outlets used European beef, and approximately 20 percent of this beef was from the United Kingdom.

A third outlet for the purchase of beef by members of the U.S. military and their families is hamburger franchises. Before the reduction of troop strength in Europe, more than 50 hamburger franchises were operating as concessions. These operations used preformed patties from the United Kingdom through 1989. From 1990 to March 2000, either U.S. beef was used or beef was ground in an AAFES-operated facility in Germany by using a combination of U.S. beef and beef from European countries other than the United Kingdom. Between March 1996 and March 2000, most beef originated from European countries without cases of BSE, and some came from the United States. Since March 2000 the beef has been of U.S. or non-European origin.

Risk for Exposure to BSE Agent

Members of U.S. forces, including their family members, commonly enjoy the local culture and consume locally prepared foods while they are stationed overseas. They purchase food in local markets and dine in local eating establishments. However, the majority of food that they consume comes from either the system used to feed troops or the commissary system.

The greatest period of risk for exposure to tainted beef products occurred between 1980 and 1996 in the United Kingdom. For continental Europe that period of risk was extended beyond 1996. In the early 1980s, the BSE outbreak was not apparent, yet cattle were infected with BSE. Effective controls to prevent further contamination of the food supply were iteratively put in place first in the United Kingdom and then throughout other European countries. During that period 4,428,572 military personnel and their family members were potentially exposed to BSE-tainted beef products (Table 6-1).

U.S. military members and their families who were living in the United Kingdom and Europe between 1980 and 1996 were at increased risk of exposure to infectious prions as a result of their consumption of locally procured beef or their consumption of beef in local eating establishments compared with the risk of their counterparts in the United States. This risk of acquiring vCJD is judged to have been relatively small compared with the local population's risk. Notification and active prospective surveillance are not warranted for these military members or their families. However, the committee encourages passive