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Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
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Jun 30 • 5 tweets • 2 min read
1/ Right now, #monkeypox is spreading actively among men who have sex with men (gay & bisexual men) & trans women.

But it's only a matter of time before we see spread among women.
2/ As of June 30th, the European CDC had reported 15 EU cases of monkeypox among women.
monkeypoxreport.ecdc.europa.eu/#demographics

The @CDCgov still isn't reporting that breakdown for the US.
3/ How is monkeypox transmitted?
🔹Direct contact with monkeypox lesions, which could be anywhere on the skin & in/or around the mouth, genitalia or anus
🔹Respiratory droplets or "sprays"
🔹Contact with contaminated objects (e.g. towels, bedsheets)
4/ You can reduce your risk of infection/transmission by using condoms & dental dams, but that only protect against transmission between covered surfaces.
5/ There is a vaccine for monkeypox.

More on that on last night's @CBSEveningNews:

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 30
1/ In WV v @EPA, SCOTUS ruled to limit the EPA's ability to regulate carbon emissions from power plants.

This seems to curtail EPA’s ability to regulate the energy sector, limiting it to measures like emission controls at individual power plants.

nytimes.com/live/2022/06/3…
2/ Unless Congress acts, the US will miss its climate change targets.

Why does this matter for health?

The ruling may limit power of all federal agencies to pass regulations, including the @CDCgov @US_FDA @OSHA_DOL etc based on the “major questions doctrine.”
3/ Congress would have to “speak with particular clarity when it authorizes executive agencies to address major political and economic questions."

This could, for example, curb CDC & OSHA's powers to protect the public's health in a pandemic.
Read 50 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 30
1/ What's ahead for COVID vaccines?

with @CBSNews @CBSMornings' @GayleKing @nateburleson @vladduthiersCBS
2/ Yes, some people have gotten 2 boosters, a total of 4 doses of vaccine.

But the SARS-CoV-2 virus keeps mutating.

To keep up, we need to update our vaccines to better match the currently circulating variants.

Omicron BA.4/BA.5 is on the rise across the country.
3/ Omicron was a gamechanger.

Our current COVID vaccines did a good job of protecting people against prior variants like Alpha & Delta.

But with Omicron, & each subsequent subvariant of Omicron (BA.2.12.1, BA4, BA.5), we've seen our vaccines become less & less protective.
Read 7 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 30
1/ Some thoughts on yesterday's @US_FDA VRBPAC meeting.

How much is "waning immunity" time since vaccination
vs the emergence of new variants (e.g. BA.2.12.1), which are immune-evading?

Immune evasion seems to be the big factor driving⬇️protection against hospitalization.
2/ I think the emergence of immune-evasive SARS-CoV-2 variants will drive our need for future boosters:
3/ So does this mean we should update our vaccines to better match the current SARS-CoV-2 variants?

It seems like that might be a good idea, with some caveats:
statnews.com/2022/06/29/fda…
Read 32 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 29
1/ The Biden administration is speeding up testing for #monkeypox & rushing 56K Jynneos vaccine doses to areas where the virus is spreading most quickly.
with @CBSNews @CBSEveningNews' @NorahODonnell
2/ We haven't moved nearly fast enough.

We've known about monkeypox cases in the US since May.

You can't control an outbreak if you don't know the scale of the problem.
3/ We should have ramped up education & access to testing a couple weeks ago, & when we realized that monkeypox was spreading, we should have deployed our vaccines more quickly & broadly, not only for close contacts of monkeypox cases, but also others known to be at high-risk.
Read 7 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 29
1/ Indigenous people in the US continue to fight for sovereignty.

Sovereignty over their lands:
Today, the Supreme Court ruled that states could prosecute non-Natives who commit crimes against indigenous people on reservations.
supremecourt.gov/opinions/21pdf…
2/ This decision highlights the precarious nature of Indigenous sovereignty in the US.

"To begin with, the Constitution allows a State to exercise jurisdiction in Indian country. Indian country is part of the State, not separate from the State," wrote Justice Brett Kavanaugh.
3/ "To be sure, under this Court's precedents, federal law may preempt that state jurisdiction in certain circumstances. But otherwise, as a matter of sovereignty, a State has jurisdiction over all of its territory, including Indian country," wrote Justice Brett Kavanaugh.
Read 5 tweets
Céline Gounder, MD, ScM, FIDSA 🇺🇦 Profile picture
Jun 28
1/ What's the US plan on monkeypox?

In summary:
🔹to expand vaccination for individuals at risk
🔹to make testing more convenient for healthcare providers and patients across the country
2/ @ASPRgov will make available:
🔹56K doses of Jynneos vaccine immediately
🔹240K more doses of Jynneos in the coming weeks
🔹750K more doses of Jynneos this summer
🔹500K more doses of Jynneos this fall

FOR A GRAND TOTAL OF: 1.6M doses of Jynneos vaccine
3/ The Jynneos vaccine will be allocated to jurisdictions based on the basis of their reported monkeypox case rates.

So if a jurisdiction is under testing, they won’t get the Jynneos supply they need.

It’ll be important to scale up monkeypox testing.
Read 16 tweets

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