Gill ON et al. 2013, Prevalent abnormal prion protein in human appendixes after bovine spongiform encephalopathy epizootic: large scale survey (BMJ 347:f5675, PMID 24129059, doi 10.1136/bmj.f5675)

A 2013 BMJ survey that tested archived appendix specimens from English hospitals for abnormal prion protein, as an indicator of subclinical vCJD-type infection after the BSE epidemic. It found 16 positives in 32,441 samples, about 493 per million or roughly 1 in 2000. The result is the main modern anchor for discussions of how many people in the UK may carry the agent, which in turn bears on blood and surgical-instrument precautions. The full text is open access and was read via a summarising tool, not line by line.

Key facts

  • Citation verified: 17 authors led by O Noel Gill, BMJ volume 347, article f5675, DOI 10.1136/bmj.f5675, PMID 24129059, PMCID PMC3805509, published October 2013.
  • The study tested 32,441 formalin-fixed, paraffin-embedded appendix samples, drawn from 40,022 blocks from operations in 2000 to 2012 at 41 hospitals in England; about 19% of blocks were rejected, mainly for inflammation or too few follicles.
  • Sixteen samples were positive (two more suspect), giving 493 per million with a 95% CI of 282 to 801.
  • Estimates were 733 per million for people born 1941 to 1960 and 412 per million for 1961 to 1985; the difference was not statistically significant, and rates were similar by sex and region.
  • Among positives, half were methionine homozygous, a quarter heterozygous and a quarter valine homozygous at PRNP codon 129, whereas all confirmed clinical vCJD cases were methionine homozygous.
  • The earlier Hilton 2004 appendix survey estimated 237 per million (CI 49 to 692); the new figure is about double with overlapping intervals.
  • The authors note 177 clinical vCJD cases in the UK at June 2013, far below what the prevalence would imply, and call for a validated blood test; they state the transmission risk from carriers through surgery or donation is unknown.
  • Stated limitations include one block per case, the chance that inflammation hides infection, and unknown timing of when abnormal PrP appears in lymphoid tissue. Funding came from the Department of Health Policy Research Programme.

Timeline

  1. 2000to 2012 Period in which the surveyed appendix operations took place.
  2. 2004Earlier appendix survey (Hilton et al.) gave 237 per million.
  3. 2013Clinical vCJD case count of 177 cited by the authors.
  4. 2013Paper published in BMJ.

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Last checked 1 November 2026

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