Thread by @Rpshahmemorial1

The UK has started stockpiling vaccines after similar information from the US , Meanwhile Montreal has 17 cases and it's spreading under the radar .

https://twitter.com/Rpshahmemorial1/status/1527272213627699200?s=20&t=REoRRAyulsl_GX25BH9yZQ

2/n It seems to me that all viruses have become overactive Mozambique🇲🇿confirms first wild poliovirus case in 30 years. Case in child in Tete province follows detection of similar strain in Malawi in February, officials say.This was also seen in Isreal 😢😢
Ctd)

3/n Though we dont want this to be a political issue BUT to change information as such will probably boomerang as kids show up with lesions on face ctd)

https://twitter.com/WicMar/status/1527269381520396288?s=20&t=KhjrYsfGHAYMo-sv5EEaSg

4/n @Tuliodna & @MarionKoopmans we agree that this is not the normal way monkey pox behaves BUT we need to agree that we arent living in normal times , the T cell responses aren't normal, Covid has caused mayhem with immunity , @medriva ,@BNONews , @fitterhappierAJ

5/n

https://twitter.com/Rpshahmemorial1/status/1527457429591830535?s=20&t=9tgj_s7FryV4fCXQX95SXQ

6/n We know what has changed in the last three years- We have Covid 19 ( 75% plus) which is now more commoner than diabetes + hypertension combined ( 12%+45%) and we are letting it rip through , the immunosupression caused is huge ( we also have permanent #Long Haulers)

7/n There have been changes in Humans (measured by Telomere length) we are aging at least 5-15 yrs faster(#LongCovid at higher end of spectrum), ot creates a perfect condition of co-evolution of the pathogens here #monkeypox , with compromised immunity we have more chains ctd)

8/n There is a school of thought which says small pox jumped into humans from animals when the timing was right & parent pox viruses ( like #monkeypox ) are waiting ,we have a pathogen which has changed gears in an immunocompromised population ctd)
-doi: 10.1038/nature02104

9/n There is a nice tracker by @medriva and that shows that the outbreak is spreading by leeps and bounds across the globe ctd)

https://twitter.com/BNODesk/status/1527472115003400192?s=20&t=o1y1fS5_xsW2idsVSAZeTQ

10/n Fact that it is spreading under radar is exemplified by @MathStuart' s efforts, this means 2 things - seems to be probably CURRENTLY not needing HOSPITALIZATIONS, may be will / may be not- may lead to long issues, we're underestimating the spread & its contagiousness ctd )

20 facts yesterday + , this becomes 31/n The first genome report is out, the virus is the same as it was spreading in Nigeria , then how come it's now spreading like BUSHFIRE, enter host changes ctd) virological.org/t/first-draft-…

32/n #Monkeypox spreads beyond Europe and Americas to land up in Australia, Not to be outdone by Sydney, Melbourne has a confirmed case of monkey pox as well. Such fast spread by the same pathogen which hasn't changed means change in host characteristics. #COVID19 ctd)

33/n If the strain is the same across the world then it’s probably the 1% CFR mortality West Africa strain instead of the 10% Congo strain. But 1% CFR is higher than COVID’s 0.6% CFR measured in 2020. Smallpox vaccine probably works, but most under 45 haven't had it. Ctd)

34/n An interesting paper from Australia looked at the most important point - Will vaccines help me tide?? They didn't find much Antibodies that can help in immediate response so we think we will see it spread faster ,but wouldn't kill as many ctd)
doi.org/10.3390/v12050…

35/n @dan_diekema 🙏 has posted his old slides , let's review what has changed - With the speed it is spreading across the globe seeding multiple communities- in the backdrop of covid where immunocompromised status (surrogate marker Lymphopenia ) is there we seemingly will 😢

36/n The lymph nodes stop the infection spread in the blood with lymphopenia my impression is that we will see lesser lymphadenopathy BUT more vesicles/ rashes spread across the body, more myalgia but lesser fever ctd)

37/n We look at the 3 hour exposure as set in stone , that depends on what the air dispersion of the virus is , the immunity of the host and hopefully the viral conditions haven't changed , let's review 31/n again ctd)

38/n While the 9% secondary attack rate on households was earlier UNFORTUNATELY this doesn't look like to be truth in today's world BECAUSE the host conditions have changed , hopefully the virus hasn't probably changed ( 31/n) . Look at the UK cases ctd)

39/n We will need to do simulation excercises in the lab to find out what level of immunity ( thorough antibodies) and through T cells is enough, the old standards may not be enough because we are having attrition in " Herd Memory "as those less than 45 haven't been exposed.

40/n Tecovirimat has been stockpiled by US but may be in short supply across the world .Its been shown to reduce death by 95% vs 5% in placebo ,caveat statement is that only safety trials were done in humans, it may not help as much against scabs as against death .ctd)

41/n Sadly Ribavarin which has been used extensively across the globe for fighting other viruses didn't find much use #monkeypox, Cidofovir is another which could be used BUT needs intravenous treatment (hospitalizations) & may need to be closely watched for kidney disease. Ctd)

42/n @adamjkucharski makes compelling case for contact tracing BUT isn't happeninģ - we are coming at the back of an ongoing pandemic- we ideally should have tried doing it , checking flights & travellers - Nope not going to happen & itch to normal ctd)

@adamjkucharski 43/n The UK today confirmed 11 cases, G7 became active, WHO became active & the UK confirmed that they had bought vaccines
HOWEVER @Neurofourier thankfully confirmed that #GlobalEquity is on CDC's mind , they are also concerned with the popping of cases across the globe ctd)

44/n WHO is convening an EC meeting out of concern for international spread of #monkeypox They will will discuss whether to declare monkeypox a Public Health Emergency of International spread.The Committee has convened 9 times before for outbreaks of International concern ctd)

45/n 6 PHEICs have been declared till date :
• Swine flu H1N1 (2009)
• Polio (2014)
• Ebola West Africa (2014)
• Zika (2016)
• Ebola DRC (2019)
• COVID-19 (2020)
The fast spread #monkeypox has jarred many, everyone thinks we may have #Monkeypox replacing Small pox ctd)

46/n So while the #monkeypox has again lead to fault lines between the global north and south, we need to understand that #globalequity is important and this message still holds true( minor changes ) ctd)

47/n @itosettiMD_MBA asked a pertinent question , what about kids ?? A paper in 2003 asked the same question BUT kids in US were being vaccinated at age 1 and above without much sideffects. Risk / reward rations need assessment with the new #monkeypox threat ctd)

@itosettiMD_MBA 48/n As usual the kids are at risk and 26 % admission for greater than 48 hours doesn't look mild by an chance #monkeypox . This will further stretch our hospitals doi.org/10.1086/498115
Ctd)

49/n pictures speak louder than words so couple of pictures by @Rajeev_The_King which correlate with papers , in a nutshell it was spilling in DRC & Nigeria BUT we didn't pay needed care ctd)

50/n wish to end with this picture - Hope no kid has to undergo this across the globe- more updates tomorrow 🙏🙏🙏