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  • Discussion - Thoughts on a global outbreak of monkeypox

    Well, another one of those days where I keep reading FT every few hours and asking myself how what I'm reading is possible. Monkeypox has now been reported domestically in the UK, Spain, Portugal, Canada, and a case in the US imported from Canada. If this really is a single outbreak due to efficient H2H spread, we're on the verge of something unthinkable. The problem is, if this were the case, I'd have expected more than the few dozen cases reported to this point. If the virus has really mutated to spread more efficiently H2H to cause this outbreak, a pandemic far worse than COVID-19 would be imminent.

    So what are the other possible explanations? Could this not be an H2H outbreak at all? Could infected animals or animal products have been distributed throughout North America and Europe? One thing that has been running through my mind repeatedly today is the possibility of contaminated animal skin condoms having been distributed in multiple countries, explaining the possible sexual transmissions.

    Could this be a bioterrorist attack, perhaps targeted at the LGBT communities in multiple nations? A group like Boko Haram might certainly be able to obtain this virus from an animal source, but coordinating an attack on multiple nations like this would be difficult? And what would be the method of dispersal? Spraying the virus in gay clubs?

    Is it possible that this is a Russian bio-attack on NATO over the war in Ukraine? We know the Soviet Union weaponized the smallpox virus in the 1970s, so it's not too inconceivable there could have been work on monkeypox as well. But sequencing the virus should tell us relatively soon if this is similar to natural strains in West Africa, and if this is not, that would almost certainly trigger a World War. If the virus is indeed fully natural, this scenario seems unlikely simply because of the response it would trigger. My mind shudders at this explanation and its possible consequences almost as badly as it does the thought of the virus naturally going pandemic.

    If this virus has indeed gained the ability to transmit more efficiently, whatever the method of mutation, the other question is why it keeps being detected in isolated cases and not large hospital clusters like the original SARS outbreak did. We have a large geographical spread of this outbreak, but not a huge number of cases.

    The timing is also suspect here. All these cases have essentially the same onset date, not in generations a couple weeks apart as would be suspected if this were multiple generations of H2H spread from a point source like an importation or release.

    Very odd....

  • #2
    One additional thought...if the sexual exposure really represents an H2H transmission, you should be able to contact trace; that is to ask the patients who they had sex with in the past two weeks, and presumably, you'd get only a short list of people who you could check to see if they had previously been ill. This would NOT be the case if an infected condom or something similar had the result of infecting one or both sexual partners during the act. I feel like the former type of contact tracing should have been done already, and the fact that it's not turning up chains of transmission might argue against H2H spread.

    This is not HIV with a long incubation period to allow for silent transmission.

    Comment


    • alert
      alert commented
      Editing a comment
      Spain is saying the pathology itself suggests infected fluid exposure to the mucus membranes. If that's correct, that basically rules out terrorism and makes a pandemic incredibly unlikely as it would not be an airborne or aerolized exposure as would be needed to produce a high R0 outbreak. So how is this spreading? This requires a piece of excellent epidemiology.

    • Emily
      Emily commented
      Editing a comment
      Thanks, Alert. I caught up with the threads. I don't usually read monkeypox reports since they've been so rare outside of Africa, and fairly rare even there. This situation is puzzling.

    • cozodapo
      cozodapo commented
      Editing a comment
      Could pre-existing immunity to similar viruses from vaccination or otherwise be an explanation for the apparent invisibility of chains?

  • #3
    Right now I think that this is an actual natural zoonotic evolution of a pox virus based on what I'm reading in academic papers. But regarding possible bioterrorism, I don't think Russia or an extremist terror group is capable of engineering an STD form of monkeypox. Other entities might be, or at least they might be vulnerable to an accident.

    https://www.sciencedirect.com/scienc...22000414#bib22
    Recently, a group of scientists was funded by a biotech company to synthesize a full-length horsepox virus genome and recover it into an infectious virus (Noyce et al., 2018). Not surprisingly, such a controversial achievement has received enormous attention and raised global debate on its biosecurity implications (DiEuliis et al., 2017; Koblentz, 2017, 2018; DiEuliis and Gronvall, 2018).
    _____________________________________________

    Ask Congress to Investigate COVID Origins and Government Response to Pandemic H.R. 834

    i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed
    Governments don't have or own souls.

    (My posts are not intended as advice or professional assessments of any kind.)
    Never forget Excalibur.

    Comment


    • #4
      https://finance.yahoo.com/news/tonix...170000236.html
      Tonix Pharmaceuticals Announces 1-for-32 Reverse Stock Split

      Tonix Pharmaceuticals Holding Corp.
      Mon, May 16, 2022, 12:00 PM

      Tonix’s infectious disease pipeline consists of a vaccine in development to prevent smallpox and monkeypox called TNX-801
      _____________________________________________

      Ask Congress to Investigate COVID Origins and Government Response to Pandemic H.R. 834

      i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed
      Governments don't have or own souls.

      (My posts are not intended as advice or professional assessments of any kind.)
      Never forget Excalibur.

      Comment


      • #5
        Monkeypox (MPV) is a double strand enveloped DNA orthopoxvirus of just under 200k base pairs, with a 190 ORFs (this seems very high for 200k BP). It is divided in to two main phylogenetic groups West African (WA) and Congo Basin (CB) with CB producing the bulk of the outbreaks, however all of the recent 'out of Africa' exports seem to have been from WA.

        Monkeypox.JPG
        The above shows just the smaller WA phylogentic branch with the later dates, and exports, clustered on one sub-branch [1].
        This second link [2] gives some data on the function of some of the coding regions but as I know nothing about MPV genetics looking at the mutations along the problem branch is not going to help me to know if they are why we seem to be having more h2h.
        Link [3] if a useful ECDC doc for HCWs on MPV.

        Comment


        • #6
          Unfortunately the geographical wide distribution of cases necessitated opening monkeypox forums. So far:

          Africa: monkeypox
          https://flutrackers.com/forum/forum/africa-ac/monkeypox

          Asia: monkeypox
          https://flutrackers.com/forum/forum/...s/monkeypox-ac (no known current cases)

          Canada: monkeypox
          https://flutrackers.com/forum/forum/...a/monkeypox-aa

          Europe: monkeypox
          https://flutrackers.com/forum/forum/...d/monkeypox-aa

          Middle East: monkeypox
          https://flutrackers.com/forum/forum/...rael-monkeypox (no known current cases)

          United States: monkeypox
          https://flutrackers.com/forum/forum/...i/monkeypox-ab

          Comment


          • #7
            We're seeing some reports that smallpox vaccine is being given to the downstream contacts of some of the cases. While we don't have enough vaccine to vaccinate everyone, even a few thousand doses (which we do have to use for vaccinating the military and for researchers) can be used to ring vaccinate the contacts of cases and contain the outbreaks.

            I'm surprised we haven't heard the results of the backward contact tracing, if this really is a purely H2H outbreak.

            Also, the lack of cases in children is a good sign as it argues against spread by casual contact. In the areas such as Nigeria where this virus is endemic, it is more severe in children.

            Comment


            • Emily
              Emily commented
              Editing a comment
              They are contact tracing in the UK. I'll post below.

            • kiwibird
              kiwibird commented
              Editing a comment
              They are also vaccinating sexual health care workers.

          • #8
            https://flutrackers.com/forum/forum/...onkeypox-cases

            Post #15:

            From:UK Health Security Agency:

            "We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay if they have concerns. Please contact clinics ahead of your visit."
            ------------------------------------------------------
            https://flutrackers.com/forum/forum/...2022-monkeypox

            Post #2

            "People infected, mainly men between 30 and 55 years old, present with genital and oral ulcerations, as well as painful lymph nodes."

            “For the moment, Quebec has no confirmed case of monkeypox , but we are investigating a dozen cases of genital ulcerative lesions,” the spokesperson for the Ministry of Health and Social Services told La Presse on Wednesday.
            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
            -Nelson Mandela

            Comment


            • #9
              Translation Google

              CANADA

              Monkey pox: “we started to see strange things”

              60 mins ago

              Mysterious cases of monkeypox have been taken care of by the Clinique l'Actuel in Montreal, founded by Dr. Réjean Thomas.

              A specialist in HIV and Sexually Transmitted Infections (STIs) admits: “No one knew about this disease 24 to 48 hours ago,” he explains in an interview with LCN.

              “We started to see strange things. We thought of chancroid, which we still saw occasionally, but still quite rare, and it looks a bit like that,” explains Dr. Thomas.

              However, he points out that the damage caused by chancroid is mainly in the genital area.

              "There's a more systemic, more general attack of smallpox," he explains, revealing a case he's been watching closely that has all the symptoms of smallpox.

              “This morning we have a classic case, an individual that we are taking. He's a man with a sore throat, lots of glands who went to the ambulance over the weekend. We treated it like strep. Then there were skin lesions. It's a disease that looks suspicious “like another disease called chancroid – a bacterial infection that can be treated well. We thought that's what we were going to have”, explains the doctor.

              The man finally arrived at the family doctor's office, further examinations are in progress. Monkeypox results are expected within 48 hours.

              The disease is not easy to diagnose and Quebec doctors even misunderstand it.

              He calls on them to be vigilant and to have patients tested for STBBIs, to carry out the appropriate biological tests and to refer them to the one in progress.

              “There is still a lot of panic in the community. […] It's not very pretty. What to tell a healthcare professional? What are the recommendations? I hope that public health can answer us, ”he concludes.

              https://news.techno-ar.com/la-variol...hoses-etranges


              (In French)
              https://www.youtube.com/watch?v=E2vn_YtoOVc
              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
              -Nelson Mandela

              Comment


              • JJackson
                JJackson commented
                Editing a comment
                This paper has a quite detailed look at the symptom set, compared to Smallpox and Chickenpox, the later having been misdiagnosed as MPV in a previous outbreak.
                https://www.thelancet.com/journals/l...856-9/fulltext

                What seems to be different, based on what little we know, is transmission before obvious symptom onset. The older documents all refer to h2h transmission from contact with scabs, or material that had been in contact with them. Here I am not seeing that those infected were aware of any visible manifestations in those who infected them. Hopefully more details from contact tracing interviews will clear this up.

            • #10
              This is a twitter thread of a woman in England reporting an unexplained rash illness and states that she has been tested for monkeypox:

              Sarah Eaglesfield on Twitter: "Didn't really want to make this common knowledge, but it's suspected I've had monkeypox for the last 4 weeks. Swabbed today. At scabbing stage now. Won't share the photos, as instant vomit factor. On a solid 8g of anti-biotics + Aciclovir anti-viral. No idea how I got it." / Twitter

              She has also suggested that she was originally diagnosed as shingles, which has not been excluded.

              Comment


              • #11
                Monkeypox is Not a Gay Disease

                May 19, 2022

                PLOS Global Public Health

                In recent weeks multiple cases of confirmed and suspected monkeypox infections have been reported in three European countries. The initial cluster of cases which first appeared in the United Kingdom so far includes four men who identify as gay or bisexual or other men who have sex with men (MSM). The narrative emerging as this outbreak evolves to involve other European countries, Canada and the United States is sadly reminiscent of initial reporting on pneumocystis pneumonia clusters in gay men with AIDS forty years ago. Monkeypox is not a gay disease and neither are any other infectious diseases. It is unfortunate that this still needs to be said, highlighting how little we have learned from previous outbreaks.

                Stigma directed at a particular group of individuals fuels fear and seriously impedes upon outbreak investigation, case identification and public health interventions. The repercussions of labelling HIV infection a homosexual disease led to untold suffering in gay communities in the 1980s who were blamed for the epidemic. Cases were under-reported in the early days of the epidemic as individuals who contracted the virus went underground instead of seeking medical care. This resulted in many missed opportunities to quickly learn about the infection, understand its transmission and importantly, provide targeted public health interventions to curb its spread. Instead, individuals in the group most affected at the time were blamed for their own suffering and ostracized as purveyors of disease.

                It wasn’t until it became obvious that HIV infections were not confined to the gay community that more resources and a political will to seriously tackle the crisis were set in motion. Four decades later, the dynamic of the HIV epidemic has been completely transformed by highly effective treatment and prevention strategies.

                ... Similar patterns of targeted stigma towards a specific group have emerged in the COVID-19 pandemic. Initially we saw stigma directed at people of Asian descent following reports of the first cases of SARS-CoV-2 infection from China and more recently unjustified stigma towards southern African countries following the identification of the omicron variant highlighting intersections with racism.

                ... In recent years there have been several reports of limited outbreaks with human-to-human transmission in endemic countries and occasional imported cases in returning travelers from these regions. Transmission can occur through close contact with contaminated fomites or bodily fluids from infected individuals and through droplet transmission. Despite uncertain variables in transmission with the April-May 2022 cases, immediately attributing a clustering of cases among MSM to sexual networks is not only premature but also feeds into negative stereotypes of sexual promiscuity being to blame for an expanding outbreak.

                https://speakingofmedicine.plos.org/...a-gay-disease/

                Comment


                • Mary Wilson
                  Mary Wilson commented
                  Editing a comment
                  @Sattam82_5
                  #monkeypox
                  Stop spreading little poor African boys old pictures , the recent infections are among white gay men mostly.
                  Stop spreading racist stereotype about this infection while the reality is the opposite.
                  8:25 PM · May 20, 2022·Twitter for Android
                  https://twitter.com/Sattam82_5/statu...22950568689671

              • #12
                Saunas could be high risk. Monkeypox can be asymptomatic so not surprising that symptomatic cases seem to have no connection at times.

                https://www.who.int/emergencies/dise...em/2022-DON383
                Public health response

                Health authorities in the United Kingdom have established an incident management team to coordinate the extensive contact tracing which is currently underway in health care settings and the community for those who have had contact with the confirmed cases. Contacts are being assessed based on their level of exposure and followed up through active or passive surveillance for 21 days from the date of last exposure to a case. Vaccination is being offered to higher risk contacts.

                A detailed backwards contact tracing investigation is also being carried out to determine the likely route of acquisition and establish whether there are any further chains of transmission within the United Kingdom for all cases. Sexual contacts and venues visited (for example saunas, bars and clubs) are actively being investigated for the four GBMSM cases.
                _____________________________________________

                Ask Congress to Investigate COVID Origins and Government Response to Pandemic H.R. 834

                i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed
                Governments don't have or own souls.

                (My posts are not intended as advice or professional assessments of any kind.)
                Never forget Excalibur.

                Comment


                • alert
                  alert commented
                  Editing a comment
                  Spain is reporting that most of its cases result from a single mass exposure in a sauna. The timing of this outbreak is far more consistent with a small number of superspreader events than many generations of silent H2H spread.

                • Pathfinder
                  Pathfinder commented
                  Editing a comment
                  https://flutrackers.com/forum/forum/...2022-monkeypox
                  Post #5:

                  "The word sauna is used in Spain to describe establishments popular with gay men looking for sex rather than just a bathhouse."

              • #13
                https://finance.yahoo.com/news/monke....tsrc=fin-srch
                SIGA, a biological warfare defense firm, rose 17% after rallying as much as 32% in its biggest intraday jump since 2016 when fears of Zika contagion were roiling the market. The company won US regulatory approval for a liquid form of its smallpox capsule today. The treatment, dubbed Tpoxx, is approved in Europe for use in monkey pox and was cited in a recent budget request to treat a US patient with the disease, the company said in a statement.

                Contract manufacturer Emergent, which is facing a Congressional probe over quality control issues in its production of Covid-19 vaccines, rallied 12%, its biggest one-day jump since July 2020. On Monday, Chimerix Inc. said it was selling its smallpox treatment to Emergent for as much as $337.5 million plus royalties.
                https://www.sciencedirect.com/scienc...64410X21014304
                Vaccine
                Volume 40, Issue 17, 14 April 2022, Pages 2478-2483
                Pacific Eclipse – A tabletop exercise on smallpox pandemic response
                _____________________________________________

                Ask Congress to Investigate COVID Origins and Government Response to Pandemic H.R. 834

                i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed
                Governments don't have or own souls.

                (My posts are not intended as advice or professional assessments of any kind.)
                Never forget Excalibur.

                Comment


                • #14
                  Originally posted by alert View Post
                  This is a twitter thread of a woman in England reporting an unexplained rash illness and states that she has been tested for monkeypox:

                  Sarah Eaglesfield on Twitter: "Didn't really want to make this common knowledge, but it's suspected I've had monkeypox for the last 4 weeks. Swabbed today. At scabbing stage now. Won't share the photos, as instant vomit factor. On a solid 8g of anti-biotics + Aciclovir anti-viral. No idea how I got it." / Twitter

                  She has also suggested that she was originally diagnosed as shingles, which has not been excluded.
                  She updated her post this morning. She has not received her test results yet, but does not believe she has monkeypox. She uploaded a picture of her rash:

                  Sarah Eaglesfield on Twitter: "If anyone's following this - the rash is looking a lot more Safe for Work now. Again, * Not Monkeypox * (as far as we know) but this is where we're at on Day 6, and awaiting swab results. Sorry for bad photo, hard to take. This is basically all over my body. https://t.co/a1i3trAU9e" / Twitter

                  Comment


                  • #15
                    African scientists baffled by monkeypox cases in Europe, US

                    ...

                    By MARIA CHENG AP Medical Writer
                    May 20, 2022, 8:02 AM

                    LONDON -- Scientists who have monitored numerous outbreaks of monkeypox in Africa say they are baffled by the disease's recent spread in Europe and North America.
                    ...
                    “I’m stunned by this. Every day I wake up and there are more countries infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science and who sits on several World Health Organization advisory boards.

                    “This is not the kind of spread we’ve seen in West Africa, so there may be something new happening in the West,” he said.
                    ...
                    One of the theories British health officials are exploring is whether the disease is being sexually transmitted. Health officials have asked doctors and nurses to be on alert for potential cases, but said the risk to the general population is low.
                    ...
                    Experts have stressed they do not know if the disease is being spread through sex or other close contact related to sex.

                    Nigeria hasn't seen sexual transmission, Tomori said, but he noted that viruses that hadn’t initially been known to transmit via sex, like Ebola, were later proven to do so after bigger epidemics showed different patterns of spread.

                    The same could be true of monkeypox, Tomori said.
                    ...
                    Scientists said that while it's possible the outbreak's first patient caught the disease while in Africa, what's happening now is exceptional.

                    “We've never seen anything like what's happening in Europe,” said Christian Happi, director of the African Centre of Excellence for Genomics of Infectious Diseases. “We haven't seen anything to say that the transmission patterns of monkeypox have been changing in Africa. So if something different is happening in Europe, then Europe needs to investigate that.”
                    ...
                    Shabir Mahdi, a professor of vaccinology at the University of Witwatersrand in Johannesburg, said a detailed investigation of the outbreak in Europe, including determining who the first patients were, was now critical.

                    “We need to really understand how this first started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that's now changing, we really need to understand why.”
                    ...
                    https://abcnews.go.com/Health/wireSt...tists-84854464
                    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                    -Nelson Mandela

                    Comment

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