Thread by @Rpshahmemorial1

Small thread on why I think we will see a bigger outbreak of #monkeypox d/t #COVID19 .We know Covid causes T cell response suppression in some & also complement mediated injury leading to effective reduction in levels of complements (hypocomplementemia) ctd)@fitterhappierAJ ctd)

2/n We know for a fact that at least in kids the complement induced injury caused hypocomplementemia in young , this was one of the pathways of acute liver injury in some kids , if the complement system is exhausted
#monkeypox
doi: 10.1097/INF.0000000000002804. PMID: 32639461.

@medriva @VirusesImmunity @britsocimm @KunstJonas @ManojShukul @Kanupriya78 @kumarmanish9 @RonaldKlain @G_LaryeaAdjei @amrit_lohia 3/n We also know that #Covid causes direct infection of T cells and leads to lymphopenia , we need to understand that post #Covid the T lymphocytes arent there to save infection ctd) .

Ctd 4/n All said and done both the T Cells and Complement system are taking a hit , that is good chance for not only Monkey Pox but a host of others to take advantage. We need to prevent reinfections #N95, #Boosters, #UpdateTheVaccines, #AirMonitoring

5/n The fact that US goes ahead and orders 13 million doses initially in a deal costing 299 million USD. That should raise some understanding that the US realizes the risk caused

6/n some pictures have been uploaded by by BK Titanji and have to see the small kid to believe how bad it can be ctd)

7/n During an outbreak of monkeypox in 2003 in USA , exposure was traced to contact with pet prairie dogs that had been co-housed with monkeypoxvirus-infected small mammals imported from Ghana. So there is a fair chance of animals getting infected & also to pass it on, ctd)

8/n The WHO said that only one case of the many has history of travel to Africa , this combined with the fact that the US case had travelled only till Canada means there is more simmering underneath,chance to prevent animal jump from humans is now ( if not already happened) ctd)

9/n Ring vaccination or vaccination of the contacts and the people who may be second / third degree contacts is a good option to prevent spread and to save the precious doses , the grapevine is that it is being contemplated. The best age group is 20- 50 Yrs old .

10/n There was a great question asked by @emilygraymd_mph - Why now ? Are the animals getting immunocompromised- We really dont know BUT the animal models did show immunosuppression and if they did, there is no doubt those in wild will . Ctd)

11/n Whetever may be the predominant means of spread BUT this effort of the @UKHSA to try and lay the cause on gay , Bisexual men is not done- Most probably we will find Airborne transmission to be the major route and not #HIV ctd)

@UKHSA 12/n there is an interesting modeling study done in 2020 which calculates the R0 of #MonkeyPox to be in the zone of 2 in Congo , Africa we therefore are sitting on a minefield
doi: 10.2471/BLT.19.242347 ctd)

13/n In 1988 WHO thought that #monkeypox just needed tracking and no vaccination , nobody thought anything till 2020 in this modeling study HOWEVER Covid changed the game and suddenly the world stares at a possible pandemic upon a pandemic 😢😢. Ctd)
doi: 10.1093/ije/17.3.643.

14/n The @WHO has said that it is primarily droplets BUT it seems we will in the end find it due to aerosols , blood borne maybe to a much lesser degree .Sweden meanwhile finds a case ,@DGBassani feels if ur wearing an #N95 & following #Covid appropriate behavior ur fine ctd)

15/n “To combat a smallpox emergency, the SNS holds enough smallpox vaccine to vaccinate the entire U.S. population. In addition, the SNS has antiviral drugs that can be deployed to treat smallpox infections, if needed,” -Department of Health & HS,what about #GlobalSouth 🤔🤔ctd)

16) There is a good 3 hour course from the WHO for tbose who want to know a little more Ctd)

17/n Interesting paper ( modeling again) which showed that for communities to do a ring type vaccination is the best option in the early stages HOWEVER if the condition reaches out of hand then mass vaccinations may be needed .Time to act is NOW !! Ctd)
doi.org/10.1080/216455…

18/n While there are questions from certain quarters if this is bioterrorism, I domt think I can say that with any confidence, all I can say is that the threat has been increasing since last 50 years and in the last 20 years by leaps & bounds ctd)
doi: 10.1073/pnas.1005769107.

19/n There've efforts to trace the changes that have happened in the small pox DNA, interestingly it was found that it became worser as time progressed & that worse disease gave life long protection , so diseases may not become #Mild with time ,monkey pox also probably changing

@WHO @DGBassani Wishing to offer a clarification from both me and @DGBassani - we both humbly accept that it can also spread from used clothes , pustular fluid as well BUT maintaining 6 feet distance from both patient / used items / body fluids along with #N95 masks would be appropriate info