It has been 2 months since the first cases were reported in the MPX multi-country outbreak, & the # of cases has now crossed 14k globally. While accurate information is critical to staying ahead, there is so much misinformation. An update on the current status of #monkeypox.🧵 Epidemiology:
Overall, over 14k MPX cases have been detected in 70 countries. 7 African countries have reported ~1400 cases this year. Some “non-endemic” countries are seeing cases w/o travel links or exporting cases, indicating ongoing community transmission. (n/1)

As the monkeypox virus (MPX) outbreak continues, a lot of data emerging in real-time & being rapidly disseminated (as well as misinformation). I complied the unfolding scientific data (with direct links to papers and threads) on what we (don’t) know so far. #IDTwitter 🧵(1/n) First, MPXV is not a novel virus. It is a viral zoonosis first discovered in 1958, with the first human infection reported in 1970. It is classified as a high priority pathogen by WHO, cases mostly identified in central & western Africa until now. (2/n) (who.int/news-room/fact…\)

Late breaker session at #ECCMID2022 on acute hepatitis cases of unknown origin in children.
So far, 169 cases have been reported from 11 countries since first case was identified in 31 March. 17 have required liver transplant & at least one death has been reported. #IDTwitter Almost all cases had high transaminases, majority of children have been hospitalised. No common exposure has been identified, no link to COVID19 vaccination. Adenovirus F41 was identified in several cases, but it doesn’t fully explain the clinical severity observed. #ECCMID2022

Very interesting analyses about the virology of #Omicron, which may explain the faster spread of this variant.

According to a new lab study, Omicron infects & multiplies ~70x faster than the Delta variant and the wild type SARS-CoV-2 in the human bronchus, but not in the lung. In this ex vivo study (press release), Michael Chan, Malik Peiris & John Nicholls et al. @hkumed show that at 24h after infection Omicron replicated ~70x faster than Delta in bronchus. Interestingly, it replicated ~10x less efficiently in the lung tissue. hkumed.hk/96b127/

Important preliminary data from SA looking at whether vaccine elicited antibodies are still effective against #Omicron.

Good & bad news: There is a big drop in neutralisation activity, but it's partial & hybrid (vax + infection) holds fairly well. 🧵

https://twitter.com/mugecevik/status/1466845581788295172?s=20

This is a live virus neutralisation assay. Neutralisation studies can tell us whether levels of Ab in the blood (convalescent and vaccinated plasma) are high enough to prevent the virus from infecting cells in the lab.

https://twitter.com/mugecevik/status/1466845570027429892?s=20

🦠 There’s a lot we don’t yet understand about Omicron, including its impact on immunity and what it means for vaccines. New data will be emerging over the next few wks, which could be misinterpreted w/o context. What we might expect & how to interpret the emerging data? 🧵(1/n) 1- Genomic data:
The biggest concern with omicron is that it contains >30 mutations in just the spike protein, the part which helps it enter human cells and the target for vaccines. This mutation profile is very different than other VOCs. (2/n)

There is a lot of concern/confusion about vaccine effectiveness against the delta variant. How effective are the vaccines against Delta & how to interpret real-world observational data? So much misinformation is being circulated, so this thread brings key data together. 🧵(1/n) Vaccine efficacy measures the relative reduction in infection/disease for the vaccinated vs unvaccinated arm. For instance, a vaccine that eliminates all risk would have an efficacy of 100%. Efficacy of 50% means you have a 50% reduced risk compared to an unvaxxed person. (2/n)

@devisridhar This is not correct. This has been corrected by several people before but Dr Topol’s table conflates effectiveness against infection with VE for symptomatic illness. 2 doses of vaccine still provide high effectiveness against symptomatic delta infection. Please see PHE data.

https://twitter.com/mugecevik/status/1425617461840318470

@devisridhar The conflating between detection of viral RNA and COVID-19 disease state can lead to unnecessary panic over vaccines' effectiveness. They are two distinct measurements.

https://twitter.com/Ryan_Mac_Phd/status/1425798126124818436

There is a lot of confusion about the efficacy of AstraZeneca/ChAdOx1 vaccine against COVID19 due to B.1.351 / 501Y.V2 - summarising the results of phase 1b/2a double-blind randomized trial conducted in South Africa (based on @GovernmentZA press conference).🧵(1/6) Adults aged 18-65 years without severe comorbidities and HIV were recruited. It was designed to show >60% efficacy against symptomatic disease, but because only 2000 participants were recruited with 42 total events, this analysis was not statistically powered. (2/6)

Concerns about outdoor transmission risk seem to be trending again. What is the risk of transmission outdoors and should we be more worried about outdoors with the new more-transmissible variant? 🧵(1/n) The risk of transmission is complex and multi-dimensional. It depends on many factors: contact pattern (duration, proximity, activity), individual factors, environment (e.g. outdoor, indoor), socioeconomic factors, and mitigation measures in place. (2/n)(gov.uk/government/pub…\)

There are several reasons to think that the new UK #SARSCoV2 variant is an important one as it might be more contagious than other variants, but there are also some uncertainties. So much misinformation is being circulated, so this thread brings key data together. 🧵 1- Genomic data
In the UK, COG-UK undertakes sequencing of SARS-CoV-2 samples from ~ 10% of positive cases. This is an enormous effort, and helps scientists to identify mutations and track them over time. Here are some variants being tracked in the UK. 1/ cogconsortium.uk/wp-content/upl…

A great article summarising our current understanding about asymptomatic infections

About 1 in 5 people w/#COVID19 will experience no symptoms whatsoever, they have shorter viral shedding & will transmit to significantly fewer ppl than someone w/symptoms

nature.com/articles/d4158… Our new paper on asymptomatic infections is published in @TheLancetInfDis - we discuss why persistently asymptomatic infections have been overestimated and describe major methodological issues that hinder attempts to estimate this fraction. #COVID19 1/
thelancet.com/journals/lanin…

Over the last 6 months, we've learned a lot about how SARS-CoV-2 spreads🦠

What does the evidence so far tell us about SARS-CoV-2 transmission dynamics, high-risk activities and environments? Thread 🧵 (1/n)
papers.ssrn.com/sol3/papers.cf… The risk of transmission is complex and multi-dimensional. It depends on many factors: contact pattern (duration, proximity, activity), individual factors, environment (i.e. outdoor, indoor) & socioeconomic factors (i.e. crowded housing, job insecurity). (2/n)

School openings and children (0-18yo) have been the most complex and contested subject of the pandemic.

In this letter, we are calling for balanced and nuanced scientific and media coverage of this subject, which has been hyper-polarised and damages our public health response.

https://twitter.com/apsmunro/status/1304441422792327169

While we all agree in the fundamental argument that children, families, educators, and society deserve to have safer schools, the current info ecology switched from underplaying the threat to exaggerating the risks by reacting to the political climate. This is causing harm.

Very excited to share our new preprint "#SARSCoV2 viral load dynamics, duration of viral shedding and infectiousness: a living systematic review and meta-analysis" #IDTwitter

A huge team effort screening and synthesising the accumulating evidence. 1/6

medrxiv.org/content/10.110… 2/6 Main findings:
- In the upper respiratory tract (URT), mean duration of RNA shedding was 17 days (95% CI, 15.5-18.6), max 83d
- Shedding duration increases with age & severity of illness
- There were limited studies reporting shedding duration in sputum (n=7) and stool (n=13)

The story is a little more complicated than “stay 6 feet away” guidelines. Coronavirus risk is simply not one-dimensional. We need to discuss high-risk activities & environments. I spoke w @B_resnick & discussed 4 dimensions of transmission risk #COVID19

vox.com/science-and-he… We need to think about risk in four dimensions: distance to other people, environment, activity, and time spent together.

A lot of discussion recently about transmission dynamics, most of which are extrapolated from viral loads & estimates. What does contact tracing/community testing data tell us about actual probability of #COVID19 transmission(infection rate), high risk environments/age?
[thread] 1/ 2147 close contacts of 157 #COVID19 cases were followed up: Overall infection rate was 6%, higher infection rate among friends (22%) and household (18%), and main risk factors include contact in household (13%), transport (11%), dining (7%).
html.rhhz.net/zhlxbx/028.htm (4/3/20)