ied bovine offal ban was introduced to minimize human exposure to BSE; however, 2 of the 34 non-UK vCJD case-patients were born after 1989. Measures equivalent to the UK ban on specified bovine offals were not introduced in many continental European countries until 2000.
Despite these caveats, our results suggest that, globally, imports from the UK may have been an important source of infection and for some countries may even have been the main source. If this is so, our findings have several implications. Past UK exports may be the major determinant of the current incidence of vCJD outside the UK. The greatest volume of these exports was to France, the Netherlands, and Ireland. Thus, initially at least, we might expect the largest number of vCJD cases to occur in these countries. However, exposure to BSE through imports from the UK ceased in 1996, and exposure to indigenous BSE is likely to have continued at some level until the measures introduced in 2000. Thus, the proportion of vCJD cases due to exposure to indigenous BSE may increase with time.
We thank our colleagues from the European and Allied Countries Collaborative Study Group of CJD (EUROCJD) and our international colleagues for the data on vCJD incidence included in this article.
The EUROCJD surveillance system is funded by the Directorate General for Health and Consumer Affairs (2003201) and the Neuroprion Network of Excellence (FOOD-CT-2004-506579). National CJD surveillance is supported in the Netherlands by the Dutch Ministry of Health Welfare and Sports. P.S.-J. was supported by the grant Wenceslao Lopez Albo from the Marques de Valdecilla Institute for Formation and Research of the Fundación Pública Marqués de Valdecilla.
Dr Sánchez-Juan is a consultant neurologist. Since 2004 he has been coordinating the Dutch CJD surveillance system at the Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, the Netherlands. His main research interests are prion diseases and the genetic epidemiology of neurodegenerative diseases.
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- Figure 1. Scatter plot of the number of cases of indigenous bovine spongiform encephalopathy (BSE) in non–UK countries and the number of non-UK variant Creutzfeldt-Jakob disease (vCJD) cases per country. SA, Saudi...
- Figure 2. Scatter plot of live bovine imports (unweighted data) from the UK (1980–1990) and the number of non-UK variant Creutzfeldt-Jakob disease (vCJD) cases per