Thread by @_ppmv

1. The real risk of #SARS Let'er R.I.P (Re-Infection Policy) is positive feedback on pathogens OTHER than SARS-CoV. Take #Mpox.

What is remarkable about this cluster in Taiwan, other than it not being in WHO statistics (Taiwan being no member state)? nidss.cdc.gov.tw/en/nndss/disea…

https://twitter.com/RealCheckMarker/status/1577974755575177224

2. "Wear a mask and seek medical attention immediately"

WOULD you LOOK at THAT! Taiwan CDC recommends N95 for #Mpox! Almost like the virus is airborne*

* given respiratory symptoms and systemic disease, OF COURSE it is

based,
very science based scicomm health-epsh.ncku.edu.tw/p/406-1097-251…

3. Taiwan reports 132 deaths, WHO only 120.

I'll share some literature next, when I find time; we volunteer ours after all.

Extending Let 'er R.I.P. (Reinfection Policy) from coronaviruses to poxviruses is quite the gamble.

cdc.gov.tw/TravelEpidemic…
worldhealthorg.shinyapps.io/mpx_global/

4. I'll cover all the bases.

https://twitter.com/_ppmv/status/1622552666374082562

5. Advanced epidemiological remarks by @RealCheckMarker. She says 'starter point' but that's really expert talk already:

https://twitter.com/RealCheckMarker/status/1648745293888749568

@RealCheckMarker 6. As soon as 90 days after #Mpox infection, reinfection is possible. Even vaccinated individuals can be infected. Thus, WHO's warning is vital: states should include Mpox testing, vaxx and treatment in other health services such as for HIV and other STIs.

https://twitter.com/WHO/status/1648241707077582848

7. There's so much trash information out nowadays that can steal your health, or degrade society unethically. Pls focus.

@jmcrookston reminds us, always read the animal studies.

As system dynamicist or political scientist, I add, always read the patents.

https://twitter.com/_ppmv/status/1572892185174974464

8. SARS-CoV-2, a ssRNA virus, neatly packaged its 29 proteins into as few as 30,000 nucleotides.

Mpox (hMPXV), a linear DNA virus, encodes ~190 ORFs in its ~197,000 nucleotide genome.

Smallpox (variola virus, VARV) is the smallest of poxviruses (186 kb).

https://twitter.com/_ppmv/status/1572885565237870594

9. Some references in no particular order. "Evolution, epidemiology, geographical distribution, and mutational landscape of newly emerging monkeypox virus" - the titles all sound the same lol link.springer.com/article/10.100…

10. Monkeypox virus: phylogenomics, host–pathogen interactome and mutational cascade microbiologyresearch.org/content/journa…

"Proteins E3 and CrmB revealed potential disruption of stability due to certain mutations. We identified a large number of mutations within the new outbreak clade. We need to move fast with the genomic analysis of newly detected strains for better prevention & treatment methods."

Mpox now follows SARS-CoV-2 to become a global challenge to humans. Said @LaurentAFKaiser poetically, Les cas de #variole dite du singe signent l’expansion d’un cousin de la variole originale que l’homme avait mis 200 ans à éliminer.

We have no 200 years.

https://twitter.com/LaurentAFKaiser/status/1554075905781293062

11. Evolutionary dissection of monkeypox virus: Positive Darwinian selection drives the adaptation of virus-host interaction proteins pubmed.ncbi.nlm.nih.gov/36710983/

12. HIV, SARS-CoV, MPXV: viral nucleic acid editing, a cellular defense mechanism mediated through protein families apolipoprotein-B mRNA-editing complex (APOBEC), ties these three viruses together. I'm not qualified to explain this stuff. very relevant.
sciencedirect.com/science/articl…

13. For such questions @RolandBakerIII is a good follow, keeping a keen eye on Mpox's next moves.

https://twitter.com/RolandBakerIII/status/1601594049739182081

14. Airborne. - Or, more precisely, you can't exclude it being airborne. Hence N95 for patients and healthcare workers. onlinelibrary.wiley.com/doi/full/10.10…

15. Mpox drug overview onlinelibrary.wiley.com/doi/full/10.10…

16. Breakthrough infections journalofinfection.com/article/S0163-…

17. Monkeypox, a Literature Review: What Is New and Where Does This concerning Virus Come From? mdpi.com/1999-4915/14/9…

18. Overview sciencedirect.com/science/articl…

19. Genomic annotation and molecular evolution of monkeypoxvirus outbreak in 2022 onlinelibrary.wiley.com/doi/full/10.10…

20. Virulence differences of mpox (monkeypox) virus clades I, IIa, and IIb.1 in a small animal model

Clade IIb.1 may be evolving for diminished virulence or adapting to other species. pnas.org/doi/abs/10.107…

21. Animal host range of mpox virus onlinelibrary.wiley.com/doi/full/10.10…

22. Can Acanthamoeba Harbor Monkeypox Virus? - No thanks 🥴 mdpi.com/2076-2607/11/4…

23. Ten new #Mpox deaths in a week globally, and in Taiwan 52 cases since the Mpox PHEIC. That's far above WHO member state average. - Good to be cautious; Japan has several new cases too.

https://twitter.com/tadanokusaibba/status/1651205501802393600

24. Taiwan is reports 3-4 Mpox infections per week on average in 2023 (not included in WHO statistics). You may guess how many cases go unreported in WHO member states that test and report less diligently. More interesting here: reinfections within months! thelancet.com/journals/lanin…

25. Branding monkeypox as gay disease, and hMPX virus as STI that is not airborne, was genius.

Evil but, I admit, ingenious. We should all change to the dark side just to confuse them, that would be unanticipated...

...if we had no ethics and conscience.

https://twitter.com/RealCheckMarker/status/1556594878699667456

26. This is my weekly reminder that orthopoxviruses, smallpox and monkeypox virus, are airborne. Not efficiently so (yet); perhaps they require a large viral load to mount infection? (Unprotected oral sex will help too) See, even the White House tells you!

https://twitter.com/RealCheckMarker/status/1555643599215161344

27. Here the difference between competent expert-led and politics-driven organizations. Taiwan CDC recommends #Mpox patients to wear N95 masks because they know poxviruses are respiratory viruses (airborne or droplet transmission). @HealthNYGov take note.

https://twitter.com/_ppmv/status/1648769011771924497

28. Human monkeypox (hMPX) virus has taken an Asian turn. Most recorded cases now are in Taiwan, Brazil, and the Western Pacific and South-East Asia region. Poxvirus experts are not amused.

worldhealthorg.shinyapps.io/mpx_global/
nidss.cdc.gov.tw/en/nndss/disea…

29. Daniel Kaufmann & @LaurentAFKaiser: "Pourquoi s’inquiéter? La raison est simple: on assiste au retour, on pourrait dire à la résurrection, d’un virus de la famille de la variole, une vieille compagne de l’humanité éliminée de la planète depuis 40 ans." revmed.ch/revue-medicale…

@LaurentAFKaiser 30. "Le virus mpox sous ses habits de singe n’a rien d’anodin: sur le plan génétique, il est quasi identique à la variole humaine et la présentation clinique est par plusieurs aspects similaire à cette dernière.

@LaurentAFKaiser Il y a par bonheur deux différences notoires entre la maladie induite par le mpox de 2022 et celle de son ancêtre: le mpox ne se transmet pas par voie respiratoire et sa mortalité, très faible, est sans comparaison à celle de la variole humaine. Est-ce suffisant pour se rassurer?

@LaurentAFKaiser "Après trois ans de pandémie, il serait naïf de compter sur la mansuétude d’un virus ; comme le SARS-CoV-2 ou d’autres virus, le mpox a un comportement et une capacité évolutive imprédictibles.

@LaurentAFKaiser "La grande chance de l’épidémie récente de 2022 est donc que le virus mpox ne se transmet pas par voie aérienne. La quasi-totalité des cas ont été contaminés via des rapports intimes.

@LaurentAFKaiser "Mais le virus est capable d’évoluer, soit par mutations, soit de manière encore plus subtile en modifiant, voire en supprimant l’expression de certains gènes.

@LaurentAFKaiser "L’histoire nous a appris qu’au fil des siècles, le virus de la variole s’est adapté à l’humain et qu’il a circulé sous différentes couleurs et formes. Rien ne nous protège de la souplesse biologique d’un virus de ce type, capable d’interagir et de s’adapter à son environnement."

@LaurentAFKaiser 30. Prof. Kaiser warns us to anticipate (1) someone could weaponize smallpox, which any number of labs are capable of, or (2) mpox can evolve to be efficiently airborne.

I translate for the public as he left twitter, hence cannot/doesn't warn effectively. revmed.ch/revue-medicale…

@LaurentAFKaiser 31. Orthopoxvirus (OPV) adaptation to new hosts works by gene loss, as seen in smallpox (Variola virus, VARV). Monkeypox virus (MPXV) follows the same pattern. Note how the authors here go wrong because they are unaware of airborne|droplet transmission.

https://twitter.com/_ppmv/status/1668169476699832322

@LaurentAFKaiser 32. Ignoring transmission routes of pox and coronaviruses is a major error. It's not just skin-to-skin contact but also indirect or direct respiratory transmission. Compare COVID: Even SARS-CoV-2 could be transmitted through the skin if we go by receptors.

https://twitter.com/_ppmv/status/1657349811069149185

@LaurentAFKaiser 33. It's extremely wild that I seem to be the only person on twitter (under clear name) who shares such links. Come on everyone. This is the little brother of smallpox, you REALLY don't wanna mess with it. journals.lww.com/international-…

34. mPox DNA detectable for 23 days (17 - 31 days) in skin lesions and 21 days in oropharynx.

21 days no sex may not be the perfect prevention policy for a respiratory virus, geniuses.
cidrap.umn.edu/mpox/study-sho…

35. Kinshasa reports almost 4000 suspected cases of human monkeypox virus (#mPox), of which 375 confirmed, and 192 deaths. That’s more than all other WHO member states and Taiwan together. agenceafrique.com/44492-rdc-kins…

36. This entire interview is required weekend reading. Past work on #mPox monkeypox hMPXV in the Soviet Union. nonproliferation.org/wp-content/upl…

https://twitter.com/_ppmv/status/1669812666183852032

37. If you like SARS-CoV as complex ssRNA virus, you will love orthopoxviruses (10x as large). Fortunately we have more OPV than CoV expertise. Still, I think it's impressive to see antiviral drug resistance develop after only some 100,000s infections yet. medrxiv.org/content/10.110…

38. On Mpox as 'gay' 'STI': 1980 article starts with: Monkeypox mutants arising spontaneously or after serial, high multiplicity passage were characterized phenotypically and by restriction endonuclease mapping. Some resemble ‘whitepox’ and variola viruses nature.com/articles/28602…

39. Great new review Harald Brüssow as weekend reading: Pandemic potential of poxviruses: From an ancient killer causing smallpox to the surge of monkeypox ami-journals.onlinelibrary.wiley.com/doi/full/10.11…

Even this article struggles with transmission. What is it about respiratory viruses that makes respiratory transmission so hard to admit?

Relatedly I deleted this comment to @mvankerkhove because it got very few views, so not worth it.

Do we really want to "live with" an OPV?

@mvankerkhove 40. LA County just told the public that human monkeypox virus is airborne (="droplet"); astonishingly not obvious even though orthopoxviruses are respiratory. Let's see whether this stays up. Perhaps some are learning, given the ongoing spread of #Mpox. 😷 abc7.com/mpox-monkeypox…

@mvankerkhove 41. In the least surprising turn of events since the invention of sliced bread, China now faces the #Mpox pandemic too, after allowing SARS-CoV-2 to dysregulate the immune systems of a billion Chinese. @ZeyiYang, for Taiwanese data simply read @Taiwan_CDC.

https://twitter.com/ZeyiYang/status/1686825748437274624

@mvankerkhove @ZeyiYang @Taiwan_CDC 42. Come on MIT @techreview, perhaps you need dedicated public health or IR reporters. WHO doesn't 'lump in' cases from Taiwan, it's not even a member state. Here the data: nidss.cdc.gov.tw/en/nndss/disea…

43. How to spot human monkeypox virus (#Mpox) and differential diagnoses: (I'd only add it's airborne, so you may want N95 masks, ie airborne protection in addition to contact protection) @lisa_iannattone 2022

https://twitter.com/KashPrime/status/1537132839761756161

@lisa_iannattone 44. "I wonder how #Mpox is doing?" -- oh 1440% increase in reported cases over last week. That's good news, states are reporting again.

Presumably China includes Taiwan in its hMPXV reporting, so beware double counting.

nidss.cdc.gov.tw/en/nndss/disea…
worldhealthorg.shinyapps.io/mpx_global/

45. Country level monkeypox virus (Mpox) data

46. Starting in Europe/US, the #Mpox monkeypox virus hMPXV pandemic shifted to South America over the course of 2022. Now it's settling in SE Asia? and the Western Pacific region. China created perfect conditions thanks to the end of #ZeroCovid (= mass infection). As we warned ☺️

48. Hard to tell what's happening in Africa. (Do DRC & Nigeria just have the best reporting?) - Median age of cases reported is 17 yo. Orthopoxviruses are most severe in children and pregnant women!

49. "The gay man's disease" - "#Mpox is sexually transmitted" - blablabla

It's not, it's not only contact but also airborne/droplet transmission.

50. This thread will get long in a 'Living with poxviruses' world. Remind people they are minimizing the cousin of #smallpox (OPVs adapt to new hosts through gene loss; #mpox means #mediumpox ☺️). Be sure you understand this thread or emerging literature.

https://twitter.com/_ppmv/status/1654149147803435009

51. Good reference on clinical implications of human monkeypox virus transmission: studies.eigenpub.com/index.php/erst…

52. The family of poxviridae includes other less pathogenic endemic zoonotic members besides orthopoxviruses, for example like Parapoxviruses. Here two cases of Orf virus (ORFV) in China. Increased OPV / SARS-CoV-2 surveillance will also generate more knowledge of these charmers.

53. The main ORFV entry pathways into host cells are clathrin-mediated endocytosis and macropinocytosis. Both account for a large proportion of infections. Side note about coronavirus cell entry pathways 👀🤷‍♂️


sciencedirect.com/science/articl…
tandfonline.com/doi/full/10.10…
sciencedirect.com/science/articl…

54. Always read the vets, not just human medicine. Less political nonsense and Words That Must Not Be Used, more science.

Feel free to share studies with the 'furin cleavage site (FCS) so unique' bros of SARS who may not appreciate how versatile CoVs are.

https://twitter.com/_ppmv/status/1679802007060729858

55. Brilliant reference. I usually tweet into the wild (dad jokes); sometimes add to the master narrative threads (general interest); or rarely to the specialized threads (hMPXV, HIV, DENV, SARS proteins, climate). - Genetic recombination in poxviruses is known for 60 years.

https://twitter.com/RealCheckMarker/status/1731767725603582074

56. No WHO member state, Taiwan offers one of the most advanced healthcare systems, a useful indicator of the human monkeypox pandemic pandemic at least for Asia. It keeps circulating at low frequency, below the alert threshold. nidss.cdc.gov.tw/en/nndss/disea…

57. Thread is aging nicely,

https://x.com/drtedros/status/1823821630973362637

58. Excellent review. hMPXV (“mpox”) isn’t efficiently airborne yet - so N95 mask required to prevent infection and pressure to evolve globally ✈️ . Everyone’s guess whether regaining smallpox-level airborness will take years or centuries. Via @mayer_iras thelancet.com/journals/lanmi…

59. How long will it take the Living with Covid crowd to embrace Living with Mpox? A few months to get used to the sight, then back to the new normal? - I’d think not, but then I thought so for SARS-CoV too and turned out to be wrong 🤷‍♂️🤷🏻‍♀️

https://x.com/eidjournal/status/1764767295904129093

60. Mpox is airborne and not in any relevant sense a STI. It simply spread in social networks that happen to have sex, and increasingly spreads out globally now. As we’ve been saying for years 👆🤷‍♂️

https://x.com/lazaruslong13/status/1828633651522810113

61. I see no problem with airborne mpox, since we got all the lessons of airborne SARS down blindfolded for five years now. Right?

https://x.com/_ppmv/status/1654149147803435009