Thread by @Rpshahmemorial1

Top 100 updates about #MonkeyPox & why I think it has become the biggest outbreak in the last 50 years outside Africa , the earlier 70 are here

https://twitter.com/Rpshahmemorial1/status/1528046339384569856?s=20&t=3tsVsFyBnyYMVz37fpc3Sw

And I will start after 70 now in the thread below

71/n Biden finally comments on monkeypox , saying: "It's something that everybody should be concerned about."😢😢. So there is definitely more than we know , it is not everyday that the President comments on stuff. Ctd)

72/n A child has been rushed to the intensive care unit of a London hospital after they were diagnosed with monkeypox, as per reports. 😢😢 ctd)

73/n According to WHO, more cases of #monkeypox are expected to emerge globally.We arent surprised😢, the next month is going to be important whether we can contact trace & ring vaccinate all that we see , else it will surely become endemic globally ,dont see the urge ctd)

74/n UKHSA has provided/updated guidance on case defs, vaccination and contact tracing/management . Links now added to monkeypox guidance page ctd)

75/n Belgium become first country to introduce compulsory monkeypox quarantine: Anyone testing positive must isolate for 21 days as 14 countries now confirm outbreaks. Ctd)

76/n According to WHO, Monkeypox is may be severe in children, pregnant women or persons with immune suppression. West African clade appear to cause less severe disease compared to the Congo Basin clade, with a case fatality rate of 3.6% compared to 10.6% for the Congo .ctd)

77/n Interestingly the CDC updated its information for Vets , wanting suspected animals not to mix with normal animals in clinics & acceptance of #airborne spread ctd)

78/n They also updated to say that rodents are suspected 🤔 as reservoir hosts BUT haven't been confirmed as many times as we would all have wanted , so the reservoir jury is still out ctd)

79/n Issuing an alert to the National Centre for Disease Control (NCDC) and Indian Council of Medical Research (ICMR), Government India has asked them to send samples of symptomatic travellers to the National Institute of Virology (NIV) in Pune ctd)

80/n WHO starts to officially report on the outbreak forming a dashboard , @medriva has some competition but they have done a great job , consider donating to them 🙏🙏. Ctd)
who.int/emergencies/di…

@medriva 81/n @BNODesk tracker shows close to 200 cases - 108 confirmed in 15 countries, the number is slowly increasing. 🤞🏾🤞🏾ctd)

@medriva @BNODesk 82/n Interestingly genome of #monkeypox is 200,000 bases compared to #SARSCoV2 30,000 bases .Genome sizes vary enormously, variation in DNA content correlates with effective population size, suggesting that deleterious changes to genome can accumulate in small populations ctd)

83/n However Pox virus are little different than other DNA viruses since they can multiply in the cytoplasm instead of the nucleus & are pretty generalists, this generalism allows them to use multiple ways to infect the host &multiple hosts & develop ways to escape immunity ctd)

84/n While this is thread for #monkeypox I am taking liberty and adding a note about #AshaWorkers , why because they exemplify how community can be mobilized against Covid in India & we need them against #monkeypox as well

https://twitter.com/Rpshahmemorial1/status/1528443416107155456?s=20&t=TsH1RwrovxsfzQ_Ozn8s1Q

Ctd)

85/n WHO released a new guidance document , what I find strange is asymptomatic contacts can continue going to school / work - That concerns me a little - Agreed that this is not Covid but till we know more , precautionary principle apply . Thank you @emilygraymd_mph ctd)

@emilygraymd_mph 86/n The
@ECDC_EU
warns that #monkeypox could become endemic in Europe if the current outbreak continues and the virus spills back into susceptible animals as more than 20 countries have by now reported cases , we are heading towards multiple concurrent pandemics #covid19 ctd)

87/n Following the 1st sequencing Portugal adds 9 more as does US of one case The multi-country outbreak likely has single origin, the virus TILL NOW belongs to the West African clade & is most closely related to viruses associated with the exportation from Nigeria in 2018 ctd)

88/n Still, the outbreak virus diverges a mean of 50 SNPs from those 2018-2019 viruses which is far more than one would expect considering the estimated substitution rate & one cannot discard the hypothesis that the divergent branch results from an evolutionary jump ctd)

89/n The first signs of microevolution within the cluster, leading to 3 descendant branches have been found .Gene loss events were already observed in Africa being hypothesized to correlate with human-to-human transmission ctd)

90/n EU health chiefs tell nations to prepare vaccination strategies amid scramble to comtain - as Denmark becomes 16th country to be struck down & Boris Johnson reveals UK is 'keeping an eye' on outbreak - Daily Mail . This seems in line of 86/n & ring vaccination Ctd)

91/n update

https://twitter.com/P_McCulloughMD/status/1528726829397422082?s=20&t=PbWgf4igRZbSWUl5Jjbd-Q

92/n Just like #Covid19 there is now open source data sharing on sequencing for #monkeypox. That is a great step ctd)

https://twitter.com/nextstrain/status/1528466157723713536?s=20&t=B2fbkr07YAaR9NBKFyPLzg

93/n @StephenAkar has a pertinent question that even in Nigeria from where the clade has arrived they haven't seen this type of outbreak where the virus easily spills from ecological niche populations- We think it's due to immunosuppression d/t #Covid & the virus is changing.ctd)

94/n The UK Health Security Agency (UKHSA) has detected 36 additional cases of monkeypox in England, bringing total number of cases in England since 7 May to 56. First case also confirmed in Scotland today.Its spreading ..😢ctd)

95/n This is an interesting study of admitted patients #monkeypox in Nigeria - just like this time young men are more involved , develop worser rashes if they have HIV or immunosuppression. Ctd)
doi.org/10.1093/cid/ci…

96/n My concern is that #covid and #monkeypox co- circulate ,close to 40% -50% of patients will have cough,cold , nausea ,sore throat and fever though thankfully( for clinical diagnosis) or unfortunately ( for patients) the lesions are more on face & 90% + can be on face ctd)

97/n At least in this study 50% of the admitted showed some or the other complications and a quarter developed anxiety and depression due to facial scarring ctd)

98/n This is a great thread on increased number of deaths in children which were erroneously put to chicken pox while it was allegedly #monkeypox, also opportunistic bacteria's in kids ctd)

https://twitter.com/EnemyInAState/status/1528523515514826753?s=20&t=tOGUMbobjGUIg9bWJWOcmQ

99/n The most important part of the story is that the Greeks were considering #airborne while transferring patients in vacuum closed chambers while ..ctd?)

100/n While there is published literature showing that #monkeypox is most commonly mislabeled as chickenpox in Congo, if it spreads across the globe there is a fair chance it will be globally as well especially in # GlobalSouth.
We end today's updates , more tomorrow 🙏