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      Creutzfeldt-Jakob Disease Mortality in Japan, 1979-2004: Analysis of National Death Certificate Data

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          Abstract

          BACKGROUND

          Trend of the mortality rate of Creutzfeldt-Jakob disease (CJD) in Japan is still unclear. This study aimed to estimate annual crude mortality rates due to CJD and examine the CJD mortality trend in Japan during the period of 1979-2004.

          METHODS

          National death certificate data on CJD were used (CJD coded as 046.1 for ICD-9 and A81.0 for ICD-10). Trends in age-standardized mortality rates for CJD were examined by using time series analyses including the Joinpoint regression analysis.

          RESULTS

          A total of 1,966 deaths (862 males and 1,104 females) were identified with CJD coded as the underlying-cause-of-death. The annual number of deaths and crude mortality rates peaked in 2004 at 163 (66 for males and 97 for females) deaths and 1.28 (1.06 for males and 1.48 for females) deaths per million population per year, respectively. The age-specific mortality rates rapidly increased with age between 50 and 74 years, especially among females, and sharply declined at 80+ years. Throughout the observed period, there were no significant change points, and the annual percentage changes (95% confidence intervals) were +3.09 (2.18-4.02) % for males and +3.90 (2.98-4.83) % and females. The total number of CJD deaths under 50 years of age was 131, and there was found no increase in the annual number of deaths for the past few years in this age group.

          CONCLUSION

          CJD mortality in trend data based on death certificates has significantly increased in Japan during the period of 1979-2004.

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          Most cited references20

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          Mortality from Creutzfeldt-Jakob disease and related disorders in Europe, Australia, and Canada.

          An international study of the epidemiologic characteristics of Creutzfeldt-Jakob disease (CJD) was established in 1993 and included national registries in France, Germany, Italy, the Netherlands, Slovakia, and the United Kingdom. In 1997, the study was extended to Australia, Austria, Canada, Spain, and Switzerland. Data were pooled from all participating countries for the years 1993 to 2002 and included deaths from definite or probable CJD of all etiologic subtypes. Four thousand four hundred forty-one cases were available for analysis and included 3,720 cases of sporadic CJD, 455 genetic cases, 138 iatrogenic cases, and 128 variant cases. The overall annual mortality rate between 1999 and 2002 was 1.67 per million for all cases and 1.39 per million for sporadic CJD. Mortality rates were similar in all countries. There was heterogeneity in the distribution of cases by etiologic subtype with an excess of genetic cases in Italy and Slovakia, of iatrogenic cases in France and the UK, and of variant CJD in the UK. This study has established overall epidemiologic characteristics for Creutzfeldt-Jakob disease (CJD) of all types in a multinational population-based study. Intercountry comparisons did not suggest any relative change in the characteristics of sporadic CJD in the United Kingdom, and the evidence in this study does not suggest the occurrence of a novel form of human bovine spongiform encephalopathy infection other than variant CJD. However, this remains a possibility, and countries currently unaffected by variant CJD may yet have cases.
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            Iatrogenic Creutzfeldt-Jakob disease at the millennium.

            The causes and geographic distribution of 267 cases of iatrogenic Creutzfeldt-Jakob disease (CJD) are here updated at the millennium. Small numbers of still-occurring cases result from disease onsets after longer and longer incubation periods following infection by cadaveric human growth hormone or dura mater grafts manufactured and distributed before the mid-1980s. The proportion of recipients acquiring CJD from growth hormone varies from 0.3 to 4.4% in different countries, and acquisition from dura mater varies between 0.02 and 0.05% in Japan (where most cases occurred). Incubation periods can extend up to 30 years, and cerebellar onsets predominate in both hormone and graft recipients (in whom the site of graft placement had no effect on the clinical presentation). Homozygosity at codon 129 of the PRNP gene is over-represented in both forms of disease; it has no effect on the incubation period of graft recipients, but may promote shorter incubation periods in hormone cases. Knowledge about potential high-risk sources of contamination gained during the last quarter century, and the implementation of methods to circumvent them, should minimize the potential for iatrogenic contributions to the current spectrum of CJD.
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              Prion diseases.

              Prion diseases are degenerative disorders of the nervous system caused by transmissible particles that contain a pathogenic isoform of the prion protein, a normal constituent of cell membranes. The most common human prion disease is Creutzfeldt-Jakob disease (CJD). Most cases are sporadic with unknown mode of transmission, 10-15% of cases are inherited, and a small number have been transmitted by medical procedures. The spread of human prion diseases through consumption of infected material has been implicated historically in kuru and recently in variant CJD. Animal prion diseases (scrapie of sheep, transmissible mink encephalopathy, chronic wasting disease of cervids, and bovine spongiform encephalopathy) all seem to be laterally transmitted by contact with infected animals or by consumption of infected feed. The different modes of transmission of different prion diseases, the unpredictable species barriers, the variable distribution of infectivity in tissues, and strain variations found in some diseases all make risk assessment and predictions of future events difficult.
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                Author and article information

                Journal
                J Epidemiol
                J Epidemiol
                JE
                Journal of Epidemiology
                Japan Epidemiological Association
                0917-5040
                1349-9092
                18 July 2007
                2007
                : 17
                : 4
                : 133-139
                Affiliations
                [1 ]Department of Epidemiology, National Institute of Public Health.
                [2 ]Department of Technology Assessment and Biostatistics, National Institute of Public Health.
                [3 ]Department of Public Health, Jichi Medical University.
                Author notes
                Address for correspondence: Yuriko Doi, MD, PhD, MPH, Department of Epidemiology, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0104, Japan. (e-mail: yuriko@ 123456niph.go.jp )

                This study was supported by a research grant for an epidemiological study on intractable diseases by the Ministry of Health, Labour and Welfare of the Japanese Government.

                Article
                17.133
                10.2188/jea.17.133
                7058474
                17641449
                c113404e-7583-4862-9b8d-eac041bc439d
                © 2007 Japan Epidemiological Association.

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 September 2006
                : 18 March 2007
                Categories
                Statistical Data

                creutzfeldt-jakob syndrome,regression analysis,mortality,death certificate,japan

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