Thread by @Rpshahmemorial1

Why I feel we will have a much bigger outbreak of #MonkeyPox & top 70 updates ( we had 50 yesterday ) in the thread below . Let's start by what we already know & then go further

https://twitter.com/Rpshahmemorial1/status/1527544931874897920?s=20&t=hbP9FzaGvFyk278-UID2Vw

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51/n Spain is seriously looking at whether the 80K strong LGBT community get together was a super spreader , they are also trying to find if one of the Saunas ( where gay men go for sex) has been the source , so the consequences are not due to genital spread but congregation ctd)

52/n The problem is its large number of likely reservoirs and things we probably can't entirely avoid including animal droppings : rats, mice, squirrels, shrews, opossums, ground hogs etc . So once it gets into a geographical location #monkeypox will be a tough nut ctd)

53/n While #monkeypox 1st genome sequencing showed that the clad is similar to one that spilled from Nigeria earlier ,drop in genetic material is becoming a reason for concern over a period of time - we hope that it hasnt happened this time ctd)
doi: 10.3201/eid2002.130118.

54/n For the 2003 #monkeypox outbreak in US , interhuman transmission was not documented & all patients were near or handled MPXV-infected prairie dogs. The clade that we tentatively have now is the same doi - 10.3201/eid1309.070175. PMID: 18252104; PMCID: PMC2857287. Ctd)

55/n A case of monkeypox was diagnosed in a returning traveler from Nigeria to Maryland, USA in 2021 . Prompt infection control measures led to no secondary cases in 40 exposed healthcare workers. We hope that this outbreak remains as mild but #Covid is the rotten apple ctd)

56/n when we look at the Congo outbreak of 2013, The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%.Mean incubation period was 8 days (range 4-14 ) , we can currently only hope to see mild one .ctd)

57/n So the @BNODesk says 94 confirmed cases currently and around 170 total ( confirm+ suspected ) the number is increasing & the germans said that it is doable to stop it " Now " provided we act " immediately- Agree 100% ctd)

58/n Sweden considering restrictions for people infected or exposed to monkeypox, including telling them to not have sex - Expressen @BNODesk
Did the Swedes consider restrictions to sex during #Covid19 @itosettiMD_MBA ?? , @GANyborg ?? If not what made them change ??
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59) The epidemiological data states that it was introduced into networks late April , bigger issue is for instance, the case in Belgium was initially only tested for HSV & Syphilis. Upon international alerts was then tested for MXP. We need to alert physician networks.ctd)

60/n So if we think it is the Nigerian clad what should we expect - 1) Young males involved 2)Immunocompromised at risk
3) Seemingly multiple non connected cases / events , the 61/n episode of LGBT congregation may be chance association ctd)

@EnemyInAState @Tuliodna @abbashu @emilygraymd_mph @LeonardiBot @brucearonow @RickABright @DmodosCutter @arimoin @LSHTM_CEPR 61/n In an interesting to be published paper from Fred Hutch Centre seemingly the #MonkeyPox will not be defenceless when it encounters either drugs or heightened immunity , it will develop genetic changes like 53/n above. So we need to evolve just as the virus is ctd)

62/n The CDC grudgingly accepted that #monkeypox can be caused by airborne transmission & also said that such patients should be ideally in a negative pressure room , for many of us it is baby steps BUT CDC took months in accepting the same for #Covid so 🦘leap ctd)

63/n many of us were stunned by the UK tendency to downplay the risk ,the Advisory Committee on dangerous pathogens has #monkeypox in group 3 ie can cause severe human disease BUT ...??
@BinitaKane ,@dgurdasani1 ,@LC_UK_Action , @CarolineLea13 ,@fact_covid ,@EnemyInAState ctd)

64/n seemingly there have been some heartburns caused by use of pictures of #monkeypox in the media ctd)

65/n In the last 1 week the number of #monkeypox pox cases seen outside #Africa is higher than the sum of the cases seen outside Africa in last 50 years,its multi centric, multi continental and thanks to Covid19 seems to be on path of firmly entrenching across the globe 😢
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66/n From CDC , Small pox Info updated 2017, droplets , spread through shared objects & scabs BUT even then they accepted #airborne spread , now they have to ( 62/n) because of much greater understanding & aerosol experts like @kprather88 ,@CorsIAQ & so many else #N95 ,#mask ctd)

67/n Small pox doesn't have animal hosts,#monkeypox does & will become impossible to eradicate, US vaccinated everyone against small pox in 1949 , can western world repeat that ?, I doubt .Indian experience in small pox showed 80% vaxxed not enough, Nigerian showed 90% isn't ctd

68/n It took 30 years after #smallpox was removed from US to be removed from across the world .And it has been said again & again that Small Pox eradication is not victory of medicine BUT management HOWEVER can we be confident now based on how #Covid19 has wrecked havoc ?? Ctd)

69/n It again took 32 years for #Polio to be eradicated from the Globe after the US eradicated it BUT with #Covid US couldn't vaccinate a lot of people .Currently 33% of US population is still not fully vaccinated ( 2 dose ), what will happen with #monkeypox. Ctd)

70/n #prevention is better than cure .Having said that wherever in the world you are , if you've read this thread & like it kindly share .Request your government to act fast & decisively to prevent another problem , the chance is now !!. Will update tomorrow 🙏Let's prevent 🙏