S/O Monkeypox news & polio news

[Arcadia]

47 minutes ago, vonfirmath said:

?? If there were supposed to be 1 million doses and there were only 2000 -- what happened to the rest?

@KSera do you think they might have included ACAM2000 doses in the 1 million?

https://aspr.hhs.gov/SNS/Pages/Monkeypox.aspx
“The SNS holds enough vaccine – both Jynneos and ACAM2000® – to vaccinate millions of Americans, if needed. ASPR’s Biomedical Advanced Research and Development Authority (BARDA) supported the development of Jynneos, which is approved by the U.S. Food and Drug Administration to prevent both smallpox and monkeypox. ACAM2000®, which was developed with support from SNS, is FDA approved for smallpox but could also be used to vaccinate at-risk individuals under an appropriate regulatory mechanism outside its labeled indication. CDC currently has an expanded access Investigational New Drug protocol that allows its use for monkeypox.”

https://time.com/6198298/monkeypox-vaccine-shortage/ (July 18th)

“The shortage may be surprising, since officials previously said the country has enough vaccines in the Strategic National Stockpile (SNS). But many of the stockpiled ones are the older ACAM2000 vaccine, which is approved for use against smallpox and can also be used for monkeypox. It’s a live virus vaccine containing a virus that’s related to smallpox but milder. The shot causes a temporary sore at the injection site, which—if not properly cared for—can potentially spread the virus to unvaccinated people in close contact. About 1 in 175 people who receive ACAM200 also experience swelling of the heart and surrounding tissues. Some immunocompromised people also cannot get ACAM2000.

A newer vaccine called Jynneos, which consists of two doses given four weeks apart and is approved for use against monkeypox and smallpox, is considered more appropriate for widespread use. The U.S. had only about 2,000 doses of that product in the SNS when the outbreak began—so authorities have been rushing to obtain more”

[KSera]

1 hour ago, Arcadia said:

@KSera do you think they might have included ACAM2000 doses in the 1 million?

That’s how that sounds to me. I had thought they were only using Jynneos for now. 

[Carrie12345]

Cases confirmed in my county.
I fear that mis/disinformation will fuel transmission. Again.

This is not an STI.
If I have a cold, who am I most likely to give it to? My partner.  A cold is not an STI.
If I have monkeypox, who am I most likely to give it to? My partner.  Just because it isn’t *as* easily transmitted to additional people as a cold is, doesn’t make it an STI.

[Arcadia]

https://www.cdc.gov/poxvirus/monkeypox/pdf/MPX_Social_Gatherings_Safer_Sex-508.pdf

“What are researchers investigating?
● If the virus can be spread when someone has no symptoms
● If the virus could be present in semen (cum), vaginal fluids, and fecal matter (poop) ● How effective the current smallpox vaccines are for the prevention of monkeypox illness

How can a person lower the chance of getting monkeypox at places like raves, parties, clubs, and festivals?
When thinking about what to do, seek out information from trusted sources like the local health department. Second, consider how much close, personal, skin-to-skin contact is likely to occur at the event you plan to attend. If you feel sick or have a rash, do not attend any gathering,
and see a healthcare provider.
● Festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer. However, attendees should be mindful of activities (like kissing) that might spread monkeypox.
● A rave, party, or club where there is minimal clothing and where
there is direct, personal, often skin-to-skin contact has some risk.
Avoid any rash you see on others and consider minimizing skin-to-skin contact.
● Enclosed spaces, such as back rooms, saunas, sex clubs, or private and public sex parties where intimate, often anonymous sexual contact with multiple partners occurs, may have a higher likelihood of spreading monkeypox.”

https://publichealth.sccgov.org/sites/g/files/exjcpb916/files/documents/What is Monkeypox - Flyer - 8.5x11.pdf

[vonfirmath]

4 hours ago, Carrie12345 said:

Cases confirmed in my county.
I fear that mis/disinformation will fuel transmission. Again.

This is not an STI.
If I have a cold, who am I most likely to give it to? My partner.  A cold is not an STI.
If I have monkeypox, who am I most likely to give it to? My partner.  Just because it isn’t *as* easily transmitted to additional people as a cold is, doesn’t make it an STI.

Minimizing it will also fuel transmission. Given what we know about how it is spreading right now, I feel there ought to be more strenuous recommendations for those at risk to lockdown a little tighter -- if they can shut down schools, businesses, etc for 2-ish months due to Covid-19, why can't they be more plain that perhaps those at risk should give up these high risk activities for a couple of months?

 

Yes, it can also spread to household contacts, etc. But if fewer people were transferring it around then the household contacts would also be safer.

[Arcadia]

2 minutes ago, vonfirmath said:

Minimizing it will also fuel transmission. Given what we know about how it is spreading right now, I feel there ought to be more strenuous recommendations for those at risk to lockdown a little tighter -- if they can shut down schools, businesses, etc for 2-ish months due to Covid-19, why can't they be more plain that perhaps those at risk should give up these high risk activities for a couple of months?

That feels like discrimination to the LGBTQ+ community

https://www.latimes.com/california/story/2022-07-22/californias-lgbtq-community-anxious-as-monkeypox-cases-rise?_amp=true

““This should be a preventable public health crisis,” San Francisco City Supervisor Rafael Mandelman said this month. “Unlike COVID-19, we did not have to wait for a vaccine to be developed. And unlike COVID-19, monkeypox does not seem to spread effectively through respiratory droplets. Yet here we are with cases rising, vaccines sparse and urgent action by our federal public health institutions absent.

“Would monkeypox have received a stronger response if it were not primarily affecting queer folks?” he asked.

… “After a million COVID deaths in the U.S. … how could we be caught flat-footed again?” Palacios asked. “Rather than rolling out treatments, they’ve just put gay men on house arrest. ... If we’re the only people that seem to be suffering from something, then the powers that be don’t seem very inclined to reach a positive solution.”
… “Are we in another moment when the lives of gay and bi men are not being prioritized?” TerMeer asked, alluding to the HIV and AIDS epidemic of the 1980s and ’90s. “There needs to be more urgency.”

… Rick Chavez Zbur, an LGBTQ civil rights leader and former executive director of Equality California, said there needs to be enough Jynneos doses to vaccinate all at-risk gay and bisexual men, as well as transgender and nonbinary people. 

“It is not an acceptable public health strategy to have members of the LGBTQ+ community put our lives on hold while we wait for insufficient supplies of vaccines to dribble out,” Zbur said. “Every day that vaccines are widely unavailable relegates gay and bi men and transgender people to living lives of fear and isolation, reminiscent to the early period of both the HIV and COVID epidemics.”“

[mommyoffive]

COVID-19 and Monkeypox: Similarities and differences (substack.com)

[Carrie12345]

2 hours ago, vonfirmath said:

Minimizing it will also fuel transmission. Given what we know about how it is spreading right now, I feel there ought to be more strenuous recommendations for those at risk to lockdown a little tighter -- if they can shut down schools, businesses, etc for 2-ish months due to Covid-19, why can't they be more plain that perhaps those at risk should give up these high risk activities for a couple of months?

 

Yes, it can also spread to household contacts, etc. But if fewer people were transferring it around then the household contacts would also be safer.

 

2 hours ago, Arcadia said:

That feels like discrimination to the LGBTQ+ community

https://www.latimes.com/california/story/2022-07-22/californias-lgbtq-community-anxious-as-monkeypox-cases-rise?_amp=true

““This should be a preventable public health crisis,” San Francisco City Supervisor Rafael Mandelman said this month. “Unlike COVID-19, we did not have to wait for a vaccine to be developed. And unlike COVID-19, monkeypox does not seem to spread effectively through respiratory droplets. Yet here we are with cases rising, vaccines sparse and urgent action by our federal public health institutions absent.

“Would monkeypox have received a stronger response if it were not primarily affecting queer folks?” he asked.

… “After a million COVID deaths in the U.S. … how could we be caught flat-footed again?” Palacios asked. “Rather than rolling out treatments, they’ve just put gay men on house arrest. ... If we’re the only people that seem to be suffering from something, then the powers that be don’t seem very inclined to reach a positive solution.”
… “Are we in another moment when the lives of gay and bi men are not being prioritized?” TerMeer asked, alluding to the HIV and AIDS epidemic of the 1980s and ’90s. “There needs to be more urgency.”

… Rick Chavez Zbur, an LGBTQ civil rights leader and former executive director of Equality California, said there needs to be enough Jynneos doses to vaccinate all at-risk gay and bisexual men, as well as transgender and nonbinary people. 

“It is not an acceptable public health strategy to have members of the LGBTQ+ community put our lives on hold while we wait for insufficient supplies of vaccines to dribble out,” Zbur said. “Every day that vaccines are widely unavailable relegates gay and bi men and transgender people to living lives of fear and isolation, reminiscent to the early period of both the HIV and COVID epidemics.”“

I don’t think the LGBTQ+ community has to be targeted.
Behaviors can be.

Don’t lay on public beach chairs.
Don’t participate in wrestling.
Don’t put your kids in ball pits.
Maybe don’t try on clothes right now?
Don’t have non-monogamous sex.
Don’t mosh, especially shirtless.

We could go on.
 

[BeachGal]

Medscape had a recent article listing what they are finding in this outbreak of monkeypox. (Might need an account to read.) Some cases have had only a single lesion or just pain so the thinking is that cases might have been missed, brushed off or misdiagnosed as something else.

https://www.medscape.com/viewarticle/977770?src=WNL_trdalrt_pos1_220725&uac=428738CV&impID=4463866

"While we expected various skin problems and rashes, we also found that one in ten people had only a single skin lesion in the genital area, and 15% had anal and/or rectal pain," John Thornhill, MD, PhD, the lead author of the research, said in a press release. Thornhill is a consultant physician in sexual health and HIV and a clinical senior lecturer at Barts NHS Health Trust and Queen Mary University of London. "These different presentations highlight that monkeypox infections could be missed or easily confused with common sexually transmitted infections such as syphilis or herpes," he said.

[wathe]

56 minutes ago, BeachGal said:

Medscape had a recent article listing what they are finding in this outbreak of monkeypox. (Might need an account to read.) Some cases have had only a single lesion or just pain so the thinking is that cases might have been missed, brushed off or misdiagnosed as something else.

 

Guaranteed this is happening.  I almost did it myself.  

[BeachGal]

1 hour ago, wathe said:

Guaranteed this is happening.  I almost did it myself.  

Also, some infected individuals are probably not linking their minor symptoms with monkeypox and could be unintentionally spreading it.

[kbutton]

2 hours ago, wathe said:

Guaranteed this is happening.  I almost did it myself.  

DH had to swab a patient that came from another ER location. She came back negative, but he said that she was already late in the course of *whatever* she had, and the lesions were dried. He didn't feel like the timing of the test made the results reliable. I don't know if what she presented with was straightforward or not since he was just doing the swabs someone ordered. 

[mommyoffive]

State declares monkeypox an 'imminent threat to public health' (msn.com)

[mommyoffive]

More than 780K doses of monkeypox vaccine available Friday; US orders 5.5M for 2023 (msn.com)

[kbutton]

This was posted on an evidence-based FB group I follow: https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/smallpox-and-other-orthopoxvirus-associated-infections?fbclid=IwAR08xhX3XqoDeSFfcEkPKmEZWc2fy04MOFyb5YgyGODlS9LqORlRBpkJC9o

Quote

Monkeypox

After zoonotic transmission, monkeypox spread from person to person is principally respiratory; contact with infectious skin lesions or scabs is another, albeit less common, means of person-to-person spread. African rodents and primates may harbor the virus and infect humans, but the reservoir host is unknown.

I really wish that we'd get the straight story. At work, DH is supposed to wear all the PPE if he encounters a case. 

[Ausmumof3]

 

[Ausmumof3]

It looks like in Spain there’s 15pc of cases outside the MSM community? Don’t know if anyone can verify from a reliable English language source. If this becomes a more significant thing my panic levels will be upping a bit. 

[Arcadia]

https://www.reuters.com/world/europe/spain-confirms-first-monkeypox-related-death-country-reports-2022-07-29/
“MADRID, July 30 (Reuters) - Spain reported its second monkeypox-related death on Saturday, in what is thought to be Europe's second death from the disease and only the third outside of Africa in the current outbreak.

Spain had reported its first death as recently as Friday, shortly after Brazil reported the first monkeypox-related death outside the African continent in the current wave of the disease. 

…. According to a World Health Organization report from July 22, only five deaths had been reported, all in the African region.

In its latest report on Saturday, the Spanish Health Ministry said 4,298 cases had been confirmed in the country. Of the 3,750 patients on which it had information, 120 or 3.2% had been hospitalised, and two had died, it said without providing further details.

The first death occurred in the northeastern Valencia region and the cause was encephalitis, an inflammation of the brain associated with the infection, local media reported, quoting the regional health department.”

[Arcadia]

https://www.bbc.com/news/health-62350022
“A 41-year-old man in Brazil became the first fatality from the virus outside Africa. Spain announced two deaths soon afterwards - the first in Europe. 

… On Friday Brazil's health ministry said the victim there had suffered from lymphoma and a weakened immune system, and "comorbidities aggravated his condition". 

Brazil has so far reported 1,066 confirmed cases and 513 suspected cases of the virus. Data from Brazil's health ministry indicates that more than 98% of confirmed cases were in men who have sex with men.“

[Arcadia]

On 7/28/2022 at 10:35 AM, BeachGal said:

Medscape had a recent article listing what they are finding in this outbreak of monkeypox. (Might need an account to read.) Some cases have had only a single lesion or just pain so the thinking is that cases might have been missed, brushed off or misdiagnosed as something else.

 

On 7/28/2022 at 11:37 AM, wathe said:

Guaranteed this is happening.  I almost did it myself.  

Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022 https://www.nejm.org/doi/10.1056/NEJMoa2207323
”We report 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had human immunodeficiency virus infection; the median age was 38 years. 

… Phylogenetic analyses suggest that the virus has circulated undetected for some time outside areas where it has been endemic, possibly masquerading as other sexually transmitted infections (STIs).¹⁷ The current international case definitions (Table S1 and Fig. S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org) may not be adequate to reflect the changing spectrum of clinical presentations, allow early identification, clarify transmission routes, and inform international public health policies and clinical trials. The case series we report here may help to inform the response.
… The clinical presentation we describe has some distinct features not included in the internationally accepted case definitions.20 Although these definitions recently expanded to include gay or bisexual men and other men who have sex with men as a risk group, they do not specifically highlight mucosal or rectal presentations, nor do they caution about the possibility of initial single-lesion manifestations. Existing definitions do recommend consideration of monkeypox in the context of any “unusual” rash but do not cover the full range of possible manifestations. Solitary genital skin lesions and lesions involving the palms and soles may easily lead to misdiagnosis as syphilis and other STIs, which may in turn delay detection. Concomitant laboratory-confirmed STIs were also reported in 29% of the persons tested. Consequently, we recommend consideration of monkeypox in at-risk persons presenting with traditional STI symptoms.“

[mommyoffive]

New York officials declare monkeypox an emergency (msn.com)

[mommyoffive]

How is the monkeypox virus affecting travel? (thepointsguy.com)

[Ausmumof3]

Two cases from India appear to be a different to strain than the current European outbreak and link back to cases from the US and Thailand from 2021. Weird. It makes me wonder if it can circulate at low levels without causing much sickness and then in the right situation causes more symptoms to emerge? Or is there some persistence in some people? 

[Arcadia]

22 hours ago, Ausmumof3 said:

Two cases from India appear to be a different to strain than the current European outbreak and link back to cases from the US and Thailand from 2021. Weird. It makes me wonder if it can circulate at low levels without causing much sickness and then in the right situation causes more symptoms to emerge? Or is there some persistence in some people? 

I am guessing mistakenly diagnosed as STD and monkeypox generally doesn’t cause severe illness which means people may not seek medical care.

[Arcadia]

California - 786 Statewide Cases, Data as of July 28, 2022

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Monkeypox.aspx

[Acadie]

ETA: I'm reading that Oxiclean Sanitizer can fade clothing. That doesn't sound so great! I wouldn't use it regularly.

Not sure if this has been posted. There's still a lot we don't know but this is the best resource I've found on laundry and monkeypox. It's focused  on laundering linens and clothing when someone has monkeypox but I'm going to pick up some Oxiclean Laundry & Home Sanitizer and have started washing and drying on hot when we've been on public transport etc.

https://www.verifythis.com/article/news/verify/monkeypox-verify/monkeypox-transmission-spread-through-contiminated-clothes-bed-linens-fact-check/536-3a4ea57d-bbd4-4d3b-9d35-9b264a440264

Edited August 2, 2022 by Acadie

[bookbard]

Saw New York declared a state of emergency due to Monkeypox, and also that it's found Polio in the wastewater.

Also saw a list of young men from different countries - Ghana, Brazil, Spain, India - who had died recently due to Monkeypox. So terribly sad and frightening. 

 

[Ausmumof3]

Illinois has declared it a public health emergency after registering 500 confirmed cases.

[mommyoffive]

2 more children in US test positive for monkeypox (msn.com)

[Ausmumof3]

https://www.medpagetoday.com/special-reports/exclusives/100010
 

not super encouraging 

Hundreds of thousands of Jynneos smallpox/monkeypox vaccines are now available in the U.S., and the CDC recommends vaccination for those who have been exposed to monkeypox or are at higher risk.

 

Health officials prefer the Jynneos vaccine, which is manufactured by the Danish company Bavarian Nordic and FDA-approved to prevent both smallpox and monkeypox. An alternative vaccine, ACAM2000, is complicated to administer, produces a nasty and infectious pustule, and can cause side effects in some people such as those with weakened immune systems, according to Vox.

As the CDC notes, "no data are available yet on the effectiveness of these vaccines in the current outbreak." As for previous outbreaks, only one study --  a retrospective analysis published in 1988 -- has examined whether a smallpox vaccine could prevent monkeypox.

In that study, researchers tracked the household contacts of 209 people infected with monkeypox in Zaire in the early 1980s. Those with scars from previous smallpox vaccination (70%) were 85% less likely to be infected. The vaccine seemed to be 89% effective at protecting contacts outside the household from infection.

The statistical analysis is limited since it has no confidence interval or adjustment for factors such as age, Ira Longini, PhD, a biostatistician at the University of Florida, told MedPage Today. Also, he said, the data are purely based on physical signs of vaccination. The study "is the only shred of evidence we have [in regard to vaccine effectiveness], which is pretty weak. In principle it should work, but we don't know."

[mommyoffive]

32 minutes ago, Ausmumof3 said:

https://www.medpagetoday.com/special-reports/exclusives/100010
 

not super encouraging 

Hundreds of thousands of Jynneos smallpox/monkeypox vaccines are now available in the U.S., and the CDC recommends vaccination for those who have been exposed to monkeypox or are at higher risk.

 

Health officials prefer the Jynneos vaccine, which is manufactured by the Danish company Bavarian Nordic and FDA-approved to prevent both smallpox and monkeypox. An alternative vaccine, ACAM2000, is complicated to administer, produces a nasty and infectious pustule, and can cause side effects in some people such as those with weakened immune systems, according to Vox.

As the CDC notes, "no data are available yet on the effectiveness of these vaccines in the current outbreak." As for previous outbreaks, only one study --  a retrospective analysis published in 1988 -- has examined whether a smallpox vaccine could prevent monkeypox.

In that study, researchers tracked the household contacts of 209 people infected with monkeypox in Zaire in the early 1980s. Those with scars from previous smallpox vaccination (70%) were 85% less likely to be infected. The vaccine seemed to be 89% effective at protecting contacts outside the household from infection.

The statistical analysis is limited since it has no confidence interval or adjustment for factors such as age, Ira Longini, PhD, a biostatistician at the University of Florida, told MedPage Today. Also, he said, the data are purely based on physical signs of vaccination. The study "is the only shred of evidence we have [in regard to vaccine effectiveness], which is pretty weak. In principle it should work, but we don't know."

And this was the better sounding one.

[vonfirmath]

Which is weird. I did not realize the evidence for the smallpox vaccine helping against monkeypox was so weak.

 

[Acadie]

National Monkeypox Public Health Response Guidelines from the Nigeria Centre for Disease Control: 

https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf

Among other information, the document covers the stages of infection on p.3 and on the following page a list of the frequency of various signs and symptoms among confirmed cases in Nigeria in 2018 and 2019. 

Rash, fever, headache and itching most common, but there are others. 

 

Edited August 2, 2022 by Acadie

[Acadie]

So You Got Monkeypox Google doc with anecdotal tips from lived experience on OTC remedies for symptoms and not wearing contacts, if infected, to avoid transmitting to eyes. 

Op or anyone else, lmk if my posts are off topic and I'll start a new thread. I'm just posting all things monkeypox here if anyone else is interested, and partly so I can find them later if needed.

https://docs.google.com/document/d/1y_x0bARgXG-KNuJOHC4DtpWWi_5_tHSZ5DZqN9ny1oE/edit

 

[Arcadia]

8 minutes ago, Acadie said:

 

Op or anyone else, lmk if my posts are off topic and I'll start a new thread.

Definitely not off topic. I meant for the thread to be about monkeypox in general 🙂

[Arcadia]

https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/02/president-biden-announces-team-to-lead-monkeypox-response/
“Today, President Biden named FEMA’s Robert Fenton as the White House National Monkeypox Response Coordinator and Dr. Demetre Daskalakis as the White House National Monkeypox Response Deputy Coordinator. Fenton and Daskalakis will lead the Administration’s strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments.

Robert Fenton currently serves as Regional Administrator for FEMA Region 9 in the American West, with nearly 50 million people in his area of responsibility. One of the Nation’s most experienced and effective emergency management leaders, Robert Fenton has twice served as Acting Administrator of FEMA and led multiple challenging prevention, response and recovery operations throughout his long and distinguished career, including for natural disasters, disease outbreaks, and complex humanitarian operations. 

Demetre Daskalakis, a leading public health expert, is currently Director of the CDC Division of HIV Prevention. Widely known as a national expert on health issues affecting the LGBGQIA+ communities, his clinical practice has focused on providing care for the underserved LGBTQIA+ communities. He previously oversaw management of infectious diseases for the New York City Department of Health and Mental Hygiene, one of the largest departments in the nation – including in serving as incident commander for the City’s COVID-19 response.”

[Arcadia]

https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html
“Updated August 1, 2022
Total confirmed monkeypox/orthopoxvirus cases:5,811

Case Count by State of Residence

Case Count by State

State	Number of Cases
Alabama	15
Alaska	1
Arizona	56
Arkansas	4
California	827
Colorado	53
Connecticut	35
Delaware	5
District Of Columbia	243
Florida	442
Georgia	430
Hawaii	10
Idaho	5
Illinois	520
Indiana	54
Iowa	10
Kansas	1
Kentucky	8
Louisiana	49
Maine	1
Maryland	129
Massachusetts	134
Michigan	29
Minnesota	34
Mississippi	3
Missouri	10
Nebraska	10
Nevada	20
New Hampshire	12
New Jersey	155
New Mexico	10
New York	1390
North Carolina	60
North Dakota	1
Ohio	26
Oklahoma	10
Oregon	70
Pennsylvania	161
Puerto Rico	19
Rhode Island	23
South Carolina	21
South Dakota	1
Tennessee	32
Texas	397
Utah	32
Vermont	1
Virginia	105
Washington	123
West Virginia	3
Wisconsin	18

Edited August 2, 2022 by Arcadia
formatting

[Arcadia]

2 hours ago, Ausmumof3 said:

https://www.medpagetoday.com/special-reports/exclusives/100010
 

not super encouraging 

Kind of expected.

FDA approves first live, non-replicating vaccine to prevent smallpox and monkeypox (September 24, 2019)

https://www.fda.gov/news-events/press-announcements/fda-approves-first-live-non-replicating-vaccine-prevent-smallpox-and-monkeypox
“The effectiveness of Jynneos for the prevention of monkeypox disease is inferred from the antibody responses in the smallpox clinical study participants and from studies in non-human primates that showed protection of animals vaccinated with Jynneos who were exposed to the monkeypox virus.“

[Acadie]

Really appreciate this context from an agricultural epidemiologist on "how diseases hang out in the landscape & sometimes run into the people & the plants/animals we hang out with." It's an interesting read that covers pox viruses in general and how eradication/no longer vaccinating for smallpox opened a window for milder pox viruses.

https://twitter.com/SarahTaber_bww/status/1551972659738673152?s=20&t=krPK1YC1-e4-kRollD2QVw

Also a good reminder that historically pox viruses, aside from smallpox, have not been super contagious. That said, if/when cases go up in my area I'll do more mitigation than just the masking and hand washing she suggests. For one thing, it sounds like alcohol-based hand sanitizer is more effective than most soaps in killing the virus. But old-fashioned physical hand-washing and cleaning still have a crucial role in decreasing how much virus we're exposed to, and thus decreasing the chance of infection.  

My Twitter scrolling also suggests that masks are helpful in reducing exposure to monkeypox. Contact exposure via mucous membranes or broken skin is one route of transmission, but from what I'm gathering airborne transmission is significant, and an infection from something like contaminated linens could actually be by inhalation of skin particles that contain a lot of virus. 

Still not liking the outlook on this, but I'm feeling like masks, handwashing/sanitizing, and regular laundering and cleaning could go a long way to reduce individual exposure and interrupt chains of transmission. The big question is whether the CDC will quit obfuscating and trying to manage public sentiment rather than providing clear guidance that actually helps. And if people will take it seriously.

[Arcadia]

@Acadie@wathe@TCB

Air and surface sampling for monkeypox virus in UK hospitals https://www.medrxiv.org/content/10.1101/2022.07.21.22277864v1

“Findings We identified widespread surface contamination (66 positive out of 73 samples) in occupied patient rooms (MPXV DNA Ct values 24·7-38·6), on healthcare worker personal protective equipment after use, and in doffing areas (Ct 26·3-34·3). Five out of fifteen air samples taken were positive. Significantly, three of four air samples collected during a bed linen change in one patient’s room were positive (Ct 32·7-35·8). Replication-competent virus was identified in two of four samples selected for viral isolation, including from air samples collected during the bed linen change.

Interpretation These data demonstrate significant contamination in isolation facilities and potential for aerosolisation of MPXV during specific activities. PPE contamination was observed after clinical contact and changing of bed linen. Additionally, contamination of hard surfaces in doffing areas supports the importance of cleaning protocols, PPE use and doffing procedures.”

[bookbard]

So I was trying to find out the Monkeypox situation in Australia, last thing I have seen was from a week ago I think. Looks like numbers had doubled in 2 weeks just as the numbers in the US had doubled. Still under 50 (then); so perhaps in another week it will be nearing 100, depending on whether people have been able to isolate. 

I ended up sending an email out to my employees, just reminding them about hand-washing and mask-wearing for Monkeypox as well as covid, flu, all the other nasties out there this winter. It's crazy. 

[TravelingChris]

1 hour ago, bookbard said:

So I was trying to find out the Monkeypox situation in Australia, last thing I have seen was from a week ago I think. Looks like numbers had doubled in 2 weeks just as the numbers in the US had doubled. Still under 50 (then); so perhaps in another week it will be nearing 100, depending on whether people have been able to isolate. 

I ended up sending an email out to my employees, just reminding them about hand-washing and mask-wearing for Monkeypox as well as covid, flu, all the other nasties out there this winter. It's crazy. 

None of the people are getting Monkeypox from the air.  The places they have monkeypox in so, so many of these cases is the areas that underwear covers.   Which is why so many were being misdiagnosed as herpes, and other STDs.  

[bookbard]

31 minutes ago, TravelingChris said:

None of the people are getting Monkeypox from the air.  The places they have monkeypox in so, so many of these cases is the areas that underwear covers.   Which is why so many were being misdiagnosed as herpes, and other STDs.  

Well, it's hard to know. It's still best to be cautious about mask wearing and handwashing. I believe there's been at least one case where contact tracers could not find a link to any known case. All I know is that it's spreading very quickly. 

[Acadie]

1 hour ago, TravelingChris said:

None of the people are getting Monkeypox from the air.  The places they have monkeypox in so, so many of these cases is the areas that underwear covers.   Which is why so many were being misdiagnosed as herpes, and other STDs.  

Actually, according to the National Monkeypox Public Health Response Guidelines linked below from Nigeria Centre for Disease Control, human-to-human transmission occurs primarily through respiratory droplets, or by direct or indirect contact with lesions, body fluids, or objects like linens that came in contact with lesions or fluids.  

Sexual contact poses particular risks because it often involves all of the above, but respiratory and fomite transmission of pox viruses has been widely understood since the Middle Ages. Smallpox was transmitted by Europeans to Native Americans through contaminated blankets, among other routes of transmission. 

Regarding genital or anal lesions, it is true that if transmission is by direct contact, the earliest lesions often appear at the site of exposure. But respiratory transmission is known to cause widespread lesions all over the body, including genital and anal lesions. 

Nigeria has kept monkeypox at bay for a long time. We need to learn from the knowledge base and public health practices they've developed, or this is going to be an absolute disaster when it reaches daycares, schools and congregate living communities including universities, nursing homes and prisons.

The CDC is repeating the mistakes in early identification of HIV by targeting the LGBTQ community, but microbes don't discriminate. Anyone can get monkeypox through several possible modes of transmission. 

"Human-to-human (HHT) or secondary transmissions occur primarily through droplet respiratory particles requiring prolonged face-to-face contact, or by direct or indirect contact with skin lesions or body fluids of an infected person, and by contact with objects recently contaminated by patient fluids or lesion material (such as clothing or linens). There is limited evidence on the persistence of variola-related viruses on materials (that may act as fomites), under controlled environmental conditions, but there is evidence to suggest that vaccinia virus may persist from weeks to months9 underscoring the importance of environmental de contamination."

https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf

Edited August 3, 2022 by Acadie

[mommyoffive]

How is monkeypox spread? - by Katelyn Jetelina (substack.com)

[TravelingChris]

34 minutes ago, mommyoffive said:

How is monkeypox spread? - by Katelyn Jetelina (substack.com)

Yes, yes, yes,.  I think that vulnerable groups should definitely change behaviors.  Now, this isn't anti gay at all.  Obviously, a lot of it is going around because of sex.  However, rave parties where people are very close together are not just a gay thing at all.  I have seen footage of concerts where people are super close together and that is another place where I think it could spread.  And what I mean about gays and behavior is that just like you can't define hetrosexuals as all behaving in one manner, neither is that true for gay men. Now I have no idea how much research has been done-- I know that in the early 90s, in criminal justice, there was already a very big push not to allow studies on homosexuals and domestic violence, for pc reasons and which all of us PhD students and faculty thought was absurd since why should homosexual victims of dv not matter?   But I know that about fifteen  years ago there was research that hetrosexual men fall into three categories of sexual behavior- 1/3 were habitual womanizers, 1/3 were mostly monogamous but if the right (or wrong) woman came  along, they would stray, and 1/3 were strictly monogamous and would not stray.  I don't know how those tendencies play out w gay and bi-sexual men but knowing some, I know there are differences in their behaviors in similar ways.  

And in this case, while condoms may help some, they are definitely not the only answer.  I should never be surprised but these festivals specifically designed for that promiscious population are still going on.  Now for me,  the main change in my behavior will be to forgo crowded close dancing if that is available on the cruise we will be taking next month.  We had a lot of fun with a silent dance party on our last cruise in 2019 and while I would do it again, I would make sure we are not too close to others and come early, leave and then come late so we aren't there at the most crowded times.

 

[Acadie]

2 hours ago, TravelingChris said:

Yes, yes, yes,.  I think that vulnerable groups should definitely change behaviors.  Now, this isn't anti gay at all.  Obviously, a lot of it is going around because of sex. 

Quotes below from the Katelyn Jetelina link above: there is droplet or aerosol transmission. Changing bedsheets in hospitals increases positive viral air samples, and there are documented cases of hospital workers changing sheets getting monkeypox. Anecdotal accounts of massage therapists, someone who changed sheets after guests left an Airbnb, and plenty of women who don't know how they were exposed. 

There's no doubt that sex is an especially effective mode of transmission, but we're playing with fire if we get complacent and think that's the only mode or that there isn't already community spread.

I've read that the MSM community is often better connected with sexual health care and public health measures because of HIV, and that worldwide we actually don't have data on the sexual activity of the vast majority of monkeypox cases. So we're drawing broad conclusions from a subset of cases for whom this data is more likely to be collected. This is reminding me of the beginning of the pandemic, when Americans couldn't get tested for Covid unless they'd just returned from China. So all of our positive cases had traveled to China, or had contact with someone who did. Meanwhile Covid was already spreading in the US the way respiratory viruses always do. 

I don't think monkeypox is nearly as contagious via respiratory transmission as Covid, or that low exposure on intact skin is going to make someone sick, but it seems bananas to me to pretend what we've always known about potential modes of transmission of monkeypox and pox viruses in general is suddenly, magically no longer the case. 

"Preliminary data also shows droplet or aerosol transmission. Some MPV cases have lesions in their mouth, so this could, theoretically, be a mode of transmission if you’re closely talking to someone who has an active (e.g., painful) infection for a long duration of time. This is why people with active MPV and those caring for them are advised to wear masks. Previous case studies in Nigeria show secondary transmission among nurses caring for MPV patients without PPE. A preprint from the UK found positive air samples in hospital rooms of infected patients, specifically when nurses were changing bed sheets. But, just like surface transmission, this isn’t likely to happen by passing someone at the supermarket."

"Because of the distinct transmission pattern, MPV has gained a foothold in one specific, tight-knit social network: men who have sex with men (MSM). This means this group is most at risk *right now,* and public health outreach, policy, and resources are laser focused on this community, rightfully so. 

MPV could spread to other social networks. We saw this happen with MRSA in 2008: It started in one network (gay men) and moved to other social networks (like wrestling teams). There is considerable chatter regarding MPV spread in colleges and schools, which isn’t too far fetched given tight-knit social and sexual networks on campuses. This doesn’t mean there should be panic, but institutions should absolutely prepare. (Here is guidance on controlling MPV in congregate settings)."

Edited August 3, 2022 by Acadie

[TravelingChris]

15 minutes ago, Acadie said:

Quotes below from the Katelyn Jetelina link above: there is droplet or aerosol transmission. Changing bedsheets in hospitals increases positive viral air samples, and there are documented cases of hospital workers changing sheets getting monkeypox. Anecdotal accounts of massage therapists, someone who changed sheets after guests left an Airbnb, and plenty of women who don't know how they were exposed. 

There's no doubt that sex is an especially effective mode of transmission, but we're playing with fire if we get complacent and think that's the only mode or that there isn't already community spread.

I've read that the MSM community is often better connected with sexual health care and public health measures because of HIV, and that worldwide we actually don't have data on the sexual activity of the vast majority of monkeypox cases. So we're drawing broad conclusions from a subset of cases for whom this data is more likely to be collected. This is reminding me of the beginning of the pandemic, when Americans couldn't get tested for Covid unless they'd just returned from China. So all of our positive cases had traveled to China, or had contact with someone who did. Meanwhile Covid was already spreading in the US the way respiratory viruses always do. 

I don't think monkeypox is nearly as contagious via respiratory transmission as Covid, or that low exposure on intact skin is going to make someone sick, but it seems bananas to me to pretend what we've always known about potential modes of transmission of monkeypox and pox viruses in general is suddenly, magically no longer the case. 

"Preliminary data also shows droplet or aerosol transmission. Some MPV cases have lesions in their mouth, so this could, theoretically, be a mode of transmission if you’re closely talking to someone who has an active (e.g., painful) infection for a long duration of time. This is why people with active MPV and those caring for them are advised to wear masks. Previous case studies in Nigeria show secondary transmission among nurses caring for MPV patients without PPE. A preprint from the UK found positive air samples in hospital rooms of infected patients, specifically when nurses were changing bed sheets. But, just like surface transmission, this isn’t likely to happen by passing someone at the supermarket."

"Because of the distinct transmission pattern, MPV has gained a foothold in one specific, tight-knit social network: men who have sex with men (MSM). This means this group is most at risk *right now,* and public health outreach, policy, and resources are laser focused on this community, rightfully so. 

MPV could spread to other social networks. We saw this happen with MRSA in 2008: It started in one network (gay men) and moved to other social networks (like wrestling teams). There is considerable chatter regarding MPV spread in colleges and schools, which isn’t too far fetched given tight-knit social and sexual networks on campuses. This doesn’t mean there should be panic, but institutions should absolutely prepare. (Here is guidance on controlling MPV in congregate settings)."

I agree with you that we may very well have more problems with this later.  But I do think that even that article mentions very close droplet problems, not anything like COVID which was definitely aerolized and we all knew it by early Feb 2020 here on WTM.  I really think the situation here is super dangerous because they are not talking about the environments where this is spreading due to the same mistaken political correctness ideas.  Raves, sauna parties, etc are NOT limited to the gay community.  If anything is different from the early 80s, it is that there is even more mixing in parties like raves, etc by different segments of the society than was common back then.  And yes, I am really afraid that even more so than MRSA--- which is really a problem that just wasn't identified correctly initially= this can easily spread to other communities but generally young people. MRSA is not a disease all that transmissible. For one thing, the evidence I read last week was that smallpox vaccines are amazingly longlasting so everyone in their mid 50s and up probably has protection.  Plus- we aren't the people who tend to go to those kinds of things.

[Arcadia]

 

ETA:

https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html
“Updated August 3, 2022
Total confirmed monkeypox/orthopoxvirus cases: 6,617 

Case Count by State of Residence

Case Count by State

State	Number of Cases
Alabama	19
Alaska	1
Arizona	85
Arkansas	5
California	826
Colorado	53
Connecticut	39
Delaware	5
District Of Columbia	257
Florida	525
Georgia	504
Hawaii	10
Idaho	5
Illinois	547
Indiana	62
Iowa	11
Kansas	1
Kentucky	8
Louisiana	58
Maine	2
Maryland	157
Massachusetts	134
Michigan	56
Minnesota	39
Mississippi	4
Missouri	12
Nebraska	10
Nevada	26
New Hampshire	14
New Jersey	160
New Mexico	10
New York	1666
North Carolina	72
North Dakota	1
Ohio	34
Oklahoma	10
Oregon	75
Pennsylvania	173
Puerto Rico	19
Rhode Island	26
South Carolina	23
South Dakota	1
Tennessee	39
Texas	527
Utah	41
Vermont	1
Virginia	105
Washington	134
West Virginia	3
Wisconsin	19

Edited August 3, 2022 by Arcadia

[bookbard]

Monkeypox vax available in Australia for selected groups from next week, although they haven't stated which groups - assume MSM but hopefully also medical workers etc.