Variant Creutzfeldt-Jakob Disease Impact on U.S. Military Service Members Lt. Col. David Lincoln Deputy Director Armed Services Blood Program Office Unclassified Slide 1

vCJD-DoD Current Deferral Policy  In residence or traveled to UK cumulative ≥3 mo( )  DoD & affiliated personnel in residence or traveled to BSE risk countries (Europe) cumulative ≥6 mo ( )*  DoD affiliated personnel in residence or traveled to BSE risk countries (Europe) cumulative ≥5 yrs (after 1996)  Other personnel in residence or traveled to BSE risk countries (Europe) ≥5 yrs or more (1980-present)  Transfusion blood/blood product in UK or France (1980-present)  Received bovine insulin prepared in the UK since 1980 *No distinction for Northern Europe vs. South of the Alps Unclassified Slide 2

Saudi Arabia Residency vCJD Deferral  New vCJD case in Canada  Believed to have contracted vCJD while living in Saudi Arabia  Two other patients from outside Canada also believed to have contracted vCJD while living in Saudi Arabia  Canadian Blood Services to follow Héma-Québec (2008) and implement an indefinite deferral for donors who spent >6 months (cumulative) in Saudi Arabia  DoD implementing same deferral effective Aug/Sep 2011 Unclassified Slide 3

Rationale Supporting Deferral  Between 1980 and 1996, Saudi Arabia imported beef from the U.K., which could have been exposed to BSE-- U.K. beef was likely available at DoD facilities  1990 DoD begins to discontinue purchase of UK beef  Interviews with DoD Veterinary Command consultants and personnel deployed to Saudi Arabia for Desert Shield/Desert Storm indicate:  U.K. beef consumption by U.S. military, civilians, and contractor personnel during that period  Estimated 10% proportion of UK beef to total beef consumed by US forces in Saudi Arabia during DS/DS force due to beef consumption on local economy. Contractors may be higher Unclassified Slide 4

Rationale supporting deferral  Not known with certainty if vCJD cases related to food consumption in Saudi Arabia, but a possible source of infection  It is possible that other bases within the Persian Gulf region may have acquired U.K beef during this time frame  May have been acquired indirectly by third party  Possible expansion of DoD deferral to include the entire Gulf Region under consideration Unclassified Slide 5

Deployments to Saudi Arabia 1980 – 2003  U.S. Military Training Mission (USMTM) Saudi Arabia ( )  Approximately 1,000 troops deployed annually  Operation Desert Shield/Storm (Aug 1990-Sept 1991)  Approximately 550,000 troops deployed  90% greater than 6 months  Operation Southern Watch ( )  U.S. combat troops and air crews enforce southern Iraqi “no-fly” zone  Approximately 5,000 troops deployed annually Unclassified Slide 6

Loss to Blood Supply from DoD Exposure  Estimated number of U.S. troops based in Saudi Arabia from = 590,000  Fact: DoD civilians, government civilians, contractors could add another 200,000  Assumption: 5% blood donor population 790,000 X 5% = 39,500 donors  However, approximately 30% of this population already deferred for vCJD risk based on European deferral or other conditions.  A large number of this population retired or left active duty service and may be donating to civilian blood collection facilities  Impact to Blood Supply appears to be minimal Unclassified Slide 7

LOOKBACKs  No recipient look backs based solely on new geographic risk deferrals will be performed by DoD Unclassified Slide 8