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Report of the Council on Scientific Affairs

Litjen Tan, PhD; Michael A. Williams, MD; Mohamed Khaleem Khan, MD, PhD; Hunter C. Champion; Nancy H. Nielsen, MD, PhD; for the Council on Scientific Affairs, American Medical Association

JAMA. 1999;281:2330-2339.

Context  The risk of possible transmission of bovine spongiform encephalopathy (BSE) in the United States is a substantial public health concern.

Objective  To systematically review the current scientific literature and discuss legislation and regulations that have been implemented to prevent the disease.

Methods  Literature review using the MEDLINE, EMBASE, and Lexis/Nexis databases for 1975 through 1997 on the terms bovine spongiform encephalopathy, prion diseases, prions, and Creutzfeldt-Jakob syndrome. The Internet was used to identify regulatory actions and health surveillance.

Data Extraction  MEDLINE, EMBASE, and Lexis/Nexis databases were searched from 1975 through 1997 for English-language articles that provided information on assessment of transmission risk.

Results  Unique circumstances in the United Kingdom caused the emergence and propagation of BSE in cattle, including widespread use of meat and bonemeal cattle feed derived from scrapie-infected sheep and the adoption of a new type of processing that did not reduce the amount of infectious prions prior to feeding. Many of these circumstances do not exist in the United States. In the United Kingdom, new variant Creutzfeldt-Jakob disease probably resulted from the ingestion of BSE-contaminated processed beef. The United Kingdom and the European Union now have strong regulations in place to stop the spread of BSE. While BSE has not been observed in the United States, the US government has surveillance and response plans in effect.

Conclusions  Current risk of transmission of BSE in the United States is minimal because (1) BSE has not been shown to exist in this country; (2) adequate regulations exist to prevent entry of foreign sources of BSE into the United States; (3) adequate regulations exist to prevent undetected cases of BSE from uncontrolled amplification within the US cattle population; and (4) adequate preventive guidelines exist to prevent high-risk bovine materials from contaminating products intended for human consumption.

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