UPDATE IN INFECTIOUS DISEASES: Asked to give update in all infectious diseases (!) for UCSF COVID town hall yesterday. Couldn't do talk justice in 10 minutes but here are 4 main updates in slides #Monkeypox outbreak epidemiology.
Major #HIV update is how far behind we have fallen in terms of HIV prevention and treatment goals over past 2 years of #COVID. UNAIDS report unaids.org/en/resources/d…
Much work to do for #HIV
Major #polio update is this infection could be eradicated as only animal reservoir is other primates but we have had setbacks due to backsliding in childhood vaccination rates during #covid
Here are some clinical features of #polio to remember; dreaded symptoms are paralytic and rare but can occur among those without vaccination
And finally #measles- very sad that 157 unvaccinated children died in Zimbabwe from a large measles outbreak (all unvaccinated; we have fallen behind)
Some important medical facts about #measles and the current vaccines and symptoms
WHAT TO DO? #HIV no vaccine yet (mRNA vaccine in trials now); HIV treatment & prevention must be disseminated more equitably worldwide. Monkeypox, polio, measles all have vaccines & must address modifiable risk factors for low rates (e.g. more production Jynneos, restore trust)
"Many called, few chosen" for POLIO, looks like it has been circulating in wastewater longer than thought in NYC but one case of paralytic polio in an unvaccinated young person in Rockland means solution is vaccination; prevents disease (not all spread) cdc.gov/mmwr/volumes/7…
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MISINFORMATION on Twitter that spreads hysteria & is inaccurate can be dangerous for public's mental health. Epidemiology of this particular monkeypox outbreak among gay men quite clear at this point; also global endemic outbreaks in West/Central Africa, need vaccine equity
To really "get" monkeypox, we have to vaccinate those at risk in this particular outbreak (gay men) but also areas in West and Central Africa where "endemic" outbreaks have been occurring for years, most often over the past decade
Endemic and nonendemic outbreaks treated the same- providing populations at risk immunity
70% of hospitalizations for COVID now incidental per state recording best- Massachusetts. Not distinguishing severe disease actually due to COVID from incidental positive swabs (hospitals swab all admits) make vaccination & immunity seem less effective; media questions immunity
Immunity is not just antibodies (which will wane with time since last exposure or booster) but T and B cell immunity; this is why 2022 is so different than 2020 in terms of immunity to this now not-so-novel coronavirus. B/T cells explained here
T cell thread here; seem durable which is why US healthcare system should avoid misclassifying hospitalizations as for versus with COVID in order to reassure public of the power of the immune system
LANGYA HENIPAVIRUS (LayV): A family of viruses have been classified in the genus called “henipavirus”; these are RNA viruses which occasionally cause illness in humans and cross over into humans from animals such as bats or pigs. For example, NIPAH virus who.int/news-room/fact…
and was first identified in 1999 in Malaysia after causing symptoms such as fevers, pneumonia and encephalitis (brain inflammation). Outbreaks have occurred ever since, seem to be most closely related to fruit bat exposure, and most commonly occur in Bangladesh. There is no cure
& mortality can range from 40-75%. The 2nd virus in this family is called HENDRA virus & also carried to humans by the fruit bat; known to cause severe disease in humans and horses with a high mortality rate. Now new virus in this family just identified who.int/health-topics/…
Breakthrough infection by SARS-CoV-2 Delta and Omicron variants elicited immune response comparable to mRNA booster vaccination academic.oup.com/jid/advance-ar…
Adds to other studies showing an infection after vaccination serves as a booster of the immune response (of antibodies, T and B cells) like this one from Yale and others in the thread below: mdlinx.com/news/booster-a…
Other studies here:
T CELLS: In fact, this important paper shows that any exposure (breakthrough infection) or any booster after vaccination actually broadens and diversifies the T cell memory repertoire (e.g. expands your immune response). nature.com/articles/s4159…
UK also has good data #monkeypox. With limited US vax supply, would 1) hold for now in those who had smallpox vax (<1970 born); 3) target those w/ multiple sex partners; 4) Give 1 dose for now (like urged with limited COVID vax at start); 4) Boost supply
US apparently rejected Jynneos doses from Denmark since FDA didn't inspect but EU did & says high quality- would trust EU CDC-very good!
Beyond strategies above, here is a background on monkeypox:
BA4/BA5 SUBVARIANTS: 2-dose Pfizer vaccine 87% protective against hospitalizations with these 2 subvariants in large S. Africa study. High protection against severe disease across variants/subvariants is due to cellular immunity (B/T cells) discussed often bloomberg.com/news/articles/…
Natural infection pre-Omicron also provides strong protection against severe disease & death (97.3%) from circulating Omicron subvariants like BA4/BA5. Despite multiple mutations across spike protein in subvariants, T cells still cover multiple epitopes medrxiv.org/content/10.110…
T cells (prevent severe disease) line up across spike protein on multiple parts or "epitopes"; even with >32 mutations across spike protein with Omicron, still have >60 T cells from vaccine on spike. BA4/BA5 booster ready by Oct to prevent mild infections investors.biontech.de/news-releases/…