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Discussion - Thoughts on a global outbreak of monkeypox

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  • alert
    replied
    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.

    Leave a comment:


  • JJackson
    commented on 's reply
    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.


    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.

  • Pathfinder
    replied
    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.




    (In French)

    Leave a comment:


  • Pathfinder
    replied


    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."
    ------------------------------------------------------


    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.

    Leave a comment:


  • alert
    replied
    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.

    Leave a comment:


  • sharon sanders
    replied
    Unfortunately the geographical wide distribution of cases necessitated opening monkeypox forums. So far:

    Africa: 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

    Leave a comment:


  • JJackson
    replied
    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.

    Click image for larger version  Name:	Monkeypox.JPG Views:	1 Size:	74.8 KB ID:	949137
    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.

    Leave a comment:


  • Emily
    replied
    CHATHAM, N.J., May 16, 2022 (GLOBE NEWSWIRE) -- Tonix Pharmaceuticals Holding Corp. (Nasdaq: TNXP) (Tonix or the Company), a clinical-stage biopharmaceutical company, today announced that it will effect a 1-for-32 reverse stock split of its outstanding common stock. This will be effective for trading purposes as of the commencement of trading on May 17, 2022. The reverse stock split was previously approved by the Board of Directors of Tonix in accordance with Nevada law, under which no stockhold

    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

    Leave a comment:


  • Emily
    replied
    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.


    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).

    Leave a comment:


  • Emily
    commented on 's reply
    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.

  • alert
    commented on 's reply
    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.

  • alert
    commented on 's reply
    Yes. Almost all the cases so far are gay men. Spain and Portugal say 23 out of 23 suspects are gay men.

  • Emily
    commented on 's reply
    Alert, is there any sign that LGBT communities might be disproportionately infected?

  • alert
    replied
    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.

    Leave a comment:


  • alert
    started a topic Discussion - Thoughts on a global outbreak of monkeypox

    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....
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