Discussion - Thoughts on a global outbreak of monkeypox

[Pathfinder]

WHO Director-General's opening remarks at the media briefing – 9 November 2022

9 November 2022
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Now to the global monkeypox outbreak.

The number of weekly cases of monkeypox reported to WHO has declined 80% from the peak in August, although there was a small rise last week, with 19 countries reporting an increase.

This week, WHO signed an agreement with SIGA Technologies, the developer of the antiviral tecovirimat, also known as TPOXX, for a donation of 2,500 treatment courses.

In the coming days, WHO will invite low- and middle-income countries to express interest in receiving tecovirimat free of charge.

While this treatment is not approved in most countries, WHO has published a protocol that researchers can use to design and conduct clinical trials of this and other medicines.

In situations where trials are not in place, WHO recommends that tecovirimat be considered for use under a different protocol to promote the collection of data on the drug’s effectiveness.

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https://www.who.int/director-general...-november-2022

[Pathfinder]

Transmission dynamics of monkeypox in the United Kingdom: contact tracing study
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Implications

We found that shorter serial intervals are more common than short incubation periods for monkeypox, which suggests considerable pre-symptomatic transmission. This has also been observed for other viral infections1112 and is a consequence of transmission during the pre-symptomatic period. Previous research has not found evidence of transmission and substantial shedding of monkeypox virus before symptom onset, which is reflected in guidance from WHO and the European Centre for Disease Prevention and Control.2333 Assuming statistical independence between the serial interval and incubation period, we found that 53% (95% credible interval 43% to 62%) of transmission occurs in the pre-symptomatic phase. However, since serial intervals depend on the incubation period this finding is an approximation of the proportion of infections due to pre-symptomatic transmission. This finding is consistent with the proportion of pre-symptomatic transmission among the subset of case-contact pairs where transmission can be identified relative to the date of symptom onset after exposure. Data for both the serial interval and the incubation period are similarly distributed across the monkeypox outbreak in the UK, so temporal changes in reporting should affect both distributions comparably (see supplementary material C).

The identification of pre-symptomatic transmission might be indicative of changes to the primary route of transmission. Pre-symptomatic transmission may be facilitated by specific types of high intensity interactions (eg, sexual contacts) where lower pre-symptomatic viral loads are infectious. This pre-symptomatic transmission could also be transmission before symptoms are detected rather than before clinical symptom onset because individuals could have lesions of which they are unaware—this might be more important for internal lesions. From the perspective of public health policy, this transmission before the detection of symptoms is equivalent to pre-symptomatic transmission, as it concerns when individuals might become aware of their infection. If a substantial proportion of secondary transmission occurs before symptom onset, the implications will be that many infections cannot be prevented by isolating individuals with symptoms. Furthermore, the effectiveness of contact tracing will be affected because when contacts are traced, they might already have generated secondary cases. Therefore, backward contact tracing strategies should account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases. The maximum time before symptoms that transmission was detected for patients who could be linked through personal identifiable infection was four days.

Conclusions

The global transmission of the monkeypox virus has been on a scale not previously seen outside of Central Africa. The shorter median estimate for the serial interval relative to the incubation period suggests that pre-symptomatic transmission might be more substantial than was previously thought, which is further supported by linked patient level data. The 95th centile of the serial interval ranged from 23 to 41 days, which suggests a potential for long infectious periods that are consistent with research of earlier clades. In the present study the incubation period, ranging from 16 to 23 days after exposure, would be adequate to identify 95% of infected individuals, so would be the required length of post-exposure isolation policies.
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Link to study:
https://flutrackers.com/forum/forum/...vember-02-2022

[Pathfinder]

WHO Director-General's opening remarks at Member State Information Session on COVID-19 and other issues – 27 October 2022

27 October 2022
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Moving to monkeypox.

More than 76 000 cases in 109 countries have now been reported to WHO, with 36 deaths.

We continue to work with countries around the world to get vital information to those most at-risk, along with increasing surveillance, testing and diagnostic capacities, supporting immunization and medical care.

On the monkeypox situation, the good news is that it is globally on the decline, but we still should not give room to complacency.

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https://www.who.int/director-general...7-october-2022

[Pathfinder]

Monkeypox cases are plummeting. Scientists are debating why
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26 OCT 202211:35 AMBYKAI KUPFERSCHMIDT

When monkeypox cases in Europe began to decline this summer, researchers’ first question was: Is it real? Some worried that people might not be getting tested because of receding fears of the virus, coupled with strict isolation requirements for patients. “They might be reluctant to be confirmed and be told not to go out at all,” says Catherine Smallwood, monkeypox incident manager at the World Health Organization’s (WHO’s) Regional Office for Europe.

But the decline is now unmistakable. WHO Europe, which reported more than 2000 cases per week during the peak in July, is now counting about 100 cases weekly. In the Americas, the other major epicenter of the outbreak, numbers have dropped by more than half (see graphic, right). “We’re seeing a true decline,” Smallwood says.

Vaccines, behavior change among the most affected group—men who have sex with men (MSM)—and immunity after natural infection are all playing a role in that decline, says Erik Volz, an infectious disease modeler at Imperial College London, but how much each factor has contributed is unclear. “This is something we’ve debated a lot internally.”
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In the United Kingdom, at least, vaccination campaigns have played a minor role, according to a model published as a preprint this month by Samuel Brand, an infectious disease modeler at the University of Warwick. Monkeypox’s reproductive number—the average number of new infections triggered by an infected person—began to drop by mid-June, even though campaigns only started in July, Brand notes. Several other European countries saw the same pattern.

That leaves behavior change and immunity from natural infections. A survey conducted by the U.S. Centers for Disease Control and Prevention among MSM in August found about half had reduced their number of sexual contacts. As awareness of the disease increased, people also became more likely to seek diagnosis and treatment early and to avoid sex while they were infectious. The UK Health Security Agency has presented data suggesting syphilis and other sexually transmitted infections declined as well—which would bolster the case for behavior change—although that signal is “suggestive but not conclusive,” Volz says.

Immunity acquired through infections in the most sexually active men may be the biggest factor, however. Monkeypox has been affecting mostly MSM and their sexual networks because parts of those networks are densely connected, with some people having a large number of sexual contacts. Rising immunity in that group could limit the viru’s ability to spread, says Jacco Wallinga, chief epidemic modeler at the Dutch National Institute for Public Health and the Environment.
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https://www.science.org/content/arti...e-debating-why

[Pathfinder]

Translation Google

Monkey pox: the epidemic is receding but has not yet disappeared

Since mid-July, the contamination curve has fallen very sharply in Western Europe and North America. However, some countries in Central and Latin America are still experiencing an increase in the number of cases.

Article written by
franceinfo with AFP
France Televisions
Postedon 10/21/2022 08:51
Updateon 21/10/2022 09:45

"We're coming to the end, but we're not there yet." The monkey pox epidemic is in full decline, virologist Jean-Claude Manguara told AFP on Friday, October 21. With more than 70,000 cases in a hundred countries since May, "an epidemic of 'monkeypox' so important in such a short time is unheard of" , recalled this head of the environment and infectious risks unit. at the Pasteur Institute.

If since mid-July, the contamination curve has dropped very significantly in Western Europe and North America, certain countries in Central and Latin America are still experiencing an increase. In addition, at present, monkeypox is "endemic" in about ten African countries. In these areas, the epidemic, which is more lethal, stems mainly from contact with wildlife in rural areas.

"The African source remains present and, in a context where there may be population movements, we may have new exported cases and a new epidemic wave at any time" , warns Steve Ahuka Mundeke, head of the virology department at the Biomedical Research Institute of the Democratic Republic of Congo and member of an IRD-Inserm team. In recent months, "we have again seen that global strategies are only deployed when the countries of the North are affected, which does not at all clear the African health authorities ", he notes.

Behavior change and vaccination

Where the epidemic is declining, experts point to the decisive role of changing behavior within communities at risk, in particular thanks to the role "of associations, perhaps more listened to than the authorities and closer to the field" , suggests Jean- Claude Manuguerra. Surveys show that more than half of men who have sex with men have reduced their number of sexual encounters.

As for vaccination, "it has helped, but the number of vaccines available remains low" , reminds AFP Carlos Maluquer de Motes, professor of virology at the British University of Surrey. The vaccine is still recommended for prevention and post-exposure. Its clinical effectiveness is not yet supported by "hard data" , according to the European Center for Disease Prevention and Control, but it is showing positive preliminary results.

In any case, “significant uncertainties remain about the evolution of the epidemic”, underlines the European agency, which draws four scenarios. Heads: rebound of the epidemic, linked in particular to the return of risky behavior, or reduced circulation of the virus with sporadic outbreaks. Tails: persistent decline in the epidemic, even elimination of the disease in Europe.

https://www.francetvinfo.fr/sante/ma...u_5431210.html

[Pathfinder]

WHO Director-General's opening remarks at media briefing – 19 October 2022

19 October 2022
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On monkeypox, the Emergency Committee will meet tomorrow to discuss the outbreak and make recommendations.

The number of reported cases globally has now dropped for eight weeks in a row, but as with COVID-19, risks and uncertainties remain, and some countries are still seeing increasing transmission.

I look forward to the Emergency Committee’s recommendations.

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https://www.who.int/news-room/speech...9-october-2022

[sharon sanders]

Helen Branswell



7h • 5 tweets • 4 min read Bookmark Save as PDF My Authors

1. Two fascinating reports from 2 different @CDCgov journals today on #monkeypox acquisition via needlestick injuries. The takeaway message for me: If you are a HCP & you have a sharps injury involving MPX, you probably want to get vaccinated right away.

2. The first report came out in #MMWR. A Florida nurse who was using a syringe to extract fluid from a suspected #monkeypox lesion pricked her finger, drawing blood. She got the first of 2 doses of Jynneos within 15 hours & only developed 1 lesion.

Monkeypox virus Infection Resulting from an ...This report describes the first occupationally acquired monkeypox infection in a health worker in the United States.https://www.cdc.gov/mmwr/volumes/71/...cid=mm7142e2_w

3. The 2nd report, in @EIDjournal, is about a Portuguese doctor who had a similar needlestick injury while sampling a suspected #monkeypox lesion. There was no bleeding, he thought his glove was intact, and he didn't report the exposure. He was not vaccinated.

4. When the Portuguese doctor developed his first #monkeypox lesion — at the site of the injury — it was determined it was too late to vaccinate. He went on to have lesions on his scalp, neck, forearm, both hands, ankle and scrotum. wwwnc.cdc.gov/eid/article/28…

5. Another takeaway, highlighted in the @EIDjournal article, is that people shouldn't be using sharps to sample #monkeypox lesions.
This is the 3rd such report I've seen. There was another published last month in @EIDjournal, from Brazil. wwwnc.cdc.gov/eid/article/28…
• • •

[sharon sanders]

Jason Kindrachuk, PhD

@KindrachukJason
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58m
Shared with permission from Dr. Thierry Kalonji. Waiting to see the results in published form but these observations highlight the need for sustained investment in #monkeypox and emerging zoonotic virus surveillance through #OneHealth approaches

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Jason Kindrachuk, PhD

@KindrachukJason
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51m
I’ll also highlight the last sentence from Thierry’s post regarding resource limitations. This is critically important. My hat’s off to all of my colleagues across Africa that have continued to find ways to do this work and rapidly share their results

[Pathfinder]

WHO Director-General's opening remarks at media briefing – 12 October 2022

12 October 2022
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On monkeypox, more than 70,000 cases have now been reported to WHO, with 26 deaths.

Globally, cases are continuing to decline, but 21 countries in the past week reported an increase in cases, mostly in the Americas, which accounted for almost 90% of all cases reported last week.

Once again, we caution that a declining outbreak can be the most dangerous outbreak, because it can tempt us to think that the crisis is over, and to let down our guard.

That’s not what WHO is doing.

We are continuing to work with countries around the world to increase their testing capacity, and to monitor trends in the outbreak.

We are concerned about reports of cases in Sudan, including in refugee camps near the border with Ethiopia.

Like COVID-19, monkeypox remains a public health emergency of international concern, and WHO will continue to treat it as such.

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https://www.who.int/news-room/speech...12-october-202

[Pathfinder]

https://www.wired.com/story/monkeypo...united-states/

Maryn McKenna

Science
Sep 15, 2022 12:01 PM

Monkeypox Cases in the US Are Falling. There's No One Reason Why



Many people changed their behavior, the vaccines might be helping, and the virus might someday burn itself out—but there’s not enough data to know.

Excerpt from post #43

Monkey pox: "This circulation of the disease is completely new"

Published: May 22, 2022 12.37pm EDT Updated: May 23, 2022 2.52am EDT
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Camille Besombes
Infectiologist in epidemiology thesis - Epidemiology of Emerging Diseases Unit, Institut Pasteur
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TC: Should we fear a strong spread of this disease? How to limit it?
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CB: For the moment, we can't be certain about what will happen.
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A rather reassuring point is that epidemics of monkeypox die out quite quickly spontaneously. The longest chain of transmission identified extended over 7 generations, in other words 7 humans pass the disease consecutively before the transmission stops.

The reasons for this spontaneous extinction of the spread are poorly understood. One hypothesis is that these epidemics have hitherto occurred in small villages, within communities of limited size with certain individuals potentially already immunized: the virus only infects people who have never been in contact with it. The 2003 epidemic in the United States had also stopped quickly, without secondary human-to-human contamination.
To be continued this time…

GO TO POST

[Emily]

https://www.wired.com/story/monkeypo...united-states/

Maryn McKenna

Science
Sep 15, 2022 12:01 PM

Monkeypox Cases in the US Are Falling. There's No One Reason Why



Many people changed their behavior, the vaccines might be helping, and the virus might someday burn itself out—but there’s not enough data to know.

[Emily]

False positives resulting in unnecessary treatment.

https://flutrackers.com/forum/forum/...sary-treatment

[Emily]

Please don't start a thread like that, Alert. Some haters are real and dangerous. Any worthwhile site would remove calls for violence if reported. Just leave a site if it is not moderated decently. You only increase a site's future sales price by participating or even viewing it.
I just hope the social media hate and fear doesn't spill over into real life like it did with Ebola. I read about kids being cruelly bullied because of that. And things are still bad for Covid unvaccinated. It's hard to be optimistic about what's ahead. Scapegoating is a real danger in dysfunctional systems.

[alert]

Another reminder that monkeypox is NOT strictly a sexually transmitted disease!

I've seen several comments on various articles from around the world suggesting that monkeypox infection in anything other than a gay man was a sign of some kind of foul play. Cases in children have been suggested as a sign of child sexual abuse. Cases in women have been suggested as a sign of closet homosexuality in their spouse. Cases in animals such as dogs have been suggested as evidence of bestiality. Even more alarming, these comments have suggested that the "solution" to this problem is vigilante violence against the supposed predator/adulterer/etc. (who may or may not be another monkeypox case themselves).

Wrong on so many levels that I feel like this is a coordinated disinformation attempt...there are plenty of common non-sexual exposures that can and likely do explain these cases. Doctors in Nigeria have been reporting family clusters of monkeypox for years. Even if a case was determined to be the result of some kind of criminal act, which is unlikely, there is a justice system for handling such issues. Violence as a disease prevention mechanism is literally medieval.

I'm tempted to open up a new thread here to expose the sources of these posts on various articles, but I suspect many of them are just propaganda bots.

[Emily]

Insightful article but I don't think being inaccurate about risk to make people feel less alone is the best approach. Compassion is needed.

https://www.insider.com/i-had-monkey...ciating-2022-8
I got monkeypox at my first Pride party in years. The physical pain was excruciating — but the intrusive feelings of self-loathing were worse.

Hilary Brueck
20 hours ago