Monday, January 07, 2008

CWD Update 89 January 4, 2008

Monday, January 07, 2008 CWD Update 89 January 4, 2008

CWD Update 89 January 4, 2008

CWD Update 89

January 4, 2008

State and Provincial Updates


Neil Anderson, Montana Fish, Wildlife and Parks, provides the following: As of December 11, 2007 a total of 1481 samples have been submitted for testing. Results from 177 elk, 1060 mule deer, 239 white-tailed deer and one moose have been received with no evidence of CWD being detected. Results are pending for the remaining 8 samples and surveillance efforts for symptomatic animals is ongoing. Table 1 indicates the number of samples collected within surveillance areas of eastern Montana. Hunter-harvested animals comprised the majority of animals tested (93.5%, n = 1381) followed by road-killed animals (5.5%, n = 81) and symptomatic animals (1.0%, n = 15). Montana FWP CWD information is available at:



Bruce Trindle, Nebraska Game and Parks Commission, provides the following: The Nebraska Game and Parks Commission tested more than 3,200 hunter-harvested deer for chronic wasting disease (CWD) during the firearm deer season that ended November 18. A total of 44 elk were also tested during the elk season. A total of 17 deer tested positive for the disease, and all but three of the positive tests were from deer harvested within the endemic area in the Panhandle. None of the elk tested positive. The three deer that tested positive outside the panhandle were all white-tailed deer. A firearm hunter in Keith County shot one of the afflicted deer a few miles west of Ogallala on the South Platte River. The second positive deer was shot in Red Willow County on the Beaver Creek drainage near the Kansas border, and the third positive was harvested in Hall County a few miles south of Alda. Biologists plan on sampling more deer from the areas where the disease has not previously been detected. Additional samples will help indicate the prevalence of CWD within those immediate harvest locations. According to Trindle, “The prevalence of CWD in deer tested over the past three years has been less than one percent, and the distribution of the disease has expanded very slowly.”

The Nebraska Game and Parks Commission confirmed CWD in the state’s deer population in 2000. To date there have been 133 free ranging deer that tested positive for CWD through the Commission’s surveillance program which has sampled over 33,000 deer. CWD has never been detected in the Nebraska wild elk population. The Commission plans on continuing its diligent testing of Nebraska’s deer herds for this disease. Nebraska Game & Parks Commission CWD information is at:

South Dakota:

Steve Griffin, South Dakota Game, Fish and Parks, provides the following: In the South Dakota CWD Surveillance period of July 1, 2007 to December 31, 2007 a total of 2,342 samples were collected for CWD surveillance. Breakdown of the sampling is as follows: 475 elk sampled--473 NOT Positive-- 1 result pending (1 Positive Elk Found) 536 mule deer sampled--518 NOT Positive-- 13 results pending (5 Positive MD Found) 1,331 white-tailed deer--1,300 NOT Positive-- 23 results pending (8 Positive WT Found) Below is a listing of the positive cervids that have been found in South Dakota during the surveillance period of July 1, 2007 to December 31, 2007. 1. White-tailed deer female from Unit BD3 in Pennington County. (Hunter Harvest) 2. Elk female from Unit H3B in Custer County. (Hunter Harvest) 3. White-tailed deer female from Unit BD3 in Pennington County. (Vehicle Kill) 4. White-tailed deer male from Rapid City in Pennington County. (Vehicle Kill) 5. White-tailed female from Unit 21A in Pennington County. (Hunter Harvest) 6. White-tailed male from Unit 27B in Fall River County. (Hunter Harvest) 7. Mule deer male from Unit 27A in Fall River County. (Hunter Harvest) 8. Mule deer female from Unit 27B in Fall River County. (Hunter Harvest) 9. White-tailed female from Unit CU1 in CSP in Custer County. (Hunter Harvest) 10. White-tailed male from Unit 27A in Fall River County. (Hunter Harvest) 11. White-tailed female from Unit 27B in Fall River County. (Hunter Harvest) 12. Mule deer male from Unit 27B in Fall River County. (Hunter Harvest) 13. Mule deer male from Unit 27A in Fall River County. (Hunter Harvest) 14. Mule deer female from Unit 27A in Fall River County. (Sick/Surveillance) In Summary: South Dakota is reporting a total of 14 positive cervids (1 elk, 13 deer) in the testing period of July 1, 2007 to December 31, 2007. To date, South Dakota has found 72 cases of CWD (52 deer and 20 elk) in free ranging deer and elk since testing began in 1997. Wind Cave National Park accounts for 17 of these animals (9 elk, 8 deer). Three elk and 1 deer have been found in Custer State Park. A total of 17,188 wild deer and elk have been tested for CWD since 1997. South Dakota Game, Fish, and Parks CWD information is at:

West Virginia:

The following press release (shortened for inclusion on this update) was issued by the West Virginia Department of Natural Resources on December 17, 2007: Five Additional Deer Test Positive for Chronic Wasting Disease in Hampshire County, West Virginia. Preliminary test results have detected the Chronic Wasting Disease (CWD) agent in five hunter-harvested deer collected in Hampshire County during the 2007 deer firearms hunting season. “As part of our agency’s ongoing and intensive CWD surveillance effort, samples were collected from 1,285 hunter-harvested deer brought to game checking stations in Hampshire County,” noted Frank Jezioro, Director for the West Virginia Division of Natural Resources (DNR). The five CWD positive deer included one 2.5 year-old doe, two 2.5 year-old bucks, one 3.5 year-old buck, and one 4.5 year-old buck. Four of the five deer were harvested within the Hampshire County CWD Containment Area (i.e., that portion of Hampshire County located North of U.S. Route 50). The fifth deer was also harvested in Hampshire County, but it was killed outside the CWD Containment Area near Yellow Springs, West Virginia. CWD has now been detected in a total of 19 deer in Hampshire County (i.e., one road-killed deer confirmed in 2005, four deer collected by the DNR in 2005, five deer collected by the DNR in 2006, one hunter-harvest deer taken during the 2006 deer season, three deer collected by the DNR in 2007 and five hunter-harvested deer taken during the 2007 deer season). Operating within guidelines established by its CWD – Incident Response Plan, the DNR has taken the steps necessary to implement appropriate management actions designed to control the spread of this disease, prevent further introduction of the disease, and possibly eliminate the disease from the state. Full text of the press release is at:

West Virginia DNR CWD information is available at:

(search for “CWD”).


CWD was detected in several new hunts areas in the state of Wyoming during 2007 hunting seasons (Deer Hunt Areas 12, 23, 87, 122, 125 and 163; Elk Hunt Areas 13 and 110). Press releases from Wyoming Game and Fish Department documenting these new areas are at:

A summary of CWD detections in Wyoming (including a map of affected hunt areas, reproduced below) is available at:

Wyoming Game and Fish Department CWD information is at:

Federal appropriations for CWD in FY2008: The “Consolidated Appropriations Act, 2008” was signed into law on December 26, 2007. Language from the USDA section of the “Joint Explanatory Statement” ( accompanying the act includes the following: “The amended bill provides $17,807,000 for chronic wasting disease. Of this amount, $1,299,000 is for surveillance in Wisconsin; $183,000 is for surveillance in Utah; and $38,000 is for surveillance in Colorado.”

Recent Publications

Species barriers for chronic wasting disease by in vitro conversion of prion protein

Li Li, Michael B. Coulthart, Aru Balachandran, Avi Chakrabartty and Neil R. Cashman Biochemical and Biophysical Research Communications 364 (2007) 796–800.


Chronic wasting disease (CWD) is a transmissible spongiform encephalopathy that can affect North American cervids (deer, elk, and moose). Using a novel in vitro conversion system based on incubation of prions with normal brain homogenates, we now report that PrPCWD of elk can readily induce the conversion of normal cervid PrP (PrPC) molecules to a protease-resistant form, but is less efficient in converting the PrPC of other species, such as human, bovine, hamster, and mouse. However, when substrate brain homogenates are partially denatured by acidic conditions (pH 3.5), PrPCWD-induced conversion can be greatly enhanced in all species. Our results demonstrate that PrPC from cervids (including moose) can be efficiently converted to a protease-resistant form by incubation with elk CWD prions, presumably due to sequence and structural similarities between these species. Moreover, partial denaturation of substrate PrPC can apparently overcome the structural barriers between more distant species

(Volume 364, Issue 4, pages 796-800).

Elk with a long incubation prion disease phenotype have a unique PrPd profile

Katherine I. O’Rourke, Terry R. Spraker, Dongyue Zhuanga, Justin J.Greenlee, Thomas E.Gidlewski and Amir N. Hamir

NeuroReport 18:1935-1938.


The transmissible spongiform encephalopathies (TSEs) invariably result in fatal neurodegeneration and accumulation of PrPd, an abnormal form of the host prion protein PrPc, encoded by the PRNP gene. A naturally occurring polymorphism (methionine/valine) at PRNP codon 129 is associated with variation in relative disease susceptibility, incubation time, clinical presentation, neuropathology, and/or PrPd biochemical characteristics in a range of human TSEs. A methionine/leucine polymorphism at the corresponding site in the Rocky Mountain elk PRNP gene is associated with variation in relative susceptibility and incubation time in the cervid TSE chronic wasting disease. We now report that elk lacking the predisposing 132-methionine allele develop chronic wasting disease after a long incubation period and display a novel PrPd folding pattern.

Direct Detection of Soil-Bound Prions

Sacha Genovesi, Liviana Leita, Paolo Sequi, Igino Andrighetto, M. Catia Sorgato and Alessandro Bertoli

PLoS ONE 2(10): e1069. doi:10.1371/journal.pone.0001069.


Scrapie and chronic wasting disease are contagious prion diseases affecting sheep and cervids, respectively. Studies have indicated that horizontal transmission is important in sustaining these epidemics, and that environmental contamination plays an important role in this. In the perspective of detecting prions in soil samples from the field by more direct methods than animal-based bioassays, we have developed a novel immuno-based approach that visualises in situ the major component (PrPSc) of prions sorbed onto agricultural soil particles. Importantly, the protocol needs no extraction of the protein from soil. Using a cell-based assay of infectivity, we also report that samples of agricultural soil, or quartz sand, acquire prion infectivity after exposure to whole brain homogenates from prion-infected mice. Our data provide further support to the notion that prion-exposed soils retain infectivity, as recently determined in Syrian hamsters intracerebrally or orally challanged with contaminated soils. The cell approach of the potential infectivity of contaminated soil is faster and cheaper than classical animal-based bioassays. Although it suffers from limitations, e.g. it can currently test only a few mouse prion strains, the cell model can nevertheless be applied in its present form to understand how soil composition influences infectivity, and to test prion-inactivating procedures. Complete article is at:

Prion Strain Discrimination Using Luminescent Conjugated Polymers

Christina J Sigurdson, K Peter R Nilsson, Simone Hornemann, Giuseppe Manco, Magdalini Polymenidou, Petra Schwarz, Mario Leclerc, Per Hammarstrom, Kurt Wuthrich and Adriano Aguzzi

Nature Methods 4, 1023 - 1030 (01 Dec 2007).


The occurrence of multiple strains of prions may reflect conformational variability of PrPSc, a disease-associated, aggregated variant of the cellular prion protein, PrPC. Here we used luminescent conjugated polymers (LCPs), which emit conformation-dependent fluorescence spectra, for characterizing prion strains. LCP reactivity and emission spectra of brain sections discriminated among four immunohistochemically indistinguishable, serially mouse-passaged prion strains derived from sheep scrapie, chronic wasting disease (CWD), bovine spongiform encephalopathy (BSE), and mouse-adapted Rocky Mountain Laboratory scrapie prions. Furthermore, using LCPs we differentiated between field isolates of BSE and bovine amyloidotic spongiform encephalopathy, and identified noncongophilic deposits in prion-infected deer and sheep. We found that fibrils with distinct morphologies generated from chemically identical recombinant PrP yielded unique LCP spectra, suggesting that spectral characteristic differences resulted from distinct supramolecular PrP structures. LCPs may help to detect structural differences among discrete protein aggregates and to link protein conformational features with disease phenotypes.

Landscape Genetics and the Spatial Distribution of Chronic Wasting Disease

Julie A. Blanchong, Michael D. Samuel, Kim T. Scribner, Byron V. Weckworth, Julia A. Langenberg and Kristine B. Filcek Biology Letters doi:10.1098/rsbl.2007.0523.


Predicting the spread of wildlife disease is critical for identifying populations at risk, targeting surveillance and designing proactive management programmes. We used a landscape genetics approach to identify landscape features that influenced gene flow and the distribution of chronic wasting disease (CWD) in Wisconsin white-tailed deer. CWD prevalence was negatively correlated with genetic differentiation of study area deer from deer in the area of disease origin (core-area). Genetic differentiation was greatest, and CWD prevalence lowest, in areas separated from the core-area by the Wisconsin River, indicating that this river reduced deer gene flow and probably disease spread. Features of the landscape that influence host dispersal and spatial patterns of disease can be identified based on host spatial genetic structure. Landscape genetics may be used to predict high-risk populations based on their genetic connection to infected populations and to target disease surveillance, control and preventative activities. Complete article is available at:

see full text ;


Chronic wasting found in Hall County deer web-posted Friday, January 4, 2008

Chronic wasting found in Hall County deer

By Mark Coddington

A deer in Hall County tested positive for chronic wasting disease this fall, the first documented case in the county since 2004.

The deer was one of 18 in the state found with the disease this year, out of 3,310 tested, said Bruce Trindle, the Nebraska Game and Parks Commission's big game research leader.

Just as in every year since the disease was first found in the state in 2000, most of the positive tests were in deer found in the Panhandle, Trindle said.

But this year's results included a few scattered occurrences outside that area, including one near Ogallala in Keith County, one south of McCook in Red Willow County and one south of Alda, almost 200 miles from the disease's "endemic" area.

Trindle said Game and Parks officials aren't sure how the diseased deer ended up in Hall County, but they'll be conducting more tests on the area's deer to see if more have the disease.

"We don't have a good explanation why it makes those big jumps," Trindle said.

Chronic wasting disease produces small lesions in the brains of infected deer and elk, causing emaciation and abnormal behavior such as poor coordination. It has never spread to humans or domestic livestock, but it is always fatal for the deer and elk that contract it.

The state's concentration of chronic wasting cases is still well shy of 1 percent, far short of the prevalence of cases in Wyoming and Colorado, which have at times topped 5 percent of the deer and elk population.

But the occurrence of the disease so far from its primary area in western Nebraska has officials concerned.

"The red flag for us is that it has spread," Trindle said. "There's a chance the disease has moved out of the Panhandle."

The case could have come as a result of a hunter who came back from a trip with a contaminated carcass and disposed of it in Hall County, he said.

It's also possible that an infected deer traveled all the way from the Panhandle, as sick deer will sometimes travel longer distances than healthy ones.

In Colorado and Wyoming, it took decades for the disease to spread slowly throughout the deer and elk population. Nebraska's totals have been steady, with positive tests usually numbering in the teens, with a high of 33 in 2004 (An elk has never tested positive in the state).

Scientists aren't sure about how the disease spreads, which makes it difficult to stop, Trindle said.

And unlike its cousin, bovine spongiform encephalopathy or mad cow disease it's occurring in wild animals that are tough to track, said Richard Nelson, a wildlife manager for the commission's District 4 in southwest Nebraska.

"You don't send deer to a clinic for a flu shot," Nelson said.

Hall County's positive test in 2004 came at the old Cornhusker Army Ammunition Plant north of Alda, Nelson said. Further testing over the next two years found no deer with the disease.

Though the disease has never been transmitted to humans, officials don't recommended eating meat from a deer that's sick with chronic wasting disease or anything else, for that matter.

Trindle and Nelson recommended that outdoorsmen be careful, especially while hunting in Wyoming, Colorado or the Panhandle, and don't shoot any sick-looking animal. If a deer they've shot might be sick, they should take it in to Game and Parks officials for testing.

In past years, hunters haven't responded to reports of the disease with alarm, judging from strong sales of deer hunting licenses, Trindle said. After all, diseased deer have been around at least as long as people have been hunting them.

"You run the risk when you hunt deer that you (might) contract those diseases," he said.

Officials dart elk Project tests chronic wasting disease, new fertility drug


ROCKY MOUNTAIHN NATIONAL PARK - Margaret Wild crouched behind a boulder, squinted down the rifle sight, then squeezed off a perfect shot in the hip that made the cow elk flinch before running off into the meadow.

Several minutes later, the elk's legs were as wobbly as a drunk's until finally the animal crumpled to the ground and lay motionless on the edge of Moraine Park.

"You never know how the elk will react,'' Wild said of the dart she just fired. "Sometimes it stings them and they run a ways; and other times they hardly feel a thing.

"But most times they don't go more than 100 yards.''

Wild isn't one of the sharpshooters that, under the park's recently announced Elk and Vegetation Management Plan, will take aim at reducing the burgeoning elk herd by 100 to 200 animals annually over the next 20 years to reduce the damage on aspen and willow.

Instead, she is a National Park Service veterinarian from Fort Collins who is helping lead a groundbreaking two-pronged study. One part of the project is to conduct, for the first time in free-ranging elk, live tests for chronic wasting disease, a fatal brain disease. Also, for the first time in free-ranging elk, the project will study the effectiveness of a multiyear fertility control drug.

As part of those projects, wildlife officials began Thursday to use tranquilizer guns to dart 120 cow (female) elk this month. As of today, they had darted 13 animals. Half of the 120 elk will receive the fertility drug GonaCon developed by Lowell Miller at the National Wildlife Research Center in Fort Collins.

The other half will receive placebos. Blood, saliva and fecal samples will be taken from the animals to help with several promising live CWD tests. Radio collars will be placed on all the animals so wildlife officials can track and kill them.

Each of the next three years, 40 of the cows - 20 given the fertility drug and 20 the placebo - will be killed and checked for pregnancy to determine the effectiveness of the drug.

"It would be a major breakthrough if we could find a live chronic wasting disease test,'' said Dan Baker, a Colorado State University research scientist leading the fertility study. "The end goal for the fertility study is to see how long the agent will work.''

Two four- to five-person teams started Thursday driving the roads around Moraine, Beaver Meadows and Horseshoe parks, looking for easy targets close to the roads. The crews darted and put radio collars on three animals Thursday.

On Friday, the crews had a much easier time. They darted 10 elk thanks to a herd of several hundred cow elk grazing next to the Moraine Park Road with some on the road licking salt from the asphalt as well as visitors' stopped vehicles.

"It can be very stressful on the animals if we make a shot and it's not in the proper place because it takes a while for them to go down,'' Baker said Friday. "It's very beneficial them being so close to the road today.''

Shooters don't like to take aim at animals much farther than 20 yards away.

Once the animal succumbs to the tranquilizer, the animals' eyes are covered and the crew begins taking samples and checking to see if the animal is pregnant. The animal's heart rate and breathing are monitored to reduce the risk of accidental death. Once the samples are taken and the radio collar attached, the animal is given a drug that reverses the effects of the tranquilizing drug. Then it is monitored for the next 48 hours to make sure it survives the stress of the capture.

"For the most part, we have no problems,'' Baker said. "We have never lost an elk to any of the drugs we're using.''

Wild said the slight risk and stress to the animals is well worth it, considering the benefits of the projects.

"It's very rare that you get an opportunity to do studies on numbers of elk like this in a protected area,'' she said. "It's something pretty fun to do when you get your elk and watch them walk away and you have the information you wanted.''



MADCOW USDA the untold story




NOR-98 ATYPICAL SCRAPIE CASES USA (5 cases documented in 5 different states in 2007)

Transmissible Mink Encephalopathy TME

SEAC 99th meeting on Friday 14th December 2007

vCJD case study highlights blood transfusion risk

vCJD transfusion-associated Fourth Case UK

risk factors for sporadic CJD

BSE (Mad Cow) Update: Do Reports of sCJD Clusters Matter?

snip... see full text ;

[In submitting these data, Terry S. Singeltary Sr. draws attention to the steady increase in the "type unknown" category, which, according to their definition, comprises cases in which vCJD could be excluded. The total of 26 cases for the current year (2007) is disturbing, possibly symptomatic of the circulation of novel agents. Characterization of these agents should be given a high priority. - Mod.CP],F2400_P1001_PUB_MAIL_ID:1010,39963

There is a growing number of human CJD cases, and they were presented last week in San Francisco by Luigi Gambatti(?) from his CJD surveillance collection.

He estimates that it may be up to 14 or 15 persons which display selectively SPRPSC and practically no detected RPRPSC proteins.


MARCH 26, 2003

RE-Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob

disease in the United States

Email Terry S. Singeltary:

I lost my mother to hvCJD (Heidenhain Variant CJD). I would like to

comment on the CDC's attempts to monitor the occurrence of emerging

forms of CJD. Asante, Collinge et al [1] have reported that BSE

transmission to the 129-methionine genotype can lead to an alternate

phenotype that is indistinguishable from type 2 PrPSc, the commonest

sporadic CJD. However, CJD and all human TSEs are not reportable

nationally. CJD and all human TSEs must be made reportable in every

state and internationally. I hope that the CDC does not continue to

expect us to still believe that the 85%+ of all CJD cases which are

sporadic are all spontaneous, without route/source. We have many TSEs in

the USA in both animal and man. CWD in deer/elk is spreading rapidly and

CWD does transmit to mink, ferret, cattle, and squirrel monkey by

intracerebral inoculation. With the known incubation periods in other

TSEs, oral transmission studies of CWD may take much longer. Every

victim/family of CJD/TSEs should be asked about route and source of this

agent. To prolong this will only spread the agent and needlessly expose

others. In light of the findings of Asante and Collinge et al, there

should be drastic measures to safeguard the medical and surgical arena

from sporadic CJDs and all human TSEs. I only ponder how many sporadic

CJDs in the USA are type 2 PrPSc?

Monitoring the occurrence of emerging forms of Creutzfeldt-Jakob disease in the United States

Creutzfeldt Jakob Disease



I only ponder how many sporadic CJDs in the USA are type 2 PrPSc?

THE PATHOLOGICAL PROTEIN Hardcover, 304 pages plus photos and illustrations. ISBN 0-387-95508-9 June 2003 BY Philip Yam


Answering critics like Terry Singeltary, who feels that the U.S. under-counts CJD, Schonberger conceded that the current surveillance system has errors but stated that most of the errors will be confined to the older population.

doi:10.1016/S1473-3099(03)00715-1Copyright © 2003 Published by Elsevier Ltd.


Tracking spongiform encephalopathies in North America

Xavier Bosch

Available online 29 July 2003. Volume 3, Issue 8, August 2003, Page 463

"My name is Terry S Singeltary Sr, and I live in Bacliff, Texas. I lost my mom to hvCJD (Heidenhain variant CJD) and have been searching for answers ever since. What I have found is that we have not been told the truth. CWD in deer and elk is a small portion of a much bigger problem." ...

Diagnosis and Reporting of Creutzfeldt-Jakob Disease

Singeltary, Sr et al. JAMA.2001; 285: 733-734.

Like lambs to the slaughter 31 March 2001 Debora MacKenzie Magazine issue 2284

FOUR years ago, Terry Singeltary watched his mother die horribly from a degenerative brain disease. Doctors told him it was Alzheimer's, but Singeltary was suspicious. The diagnosis didn't fit her violent symptoms, and he demanded an autopsy. It showed she had died of sporadic Creutzfeldt-Jakob disease. Most doctors believe that sCJD is caused by a prion protein deforming by chance into a killer. But Singeltary thinks otherwise. He is one of a number of campaigners who say that some sCJD, like the variant CJD related to BSE, is caused by eating meat from infected animals. Their suspicions have focused on sheep carrying scrapie, a BSE-like disease that is wide spread in flocks across Europe and North America. Now scientists in France have stumbled across new evidence that adds weight to the campaigners' fears. To their complete surprise, the researchers found that one strain of scrapie causes the same brain damage in mice as sCJD. "This means we cannot rule out that at least some sCJD may be caused by some strains of scrapie," says team member Jean-Philippe Deslys of the French Atomic Energy Commission's medical research laboratory in Fontenay-aux-Roses, south-west of Paris. Hans Kretschmar of the University of Göttingen, who coordinates CJD surveillance in Germany, is so concerned by the findings that he now wants to trawl back through past sCJD cases to see if any might have been caused by eating infected mutton or lamb. ...

DER SPIEGEL (9/2001) - 24.02.2001 (9397 Zeichen)USA: Loch in der MauerDie BSE-Angst erreicht Amerika: Trotz strikter Auflagen gelangte in Texasverbotenes Tiermehl ins Rinderfutter - die Kontrollen der Aufsichtsbehördensind lax. Link auf diesen Artikel im Archiv:"

Its as full of holes as Swiss Cheese" says Terry Singeltary of the FDA regulations. ...

Thu Dec 6, 2007 11:38



2 January 2000 British Medical Journal

U.S. Scientist should be concerned with a CJD epidemic in the U.S., as well

15 November 1999 British Medical Journal

vCJD in the USA * BSE in U.S.



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