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 Post subject: Re: ASK DR. NIMAN
PostPosted: Tue Sep 30, 2014 11:44 pm 
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Dr. Niman,
Long time reader of yours.

Questions:
1. Is Ebola now airborne?
2. When will public events be cancelled in Dallas? e.g. sporting events, church, school, etc
3 Which Ebola strain in Dallas?
4. What is the R0 for the Ebola in Dallas?

The CDC requirements for US health care personnel are quite different from the recommended safety precautions in Africa.
5. What would you do if you were a health care worker in Dallas?

Thanks.


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 02, 2014 3:57 pm 
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Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
ixy wrote:
Dr. Niman,
Long time reader of yours.

Questions:
1. Is Ebola now airborne?
2. When will public events be cancelled in Dallas? e.g. sporting events, church, school, etc
3 Which Ebola strain in Dallas?
4. What is the R0 for the Ebola in Dallas?

The CDC requirements for US health care personnel are quite different from the recommended safety precautions in Africa.
5. What would you do if you were a health care worker in Dallas?

Thanks.

Welcome to the flutracker!
1. There is no evidence supporting any altered transmission. Media reports of high profile cases support transmission through contact with blood, vomit, or feces.

2. There is only one known Ebola cases in Dallas and he is hospitalized. I don't expect any closures.

3. Dallas strain is the same as Guinea, Sierra Leone, Liberia, Nigeria, and Senegal. It is a novel sub-clade of teh Zaire strain.

4. R0 is generall believed to be between 1 and 2.

5. Exercise universal precautions.

_________________
www.twitter.com/hniman


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Fri Oct 03, 2014 6:09 pm 
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Posts: 5
Dr. Niman,
Why does it take so long to get the results from an Ebola test? Meaning why do we have to wait 24 hours from the time the test is administered until the results are known? It seems like an awfully long time to wonder if the person is actually infected and then determine if further investigations need to be done with their contacts.
Thanks very much in advance.


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sat Oct 04, 2014 5:22 am 
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Location: Pittsburgh, PA USA
vv60 wrote:
Dr. Niman,
Why does it take so long to get the results from an Ebola test? Meaning why do we have to wait 24 hours from the time the test is administered until the results are known? It seems like an awfully long time to wonder if the person is actually infected and then determine if further investigations need to be done with their contacts.
Thanks very much in advance.

Samples have to be shipped to CDC (or state lab if it has passed a proficiency test, which has happened in Texas - state lab there in Austin).

For index, he was identified Sunday, sample shipped Monday, and results on Tuesday. However, there is no approved treatment for Ebola.

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Fri Oct 10, 2014 7:35 pm 
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Posts: 2
Dr, long time reader, thanks for the site and all your hard work here updating the site.

I know you're probably tired of the Ebola airborne questions but I have to know... In the wild, what would it take for ebola to become airborne ? Is it completely impossible for that to happen ?


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sat Oct 11, 2014 9:37 am 
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Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
the_watcher wrote:
Dr, long time reader, thanks for the site and all your hard work here updating the site.

I know you're probably tired of the Ebola airborne questions but I have to know... In the wild, what would it take for ebola to become airborne ? Is it completely impossible for that to happen ?

The Reston strain has passed through the air from caged non-human primate to non-human primate. This happened in a research lab in Restin, Virginia (which is how the strain got its name) in non-human primates imported from the Philippines for research (but not for Ebola research).

However, it has never been identified outside of this lab and was not transmitted to humans. I think one technician had a needle stick, but didn't develop symptoms, which is also true for those who handled the non-human primates, and that handling was without exotic PPEs because there was no indication that the primates were infected until they became symptomatic and started to die.

Finding Ebola in the dead primates was a VERY big surprise.

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sat Oct 11, 2014 10:28 am 
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Good morning Dr. Niman - another longtime reader here. I am wondering - as the days continue to go by without news of illness among Eric Duncan's family and other contacts, is there any realistic likelihood that none of these will contract ebola?


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sat Oct 11, 2014 1:50 pm 
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Location: Pittsburgh, PA USA
captain1 wrote:
Good morning Dr. Niman - another longtime reader here. I am wondering - as the days continue to go by without news of illness among Eric Duncan's family and other contacts, is there any realistic likelihood that none of these will contract ebola?

captain1,

Welcome to the flutracker!

It seems very likely that there will be no onward transmission in Dallas. The most likely candidates are those he contacted between his 1st and 2nd visit to the ER, whic goes back to Sept 25, so it has been well over 2 weeks and most incubations are in the 8-10 day range.

Ebola really doesn't transmit very well. Patrick Sawyer was very symptomatic when he flew from Monrovia to Accra to Lome to Lagos, but no one on the flights were reported as infected These two index cases are the only two examples of export by commercial airline..

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sat Oct 11, 2014 9:43 pm 
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Joined: Tue Aug 25, 2009 8:54 pm
Posts: 894
Hi Dr. Niman,
I hope you have been well!
Do you find this study of concern?
http://www.nature.com/srep/2012/121115/ ... 00811.html

Also I wanted to ask you about the testing all of these hospitals are doing now. Is all blood currently being tested through the CDC or are they using kits?
You mentioned this is a novel sub clade of Zaire strain? Depending on the test it would seem that even a single SNP could result in a false negative?
What type of tests are they using?


Thanks :)


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sat Oct 11, 2014 10:38 pm 
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Joined: Tue Aug 26, 2014 7:27 pm
Posts: 122
This 2 day old peer reviewed piece in the NEJM may provide some new details that may relate to false negative results using previous testing methods on the current new Guinean EVD strain, but I remain unqualified to comment:

"This study demonstrates the emergence of a new EBOV strain in Guinea."

"Discussion: This study demonstrates the emergence of EBOV in Guinea. The high degree of similarity among the 15 partial L gene sequences, along with the three full-length sequences and the epidemiologic links between the cases, suggest a single introduction of the virus into the human population. This introduction seems to have happened in December 2013. Further epidemiologic investigation is ongoing to identify the presumed animal source of the outbreak. It is suspected that the virus was transmitted for months before the outbreak became apparent because of clusters of cases in the hospitals of Guéckédou and Macenta. This length of exposure appears to have allowed many transmission chains and thus increased the number of cases of Ebola virus disease."

http://www.nejm.org/doi/full/10.1056/NEJMoa1404505


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