As COVID cases rise in China and protestors challenge policies, note:
the country does not have the immunity the rest of the world does - no mRNA vaccines, little infection-derived immunity.

Of those most vulnerable, over 80, only 40% have had the 3 vaccine doses needed
1/n Immunity derived from vaccination and infection cushions the rest of the world

China does not have the same immunity

It also has an older population

Two populations of similar sizes - China (1.44B) and India (1.38B) - and China, after decades of 1 child policies - is older

San Miguel de Tucumán, Tucumán, Argentina
- 8 healthcare workers and 1 patient ill
- Symptoms: fever, myalgia, abdominal pain, dyspnea
- 6 cases with bilateral pneumonia
- Multiple requiring technical ventilation
- 3 of 9 have died

So what could this be?
paho.org/en/documents/i… Cases occurred in Sanatorium Luz Médica, where 1st patient admitted and healthcare workers worked.

Patients described as working age adults
40yo pharmacy assistant
44F nurse (isolated at home)
30M nurse w/ comorbidities

https://twitter.com/HenrikAborym/status/1565507513604251648?s=20&t=qjq-8BDwGUsf9zcHgtOimA

tucumanalas7.com.ar/local/2022/8/3…

What are the caveats of the ACAM2000 vaccine (replication-competent vaccinia virus) for monkeypox/smallpox? The stocks are much larger but why not used?
- Contraindications for many (see next tweets)
- Need to cover vaccine site to avoid spread to others (given contraindications) So for whom would ACAM2000 be a concern?
From the US CDC:
These include those at high risk for heart disease (given risk of myocarditis), eczema or other exfoliative skin conditions, immunosuppressed, HIV+, use topical ophthalmic steroids, pregnant, breastfeeding, under 1,

If you've never seen what diphtheria, tetanus, or polio can do, you're lucky.

Your parents or grandparents or great grandparents weren't so lucky.

These are horrible diseases with no good treatments. This is why there are vaccines.

A little reminder of the reality: Tetanus - each movement leads to painful waves of twitching. the patient is smiling sardonically, taking shallower and shallower breaths. others say they're fine. They look happy, not struggling for breath, just slowly silently suffocating, unable to move. it's a horror film.

Monkeypox confirmed: 770+
🏴󠁧󠁢󠁥󠁮󠁧󠁿199 London+
🇵🇹138 Lisbon+
🇪🇸156 Madrid+
🇮🇹20 Rome+
🇸🇪5
🇺🇸MA1 NYC4 UT2 F 3 WA1 CA3 VA1^ CO2 PA2 GA2
🇨🇦54 Montreal+
🇫🇷33 Paris+
🇧🇪15
🇦🇺3
🇩🇪43
🇳🇱40
🇨🇭6
🇮🇱2
🇦🇹1
🏴󠁧󠁢󠁳󠁣󠁴󠁿5
🇩🇰2
🇸🇮2
🇨🇿6
🇫🇮1
🇦🇪8^
🏴󠁧󠁢󠁷󠁬󠁳󠁿1
N Ireland 2
🇦🇷2
🇮🇪6
🇲🇽1
🇲🇹1
🇳🇴1
🇬🇮1
🇭🇺1
🇲🇦1
?🇸🇩🇪🇨^🇮🇷🇬🇫🇧🇷🇺🇾🇵🇾🇲🇺🇨🇷 + cases also outside of metropolitan area
? suspected
^ likely includes separate introduction from endemic area, unrelated to main European transmission chain

Some cases may be reported as confirmed when test positive for orthopoxvirus but monkeypox not specifically confirmed

Current monkeypox cases detected do not correspond to real time transmission
1) We are playing catch up identifying patients not recognized before
2) Monkeypox serial intervals* are much longer than say for COVID
Rising cases can still mean we are finding what we've been missing *Serial Interval - time from illness onset in primary case to illness onset in secondary case
With some diseases this is short. 2 cases today may mean 4 new cases in 2 days. Other diseases have short incubation periods. With monkeypox 6-13 days(5-21 range)
who.int/emergencies/di…

Monkeypox confirmed in 600+
🏴󠁧󠁢󠁥󠁮󠁧󠁿183 London+
🇵🇹100 Lisbon+
🇪🇸137 Madrid+
🇮🇹13 Rome+
🇸🇪4
🇺🇸MA 1 NYC 2 UT 2 FL 3 WA 1 CA 3 VA 1^ CO 2
🇨🇦27 Montreal+
🇫🇷17 Paris+
🇧🇪9 Antwerp+
🇦🇺MEL 1 SYD 1
🇩🇪38
🇳🇱26
🇨🇭4
🇮🇱2
🇦🇹1
🏴󠁧󠁢󠁳󠁣󠁴󠁿4
🇩🇰2
🇸🇮2
🇨🇿5
🇫🇮1
🇦🇪4^
🏴󠁧󠁢󠁷󠁬󠁳󠁿1
N Ireland 1
🇦🇷2
🇮🇪2
🇲🇽1
🇲🇹1
🇳🇴1
?🇸🇩🇪🇨^🇮🇷🇬🇫🇧🇷 + cases also outside of metropolitan area
? suspected
^ likely includes separate introduction from endemic area, unrelated to main European transmission chain

Some cases may be reported as confirmed when test positive for orthopoxvirus but monkeypox not specifically confirmed

Monkeypox confirmed in 600+
🏴󠁧󠁢󠁥󠁮󠁧󠁿183 LDN+
🇵🇹100 LX+
🇪🇸137 MAD+
🇮🇹13 Rome+
🇸🇪4
🇺🇸MA 1 NYC 2 UT 2 FL 3 WA 1 CA 3 VA 1^ CO 2
🇨🇦27
🇫🇷17 Paris+
🇧🇪9 Antwerp+
🇦🇺MEL 1 SYD 1
🇩🇪38
🇳🇱26
🇨🇭4
🇮🇱 2
🇦🇹 1
🏴󠁧󠁢󠁳󠁣󠁴󠁿 4
🇩🇰 2
🇸🇮 2
🇨🇿 5
🇫🇮 1
🇦🇪 4^
🏴󠁧󠁢󠁷󠁬󠁳󠁿 1
N Ireland 1
🇦🇷 2
🇮🇪 2
🇲🇽 1
🇲🇹 1
?🇸🇩🇪🇨^🇮🇷🇬🇫🇧🇷 + cases also outside of metropolitan area
? suspected
^ likely includes separate introduction from endemic area, unrelated to main European transmission chain

Some cases may be reported as confirmed when test positive for orthopoxvirus but monkeypox not specifically confirmed

Another thing to keep into account:

The US has lost more to COVID than to the 1918 flu

Over 1 million have died from COVID in the US, while
675,000 died from the 1918 flu in the US
cdc.gov/flu/pandemic-r…

https://twitter.com/phylogenomics/status/1531744881059647488

Quote "That’s not to say that the 5 million people who’ve died from COVID are insignificant, but we are also still far below the deaths that occurred in 1918 which is another thing to keep into account"
Globally, 5 (or 6+) million from COVID is less than 50 million from 1918 flu

Monkeypox confirmed in 550+
🏴󠁧󠁢󠁥󠁮󠁧󠁿172 LDN+
🇵🇹96 LX+
🇪🇸120 MAD+
🇮🇹13 Rome+
🇸🇪3
🇺🇸MA 1 NYC 2 UT 2 FL 3 WA 1 CA 3 VA 1^ CO 2
🇨🇦26 Quebec+
🇫🇷17 Paris+
🇧🇪9 Antwerp+
🇦🇺MEL 1 SYD 1
🇩🇪25
🇳🇱26
🇨🇭4
🇮🇱 2
🇦🇹 1
🏴󠁧󠁢󠁳󠁣󠁴󠁿 4
🇩🇰 2
🇸🇮 2
🇨🇿 5
🇫🇮 1
🇦🇪 4^
🏴󠁧󠁢󠁷󠁬󠁳󠁿 1
N Ireland 1
🇦🇷 2
🇮🇪 2
🇲🇽 1
🇲🇹 1
?🇸🇩🇪🇨^🇮🇷🇬🇫🇧🇷 + cases also outside of metropolitan area
? suspected
^ likely includes separate introduction from endemic area, unrelated to main European transmission chain
Some cases may be reported as confirmed when test positive for orthopoxvirus but monkeypox not specifically confirmed

Women can get monkeypox

One woman in the Czech Republic was diagnosed after attending a music festival in Belgium

Other women in Virginia (USA) + UAE were confirmed to have monkeypox after travel to African countries w/endemic spread (separate from European transmission chains) Sources
Czech
reuters.com/world/europe/c…

UAE, 29F traveled from West Africa

https://twitter.com/RoryReynolds/status/1529117375005589507?s=20&t=zG_hn9hguM9IAdWTCABS5A

Virginia
wjla.com/news/local/mon…
washingtonpost.com/dc-md-va/2022/…
2/3

Women can get monkeypox

One woman in the Czech Republic was diagnosed after attending a music festival in Belgium

Other woman in Virginia (USA) + UAE were confirmed to have monkeypox after travel to African countries w/endemic spread (separate from European transmission chains) Sources
Czech
reuters.com/world/europe/c……

UAE, 29F traveled from West Africa

https://twitter.com/RoryReynolds/status/1529117375005589507?s=20&t=zG_hn9hguM9IAdWTCABS5A

…

Virginia
wjla.com/news/local/mon……
washingtonpost.com/dc-md-va/2022/…
2/3

There are heroes everywhere

https://twitter.com/CTZebra/status/1332451635172237312?s=20&t=k2uxWDYJsCUvfN3bd8vmDg

https://twitter.com/FemiOke/status/1245961766246518788?s=20&t=H8KZEYnzq3_TXyIeXzrQKQ

Infectious disease control is about good governance -about managing resources and infrastructure, responding to public, and listening to and protecting the vulnerable and marginalized. Cholera is the classic example. Climate change will increase the pressure. 1/n "Cholera outbreaks in Pakistan kill 6 and infect hundreds amid a pummelling heat wave and water shortages"

https://twitter.com/diaahadid/status/1526491177452810241?s=20&t=44tkjD4xFiSdhRkK--UjFQ

Fiji has had a run of lepto cases associated with flooding (and rats). There have been over 2000 diagnosed cases, close to 700 hospitalizations, and at least 40 deaths including teenagers. This is up sharply from the last few years.
fijisun.com.fj/2022/04/27/tai…

https://twitter.com/maitvfiji/status/1526299358299574272

https://twitter.com/maitvfiji/status/1526299358299574272?s=20&t=_7rTvvycTTqR0V5pjAAYuQ

Anthrax is not as uncommon as one might think. It is a vaccine preventable disease of livestock that can affect those with animal contact. Largely only farm/abbatoir workers have exposures. In the 1950s, 20-100K were infected, by 1980s, 2K a year were worldwide. Sources
apps.who.int/iris/bitstream…
nature.com/articles/s4156…

Monkeypox confirmed in 200+
🏴󠁧󠁢󠁥󠁮󠁧󠁿70 London+
🇵🇹39 Lisbon+
🇪🇸51 Madrid+
🇮🇹5 Rome+
🇸🇪SK 1
🇺🇸Boston 1 NYC 1* UT 2* FL 2* WA 1* CA 1*
🇨🇦Quebec 15
🇫🇷3 Paris+
🇧🇪3 Antwerp+
🇦🇺MEL 1 SYD 1
🇩🇪 12 Berlin, Cologne+
🇳🇱6
🇨🇭Bern 1 GVA 1
🇮🇱Tel Aviv 1
🇦🇹Vienna 1
🏴󠁧󠁢󠁳󠁣󠁴󠁿 1
🇩🇰CPH 1
🇸🇮 1
🇨🇿 1

🇦🇪 1

?🇦🇷🇲🇦 Case in UAE may be from a separate, unrelated introduction from West Africa.

Most monkeypox outbreaks have had substantially shorter chains of transmission than seen here. Infections are usually sporadically spread to humans but maintained in rodents, other wildlife.

Climate change will have many effects, one is a change in the incidence of infectious diseases

In 2013, researchers looked to see the impact of deforestation and climate change on animal reservoirs in Central Africa to predict monkeypox risk.

Not surprisingly in hindsight: 1/n The paper elaborates "The question whether MPXV will be transmitted to humans in areas that will become more favorable to MPXV reservoir species is at least partially dependent on human behavior"

Source: journals.plos.org/plosone/articl…

100+ confirmed w/monkeypox
🏴󠁧󠁢󠁥󠁮󠁧󠁿20 London+
🇵🇹37 Lisbon+
🇪🇸40 Madrid+
🇮🇹 Rome 3 Tuscany 1
🇸🇪 Stockholm 1
🇺🇸 Boston 1, NYC 1
🇨🇦 Quebec 5
🇫🇷 Paris 1
🇧🇪 4 Antwerp+
🇦🇺 Melbourne 1 Sydney 1
🇩🇪 Bavaria 1 Berlin 2
🇳🇱 2
🇨🇭 Bern 1
🇮🇱 Tel Aviv 1
🇦🇹 Vienna 1
🏴󠁧󠁢󠁳󠁣󠁴󠁿 1
🇩🇰 Copenhagen 1
suspect🇦🇷

https://twitter.com/InfectiousDz/status/1528708214518427648?s=20&t=uoDNUMJ4xB00su6_mx0bkA

100+ confirmed w/monkeypox
🏴󠁧󠁢󠁥󠁮󠁧󠁿20 London+
🇵🇹37 Lisbon+
🇪🇸40 Madrid+
🇮🇹 Rome 3 Tuscany 1
🇸🇪 Stockholm 1
🇺🇸 Boston 1, NYC 1
🇨🇦 Quebec 5
🇫🇷 Paris 1
🇧🇪 3 Antwerp+
🇦🇺 Melbourne 1 Sydney 1
🇩🇪 Bavaria 1 Berlin 2
🇳🇱 2
🇨🇭 Bern 1
🇮🇱 Tel Aviv 1
🇦🇹 Vienna 1
🏴󠁧󠁢󠁳󠁣󠁴󠁿 1
🇩🇰 Copenhagen 1
suspect🇦🇷 + signs indicate cases also found outside of initial metropolitan area

In England, London and Newcastle and southeast of England
In Spain and Portugal, cases found outside the capital areas
In Belgium, one case tested positive in Leuven outside of Antwerp

100+ confirmed w/monkeypox
🏴󠁧󠁢󠁥󠁮󠁧󠁿20 London+
🇵🇹 Lisbon 23
🇪🇸 40 Madrid+
🇮🇹 Rome 3
🇸🇪 Stockholm 1
🇺🇸 Boston 1, NYC 1
🇨🇦 Quebec 5
🇫🇷 Paris 1
🇧🇪 Antwerp 3 Flanders 1
🇦🇺 Melbourne 1 Sydney 1
🇩🇪 Bavaria 1 Berlin 2
🇳🇱 2
🇨🇭 Bern 1
🇮🇱 Tel Aviv 1
🇦🇹 Vienna 1
🏴󠁧󠁢󠁳󠁣󠁴󠁿 1
🇩🇰 Copenhagen 1
suspected🇦🇷 There are many cases in other part of Spain, awaiting testing results. Some countries report patients recently traveled, often from Spain.
Locations listed by public health authorities. In Canada, Quebec province, not Quebec City, is listed, though outbreak centered in Montreal.