Out of the 3 possibilities: 1.) Relapse: most likely, several documented cases. 2.) Reinfection: no case confirmed since 1976, only anecdotal hints on possibility. 3.) False positive and then declared cured and employed as care taker? Very unlikely. Because: Assuming that the
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Als antwoord op @koppk_OHPGXC @HelenBranswell
patient had been admitted to a ETC, the first positive test certainly had been followed up by at least 1 more positive and 1 negative, finally before being declared declared cured & fit as becoming a "care taker". GeneXpert real-time RT-PCR uses 2 different gene targets which
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Als antwoord op @koppk_OHPGXC @HelenBranswell
makes it very specific, i.e. to show a positive result 2 "sub-tests" must be found positive. more details on relapse vs. reinfection: https://www.sciencedirect.com/science/article/pii/S1201971215002921 … sensitivity & specificity GeneXpert:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811569/ …
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Als antwoord op @koppk_OHPGXC
There is ... informed discussion of some false positives in this outbreak. People who ended up in ETCs.
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Als antwoord op @HelenBranswell @koppk_OHPGXC
Wasn't there a relapse case near the end of the West African outbreak?
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Als antwoord op @HelenBranswell @koppk_OHPGXC
There were a few cases where a survivor infected a sexual partner resulting in a cluster of acute cases. But the survivor didn’t have a relapse of disease. The Scottish nurse is the only case I know of where someone become ill again and that was an infection of the CNS.
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Als antwoord op @arambaut @koppk_OHPGXC
Thanks, you are right. I was mixing up the sexual transmission case in ... I want to say March 2016 with the case of the Scottish nurse, who has had 2 relapses, I think.
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Als antwoord op @HelenBranswell @koppk_OHPGXC
Yes - the last cluster of cases in Guinea and Liberia were the result of transmission from a survivor who had been acutely infected 10 months earlier (he did not become ill again).
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IMO false positive HIGHLY likely. Happens all the time (there were a lot of these in W. Africa) and not just during Ebola outbreaks.
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Which reference for "lot of" false positive GeneXpert assays during the West Africa 2014-2016 epidemic? Some other PCR assays did actually not perform as well as merely analytical evaluations suggested.
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Local knowledge. The studies you see assess best-case-scenario analytical specificity and don't really give an accurate account of what is really going on during a chaotic situation. I should say, that I think all three options are definitely possibilities here.
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Human error before using a nuclease probe-based real-time RT-PCR system under chaotic conditions is the problem: mixing up samples, patient records, sample degradation due to wrong storage/transport. Not the test which is the most reliable assay type for EVD to date.
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