Surveillance and control
Establishing global surveillance for the containment and prevention of new BSE epidemics is an essential first step in determining the extent of the problem of vCJD at a global level. However, at present only the wealthiest countries have extensive surveillance activities for BSE and vCJD in place. WHO is working directly with regions and countries to help build surveillance systems for vCJD or extend the capacity of those already existing and to conduct risk analysis for BSE.
Facilitating standard surveillance methods
WHO has published The Revision of the Surveillance Case Definition for Variant Creutzfeldt-Jakob Disease (vCJD). It is organized to reflect the clinical hierarchy used in the diagnosis of human diseases - symptoms, signs found in clinical examination, and clinical investigations of increasing invasiveness ending in neuropathology.
Collaborating with international partners
A Technical Consultation on BSE, Public Health and Trade was organized jointly with FAO and OIE and considered the importance of intervention measures to control BSE, and the need for surveillance systems capable of identifying BSE or vCJD. For more information see the Report of the Consultation and the WHO Press Release.
Establishing new networks
WHO is establishing a series of Collaborating Centres in Transmissible Spongiform Encephalopathies to aid in the diagnosis of human TSEs. These collaborating centres will directly assist countries in making the diagnosis of vCJD, thus ensuring that WHO will contribute to the rapid identification of new cases of vCJD. WHO has also strengthened its relationship with two major surveillance systems for vCJD, EuroCJD and NeuroCJD, principally in European countries, including Eastern Europe and the Russian Federation.
WHO has directly contributed to a new surveillance network for CJD and for risk assessment of BSE in Central and Eastern Europe (Hungary, Poland, Slovakia) and China. The European Union has funded the project.
Producing guidelines on further reducing the risk of healthcare associated transmission of CJD and vCJD
WHO has published a guide to procedures and precautions needed to prevent iatrogenic and nosocomial exposure to transmissible spongiform encephalopathies (TSEs) in hospitals, health care facilities, and laboratories. Prepared by an international group of 32 leading experts, the guidelines respond to the unusual resistance of TSE agents to conventional chemical and physical methods of decontamination and the corresponding need for special precautions. Areas of patient care and categories of interventions, tissues, instruments, and wastes that do not require special precautions are also clearly indicated.
In issuing these guidelines, WHO aims to help medical officers, specialists in infection control, care-givers, and laboratory workers reduce the risks of TSE transmission to negligible levels. With this goal in mind, the guidelines provide a logical framework for determining levels of risk and knowing when departures from standard procedures for infection control are required.
Regional training workshops have been held on developing surveillance systems for vCJD in Argentina, China, Egypt, Slovakia and Thailand. Training is given in laboratory diagnosis of human TSEs; the participants learn how to make the diagnosis through neuropathology, Western blot and cerebrospinal fluid testing.