A rare and fatal brain disease with a 100% mortality rate has gripped Hood River County, Oregon, raising concerns within the medical community and eliciting intense probes by local and federal health officials. It is called Creutzfeldt-Jakob Disease (CJD), and it has killed two people and impacted a third in eight months—a terrifying cluster in a county of only slightly more than 23,000 people.

On April 14, the Hood River County Health Department reported one case of Creutzfeldt-Jakob Disease and two more probable cases. Although only one case has been confirmed by a diagnosis through an autopsy, the other two are presumptive and await post-mortem confirmation through examination of brain tissue and cerebrospinal fluid. Such examination, as explained by Trish Elliott, Director of the Hood River County Health Department, may take months.

Although the origins of these three cases are still unknown, the cluster is epidemiologically significant. The U.S. experiences about 350 cases of CJD each year, or 1 to 2 cases per million individuals globally. For Hood River County, with only 23,000 people, to see three cases over such a brief time span is an epidemiologic outlier.

What Is Creutzfeldt-Jakob Disease (CJD)?

Creutzfeldt-Jakob Disease is a rapidly advancing and always lethal neurodegenerative disease resulting from misfolded proteins known as prions. Initially documented in the 1920s by German physicians Hans Gerhard Creutzfeldt and Alfons Jakob, CJD causes sponge-like holes to form within the brain, destroying its structure and function.

CJD is a member of the larger family of prion diseases, which also encompasses other rare but fatal disorders like kuru and fatal familial insomnia. Similar to bovine spongiform encephalopathy (BSE), commonly referred to as mad cow disease, CJD irreversibly destroys the brain and has no cure.

CJD Symptoms and Progression

The symptoms of CJD are extreme and worsen quickly. Early symptoms may involve confusion, disorientation, personality changes, memory loss, visual disturbances, and stiffness of the muscles. Later in the disease, patients can develop hallucinations, difficulty speaking or swallowing, seizures, and sudden jerky movements.

Death typically occurs within a year of the onset of symptoms, usually as a result of complications such as pneumonia, heart failure, or problems arising from neurological deterioration such as falls and choking.

Symptoms in the early stages of sporadic CJD usually resemble other dementias but worsen with terrifying rapidity. The majority of individuals with sporadic CJD are between 50 and 80 years of age, but some genetic forms can occur earlier, even in some people as young as 30.

Various Types of CJD

CJD comes in several types:

Sporadic CJD (sCJD): This type is the most prevalent, affecting about 85% of the cases. This type happens spontaneously when healthy proteins in the brain misfolded into prions for unknown reasons.

Genetic CJD (fCJD): Due to mutations in the PRNP gene, this form is inherited and represents about 10–15% of the total cases. The PRNP gene codes for the prion protein (PrP), a protein involved in neuronal communication and protection.

Acquired CJD (also referred to as iatrogenic or variant CJD): This is a rare type that involves outside sources of infection, such as eating infected beef (BSE/mad cow disease) or through tainted medical equipment or transplanted tissue.

In spite of concerns, authorities from Hood River County stressed that the present cases do not seem to have resulted from infected cows. "At this point in time, there is no cause identified between these three cases," the department noted. They also pointed out that CJD cannot be transmitted via air, touching, social contact, or water.

Public Health Measures and Continued Investigations

The Hood River County Health Department, in collaboration with the Oregon Health Authority and the Centers for Disease Control and Prevention (CDC), has launched an "active and ongoing investigation" into the three reported cases.

“We’re trying to look at any common risk factors that might link these cases,” Trish Elliott told The Oregonian. “But it’s pretty hard in some cases to come up with what the real cause is.”

Although risk to the general population is "extremely low," the health department continues to monitor it. Since CJD cannot be definitely diagnosed until after death, real-time monitoring is not easy, and so robust surveillance is essential.

Can CJD Be Prevented?

Although there is no treatment or cure to prevent the development of CJD, the U.S. has established strict public health measures to minimize the risk of acquired CJD, especially through food supply control and medical safety measures.

Federal authorities have maintained since the 1990s a prohibition against feeding cattle which could be contaminated with BSE, and employment of high-risk material in foods is strictly barred. Sterilization processes of surgical devices as well as strict donor screening in transplantation and transfusions are all undertaken to cut back on iatrogenic spread.

While medical officials wait for further verification and possible connections between the three patients, the attention is on education, surveillance, and reassurance to the public.

Although it is reassuringly ominous to witness a disease of this kind emerging in a small American community, the risk at the international level remains low, especially with measures presently in place. Nevertheless, the cases are a sobering reminder of the enigma that prion diseases continue to pose to modern medicine.

Health officials are still keeping an eye on the matter and are asking people not to panic but to remain updated. "The health department will remain vigilant and inform you of any public health risk," officials promised in a statement.

The uncertainty around the Novavax's COVID-19 vaccine has been exacerbated by the Trump administration. The new government has imposed new requirements on the nation's only traditional protein-based vaccine. These new requirements have led to many confusions about vaccine updates, including other vaccines too, which await approval.

The Wait For Full Approval Is Too Long

Novavax is the maker of the protein-based COVID-19 vaccine, which was on track to receive full approval from the US Food and Drug Administration (FDA) by April 1. However, the approval process was paused because of Dr Sara Brenner, the FDA's acting commissioner. The reason for delay has raised many questions about the interference, including political, especially after Dr Peter Marks, FDA's longtime vaccine chief had left following disagreements with Health Secretary Robert F Kennedy Jr. These events have further led to the apprehensions of uncertainty regarding the vaccine's future.

As of now, Novavax's vaccine is only authorized for emergency use. Unlike mRNA vaccines form Pfizer and Moderna, which have full approval, the Novavax vaccine holds the EUA or the Emergency Use Authorization, which allows it to be distributed during public health emergencies. However, once the emergency ends, the FDA can remove these vaccines from market unless full approval is granted.

What Caused The Delay?

The FDA had initially planned to approve Novavax's vaccine by its April 1 target date. However, sources familiar with the situation revealed that Trump appointees influenced the delay. Since then, Novavax has been in discussions with the FDA to determine additional requirements for approval. In the meantime, the FDA's recent comments have fueled concerns that Novavax’s vaccine may be treated as a “new product” due to its updates to match last year’s coronavirus strain. This would require new clinical trials, a process unlikely to be completed before the fall.

ALSO READ: Novavax Says FDA Approval Back on Track for Its COVID Vaccine

This approach to Novavax’s vaccine approval stands in stark contrast to the FDA’s treatment of the mRNA vaccines, where annual strain updates have been handled in a way similar to flu vaccines, requiring only small-scale tests to demonstrate the vaccine’s continued effectiveness against new strains. Dr. Paul Offit, a vaccine expert, argued that it would be unnecessary to treat these annual updates as “new products” requiring full trials, as long as the updated vaccines show that they produce protective antibody levels.

Role Of HHS Secretary

Of course Robert F Kennedy Jr will have a role to play, being the Health Secretary, and a known vaccine skeptic. Despite claiming in recent speeches that he is not anti-vaccine, Kennedy’s past associations with anti-vaccine groups have raised alarms. His nonprofit, Children’s Health Defense, has been involved in campaigns questioning vaccine safety, and Kennedy himself has made public statements suggesting that vaccines can cause autism—a long-debunked claim.

His actions have also contributed to the uncertainty that surrounds the Novavax's approval today and the overall direction of US vaccine policies.

Is Novavax Different From Other Vaccines?

What sets Novavax apart from other COVID-19 vaccines is its traditional approach. While Pfizer and Moderna’s mRNA vaccines use genetic instructions to create a temporary version of the virus’ spike protein, Novavax’s vaccine contains lab-grown copies of the spike protein itself. This approach has been used for decades in vaccines for diseases like hepatitis B and shingles, making it a more familiar method for people who may be hesitant about mRNA vaccines.

Danish multinational pharmaceutical company Novo Nordisk has launched Wegovy in Thailand, marking the entry of its hugely popular weight loss drug in Southeast Asian market. First launched in 2021, Wegovy helped make Novo Nordisk Europe's most valuable listed company until recently, worth $615 billion at its peak. Wegovy is a semaglutide shot, which means that it is a GLP-1 receptor agonist.

"We actually received the Thai FDA approval already in 2023," said Enrico Canal Bruland, vice president and general manager of Novo's Thai subsidiary. He noted that Novo was making Wegovy available in Thailand ahead of rival Eli Lilly's Zepbound. Wegovy is currently available for prescription in private hospitals around the country and will be available soon in public hospitals. Notably, Bruland declined to provide details on Wegovy's pricing in Thailand, which has a population of around 66 million, or Novo Nordisk's plans for expansion into other Southeast Asian markets.

Notably, the most popular GLP-1 agonist Ozempic was also created by Novo Nordisk. Earlier this month, the pharma giant expanded its research in the field diabetes and weight loss drug and announced that its diabetes pill, Rybelsus, demonstrated cardiovascular benefits in a late-stage trial. The findings pave the way for the medication to become a new treatment option for people living with both diabetes and heart disease.

How Do Semaglutides Work?

Semglutide is the synthetic version of GLP-1—a natural hormone produced in the intestines that regulates blood sugar, appetite, and digestion. Now, every time you eat, your body produces various hormones, including GLP-1. These are called Post nutrition hormones, and help you absorb the energy you just consumed.

GLP-1 travels to your pancreas, prompting it to produce insulin. It also travels to the hypothalamus in your brain, which gives you the feeling of being full or satiated. Ozempic imitates this hormone, thereby, silencing the food chatter in the brain. Interestingly, for some people this food chatter is really quiet ( people with low appetite) and for others it is an outbrurst, (people who generally binge eat.) So with Ozempic, silencing this self-talk in the brain, people tend to lose their appetite and eventually weight.

However, it is important to note that losing weight includes not just fat but muscle as well. Losing too much muscle can lead to reduced strength and a shorter life span. Notably, records show that most people who start taking them stop it at 12 weeks; therefore, it is important for some but not for others.

Notably, last month, US pharma major Eli Lilly launched the obesity management drug Mounjaro in India at one-fifth of the US price. The company rolled out the drug in a single-dose vial following the marketing authorisation from the Central Drugs Standard Control Organization (CDSCO). It has been priced at Rs 3,500 for a 2.5 mg vial and Rs 4,375 for a 5 mg vial. "It is a first-of-its-kind treatment for obesity, overweight, and type 2 diabetes that activates both GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) hormone receptors," the company said.

One moment, Dr Cornelius Sullivan was focused on a patient during surgery, and the next moment, he woke up in ambulance, headed to the emergency room.

According to the American Society of Anesthesiologists (ASA), Dr Sullivan had struck his head on a monitor that had been moved behind him in a surgery center. This serious accident had resulted in a two-night hospital stay and kept him away from work for weeks. However, this is not the first time he had suffered a work-related injury. This is, in fact, the third time this has happened, noted ASA.

"Boom Strikes"

These injuries are often called "boom strikes". These occur when anesthesiologists accidentally bump into operating room (OR) equipment that is mounted on fixed or moveable arms. These could be monitors, lights, or screens.

While any OR staff member could be hurt this way, anesthesiologists are particularly more vulnerable to such injuries. Their work requires them to operate in tight, also, often crowded spaces. It also requires them to move quickly during emergencies, which further increases the risk of collision with equipment.

Why The Problem Is Growing?

As per ASA, the risk of boom strikes have been on the rise. This is also because of an increase in sophisticated equipment being added to operating rooms and surgeries are also now performed in much smaller spaces.

As per a survey conducted by the organization, it was found that more than half of anesthesiologists reported experiencing at least one work-related injury, including head injuries. These numbers have highlighted the growing concern over physical safety in an already demanding and high-pressure environment.

Can New Guidelines Improve Safety?

In response to these alarming findings, the ASA has issued a new Statement on Anesthesiologist Head Injuries in Anesthetizing Locations.

The statement formally recognizes boom strikes as a serious occupational hazard and even a potential medical emergency — especially dangerous during outpatient procedures or in cases where no backup anesthesiologist is immediately available to take over patient care.

Dr. Mary Ann Vann, chair of ASA's Ad Hoc Committee on the Physical Demands of Anesthesiologists, also experienced a work-related head injury. Drawing from personal experience, Dr. Vann helped develop the new safety recommendations, aimed at preventing such incidents.

What Have Been The Key Recommendations?

The ASA outlined several measures to reduce the risk of head injuries among anesthesiologists, including:

Holding Regular Safety Meetings: OR teams should meet frequently to discuss safety concerns and review past incidents.

Creating Safety Teams: Special teams should be tasked with reviewing and tracking reports of boom strikes to identify patterns and solutions.

Involving Anesthesia Staff in Room Planning: Clinical anesthesia personnel should have a voice when designing or rearranging procedure rooms to ensure equipment placement considers movement and space needs.

Tracking Head Injuries: Systematic documentation of head injuries can help health systems better understand causes and outcomes, leading to more informed prevention strategies.

The ASA emphasized that head injuries in the OR are not just minor accidents but events that can have serious consequences for patient safety and anesthesiologists’ health.

By implementing the new guidelines and raising awareness, the ASA hopes to make operating rooms safer environments for all medical professionals — and ensure that anesthesiologists can continue their vital work without unnecessary risk.