49 people being contacted after risk discovered

Forty-nine patients who underwent a stomach investigation and biopsy are being contacted by medical authorities after it was discovered that they may be at risk of cross-contamination from the Republic's first diagnosed case of Creutzfeldt-Jakob Disease, a form of the animal disease BSE, which can be fatal in humans.

The 49 patients all underwent treatment at St Vincent's Hospital in Dublin this year involving a gastroscope.

The instrument had been used on the patient who was subsequently confirmed as having variant CJD (vCJD).

The 49 patients are being contacted because of the potential risk of contamination from the gastroscope.

Most have already been contacted, representatives of the hospital and the State CJD Surveillance Committee announced yesterday.

However, Prof Michael Farrell, a neuropathologist at Beaumont Hospital and a member of the State's CJD surveillance committee, confirmed that while CJD has an incubation period of up to 10 years, there is no known test for the variant at its incubation stage.

At a press conference yesterday Mr Nicholas Jermyn, chief executive of St Vincent's Hospital, revealed that the diagnosis of CJD was made on May 31st.

The patient had earlier this year undergone a gastroscopic biopsy at St Vincent's before CJD was diagnosed. The hospital immediately contacted the Department of Health and the CJD Surveillance Committee and it was decided to quarantine all instruments used in the gastroscopic biopsy.

CJD has been shown to be transmitted from one infected patient to another via inadequately sterilised electrodes inserted into the brain during neurosurgery, by corneal grafts, by grafts of duramatter, and by human pituitary-derived growth hormone given intra-muscularly.

CJD is invariably fatal within 18 months to two years after it has incubated. Given the sensitive nature of the case the hospital yesterday declined to give any information on the age, gender or race of the patient, although Mr Jermyn did disclose that the patient had lived in the UK for "an extended period" in the recent past.

He also revealed that of the 40 cases of CJD recorded since 1996, one was in France, one was in Northern Ireland and 38 were in Britain. The risk ages for the disease are relatively low, from 16 or 17 to about 37, Prof Farrell said yesterday. Another significant risk factor was residence in the UK, he added.

The consultant's remarks have already led to speculation that the CJD was contracted in the UK. However, with a 10-year incubation period this is not certain.

The hospital is adamant that the risk of contamination of other patients who were treated with the gastroscope is "infinitesimal", and Prof Farrell has commented that there is no known incidence of transmission of the disease in this way anywhere else in the world.

At a press conference yesterday Mr Jermyn denied that the announcement was being made because the matter was about to be reported in the media. He said that of the 49 patients which it had been decided to contact, one was abroad and the hospital had not had the opportunity to speak to two others. A press information meeting would have been arranged in any event, to brief medical correspondents on the diagnosis, Mr Jermyn insisted.

It is not known if prion, the agent which indicates the presence of CJD, is present in the duodenal tissue of patients with variant CJD. It has been found in the appendix of one patient to date and has also been found in tonsular tissue.

Despite this Mr Jermyn insisted that the risk of infection being transmitted by the procedure in this case has been estimated by experts to be infinitesmal.