1. Great news: vaccine, so far, 90% effective in reducing symptomatic COVID, as opposed to saline injection
2. Study enrolled 43,538 volunteers and 38,955 had 2 doses; 94 cases in unvaccinated statnews.com/2020/11/09/cov…
3. Interim analysis found 94 cases in the non-vaccinated sooner than 1st expected. Surges in cases will mean more potential cases and faster vaccine study results
4. Authorization process will not begin in US until 2 months after 2nd doses given. Likely late Nov.
5. Phase 3 trial still on-going, will need over 164 cases for final analysis, which given recent surges will likely coincide with the 2 months after 2nd dose time period.
6. No mRNA vaccine has been approved in any country ever, though such vaccines have been studied for years
7. Logistics of distribution to reach herd immunity will be complicated. Pfizer vaccine will require 2 doses. It will need to be stored in neg 80C sub zero fridges.
8. If the vaccine is authorized for use, doses will be limited. 50M planned by end of 2020, 1.3B in 2021
9. Many countries already pre-ordered the vaccine - EU, US, UK, Canada, Australia. These orders exceed the stock available in 2020. UK alone has ordered 30M. Countries outside initial purchasing groups will have difficulty obtaining the vaccine, besides sub zero fridge logistics
10. Vaccine studied around world (Argentina, Brazil, Germany, South Africa, US), will need to ensure diversity
11. Vaccine studied in adolescents and older adults (65-85). Early data showed older adults hadgreater neutralizing antibody response w/vaccine than natural infection
12. Still waiting for data on safety, side effects, and longterm durability and effectiveness of the vaccine. Early work showed side effects included standard findings - pain at the injection site and fatigue, chills and fever
13. What may matter most in some parts of the world may be trust in the vaccine, rather than just enough doses.
Note among African Americans surveyed, 32% said they would definitely/probably take a vaccine if available today. pewresearch.org/science/2020/0…
US population 331 million.
To achieve herd immunity with 2 doses, even with 90% efficacy and some natural immunity, this will require a lot of vaccines.
Vaccination of 80% of population = 530 shots
The annual flu vaccination has reached 140-170 shots/year cdc.gov/flu/prevent/va…
14. Longer term data is needed to better understand how long vaccine immunity will last. It's possible that 2 shot vaccination will need to be followed by regular boosters, complicating control and logistics even more.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
As COVID cases rise in China and protestors challenge policies, note:
the country does not have the immunity the rest of the world does - no mRNA vaccines, little infection-derived immunity.
Of those most vulnerable, over 80, only 40% have had the 3 vaccine doses needed 1/n
Immunity derived from vaccination and infection cushions the rest of the world
China does not have the same immunity
It also has an older population
Two populations of similar sizes - China (1.44B) and India (1.38B) - and China, after decades of 1 child policies - is older
An even more extreme age distribution difference can be seen between China and the whole of Africa, 1.44B and 1.34B, respectively. populationpyramid.net/china/
Age remains the greatest common risk factor for severe disease.
San Miguel de Tucumán, Tucumán, Argentina
- 8 healthcare workers and 1 patient ill
- Symptoms: fever, myalgia, abdominal pain, dyspnea
- 6 cases with bilateral pneumonia
- Multiple requiring technical ventilation
- 3 of 9 have died
Testing has included common viral causes of illness to account for bilateral pneumonia and myalgias (muscle aches) but not necessarily viral. Testing was described as completed with a FilmArray for 25 pathogens. This appears to be a Biofire Multiplex PCR
What are the caveats of the ACAM2000 vaccine (replication-competent vaccinia virus) for monkeypox/smallpox? The stocks are much larger but why not used?
- Contraindications for many (see next tweets)
- Need to cover vaccine site to avoid spread to others (given contraindications)
So for whom would ACAM2000 be a concern?
From the US CDC:
These include those at high risk for heart disease (given risk of myocarditis), eczema or other exfoliative skin conditions, immunosuppressed, HIV+, use topical ophthalmic steroids, pregnant, breastfeeding, under 1,
If you've never seen what diphtheria, tetanus, or polio can do, you're lucky.
Your parents or grandparents or great grandparents weren't so lucky.
These are horrible diseases with no good treatments. This is why there are vaccines.
A little reminder of the reality:
Tetanus - each movement leads to painful waves of twitching. the patient is smiling sardonically, taking shallower and shallower breaths. others say they're fine. They look happy, not struggling for breath, just slowly silently suffocating, unable to move. it's a horror film.
Diphtheria - a choking choking, strangled by the layers of phlegm in their throat. it was the strangling angel, so horrifying to watch that doctors first invented tracheostomies, sticking knives and needles into children's necks desperately to keep them alive
+ cases also outside of metropolitan area
? suspected
^ likely includes separate introduction from endemic area, unrelated to main European transmission chain
Some cases may be reported as confirmed when test positive for orthopoxvirus but monkeypox not specifically confirmed
Although cases have a genetic link to Nigeria, this would be from past case(s). There are no reported outbreaks in Nigeria. Sporadic cases, likely related to animal reservoirs and not continued human transmission, have been reported in 2022, with 21 confirmed cases and 1 death.
Current monkeypox cases detected do not correspond to real time transmission 1) We are playing catch up identifying patients not recognized before 2) Monkeypox serial intervals* are much longer than say for COVID
Rising cases can still mean we are finding what we've been missing
*Serial Interval - time from illness onset in primary case to illness onset in secondary case
With some diseases this is short. 2 cases today may mean 4 new cases in 2 days. Other diseases have short incubation periods. With monkeypox 6-13 days(5-21 range) who.int/emergencies/di…
Study tracing person to person transmission of a different monkeypox clade (in the DRC). Incubation period on average 8 days (4-14) ncbi.nlm.nih.gov/pmc/articles/P…