Screening for vitamin D deficiency: is the goal disease prevention or full nutrient repletion?
نویسنده
چکیده
TO THE EDITOR: Yamin and colleagues (1) evaluated the probability of eliminating Ebola by case isolation of 50% to 100% of nonsurvivors compared with isolation of all infected persons when the type of contact is dominated by conversation or by sharing a meal or a bed. However, they do not mention the transmission of the virus during conversation, or aerosol transmission. Masks are protective only when they are of good quality and properly used. Filoviruses are classified as category A bioterrorism agents by the Centers for Disease Control and Prevention and are thought to be aerosol-mediated. Countering aerosolized filovirus infection has been a major priority of biodefense research (2). Transmission of Marburg virus by exposure to batinhabited caves and mines has already been reported (3). In a study by Reed and associates, when cynomolgus and rhesus macaques and African green monkeys were exposed to aerosolized Zaire ebolavirus, all 3 species developed similar clinical signs and symptoms and the outcome resembled that of parenteral inoculation with the virus for each species (4). Rhesus monkeys who experimentally inhaled droplets of 0.8 to 1.2 microns containing Ebola virus died of ebolavirus disease within a few days. Immunocytochemistry has also shown Ebola virus antigens in airway epithelium, alveolar pneumocytes, and macrophages in the lung and mediastinal lymph nodes. Aggregates of characteristic filamentous virus were present in type 1 pneumocytes, macrophages, and air spaces of the lung by electron microscopy (5). Similar lethal infections by aerosol exposure were reported in 18 rhesus macaques, including early infection of the respiratory lymphoid tissues (6), and aerosol exposure to Zaire ebolavirus has been reported to cause lethal infections in rhesus monkeys. Two rhesus monkeys were exposed to 400 plaqueforming units of the virus and 2 others to 50 000 plaqueforming units; all 4 monkeys developed diseases and died 7 to 9 days after exposure (5). In a fatal disease like Ebola, where human experimentation cannot be used to prove the route of transmission, evidence available from nonhuman primates should be taken seriously. However, the absence of evidence in humans is not evidence of the absence of aerosol transmission. Demonstration of fatal aerosol transmission of Ebola virus in monkeys reinforces the importance of taking appropriate precautions to prevent its potential aerosol transmission to humans. We request that Yamin and colleagues discuss these issues related to their study to clear the air.
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ورودعنوان ژورنال:
- Annals of internal medicine
دوره 162 10 شماره
صفحات -
تاریخ انتشار 2015