Variant Creutzfeldt-Jakob Disease Impact on U.S. Military Service Members

Lt. Col. David Lincoln

Deputy Director

Armed Services Blood Program Office

Unclassified Slide 1

vCJD-DoD Current Deferral Policy

In residence or traveled to UK cumulative ≥3 mo(1980-1996)

DoD & affiliated personnel in residence or traveled to BSE risk

countries (Europe) cumulative ≥6 mo (1980-1996)*

DoD affiliated personnel in residence or traveled to BSE risk

countries (Europe) cumulative ≥5 yrs (after 1996)

Other personnel in residence or traveled to BSE risk countries

(Europe) ≥5 yrs or more (1980-present)

Transfusion blood/blood product in UK or France (1980-present)

Received bovine insulin prepared in the UK since 1980

*No distinction for Northern Europe vs. South of the Alps

Unclassified Slide 2

Saudi Arabia Residency vCJD Deferral

New vCJD case in Canada Believed to have contracted vCJD while living in

Saudi Arabia Two other patients from outside Canada also believed to

have contracted vCJD while living in Saudi Arabia Canadian Blood Services to follow Héma-Québec (2008)

and implement an indefinite deferral for donors who spent >6 months (cumulative) in Saudi Arabia 1980-1996

DoD implementing same deferral effective Aug/Sep 2011

UnclassifiedSlide 3

Rationale Supporting Deferral

Between 1980 and 1996, Saudi Arabia imported beef from the U.K., which could have been exposed to BSE-- U.K. beef was likely available at DoD facilities

1990 DoD begins to discontinue purchase of UK beef Interviews with DoD Veterinary Command consultants

and personnel deployed to Saudi Arabia for Desert Shield/Desert Storm indicate:

U.K. beef consumption by U.S. military, civilians, and contractor personnel during that period

Estimated 10% proportion of UK beef to total beef consumed by US forces in Saudi Arabia during DS/DS force due to beef consumption on local economy. Contractors may be higher

Unclassified Slide 4

Rationale supporting deferral

Not known with certainty if vCJD cases related to food consumption in Saudi Arabia, but a possible source of infection

It is possible that other bases within the Persian Gulf region may have acquired U.K beef during this time frame

May have been acquired indirectly by third party

Possible expansion of DoD deferral to include the entire Gulf Region under consideration

Unclassified Slide 5

Deployments to Saudi Arabia 1980 – 2003

U.S. Military Training Mission (USMTM) Saudi Arabia (1980-1990)

Approximately 1,000 troops deployed annually Operation Desert Shield/Storm (Aug 1990-Sept 1991)

Approximately 550,000 troops deployed 90% greater than 6 months

Operation Southern Watch (1991-2003) U.S. combat troops and air crews enforce southern

Iraqi “no-fly” zone Approximately 5,000 troops deployed annually

UnclassifiedSlide 6

Loss to Blood Supply from DoD Exposure

Estimated number of U.S. troops based in Saudi Arabia from 1980-1996

= 590,000 Fact: DoD civilians, government civilians, contractors could add another

200,000 Assumption: 5% blood donor population 790,000 X 5% = 39,500 donors

However, approximately 30% of this population already deferred for

vCJD risk based on European deferral or other conditions . A large number of this population retired or left active duty service

and may be donating to civilian blood collection facilities Impact to Blood Supply appears to be minimal

Unclassified Slide 7

LOOKBACKs

No recipient look backs based solely on new geographic risk deferrals will be performed by DoD

Unclassified Slide 8