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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sun Oct 12, 2014 6:42 am 
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Location: Pittsburgh, PA USA
TheHappyScientist wrote:
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 :)

In the Nature study, cages were 20 cm (8 inches) apart. CDC defines close contact as 3 feet.

Ebola is not easily transmitted. Contact with body fluids is driving the outbreaks.

For testing in the US, many state labs have passed proficiency tests and can test, which was done in Austin for TED and HCW.

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sun Oct 12, 2014 6:48 am 
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franzpick wrote:
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

Not sure why the article is listed as Aug 9. It was published in April (see articles below citing it)

CITING ARTICLES
1Thomas Hoenen, Heinz Feldmann. (2014) Ebolavirus in West Africa, and the use of experimental therapies or vaccines. BMC Biology 12:1,
CrossRef
2C. Raina MacIntyre, Abrar Ahmad Chughtai, Holly Seale, Guy A. Richards, Patricia M. Davidson. (2014) Respiratory protection for healthcare workers treating Ebola virus disease (EVD): Are facemasks sufficient to meet occupational health and safety obligations?. International Journal of Nursing Studies 51:11, 1421-1426
CrossRef
3 Baden , Lindsey R. , Kanapathipillai , Rupa , Campion , Edward W. , Morrissey , Stephen , Rubin , Eric J. , Drazen , Jeffrey M. , . (2014) Ebola — An Ongoing Crisis. New England Journal of Medicine 371:15, 1458-1459
Free Full Text
4 Feldmann , Heinz , . (2014) Ebola — A Growing Threat?. New England Journal of Medicine 371:15, 1375-1378
Free Full Text
5Audrey Ceschia. (2014) The Institut Pasteur network: a crucial partner against Ebola. The Lancet 384:9950, 1239-1240
CrossRef
6Allen C. Cheng, Heath Kelly. (2014) Are we prepared for Ebola and other viral haemorrhagic fevers?. Australian and New Zealand Journal of Public Health 38:5, 403-404
CrossRef
7A. Camacho, A.J. Kucharski, S. Funk, J. Breman, P. Piot, W.J. Edmunds. (2014) Potential for large outbreaks of Ebola virus disease. Epidemics
CrossRef
8Rosalind Parkes-Ratanshi, Umaru Ssekabira, Ian Crozier. (2014) Ebola in West Africa: be aware and prepare. Intensive Care Medicine
CrossRef
9A Kucharski, P Piot. (2014) Containing Ebola virus infection in West Africa. Eurosurveillance 19:36, 20899
CrossRef
10David M Pigott, Nick Golding, Adrian Mylne, Zhi Huang, Andrew J Henry, Daniel J Weiss, Oliver J Brady, Moritz UG Kraemer, David L Smith, Catherine L Moyes, Samir Bhatt, Peter W Gething, Peter W Horby, Isaac I Bogoch, John S Brownstein, Sumiko R Mekaru, Andrew J Tatem, Kamran Khan, Simon I Hay. (2014) Mapping the zoonotic niche of Ebola virus disease in Africa. eLife 3,
CrossRef
11S Ng, N Basta, B Cowling. (2014) Association between temperature, humidity and ebolavirus disease outbreaks in Africa, 1976 to 2014. Eurosurveillance 19:35, 20892
CrossRef
12Pierre Tattevin, Emanuele Durante-Mangoni, Moses Massaquoi. (2014) Does this patient have Ebola virus disease?. Intensive Care Medicine
CrossRef
13E. M. Leroy, I. Labouba, G. D. Maganga, N. Berthet. (2014) Ebola in West Africa: the outbreak able to change many things. Clinical Microbiology and Infectionn/a-n/a
CrossRef
14Mamadou B. Keita, Ibrahim Hamad, Fadi Bittar. (2014) Looking in apes as a source of human pathogens. Microbial Pathogenesis
CrossRef
15François Bricaire. (2014) Alerte – épidémie due au virus Ebola. La Presse Médicale
CrossRef
16Katendi Changula, Masahiro Kajihara, Aaron S. Mweene, Ayato Takada. (2014) Ebola and Marburg virus diseases in Africa: Increased risk of outbreaks in previously unaffected areas?. Microbiology and Immunology 58:9, 483-491
CrossRef
17A. Lefebvre, C. Fiet, C. Belpois-Duchamp, M. Tiv, K. Astruc, L.S. Aho Glélé. (2014) Case fatality rates of Ebola virus diseases: A meta-analysis of World Health Organization data. Médecine et Maladies Infectieuses 44:9, 412-416
CrossRef
18Aftab A. Ansari. (2014) Clinical features and pathobiology of Ebolavirus infection. Journal of Autoimmunity
CrossRef
19Gang Chen, Jayne F. Koellhoffer, Samantha E. Zak, Julia C. Frei, Nina Liu, Hua Long, Wei Ye, Kaajal Nagar, Guohua Pan, Kartik Chandran, John M. Dye, Sachdev S. Sidhu, Jonathan R. Lai. (2014) Synthetic Antibodies with a Human Framework That Protect Mice from Lethal Sudan Ebolavirus Challenge. ACS Chemical Biology140826080257004
CrossRef
20Lucy J. Robertson, Kjersti Selstad Utaaker, Kapil Goyal, Rakesh Sehgal. (2014) Keeping parasitology under the One Health umbrella. Trends in Parasitology 30:8, 369-372
CrossRef
21Stanford T. Shulman. (2014) What, Ebola Here?. Pediatric Annals 43:9, 332-333
CrossRef
22G. Greub, M. P. Grobusch. (2014) Bioterrorism: myth or reality?. Clinical Microbiology and Infection 20:6, 485-487
CrossRef
23Sora Yasri, Viroj Wiwanitkit. (2014) Abortion rate among the pregnant infected with Ebola virus infection: a summarization on existed evidences. Asian Pacific Journal of Tropical Disease 4, S529
CrossRef
24Somsri Wiwanitkit, Viroj Wiwanitkit. (2014) Emerging 2014 African Ebola: relationship between clinical presentation and mortal outcome. Asian Pacific Journal of Tropical Disease 4, S528
CrossRef
25Moran Ki. (2014) What do we really fear? The epidemiological characteristics of Ebola and our preparedness. Epidemiology and Healthe2014014
CrossRef

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Sun Oct 12, 2014 6:51 am 
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Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
franzpick wrote:
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

Sequences discussed in July

viewtopic.php?f=5&t=11862&start=100&hilit=Baize

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Wed Oct 15, 2014 11:06 am 
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Posts: 782
Location: Southern California
Dr. Niman,

1. Would it be possible to expand the serum supply of people with antibodies by giving more people the blood/plasma from those who have survived ebola....then taking those individuals and having them donate blood to be given to others?

2. If we can get the antibodies in the manner above, could we then theoretically give the blood/plasma to health care workers who are caring for ebola patients to protect them prophylacticly?

3. Once we have a larger supply of people with the antibodies, could we then theoretically give it to the general population (hopefully there will be an actual vaccine by then so this step can be eliminated because of the risk of blood borne pathogens)


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 16, 2014 4:06 am 
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Angel_B wrote:
Dr. Niman,

1. Would it be possible to expand the serum supply of people with antibodies by giving more people the blood/plasma from those who have survived ebola....then taking those individuals and having them donate blood to be given to others?

2. If we can get the antibodies in the manner above, could we then theoretically give the blood/plasma to health care workers who are caring for ebola patients to protect them prophylacticly?

3. Once we have a larger supply of people with the antibodies, could we then theoretically give it to the general population (hopefully there will be an actual vaccine by then so this step can be eliminated because of the risk of blood borne pathogens)

Kent Brantly has already given blood to four of the Ebola cases in the US. If plasma is drawn, a donor can give multiple times per week (much less frequently if whole blood is collected). The WHO recommendations for Ebola recovered cases indicates that plasma donations are not limited by ABO type, but the donations appear to be good for a very limited number of cases. No one else in the US has stepped forward (Nancy Writebol appears to be a donor candidate, while Rick Sacra was re-admitted so he may not be avaiable. Other cases in the US are still hospitalized and I have not heard about plans for Amber Vinson.

I think donors are limited, so broad use is unlikely.

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 16, 2014 1:13 pm 
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Joined: Mon Aug 11, 2014 9:15 am
Posts: 52
Location: Idabel, OK
Quote:
1. Would it be possible to expand the serum supply of people with antibodies by giving more people the blood/plasma from those who have survived ebola....then taking those individuals and having them donate blood to be given to others?

2. If we can get the antibodies in the manner above, could we then theoretically give the blood/plasma to health care workers who are caring for ebola patients to protect them prophylacticly?

3. Once we have a larger supply of people with the antibodies, could we then theoretically give it to the general population (hopefully there will be an actual vaccine by then so this step can be eliminated because of the risk of blood borne pathogens)


I'm not an expert in this but in my understanding this won't work. In order to create antibodies, you have to be exposed to a bacteria or virus. If you are already infected, the antibodies help to "jump start" the immune response helping you to recover. If however the antibodies were injected into a healthy person they would just be ignored because their body wouldn't know what to do with them. It wouldn't create additional antibodies.

Hopefully if I'm wrong in this someone will correct me.


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 16, 2014 1:16 pm 
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alforddm wrote:
Quote:
1. Would it be possible to expand the serum supply of people with antibodies by giving more people the blood/plasma from those who have survived ebola....then taking those individuals and having them donate blood to be given to others?

2. If we can get the antibodies in the manner above, could we then theoretically give the blood/plasma to health care workers who are caring for ebola patients to protect them prophylacticly?

3. Once we have a larger supply of people with the antibodies, could we then theoretically give it to the general population (hopefully there will be an actual vaccine by then so this step can be eliminated because of the risk of blood borne pathogens)


I'm not an expert in this but in my understanding this won't work. In order to create antibodies, you have to be exposed to a bacteria or virus. If you are already infected, the antibodies help to "jump start" the immune response helping you to recover. If however the antibodies were injected into a healthy person they would just be ignored because their body wouldn't know what to do with them. It wouldn't create additional antibodies.

Hopefully if I'm wrong in this someone will correct me.

Passive immunization (netralizing antibodies from convelescent plasma) will protect.

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 16, 2014 1:19 pm 
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Quote:
Passive immunization (netralizing antibodies from convelescent plasma) will protect.


Ok, so you couldinject antibodies into a healthy host and it would act as a vaccine?


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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 16, 2014 1:23 pm 
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Location: Pittsburgh, PA USA
alforddm wrote:
Quote:
Passive immunization (netralizing antibodies from convelescent plasma) will protect.


Ok, so you couldinject antibodies into a healthy host and it would act as a vaccine?

A vaccine leads to the production of new antibodies. Passive immunization does not, but the added antibodies do protect.

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 Post subject: Re: ASK DR. NIMAN
PostPosted: Thu Oct 16, 2014 1:30 pm 
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Joined: Mon Aug 11, 2014 9:15 am
Posts: 52
Location: Idabel, OK
Ahhhh, I see. Thank you very much for the clarification. How long would the Passive immunization provide protection? Probably isn't known at this point? Why hasn't this been attempted in HCW? Seems like some protection would be better than nothing?

Sorry for all the questions.


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