2020年南部某庫賈氏病極可能病例事件處理報告

Management of A Probable Case of Creutzfeldt-Jakob Disease in Southern Taiwan, 2020

庫賈氏病由變性普利昂蛋白在腦中累積，造成大腦海綿樣的疾病。該變性蛋白不易破壞，可長期存在土壤並有感染力，為避免進入環境及食物鏈，必須火化相關個案遺體。2018年南部某個案經庫賈氏病病例審查研判為極可能病例，該案於2020年6月死亡，依庫賈氏病工作手冊規定，遺體應火化處理，但家屬因宗教信仰及表示個案未被研判為確定病例，拒絕遺體火化。地方衛生單位多次與家屬協商，仍無共識，故提請衛生福利部疾病管制署協助。後續在中央、地方相關單位共同合作，以及對家屬有影響力之民意代表協助下，家屬最終同意並完成遺體火化。本文記錄此事件處理過程、探討相關政策及提出建議，作為類似案件及修訂政策之參考。

Creutzfeldt-Jakob disease (CJD) is caused by the accumulation of abnormal prion proteins in the brain, resulting in a spongiform encephalopathy. Prions are highly resistant to destruction, can persist in soil for extended periods, and remain infectious. To prevent the spread of prions in the environment and food chain, human remains of CJD cases must be cremated.
In 2018, a patient in southern Taiwan was diagnosed as a probable case of CJD following a panel review and passed away in June 2020. According to the CJD infection control manual, the remains should have been cremated. However, the patient's family members refused cremation due to their religious beliefs and because the patient had not been definitively diagnosed with CJD.
Despite negotiations by the Public Health Bureau, no consensus was reached with the family members. Subsequently, the Public Health Bureau, Taiwan Centers for Disease Control, and an influential local councilor familiar to the family members collaborated to secure the family's agreement to cremate the remains.
This article outlines the incident's handling process, discusses relevant policies, and offers recommendations for managing similar cases and policy revisions.