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A case-control study of sporadic Creutzfeldt-Jakob disease in the United Kingdom

Analysis of clustering

From the Department of Infectious and Tropical Diseases (Dr. Smith, L. Linsell and S.N. Cousens), London School of Hygiene and Tropical Medicine, London, and National CJD Surveillance Unit (Drs. Knight, Zeidler, Stewart, de Silva, Esmonde, Ward, and Will), Western General Hospital, Edinburgh, UK.

Address correspondence and reprint requests to S.N. Cousens, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; e-mail: simon.cousens{at}lshtm.ac.uk

Background: The authors investigated whether cases of sporadic Creutzfeldt-Jakob disease (CJD) had lived closer to one another at some time in life than individuals without sporadic CJD. Such a phenomenon would be compatible with some cases resulting from transmission.

Methods: UK sporadic CJD cases occurring from 1990 to 1998 were identified. Age-, sex- and hospital-matched controls were recruited. Lifetime residential histories were obtained by interview, usually with a proxy respondent. With use of Monte Carlo simulation, the residential proximity of cases during various time periods was compared with that expected in the absence of any clustering, using the information collected on the controls.

Results: Two hundred twenty sporadic CJD disease cases and 220 controls were included. Cases lived closer together than might be expected in the absence of any disease-clustering mechanism. This evidence became stronger as the critical period during which residential proximity was required to have occurred extended further into the past.

Conclusions: These findings are consistent with some sporadic Creutzfeldt-Jakob disease (CJD) cases resulting from exposure to a common external factor. The rarity of sporadic CJD suggests that repeated point-source outbreaks of infection are more likely to explain our observations than direct case-to-case transmission. Identifying sources of such outbreaks many years after the event will be extremely difficult.

Received March 17, 2004. Accepted in final form August 12, 2004.

The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

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