Thread by @PeopleDocGeneva

Aerosol spread is possible, not confirmed. Please review transmission statement in WHO clinical /IPC guidance for #monkeypox. Much we still don’t know so provide data if you have it. There is early information coming out about different modes of transmission during this outbreak

https://twitter.com/johnjohnstoned/status/1548673873230831621

who.int/publications/i…

2.5 Transmission and viral shedding
Despite decades of circulation in animals with spread to humans, there are limited data available describing transmission and viral shedding of monkeypox

Available info supports that transmission can occur from animal to human, human to human and from contaminated environments to humans To date, most information is from countries in West and Central Africa and less from other WHO regions with limited info from Europe and the US

Human-to-human transmission can occur through contact with infectious skin or mucocutaneous lesions, this includes face-to-face, skin-to-skin, mouth-to-mouth or mouth-to-skin contact and respiratory droplets (and possibly short-range aerosols)

The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular and genital), or via the respiratory tract. Generally patients are infectious until skin lesions have crusted, the scabs have fallen off and a fresh layer of skin has formed

Transmission can also occur from the environment to humans from contaminated clothing or linens that have infectious skin particles (fomite transmission) If shaken, these particles containing virus can disperse into the air and be inhaled, land on broken skin or mucosal membranes

Persistence of other orthopoxviruses in the environment and on different surfaces has been found to last days depending on room temperature and humidity; New studies are finding DNA on surfaces in patient rooms - what this means for transmission still needs to be worked out.

#monkeypox skin scabs contain significant quantities of viral DNA, until and including when they fall off, which are higher than the levels found in the blood and throat. New studies are finding high levels of viral DNA in a wide range of body fluids/ clinical specimens.

More information is needed to better understand modes of transmission via contact with other bodily fluids (such as breastmilk, semen, vaginal fluid, amniotic fluid or blood) and to better understand transmission by respiratory droplets and aerosols

In the current outbreak, spread appears to be occurring primarily through physical and sexual contact. Whether virus is transmitted through semen is not known but wouldn’t be surprising, may also help explain the higher % of women affected where the disease has been around longer

It has long been known that sub-clinical monkeypox virus infection occurs- in a 1988 study, 28% of unvaccinated close (mostly household) contacts had antibodies in the absence of symptoms or signs of disease. New studies also suggest that people may be infected without knowing it

We still don’t know whether persons without symptoms (fever, rash, swollen lymph nodes, backache) can transmit the virus to others. However someone can have lesions full of virus beginning in the mouth so it makes sense that spread can occur by droplets/aerosols or by oral sex.

So yes WHO has advised that persons taking care of someone with #monkeypox should wear a respirator mask such as N95 or FFP2 as a precaution to protect themselves.
Also recommended for patients is to wear condoms after recovery until we know more about where virus may linger…

Never hesitate to ask for more information about #monkeypox even if it is the same question repeatedly as others will want to hear the answers that science can so far provide. Thanks for your interest and engagement on this with @WHO @WHO_Europe @pahowho

Thnx for appreciating that at the risk of being criticised for inconstancy, @WHO will continue to evolve information along with the science as best we can. Please do share your data as well. Please help us get out messages that will help people protect themselves from #MPX.

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