Thread by @Rpshahmemorial1

After top 100 updates we will put the top 120 updates , we will start with a thread of top 100 & then move along .

https://twitter.com/Rpshahmemorial1/status/1528352416185597952?s=20&t=tgUf07q3YAFXwTuytXLEQQ

It is a concerning since we may end up seeing either multiple pandemics together or relay race as new organisms try jump into humans ctd)

101/n Whie people like all of us were fighting #Covid , #Hepatitis in kids we all missed how 1284 people got #monkeypox with lethality of 4.5 % ctd)

102/n Interesting paper on efficacy of soaps shows that 1 min hand washing to be effective in cell free virus but not as much in intracellular virus doi.org/10.1016/S0166-…
Ctd)

103/n While the question is great I think we are benefiting by - better media attention & better diagnosis because sequencing data shows so BUT the host issues caused by #Covid19 is a question that can put a spanner into the idea ctd)

104/n cautious BUT very active - 1) Immeditate quarantine of all at risk 2) #Ring vaccination of the contacts 3) creating international coordination to get vaccine doses to everyone exposed 4) creating media attention 5) informing HCW 6) masking @DrEricDing @CT_Bergstrom ctd)

105/n In the US, the two-dose live Jynneos vaccine is licensed to prevent monkeypox, they have over 1,000 doses of that available, and expect that level to ramp up very quickly in the coming weeks as the company provides more doses BUT that's 500 cases ONLY ctd)

106/n There is another smallpox vaccine licensed in the US, ACAM2000, that could be used to prevent monkeypox, and US has more than 100 million doses.ACAM2000 is an older-generation smallpox vaccine that has some potential significant side effects with it. Ctd)

107) So what happens in the next few weeks is very important as companies ramp up production, but we can land up in soup at 2 scenarios a) we allow the virus to establish animal niches BEFORE we can break the chain by vaccines b) we fail to apply vaccine + strategy ctd)

108/n There have been questions asked about why the WHO has not supported isolation now when they supported it earlier . One reason given was CFR is higher in Congo clade BUT ctd) ttps://twitter.com/baconsauerkraut/status/1528818733686239232?s=20&t=lo2jMxuzTIf7SUjLObYFcQ

109/n We need to realize that the huge population base may end up to cause more deaths . 1% of 300 million may be more than 6% of smaller population at risk ctd)

110/n @CBroendsholmA & @itosettiMD_MBA correctly call out the @SSTSundhed for misinformation, #monkeypox is NOT HIV , it can still spread through #aerosols and close contact. We need to get the messaging right ctd)

@CBroendsholmA @itosettiMD_MBA @SSTSundhed 111/n While the divergence is not enough to find huge mutation into new form there is impression that these SNP's are small changes which accumulate to allow enough changes in the virus to adapt.

https://twitter.com/RolandBakerIII/status/1528839273859932161?s=20&t=NiiOOf6Uc3y8HVIIDQEx8g

@CBroendsholmA @itosettiMD_MBA @SSTSundhed 112/n @vmuecke_k posted how couple of weeks ago nobody thought of #monkeypox when a lesion like this presented in University Hospital. Even in Congo the misdiagnosis was 50% helping all health care workers * & general public know what to look for is very important .Ctd)

@CBroendsholmA @itosettiMD_MBA @SSTSundhed @vmuecke_k 113/n In 1949 the last case of small pox was found in US , that means only 72 yr + will have been vaccinated/ exposed , that leaves a large population at risk , @RolandBakerIII has posted 21% , even cross Immunity to others pox viruses may not help. ctd)

114/n )At 3/n & 4/n we discussed how #COVID19 is suppressing T cell responses along with hypocomplementemia causing immunocompromised status, now we know that #monkeypox is able to hide from T cells & suppress recognition @fitterhappierAJ
doi: 10.1073/pnas.0800589105.

115/n In 12/n modeling study from Congo showed R0 of 2 @fitterhappierAJ is quoting the R0 of the Nigerian clade HOWEVER we both agree that the T cell depression may cause this to change , let me remind of #mucor outbreak in India during #Delta wave ctd)

https://twitter.com/fitterhappierAJ/status/1528563163884572674?s=20&t=KawONs8M8V9dwXNxAxTUPg

116/n The NHS website warns people from eating meat , have we accepted that it has spilled over to animals ??🤔🤔. Fairly possible if the disease spreads , at least that happens in Africa @G_LaryeaAdjei , @AshleyGWinter ,@arimoin ,@medriva ,@LeonardiBot ,@EnemyInAState

@G_LaryeaAdjei @AshleyGWinter @arimoin @medriva @LeonardiBot @EnemyInAState @emilygraymd_mph @StephenAkar @UCSF_ID @KindrachukJason @joshmcgoo @KunstJonas @NjbBari3 118/n Should the NHS have sounded the alarm or its fearmongering , apparently not because #poxvirus can be spread even being in the same room as Animals #airborne, #MonkeyPoxIsAirborne and we know this for long
doi.org/10.1086/505880

119/n @AndrewALover has put a good thread from old history BUT the important point here is that 18% patients may go asymptomatic, they will therefore lead to poorer detection rate & progression of the disease .

120/n Over 200 people being monitored for monkeypox in Massachusetts , USA from the 1st patient , most of them health care workers who inadvertently came in contact BUT also relatives & friends reports NYT .

121/n For my Australian friends where mass smallpox vaccination was never used and only an estimated 10% of Australians have been vaccinated, that too most above 70 yrs age . All in all Australia may see a bigger outbreak since it may possibly have lesser protection 😢😢 ctd)