Monkeypox

[Guest]

I've been largely ignoring the news on Monkeypox, on the presumption that the press are more likely to over report every low risk disease for a few years now. 

However, the following article is worth reading (link below). 

Extracts:   "Since the first was announced in the UK on 7 May – a person who arrived in London from Nigeria – the agency has confirmed 19 more cases, the majority among young men who have sex with men."

"Hopkins told BBC One’s Sunday Morning show that community transmission in the UK was “largely centred in urban areas and we are predominantly seeing it in individuals who self-identify as gay or bisexual, or other men who have sex with men”. Asked why cases were mostly in that group, she said: “That’s because of the frequent close contacts they may have."

https://www.theguardian.com/world/2022/may/22/monkeypox-uk-health-security-agency-to-announce-more-cases

 

Apparently there is a vaccine.    Also vaccination against smallpox gives good protection, however, in the case of the UK, that stopped decades ago. 

[JKane]

Yeah, I got annoyed that I had heard more about Amber Hurd's turd than anything in-depth about this and went and looked it up, and it really amounts to almost nothing.  It's not terribly easy to spread but close, intimate contact can work.  Oh us promiscuous gays.  Case counts are in the dozens and even without a smallpox vaccine this variant is a mild infection people get over pretty easily. 

So now that's two things being breathlessly reported in the news I don't give a damn about...

[reader]

From the Thaiger

Thailand to strictly screen those arriving from countries with Monkeypox

Thailand is creating a new emergency centre to monitor the spread of monkeypox, which has now been detected in at least 12 countries, although in very small numbers at this stage. The Bangkok Post reports that Dr. Opas Karnkawinpong, virologist and director-general of the ministry’s Department of Disease Control says Thai health officials are closely monitoring the outbreak, even if the virus has not yet been reported here.

According to Dr. Opas, following the recent easing of travel restrictions, Thailand now needs to be on alert, particularly when it comes to visitors from areas in Africa where monkeypox is endemic. To date, the virus has been reported in the US, Australia, and Canada, as well as in several European countries, including the UK, France, Germany, Belgium, Italy, the Netherlands, Portugal, Spain, and Sweden. To date, over 100 cases have been reported in Europe.K

The DDC says humans can contract monkeypox through close contact with an infected person or animal. The virus can be found in a variety of rodents and in primates. Human-to-human transmission is limited, but can occur through body fluids, respiratory droplets, and contaminated materials. However, scientists say this virus is unlikely to result in another pandemic.

At this stage a lot of the human-to-human transmission has happened through sexual contact.

The symptoms of monkeypox include a fever, rash, body aches, fatigue, headache, and swollen lymph nodes, and can last between 2 and 4 weeks. Lesions, the ‘pox’ part of the name, will often fester, then slowly dry up and disappear in between the second and third week.

Whilst monkeypox is rarely lethal, one variant of the disease has a fatality rate of around 10%, with deaths mostly occurring as a result of lung or brain inflammation and dehydration.

[Guest]

Who Is Protected Against Monkeypox?
https://www.nytimes.com/2022/05/26/health/monkeypox-vaccine-immunity.html?referringSource=articleShare

[Darden911]

Quote

 

Do these lesions scar in the way that smallpox did? Or chickenpox, for that matter?

Yeah, they can lead to hypo- or hyper-pigmentation and scarring, yes. Darker-skinned individuals may present after healing with hypo-pigmentation, lighter areas where lesions were.

 

https://www.statnews.com/2022/05/19/a-cdc-expert-answers-questions-on-monkeypox/

 

 

[alvnv]

1000+ cases in over 30 countries. CDC issues level 2 of the 3-tier travel warning. Some cases point to possible air droplet transmission. CDC also issued a mask recommendation, which was later retracted.

[Guest]

this is definitely concerning - sounds like medical community doesn’t really know what’s happening yet & spreading in gay community first. 
New York Times June 7, 2022 article below 

Monkeypox Can Be Airborne, Too
https://www.nytimes.com/2022/06/07/health/monkeypox-masks-cdc.html?referringSource=articleShare

[Riobard]

Québec province (well, Montreal essentially) is taking a very precautionary approach, early indication is case-doubling per week (about 50 -> 100 recently) but too early to predict ongoing trajectory. MSM/GBT can get the 3rd generation smallpox vaccine Imvamune (called Jynneos in USA and yet another name in Europe) on walk-in basis in The Village with virtually no questions asked. Just broad criteria such as known contact infection; or two or more intimate male contacts within past two weeks; or having been in a sexual activity environment that I presume includes bathhouses and strip clubs, due to fomite surface contact let alone human contact. Beyond a limited current supply in Canada, the large Bavarian Nordic vaccine order targets delivery in 2023. 

Québec has administered about 1,000 first doses, of two sub-cutaneous in the vaxx series 4 weeks apart. I am thinking of stepping up for it in Montreal before end of month. By then, any adverse events albeit a small sample of a few thousand would likely be better known. 

So far there is no human placebo-control randomized vaccine trial that includes efficacy against monkeypox launched anywhere. Outside of a few older African trials, a small Jynneos immunogenicity study in Omaha and Columbus where all subjects get the vaccine but have to commit to being randomized to an oral pill TPOXX (vs placebo) twice daily for the 28-day vaxx dose interval, administered as an adjunct to assess immunogenicity interference or boosting potential. Age 18-42 and you would likely have to mostly stick around for 43 days from the outset; apart from scheduled blood draws Day 29 & 43, be able to attend for physical exams in the event of side effects, etc. Bear in mind this would be a back-door access (beyond occupational MPOXX exposure) to Jynneos but not contributing to monkeypox research specifically because smallpox is the disease target. 
https://www.clinicaltrials.gov/ct2/show/NCT04957485?term=Vaccine&recrs=ab&cond=Smallpox&draw=2&rank=2

[Guest]

I think this Monkeypox spread is much further along than we are being told - at least in the US.  
The incubation period can be up to 21 days and it’s unknown whether it’s just close intimate contact, or airborne too. 

Montreal has case-doubling in one week, but no similar activity in US ?.  There were 35 reported confirmed cases in US yesterday.  No way that is possible given what is being seen in other places.  The Canadians are being proactive and looking for it - the Americans are, as usual unprepared.  Although it won’t be a Covid type event - it does have similar initial dismissive response by CDC and others.  

There is a no current testing/screening or plans to use vaccines in US - it’s all in a national stockpile that requires special access on case-by-case basis for now. 

Whoever still thinks the US has the best healthcare system in the world - will be proven wrong, again. Stay safe guys.
 

[Riobard]

Here is an initial MPOXX daily global tracker. For specific nations click on the blue typeface link in the far right column. What is unusual in many places is the scattered seemingly isolated distribution of cases over large geographical areas for countries with low incidence so far, often with no clear risk vector or travel history. 

https://bnonews.com/monkeypox/

My next upcoming trip is Brazil. Thus far, of the handful of cases reported, none in São Paulo or Rio.

Glad I got my two Springtime European trips out of the way. Europe seems to be the main prevalence source from which global cases are radiating. 

[Guest]

8 minutes ago, Riobard said:

Here is an initial MPOXX daily global tracker

this is great - thank you.

just a note that every country reporting more cases than US (more than 35) has a far more robust public health system, more capable to identify and deal with a sudden outbreak of any virus.  And those same countries are looking for Monkeypox cases with action plans.  

The US is identifying only obvious cases with no current plans to test/trace/vaccinate.  Our fragmented health care system between public/private has left us entirely unprepared to deal with these type situations. Again.  They learned nothing from Covid.

[Riobard]

Netherlands’ BNO News has ceased tracking in non-endemic nations. Our World in Data is tracking it. New case incidence has been levelling out for now.

[Riobard]

I have ascertained that Montreal’s Monkeypox vaccination clinic in The (Gay) Village has a broad, welcoming ‘open door’ policy. Anyone generally meeting the exposure risk criteria qualifies for the Imvamune (aka Jynneos, Imnavex) dose. You do not need to necessarily strictly check one or more of the eligibility boxes. You can simply indicate belonging to the/a higher risk group. You do not need to be a Quebec resident or Canadian. **Foreign nationals are eligible.** I used my Quebec provincial health insurance card but it was for identification, not eligibility or cost coverage.

Here are the steps as well as some attached images and a link to the just released Canadian guidance. I had thought of skipping the 28-day boost dose they had instructed me to pursue when I received the prime dose last week, because I had childhood Vaccinia inoculation, but the current recommendation turns out to be the single dose anyway. Good news for those going out of their way to come here. BUT I just thoroughly read the national guidelines and the fly in the ointment is that Quebec’s procedure is actually a departure. So I did not ask at the site today if they had formally lifted the 2nd dose! I assumed they had. The whole plan does not knit together completely yet. I myself will not get the 2nd dose even if offered. I may try to ascertain the actual Quebec province guidance at a later date. 

If you are particularly observant in reading the national guidance you will notice that the pre-exposure prophylaxis (PrEP for MPOXX) category is indicated for immunocompromised and other select sub-populations. You may wonder if this poses a contradiction. However, Quebec is taking a more liberal approach and basing eligibility on behavioural susceptibility viz MSM settings. I myself am not immunocompromised. 

—->>
Welcome guard on the sidewalk, ascertaining you are there for the Monkeypox vaccination.

Through entrance door to hand sanitation and a site-issue surgical mask, even if you have your own face covering. No COVID vaccination proof requested. 

A few steps to a site nurse to briefly go over your understanding of the disease and vaccination, more to address concerns and questions than anything else. You may be asked about risk grouping but nothing particularly intrusive. They also want to ensure you currently have no symptoms of having recently acquiring MPOXX infection as the vaccine is contraindicated depending on specific exposure incubation timelines.

Ushered into an elevator to the open-concept dispensing area. Directed to a registration desk requiring ID (ideally passport if without Quebec REGIE health card). The full name of your father and your mother (maiden, I presume) is added to your name and birthdate in the registration system. This is to triangulate ID for safety/tracking purposes in case a popular name (eg, John Smith) and dob is duplicated due to volume. This is also the standard for COVID vaccination in Quebec. Your address and phone contact is also entered. Perhaps your Montreal lodgings suffices as phone contact is likely more paramount. 

Your ID sticker is fixed to a requisition as is common for any lab procedure. You are directed to another gatekeeper to confirm your identity is correctly delineated on the requisition. 

Then directed to the health professional administering the subcutaneous jab. I was miffed that she did not let the alcohol swabbing dry before the jab, as it can compromise the integrity of the active pharmaceutical ingredients, but perhaps this is more relevant for the earlier generation smallpox scarification procedure where the dozens of miniscule punctures would be picking up alcohol traces on the way into your dermis. Anyway, I forgot to stall in the unlikely event of an impatient more irascible type of person administering the dose. She had several minutes between each victim so no need to rush.

That same person gives you a paper slip record, or enters the info in your immunization booklet if you have one, or both versions on request. Nothing digital. 

Finally the usual 15-minute sitting in a chair in the unlikely event of immediate reactogenicity. 
~~~~~~~
The immunity sufficiency buildup is a few weeks. If you are in earnest about prophylaxis, a visit to the strip clubs likely defeats the purpose.

https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-imvamune-monkeypox.html

[Riobard]

OK … man, is this getting complicated. Quebec’s departure seems to pertain to offering Imvamune beyond occupational exposure risk. Quebec, in fact, may be stratifying the PrEP category according to single dose if previously vaccinated against Smallpox but immunocompetent (my situation as in attached screenshot) VERSUS prime-boost 28-day interval for immunocompromised irrespective of Smallpox vaccination history, all otherwise in accordance with the national recommendations. Prospective visitors should read the Guidance I linked in order to judge whether two visits are recommended. My sense is that the 2nd dose would not be withheld and that recipients have the prerogative of 2 upcoming doses. This could also be an important decision for immunocompetent but never having had Smallpox inoculation, though the national guidance plunks this into occupational exposure. The question is: does Quebec similarly recommend the two doses for (typically younger) Vaccinia-naïve that are behaviourally susceptible to infection viz MSM risk, etc. I think so. Sorry it’s not clearer yet. There is insufficient research about multiple dosing for the never vaccinated should an Orthopox pandemic emerge. The 28-day interval is possibly arbitrary anyway because it takes very complex research design to alter duration and recruit enough subjects for each research trial arm. 

[Riobard]

New case incidence is slowly edging up in Montreal, considered a/the North American epicentre of Simian Smallpox (seemingly the province’s preferred term). It was officially announced that all cis-/trans- gender men in or visiting the city can receive the Imnavex vaccine. Apart from the walk-in clinic above, additional sites here and likely in Quebec province (eg, getting inoculated sufficiently ahead of coming to Montreal) will open up. The booking portal, ClicSanté, for COVID vaccination, has added Imvamune, perhaps because scheduling demand will call for a balance of queue waiting and first-book-first-serve. I have no idea how easy it is to register in the booking portal. Frankly, I do not think you need to register an account or log in, as you can pick a slot and you will fill in the requested info and be sent a confirmation by email or SMS. You will need to enter a local postal code; that is simply to list available sites by distance, not for purposes of corroborating a home address zip code. Perhaps enter your accommodations code, or just enter the code for Hyatt Place that has a soft opening today. 

In any case, COVID vaccinations here were/are accessed by appointment or by walk-in, so my sense is that there is no need to book online. But you can view the time slots regularly prior to making an actual booking in case you want to plan a very brief trip and get a sense of openings within your planned window, and perhaps obtain a guaranteed appointment.

The portal’s address for the clinic I attended is #955 but I think it should be #965 (as in the flyer) unless they happen to adjacent public health offices. 

 

[Lonnie]

1 hour ago, Riobard said:

Simian

OMG... What's wrong with monkey?

[Riobard]

15 minutes ago, Lonnie said:

OMG... What's wrong with monkey?

More accurate in terms of taxonomy, less colloquial in the disease vernacular, perhaps more neutral, draws on Latin roots; eg “coronavirus” due to the spike halo effect presentation of that virus … not ‘crown’ virus, not Wuhan virus. Jackasses on media accompanying the name with images of children in Africa. SIV is not ‘monkey immunodeficiency virus’. Actually, by rights, it should be named Human something-or-other Pox so the faster getting some distance from the inappropriate nomenclature the better. 

[Riobard]

16 hours ago, Riobard said:

New case incidence is slowly edging up in Montreal, considered a/the North American epicentre of Simian Smallpox (seemingly the province’s preferred term). It was officially announced that all cis-/trans- gender men in or visiting the city can receive the Imnavex vaccine. Apart from the walk-in clinic above, additional sites here and likely in Quebec province (eg, getting inoculated sufficiently ahead of coming to Montreal) will open up. The booking portal, ClicSanté, for COVID vaccination, has added Imvamune …

Apologies. Imnavex (same vaccine but European name) above should read Imvamune. 

[Riobard]

The PAHO has declared an emergency alert even if the WHO does not decide such a similar status next week. Now wondering if my upcoming Montreal-Brazil direct flight will be grounded due to epicentre status. I doubt my Imvamune certification will be worth the paper it is stamped on because it will take forever to line up these types of contingencies. It is apparently likely travel restrictions will ensue from a WHO ‘emergency of international concern’ designation. 

Interesting comparative tidbit: Quebec province has reported at least 20,000 new SARS-CoV-2 cases over the same period, likely an undercount, and 225 deaths. 

[Guest]

Some additional information on US Monkeypox 

Monkeypox in the US is vastly underreported and is spreading exponentially in major US cities and anywhere with a significant gay population.  There is no commercial testing available anywhere in the US and is only being done by each states Department of Public Health.  You can get vaccinated if you think you’ve been exposed and can be linked to an event with known transmission. I’m assuming each state has their own eligibility criteria which should all be available online.  In Florida, friends tell me it’s easy and no wait with plenty of vaccines and same day appointments are available.  In NYC, the demand is exceeding the current vaccine supply and no appointments currently available, although they are releasing more appointment dates as vaccine supply comes in.

if you can get the vaccine now - do it.  The Jynneos vaccine is the one recommended for gay men & appears most commonly used.  The other vaccine in use, ACAM2000 is not recommended for gay men as it contains a replication competent virtue and may cause complications with HIV meds.

Many doctors are not diagnosing this accurately when patients come in as they are not familiar w symptoms.  
 

FYI - the preferred Jenneos Monkeypox vaccine is in short supply and it will be months before they get production started again. So if you can get it now, that would be wise.  See below NYT article for details 

Will There Be Enough Monkeypox Vaccine?
https://www.nytimes.com/2022/07/01/health/monkeypox-vaccine-bavarian-nordic.html?referringSource=articleShare

[Guest]

for the Monkeypox naysayers - read todays New York Times 

You’ve been warned 

The U.S. May Be Losing the Fight Against Monkeypox, Scientists Say
https://www.nytimes.com/2022/07/08/health/monkeypox-vaccine-treatment.html?referringSource=articleShare

 

[Guest]

Yup - nothing to worry about at all

Just exponential unchecked growth w limited vaccines in the near future 

 

[belkinDC]

I have been trying to keep up with availability of Jynneos from my local health dept in DC - VA suburbs (it has been available from the DC dept of health for a few weeks, but only for District residents and apparently they run out of appointment slots quite quickly when posted). Online information from VDH to date has indicated that vaccine availability is limited to contacts of known cases. But saw a guy with a PSA on Scruff tonight who advised that if you call the county health dept and let them know you are a MSM with multiple sexual contacts in the last 14 days, they will schedule an appointment for you. Planning to call tomorrow and will report back…

[belkinDC]

Was indeed able to schedule an appointment for Jynneos after answering the screening behavioral survey despite not having symptoms or contact with a confirmed positive case (which the online info would lead one to believe is who they are limiting shots to at this point). Had to be a Virginia resident too it seemed.

[alvnv]

Monkeypox was declared a global health emergency by the WHO

https://www.inquirer.com/health/monkeypox-global-health-emergency-world-health-organization-20220723.html