{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T17:07:49Z","timestamp":1791047269005,"version":"4.1.0"},"reference-count":26,"publisher":"The Royal Society","issue":"11","license":[{"start":{"date-parts":[[2006,8,1]],"date-time":"2006-08-01T00:00:00Z","timestamp":1154390400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/royalsociety.org\/journals\/ethics-policies\/data-sharing-mining\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. R. Soc. Interface."],"published-print":{"date-parts":[[2006,12,22]]},"abstract":"<jats:p>While the number of variant Creutzfeldt\u2013Jakob disease (vCJD) cases continues to decline, concern has been raised that transmission could occur directly from one person to another through routes including the transfer of blood and shared use of surgical instruments. Here we firstly present data on the surgical procedures undertaken on vCJD patients prior to onset of clinical symptoms, which supports the hypothesis that cases via this route are possible. We then apply a mathematical framework to assess the potential for self-sustaining epidemics via surgical procedures. Data from hospital episode statistics on the rates of high- and medium-risk procedures in the UK were used to estimate model parameters, and sensitivity to other unknown parameters about surgically transmitted vCJD was assessed. Our results demonstrate that a key uncertainty determining the scale of an epidemic and whether it is self-sustaining is the number of times a single instrument is re-used, alongside the infectivity of contaminated instruments and the effectiveness of cleaning. A survey into the frequency of re-use of surgical instruments would help reduce these uncertainties.<\/jats:p>","DOI":"10.1098\/rsif.2006.0142","type":"journal-article","created":{"date-parts":[[2006,8,14]],"date-time":"2006-08-14T19:14:34Z","timestamp":1155582874000},"page":"757-766","source":"Crossref","is-referenced-by-count":13,"title":["Factors determining the potential for onward transmission of variant Creutzfeldt\u2013Jakob disease via surgical instruments"],"prefix":"10.1098","volume":"3","author":[{"given":"Tini","family":"Garske","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineKeppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester J.T","family":"Ward","sequence":"additional","affiliation":[{"name":"National Creutzfeldt\u2013Jakob Disease Surveillance Unit, Western General HospitalEdinburgh EH4 2XU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineKeppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G","family":"Will","sequence":"additional","affiliation":[{"name":"National Creutzfeldt\u2013Jakob Disease Surveillance Unit, Western General HospitalEdinburgh EH4 2XU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azra C","family":"Ghani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineKeppel Street, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2006,8]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Anderson R.M& May R.M. 1991 Infectious diseases of humans. Oxford UK:Oxford University Press.","DOI":"10.1093\/oso\/9780198545996.001.0001"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(06)70413-6"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/39057"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2004.0017"},{"key":"e_1_3_3_6_1","unstructured":"Clarke P. Will R. G. & Ghani A. C. Submitted. Is there the potential for a self-sustaining epidemic of variant creutzfeldt-jakob disease via blood transfusion in the UK?."},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00178324"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.2002.2156"},{"key":"e_1_3_3_9_1","unstructured":"Economics and Operational Research Division 2001 Risk assessment for transmission of vCJD via surgical instruments: a modelling approach and numerical scenarios. Technical report Department of Health."},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03401958"},{"key":"e_1_3_3_11_1","first-page":"30","article-title":"Updated projections of future vCJD deaths in the UK","author":"Ghani A.C","year":"2003","journal-title":"BMC Infect. Dis"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tim.2003.10.007"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/38925"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.97.18.10248"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)24035-9"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/path.1580"},{"key":"e_1_3_3_17_1","unstructured":"HSMO 1990 Tabular list of the classification of surgical operations and procedures vol. 1. 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Technical report Department of Health."},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16811-6"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.96.26.15137"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05403-4"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20708"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7368.803"},{"key":"e_1_3_3_26_1","unstructured":"WHO 2003 WHO guidelines on transmissible spongiform encephalopathies in relation to biological and pharmaceutical products. 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