Prions Undetectable, Unstoppable
We can’t sterilize surgical equipment used on people who have prion disease. Prions are so resistant to sterilization that surgical instruments used on a person with CJD must be disposed because they are permanently contaminated. Hospitals have been sued successfully for exposing subsequent patients to deadly prions. In fact, a case unfolded in Scotland in 2013 where at least 20 patients were exposed to prion contamination in surgery at a local hospital.
Just as we published this book, another tragic case made headlines in New Hampshire and Massachusetts in September 2013. After public health officials came to the conclusion that one New Hampshire patient died from the rare, degenerative brain disease Creutzfeldt-Jakob disease (similar to mad cow disease), there’s a small chance that up to 13 other patients in multiple states may have also been exposed to the disease — a debacle for which officials are apologizing profusely, while also emphasizing that the risk of exposure remains extremely low.
“The risk of exposure is extremely low, but it’s not zero,” said Dr. José Montero, director of public health at the New Hampshire Department of Health and Human Services. “After extensive expert discussion, we could not conclude that there was no risk, so we are taking the step of notifying the patients and providing them with as much information as we can. Our sympathies are with all of the patients and their families, as this may be a confusing and difficult situation.”
People also extract the pituitary gland from cadavers to use the growth hormone found within. People have contracted fatal cases of prion disease from this practice, including a case in May 2012. Before accepting any hormone, ask about its source.
Blood and saliva are infectious. Therefore, dental and oral surgery settings have the same challenge, but these industries often have ignored those risks.
Picks, drills, hand mirrors and hygiene devices all put patients at risk. Actor Peter Falk died of Alzheimer’s. He rapidly developed dementia after a series of dental operations. He could not recall his famous TV role as Lieutenant Columbo. Within just a few weeks of having dental surgery, his daughter went to court to assume legal guardianship of her father. He no longer recognized familiar people, places or things. He required full-time care until he passed away.
If you have ever had a cosmetic dental implant, there is a good chance your dentist could use a popular bone graft product such as BioOss (Geistlich) or NuOss (Collagen Matrix) as part of the procedure. Researchers now identify bovine bone graft material as a pathway for prion diseases. In an extensive 2011 study titled “Risk of Prion Disease Transmission through Bovine-Derived Bone Substitutes,” researchers reported that “despite the causal association between variant Creutzfeldt-Jakob disease and bovine spongiform encephalopathy (BSE), bovine origin graft materials are widely used during dental surgical procedures.”
In 2012, British scientists were surprised at the high rate of prion disease transmission after studying first “whether oral tissues could become infectious following dietary exposure to BSE. Secondly, would a CJD-contaminated dental instrument be able to transmit disease to another patient.”
After a five-minute exposure to a deliberately contaminated dental sample, 97 percent of the lab animals tested positive for prion disease within three weeks. Such infectivity was observed in all oral tissues even before clinical symptoms appeared. In other words, the test subjects were infectious to others before they were visibly sick. “Infectivity was higher than expected in a wider range of oral tissues. These observations provide evidence that dental procedures could be a route of cross infection for CJD and support the enforcement of single use for certain dental instruments.”