Letters

Blood donated after vaccination with rabies vaccine derived from sheep brain cells might transmit CJD

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7069.1405a (Published 30 November 1996) Cite this as: BMJ 1996;313:1405
  1. Subhash C Arya
  1. Clinical microbiologist Centre for Logistical Research and Innovation, M-122 (of part 2), Greater Kailash-II, New Delhi-110048, India

    EDITOR,—Janet Morgan reports that the National Blood Authority in Britain has decided to tighten the donor screening programme to exclude transmission of Creutzfeldt-Jakob disease or its variant through blood donations.1 Prospective donors will be prevented from donating blood if they have a history of treatment with human growth hormone or if one of their siblings, parents, or grandparents developed the disease. I would point out that similar care should also be taken when immigrants from Asia and Africa offer to donate blood, in case they received rabies vaccine derived from culture of sheep brain cells when they were living in their country of origin.

    In many countries in Asia and Africa limited supplies of imported rabies vaccines derived from culture of human cells have been available. Many people continue to be offered indigenously produced sheep brain vaccine after exposure to a rabid animal. Scrapie is known to exist in sheep around many centres where the vaccine is produced. In the mountain sheep of the Kumaon foothills in the Himalayas, for example, scrapie was established more than four decades ago and 1–10% of the flock was reported to have the disease in 1961.2 In the Himalayan foothills the Central Research Institute continues to produce four to five million doses of sheep brain vaccine annually. Transmission of abnormal prion protein, PrPsc, in sheep brain vaccine might have occurred in some of the 30 documented cases of Creutzfeldt-Jakob disease in different regions in India.3 Because Creutzfeldt-Jakob disease has a latency of about 20 years, many recipients of sheep brain rabies vaccine could emigrate to Britain before becoming ill.

    Before accepting blood donations from immigrants it would be desirable to ask the potential donors whether they were exposed to a rabid animal and immunised with sheep brain rabies vaccine in their country of origin. Furthermore, indirect assessment should be possible through, for example, assay looking for antibodies specific to rabies.

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