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Resources - Information for Funeral Homes

Creutzfeldt-Jakob disease (CJD) is the most common form of human prion disease, which is caused by the abnormal prion protein. Under very specific circumstances, prion disease may be transmitted from one individual to another. For prion disease to be acquired, two conditions are required. First, the contaminated material must be from the central nervous system of an affected individual*. Second, contaminated materials must be introduced into another person’s central nervous system, inoculated via hematogenous administration, or ingested in sufficient quantities to transmit the disease. None of these instances should occur during routine autopsy or embalming procedures.

Underneath the American with Disabilities Act, funeral homes are considered public accommodations and cannot withhold services or impose additional expenses for individuals with disabilities or their families. One exception that is often cited is if rendered services pose a substantial risk of serious harm to the health and safety of others. Given the above statement, the risk of contracting HIV or hepatitis is much greater given the level of infectivity in tissues, type of infected tissues, and route of infectivity in these more common diseases compared to prion disease. There is also an ethical obligation for providers to supply services to these individuals and their families. Please note that many citations in magazine and journal articles are out of date and thus have not been updated in well over a decade.

A meta-analytic review conducted by members of the European Creutzfeldt-Jakob Disease Surveillance Network concluded that there was no data to suggest that healthcare workers are at any increased risk of developing CJD. This report used two sources of data to arrive at its conclusions: 1) data from various countries’ CJD registries, and 2) an in depth review of the literature. Results of the study suggest that when appropriate precautions are taken, there is no elevated risk of developing CJD in healthcare workers 1. Also, no case of human prion disease has ever been demonstrated to occur through occupational exposure 2.

When handling bodies affected by CJD, the CDC recommends universal precautions 3. If no autopsy is performed, no additional precautions are suggested. If a brain-only autopsy is conducted, the CDC recommends further precautions such as wiping the body down with bleach and requesting family members not to touch the body. However, WHO guidelines conclude that superficial contact with the body such as touching or kissing need not be discouraged 2. In no way, do CDC or WHO guidelines suggest that embalming, burial, cremation, and/or open viewings cannot be conducted in individuals affected by CJD.

If you are a pathologist, funeral director, or embalmer and have further questions regarding handling a body affected by CJD, please contact the NPDPSC and we can help guide you to relevant information or individuals that may be of further assistance.

*One exception to this is variant CJD, which is bovine spongiform encephalopathy (“mad cow disease”) manifest in humans. In vCJD, transmission has occurred through blood transfusions. This is an exceedingly rare form of CJD that is rarely seen within the U.S.A.

References
1. Alcalde-Cabero, E. et al. Health professions and risk of sporadic Creutzfeldt-Jakob disease, 1965 to 2010. Euro Surveill. 17, (2012).

2. World Health Organization. WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies. (World Health Organization, 2000).

3. Centers for Disease Control and Prevention. Information for Funeral and Crematory Practitioners. cdc.gov at