CJD deaths leave questions over clusters

Two more deaths from the "new variant" strain of the fatal brain disorder Creutzfeldt-Jakob Disease (CJD), linked with "mad cow disease" were disclosed yesterday by the Government, bringing the total number of notified cases to 21 at the end of June.

But the figures hide a peculiar clustering of cases: in Ashford, Kent, in Tyne and Wear in the North-east and near Glasgow. So far, three of the people who have died of "v-CJD" have lived near Ashford - which itself is close to the site where the first case of bovine spongiform encephalopathy (BSE) was diagnosed in 1985. Susan Carey, who died five months ago, lived near Ashford in the 1980s before moving to Rochester, also in Kent.

Another two cases have occurred in comparatively small areas in Tyne and Wear, including Jean Wake, who worked as a meat-chopper in a pie factory, and lived in Washington until she died in October 1995; and Mandy Minto, a former European judo champion, who died aged 27 last weekend in Sunderland Royal Hospital.

Two other cases are based near Glasgow, including Janice Stuart, of Milton of Campsie near Glasgow, who died of v-CJD aged 35 last September; and a suspected victim, Donnamarie McGivern, aged 15, who has a serious brain disorder, at Southern General Hospital in Glasgow.

The presence of clusters among such a small number of cases could be a statistical accident. "When the numbers are so small you can convince yourself of anything," said Dr Stephen Dealler, an independent analyst of the BSE epidemic yesterday. "But the fact is, the first cases of BSE were noticed in Ashford."

Last night, members of the CJD Support Association were unwilling to discuss the idea. "If that is all you want to talk about, we may have to find some other way of getting this across to newspapers," said one member.

The Government triggered a major BSE scare when announced in March 1996 that the growing number of cases of v-CJD was probably caused by exposure to the disease agent that causes BSE. However, it has never specified that this had to be through eating BSE-infected food.

People in Ashford would be no more likely to eat BSE-infected food than other people at most stages of the epidemic. However, some scientists have called attention to the presence of a rendering plant which discharges 120,000 litres of effluent daily, and to an event in 1963 in Smarden when two acres of land were contaminated by fluoracetamide, a highly toxic organo-halogen which is chemically related to organo- phosphates (OPs). Some people have suggested that OPs caused BSE - although evidence from the Continent contradicts this.

At the same time, there is no clear match for the incidents around Ashford in Tyne and Wear or near Glasgow. The CJD Surveillance Unit, which monitors cases and records victims' personal histories, had no comment last night.

"While the numbers are so small, you can sum it up and say that there's no excess, that it's just statistical anomaly," said Dr Dealler.

"But after a while it becomes a different type of analysis." He suspects that there may be a contributory cause for BSE which has not yet been identified - and that the Government will resist any attempt to identify it.

The long incubation period of up to 20 years for forms of CJD means that victims were probably infected in the 1980s, before the most infectious parts of cattle - the brain, spinal cord spleen and various organs - were banned from human consumption.

Experts still do not know if a major epidemic of new variant CJD is likely to occur or not.