental autoinoculation, or other traumatic 
parenteral inoculations of
     infectious tissues and fluids (76). Although there is no evidence to 
suggest that aerosol
     transmission occurs in the natural disease, it is prudent to avoid the 
generation of aerosols
     or droplets during the manipulation of tissues or fluids, and during 
the necropsy of
     experimental animals. It is further strongly recommended that gloves be 
worn for activities
     that provide the opportunity for skin contact with infectious tissues 
and fluids.
     Formaldehyde-fixed and paraffin-embedded tissues, especially of the 
brain, remain
     infectious. It is recommended that formalin-fixed tissues from 
suspected cases of
     transmissible encephalopathy be immersed in 96% formic acid for 30 
minutes before
     histopathologic processing (15). Vaccines are not available for use in 
humans (51).


From: (Wenk, Lee & Peggy) Save Address Block Sender
To: "Carson, Karla" <>
CC: "'Histonet'" <>
Subject: Re: CJD
Date: Wed, 21 Jul 1999 21:52:34 -0400

NSH just had a teleconference on this TODAY - Wed. July 21, 1999.

Contact the NSH office at 301-262-6221. Ask them for Jennifer's
phone number, the person who gave the teleconference today. I
forget her last name, and I'm at home, and that's at work.

You really need a good procedure. THIS IS NOTHING TO GOOF UP ON.

Basically, you will need to fix the tissue in 10% NBF for several
days, place it in 90% formic acid for an hour, go back into NBF,
hand process in plastic dishes, collect all the fixation and processing
solutions and dishes for special sterilization and incineration,
wear all the personal protective equipment you can, cover your
microtomes with plastic wrap or aluminum foil to collect all
the shavings (to be sterilized and incinerated), hand stain
in plastic disposable containers (and again collect all
staining solutions to be sterilized and incinerated).

I hope someone will be able to contact Jennifer early
tomorrow, or that someone will be able to email you their
procedure. (Sorry, I got a new computer at work, and literally
cannot do a thing with it. But that's another story.)

Also, maybe someone can email you the address of the
Histonet archives. I can't find my bookmark on it.
I know this has been discussed before, so you might be able
to find a procedure from previous postings.

Good luck.

Peggy A. Wenk, HTL(ASCP)
William Beaumont Hospital
Royal Oak, MI 48073

----Original Message Follows----
Subject: CJD cases
Date: Wed, 19 Apr 2000 13:48:38 -0400 (EDT)

Hi All,
      We had some questions arise this morning in our histology lab in
relation to a possible  CJD case. First of all, does 96-100% formic acid
render the virus inactive and is it ok to run a possible CJD case after it's
been treated with formic acid with other surgical biopsies on the same
processor without the risk of contamination to the solutions and the other
tissues? Also, as far as decontamination goes, is a 10% bleach solution
enough? In speaking with our OESO department this afternoon, they mentioned
an article published by the CDC  in May of 1999 that stated a either a 6N
NaOh or a 2N NaOh should be used for treatment of tissue prior to processing
and using the 2N NaOh as the decontaminating solution. Also, one more
question regarding where the tissue should be treated. Is it ok to treat the
tissue in a histology lab under a hood or should it be done in a "gross 
room or autopsy suite? Thanks in advance for the information........
    Donna B.

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