Thread by @WesElyMD

1/🧵 MonkeyPox, ChickenPox, SmallPox:

Let’s talk poxpoxpox…
 
✔️#MonkeyPox has 4 deaths
✔️Is it a panedmic?
✔️What do you need to know?
✔️Here are key take homes
 
JAMA -bit.ly/3S6IKs9

2/ Many people are holding off calling #MonkeyPox a pandemic.
 
Epidemics that “get passports” travel.
 
Mpox seems to have a global passport.
 
Sustained spread in >80 countries seems likely.
 
bit.ly/3ShYQzf

3/ The window for controlling Mpox is closing - eternal optimists are hoping enough vaccination can beat it.
 
Judging by how we handled #COVID, I’m betting Mpox will win.
 
@DrEricDing @kavitapmd make great points:

wapo.st/3NSdGcr

4/ This is generally a self-limiting 2-4 week illness…

BUT 4 fatalities from escalating #monkeypox outbreak are confirmed in the past week: 2 Spain, 1 India & 1 Brazil.
 
Let’s break the situation down…
 
wb.md/3Sg68nf

5/ You get Mpox from close skin-to-skin contact.

Large outdoor events rubbing against someone w skin lesions? You got MonkeyPox.

If you’re distanced, you won’t.

You can get it from contaminated bed sheets. Pick a hotel that changes sheets!

Capeesh?
 
bit.ly/3BBg6cI

6/ Importantly, it’s not an STD, though many people are presenting with the vesicles and pustules of MonkeyPox in their genital and perianal region.

Why?

Sex is a high risk skin-to-skin activity. So be careful out there.
 
bit.ly/3vBhXuy

7/ People present w rash and fever (usually). There are medical reports of folks being misdiagnosed w ChickenPox.

The main difference is MPox has more lymph node swelling.

Painful large nodes in a region w rash & fever = you probably have MonkeyPox.  
 
bit.ly/3JoUSRm

8/ Read @JAMA_current👇

Traditionally, you aren’t contagious until you have symptoms (see next tweet).

In COVID you can spread to others without knowing it (hint: wear mask indoors).

Once sick w rash, strict isolation prevents you from injuring others.

cle.clinic/3PVWMeD

9/ Asymptomatic Spread has been reported. 3 of 224 men with positive anorectal Mpox PCRs all denied having any symptoms in this recent report. Close contact with asymptomatic infected people may be possible but rare.
 
MedRx link - bit.ly/3BBUH3f

https://twitter.com/drericding/status/1554058255869132802

10/ Analysis of 528 cases in 16 countries found MPox DNA was found in seminal fluid of 29 of 32 pts (91%).

You have potential transmission wherever there is infected body fluid, mucous membranes, cuts or scratches.
 
bit.ly/3Qcg92L

11/ Public health communication needs to be specific and non-stigmatizing.

High risk communities need to recognize & seek care for MPox symptoms to reduce transmission risk, for example, during sex and other skin-to-skin encounters.
 
n.pr/3bvmiIF

12/ To destigmatize this illness, @WHO & @CDCgov & other global leaders are considering changing the name.

Some have discussed that changes in the genetic makeup of this outbreak virus & transmission patterns argue for calling it a new virus.

bit.ly/3JrG0la

13/ Vaccines

ChickenPox is Varicella & chicken pox vaccine doesn’t help w MPox.

I’m old so I got a #SmallPox vax. When we eliminated SPox in 1972, that program dissolved.

They are both orthopox, so Spox vaxx might help, but immunity may have waned.
 
bit.ly/3cZUZXg

14/ MPox Treatment:

We need rigorous trials. Until now that was impossible, but we now have plenty of pts to enroll (>20,000 cases & rising).

2 antiviral meds against Orthopox: tecovirimat & brincidofovir for sick folks.

Overuse may lead to resistance.

bit.ly/3ONi2Sw

15/ There are 3 current PHEICs (Public Health Emergency of International Concern): COVID, Polio (case recently in NY) & MonkeyPox.

Mpox meets all the PHEIC. It’ll likely be entrenched soon. We have people within a mile of me w this virus. How ‘bout you?

bit.ly/3oRiZyJ

16/fin
Call to Action:

<=10% of Mpox patients need hospitalization. But it can be fatal.

The @WHO & @CDCgov are hopefully developing global action plans for rolling out #vaccines, studying medications, and educating society to help contain this “pandemic.”

Stay safe, please.

Mask science…👇💥

https://twitter.com/weselymd/status/1484597211803668480

ID experts are conservative in not calling #Mpox a pandemic.

#Inevitable

They’re waiting for traditional “sustained” rise in epidemic areas.

When we wait too long, we get behind an “irrecoverable eight ball.”

This ain’t COVID, but it’s so serious.

cnn.it/3oPw5wa