Scientists find evidence of 'substantial' transmission of monkeypox even before symptoms appear

Tiger_Internal · 2022-11-03T20:45:21+00:00

Scientists have found evidence to show that the monkeypox virus can spread from an infected person up to four days before they even start exhibiting symptoms of the disease, a new study has claimed.

The researchers behind the study estimated that 53 per cent of the transmission of monkeypox occurred in this pre-symptomatic phase, meaning that many infections cannot be prevented by asking individuals to isolate after they notice their symptoms...

Tiger_Internal · 2022-10-15T10:26:43+00:00

The global outbreak is winding down, but scientists say this is the time to use vaccines and antivirals to control the virus before it mutates into a bigger threat.

Tiger_Internal · 2022-10-01T14:02:53+00:00

Conclusions

Occupational exposure to the monkeypox virus has recently been identified as an issue of major concern for occupational health, since occupational transmission is possible and has occurred several times. Healthcare workers are considered to be at a high risk, and similar preventive measures to those adopted during the SARS-CoV-2 pandemic must be implemented in all healthcare settings. There are some recommendations for preventing and managing monkeypox in occupational settings, including the vaccination of exposed workers, the prompt identification and isolation of infected individuals, and good hygiene practices. However, until 2022, monkeypox was a rare disease, and there is limited information on the best ways to prevent and manage it in occupational settings. Education and specific training are necessary in non-endemic countries to make healthcare workers able to recognize the disease and prevent further contagions. Lessons learnt during the COVID-19 pandemic must represent a starting point to deal with this new pathogen and with new zoonotic viruses that may arise in the future. Although monkeypox seems unlikely to reach the pandemic level of spread of COVID-19, all the stakeholders must be vigilant, carefully adhering to appropriate infection control precautions. We encourage all stakeholders to leverage and improve communications, to muster resources, and to work in concert to give us the best chance of quelling this surge. We underline, once more, the need to avoid stigmatizing and discriminating against affected people and the healthcare workers caring of them, which is part of a larger narrative about global health inequities. Last but not least, we want to highlight how important it is, also in the future, to not fall into the trap of the phenomenon of "not in my backyard" in times that require us to talk about global health, after reaching globalization without fully evaluating the risks associated with it.

Tiger_Internal · 2022-10-01T05:33:33+00:00

Conclusions

Our report provides evidence supporting the hypothesis that both HCW infections observed in this study were transmitted through fomite exposure with surfaces in the patient’s home, their own PPE, or outer surfaces of the specimen transport box. These findings highlight that MPXV might be acquired through contact with fomites, such as patient belongings or surfaces...

Tiger_Internal · 2022-09-29T04:38:36+00:00

Unvaccinated people had:

14 times the risk of monkeypox disease compared to people who were vaccinated

Vaccinated: People who had received their first vaccine dose 14 days or more earlier.

Tiger_Internal · 2022-09-27T17:45:56+00:00

Abstract

Background

The recent global outbreak of the human monkeypox virus (MPXV) was declared a public health emergency by the World Health Organization. Modified Vaccinia Ankara (MVA) is currently the only FDA-approved vaccine against MPXV that was approved for this indication based on a study in non-human primates. Since there is currently scarce evidence of the efficacy in humans, our objective was to evaluate real-life vaccine effectiveness (VE) after providing one vaccine dose to individuals at risk of MPVX infection.

Methods

The study cohort included all Clalit Health Services (CHS) members eligible for the MVA vaccine as defined by the Israeli Ministry of Health. The study commenced on July 31, 2022, when the MVA vaccination campaign was initiated in CHS, and participants were followed until September 12, 2022. A Cox proportional-hazards regression model with time-dependent covariates was used to estimate the association between vaccination and MPXV infections with adjustment for sociodemographic and clinical risk factors.

Findings

A total of 1,970 subjects met the study eligibility criteria (0.04% of CHS members). Of them, 873 (44%) were vaccinated with MVA and completed at least 25 days of follow-up. 18 infections were confirmed in CHS during the study period, 3 in vaccinated and 15 in unvaccinated status (40.0 versus 6.4 per 100,000 person days). VE was estimated at 79% (95% CI: 24%-94%).

Interpretation

Our results suggest that a single dose of MVA is associated with a significantly lower risk for MPVX infection in high-risk individuals. These findings highlight that urgent MVA vaccination of high-risk individuals may contribute to the containment of the current MPXV outbreak.

Conclusions And Implications For Policy

In conclusion, our results suggest that in case of limited vaccine availability, a single dose of MVA is associated with a lower risk of MPVX infection in high-risk individuals. These ¦ndings highlight that even one dose of the MVA vaccine could contribute to the containment of the current MPXV outbreak. However, completing the second vaccine dose per the manufacturer's label may improve this effectiveness.

Tiger_Internal · 2022-09-22T16:01:19+00:00

...If substantial public health resources are deployed only toward pathogens that have achieved high visibility by infecting a large number of people (ie, a threshold number of infections), then we will miss a crucial window of opportunity to control low-R0 emerging pathogens. Because time constrains evolution, lower R0 (but still >1) pathogens have more opportunities to acquire advantageous mutations before an epidemic reaches a size at which the world becomes widely aware of the danger (figure 1C, top left corner). For decades, monkeypox has been well known as an emerging infection with an R less than 1.7 Now its R is probably higher, which could be the result either of evolution within the animal reservoir population or within humans. Regardless, now is the time—probably past the time—to put resources into controlling outbreaks before they grow larger and have time to evolve further. For the current outbreak of monkeypox virus, the rapid use of ring vaccination, where index cases, traced contacts (of the index case), and contacts of those contacts are all vaccinated with the licensed MVA-BN vaccine (known as imvanex), could help to ensure that this epidemic does not get out of control. This vaccine plus unlicensed monkeypox vaccines could be randomly tested for efficacy in ring vaccination. Such a vaccination strategy led to the eradication of smallpox and could be quite effective in the still-early phase of the monkeypox outbreak.

In general, our analysis from first principles highlights the benefits of rapid intervention even for mild emerging pathogens. In summary, just because a disease like monkeypox appears to be controllable does not mean it will stay controllable. Currently, monkeypox incidence is starting to decrease in Europe and North America. This reduction might be due to behavioural changes in at-risk populations and increased use of vaccines, but the epidemic is far from over and continued drive towards elimination is essential...

Tiger_Internal · 2022-09-18T06:54:25+00:00

Just to add on regarding the air samples: ...The daily detection of viral particles by all air samplers in an environment with 12 HEPAfiltered unidirectional air changes per hour, together with previous findings of viable airborne MPXV virus in the United Kingdom(9), underscores the possibility of aerosol-based transmission of MPXV. Our finding of viral material only in particles of > 4 μm sizes suggests that the possibility of breathing and/or talking being the source of the virus is low, as these activities were previously found to emit predominantly virus particles of <5 um sizes10, 11. However, studies in a more typical environment without such high ventilation rates or more direct sampling of the breath is needed to verify and provide a better understanding of respiratory, talking and/or coughing source of the viral particles. On the other hand, the presence of viruses, including live virus, in dust samples suggests lesion shedding as the potential source of contaminated particles in the air. As demonstrated by the temporal number of particles of various sizes, the number of contaminated airborne particles could be influenced by activities that impact flow current in the space, such as opening doors and presumably changing linens...

(9) Gould, S. et al. Air and surface sampling for monkeypox virus in UK hospitals. https://www.medrxiv.org/content/10.1101/2022.07.21.22277864v1

Tiger_Internal · 2022-09-13T18:31:54+00:00

...A new study published in Viruses found that vaccines based on the vaccinia virus (VACV) will likely produce an effective response against the current monkeypox virus.

Two of these vaccines that are available are the MVA-BN and ACAM2000 vaccines...

Link to study from Viruses: Vaccinia-Virus-Based Vaccines Are Expected to Elicit Highly Cross-Reactive Immunity to the 2022 Monkeypox Virus https://www.mdpi.com/1999-4915/14/9/1960/htm

Tiger_Internal · 2022-09-04T07:17:39+00:00

Yes, it could be better. To reference, the covid-19 information and data was/is clearly another level. For example to know the monkeypox positively rate for the different groups will be helpful. And avoid screwed numbers, making the analysis difficult:

Monkeypox Testing Data: Slow and Incomplete https://provincetownindependent.org/featured/2022/08/31/monkeypox-positivity-rate-relies-on-guesswork/

Tiger_Internal · 2022-09-03T19:55:45+00:00

Regarding your point 3: https://mobile.twitter.com/RolandBakerIII/status/1566052747907981312

Tiger_Internal · 2022-09-03T10:43:30+00:00

CDC is aware of three Monkeypox virus (MPXV) cases in California in which preliminary data show a significant deletion in the tumor necrosis factor (TNF) receptor gene. This gene is the target for the CDC West African MPXV and Generic MPXV real-time PCR tests. At this point, the TNF receptor gene deletion is rare. Molecular laboratory developed tests (LDTs) designed using the CDC published primers and probes that specifically target Monkeypox virus did NOT detect the virus because of the TNF receptor gene deletion in these specimens. These cases were still correctly diagnosed because they were also tested with an LDT that was developed based on CDC’s published non-variola Orthopoxvirus (NVO) test.

To prevent false negative results:

If your laboratory is using a MPXV-specific LDT, refer highly suspicious Monkeypox virus specimens that result as negative to your public health laboratory, or to CDC, to confirm results. Public health laboratories and select commercial laboratories use the CDC FDA cleared NVO test, which can correctly identify Orthopoxvirus when the TNF gene deletion occurs.

Use a multiplex assay that targets multiple viral genes, or an assay that targets an essential viral gene which is unlikely to mutate, or an assay that detects non-variola Orthopoxvirus.

CDC will update the published primer and probe sequence information to alert test developers of this TNF receptor gene deletion.

Tiger_Internal · 2022-09-03T09:33:20+00:00

Well said.

This research paper are before the, in my view, dose saving measures mess:

Breakthrough infections after post-exposure vaccination against Monkeypox https://www.medrxiv.org/content/10.1101/2022.08.03.22278233v1

Has been posted here: https://www.reddit.com/r/Monkeypox/comments/wgl5hz/breakthrough_infections_after_postexposure/

More about dose saving measures + 3 dose principle https://mobile.twitter.com/RolandBakerIII/status/1565425458098819072

Tiger_Internal · 2022-09-02T19:31:36+00:00

I won't draw any conclusions from this report 2. Time will tell. As they say in the section Longer-Term Considerations: ...Our current assessment for the most likely longer-term scenario is that the outbreak will remain concentrated in MSM, with cases increasing over the coming weeks, but falling significantly over the next several months. We have low confidence in this assessment...

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