Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation 英文参考文献.docVIP

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Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation 英文参考文献.doc

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Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation 英文参考文献

RiskAssessmentofTransmissionofSporadicCreutzfeldt- JakobDiseaseinEndodonticPracticeinAbsenceof AdequatePrionInactivation Nade`geBourvis1,2,Pierre-YvesBoelle1,2,3,Jean-YvesCesbron4,5,6,Alain-JacquesValleron1,2,3 * 1Universite′PierreetMarieCurie-Paris6,Unite′deRechercheEpide′miologie-Syste`mesd’information-Mode′lisation,UMRS707,Paris,France,2INSERM, U707, Paris, France, 3Assistance Publique-Ho?pitaux de Paris (AP-HP), Unite′ de Sante′ Publique, Ho?pital St Antoine, Paris, France, 4Laboratoire Adaptation et de Pathoge′nie des Micro-organismes, Universite′ Joseph Fourier, UMR 5163, Grenoble, France, 5Centre National de la Recherche Scientifique(CNRS),UMR5163,Grenoble,France,6Centrehospitalieruniversitaire(CHU)deGrenoble,Laboratoired’Immunologie,Grenoble,France Background.Experimentalresultsevidencedtheinfectiouspotentialofthedentalpulpofanimalsinfectedwithtransmissible spongiform encephalopathies (TSE). This route of iatrogenic transmission of sporadic Creutzfeldt-Jakob disease (sCJD) may existinhumansviareusedendodonticinstrumentsifinadequatepriondecontaminationproceduresareused.Methodology/ Principal Findings. To assess this risk, 10 critical parameters in the transmission process were identified, starting with contaminationofanendodonticfileduringtreatmentofaninfectioussCJDpatientandendingwithpossibleinfectionofa subsequent susceptible patient. It was assumed that a dose-risk response existed, with no-risk below threshold values. Plausiblerangesofthoseparameterswereobtainedthroughliteraturesearchandexpertopinions,andasensitivityanalysis was conducted. Without effective prion-deactivation procedures, the risk of being infected during endodontic treatment ranged between 3.4 and 13 per million procedures. The probability that more than one case was infected secondary to endodontictreatmentofaninfectedsCJDpatientrangedfrom47%to77%dependingontheassumedquantityofinfective materialnecessaryfordiseasetransmission.Ifcurrentofficialrecommendationsonendodonticinstrumentdecont