Variant Creutzfeldt-Jakob disease (vCJD) Restriction

What is vCJD?

Variant Creutzfeldt-Jakob disease (vCJD) is a disease that affects the brain leading to dementia, loss of the ability to speak and perform essential daily activities, and eventually death. No treatment is available and it is fatal in all cases.

It is caused by infectious proteins called prions that are transmitted through the consumption of meat and meat products from cows carrying the bovine spongiform encephalopathy (BSE or ‘mad cow’ disease) prion. In blood, the prion protein is found mainly in white blood cells.

vCJD can thus be acquired by exposure to contaminated food and by blood transfusion. There is no effective way to destroy prions.

Why is vCJD restriction necessary?

vCJD has an incubation period of up to several decades from the time that the person is exposed to the prion to developing the disease. Such individuals be well for many years, while carrying the infection. Hence, there is a risk that a blood donor could unknowingly infect many people through blood donation.

There is no reliable screening test for vCJD in the blood donations. So far, HSA has adopted a risk mitigation strategy to defer donors with a history of residence or travel in areas where BSE might have been present, to prevent transfusion transmitted vCJD in Singapore.

When will HSA be easing the vCJD restrictions?

Effective 2 October 2023, donors with geographical risk exposure to vCJD (stayed or lived in the United Kingdom, France, Ireland and other European countries during the affected period) can now make apheresis donations (plateletpheresis, plasmapheresis or double red cell donation). Apheresis donation is only at the Bloodbank@HSA.

Apheresis donation is a specialized donation method where specific blood components, such as platelets, plasma, or red blood cells, are collected, while returning the rest of the blood to the donor.

The following donors are still not eligible to donate blood:

1. Donors who have been diagnosed with CJD, vCJD or any other Transmissible Spongiform Encephalopathies (TSE).

2. Donors who are considered to have an increased risk for CJD,

   1. Received a dura mater transplant,

   2. taken human pituitary-derived hormones,

   3. have one or more blood relatives diagnosed with familial prion disease (e.g., familial CJD, Gerstmann-Sträussler-Scheinker syndrome (GSS) and fatal familial insomnia (FFI)),

   4. received a corneal transplant.

3. Donors who have received a blood transfusion in the United Kingdom, the Republic of Ireland or France between 1980 and present.

What is HSA’s rationale for doing so?

Based on the experience of blood transfusion services overseas, the risk of transfusion-transmitted vCJD can be mitigated by removing white blood cells from the donated blood of at-risk donors. HSA has done a comprehensive review of these new scientific findings before deciding to ease vCJD restrictions.

Why are the donors only allowed to do apheresis donation?

The easing of restrictions will only be applicable to apheresis donation for now because apheresis donation allows direct collection of blood components without collecting the white blood cells.

A phased approach is an important safeguard to ensure the safety of our blood supply while we work towards including whole blood donation.

What is apheresis donation?

Apheresis donation is a specialized donation method that allows the collection of specific blood components, such as platelets, plasma, or red blood cells, while returning the rest of the blood back to the donor. It enables us to collect a larger and more uniform quantity of the needed blood components, thus providing lifesaving treatments to a wider range of patients. To know more about apheresis donation, learn about our types of blood donation.

What should donors interested in apheresis donation do?

Interested donors can check our website to find out about your eligibility or call the Bloodbank@HSA at 6213 0626 to speak to our medical staff to check on their eligibility. The final determination of eligibility will be determined at the Bloodbank@HSA by our medical staff during the donor interview.

The opening hours for Apheresis donation are as follows:

Should I make an appointment for apheresis donation?

As the donation time for apheresis donation is longer, donors are encouraged to make an appointment. For new donors (with no deferral record), you can make an appointment through our website or using the DonateBlood app. The Donate blood app can be downloaded from the Google Play Store or Apple Store.

For donors who were previously deferred by the Bloodbank due to prior residence in the United Kingdom, France, Republic of Ireland or other European countries during the affected period, please call 62130626 to make an appointment.

Walk in donors will still be accepted if there are available slots for the day.

What happens if I am not eligible to donate apheresis?

Donors who are not eligible to donate apheresis (e.g., due to unsuitable vein size) may be allowed to donate whole blood in the future.

HSA is currently looking into the process and will provide further updates when this group of donors can donate whole blood.