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Thread: Monkey Flu

  1. #101
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    Quote Originally Posted by summit View Post
    Possible, but not likely. Fomite transmission (they touch something, you then touch that and become infected) outside of the healthcare setting is not well demonstrated. Hair dresser? Well if your hair dresser has hands covered in monkeypox sores well then you might notice that. And they will probably feel sick, notice lesions, not come to work. People aren't writing Monkepox off as "just my allergies" or "just a cold." The closest minimization analogy has really been "it's my genital herpes."

    If you want a thorough presentation on the epidemiology and treatment challenges, listen to this: https://www.idsociety.org/multimedia...on--treatment/

    It is about 90m long though. It is meant for clinicians and epis.

    One striking datapoint from the UK dataset was this breakdown of risk factors:

    Gay, bisexual, or men who have sex with men (96.2%)
    Travel abroad prior to symptom onset (21 days) (30.6%)
    Age under 30 years (21.5%)
    History of STI in the last year (53.7%)
    One or no sexual partners in last 3 months (15.7%)
    2-9 sexual partners in the last 3 months (53%)
    10+ sexual partners in last 3 months (31.3%)
    Living with HIV (29.5%)
    On HIV treatment (among living with HIV) (99.2%)
    Ever used PrEP (among HIV negative) 222 (79.3%)

    So we see young MSM, often well to do, engaging in high risk sexual activity or with those that do. This is illustrated by most monkeypox patients having had another STD in the previous year (vs <5% for adult population), and 79% had taken PRE-exposure HIV prophylaxis which is offered to folks who regularly engage in high HIV risk sex activities. 30% are living with HIV. The area transfer (sexual venues) again illustrates high risk community/activity contact. I think there is a risk of this jumping into a high risk pool like non-MSM high risk sex subgroups.

    The outbreak is most contained to a subgroup of a subpopulation. Spillover occurs, but the disease doesn't rapidly spread from spillover events because the transmission rates are much much much lower outside of that subgroup.
    Excellent info. Thanks. Even though I'm not that far removed from members of the gay community, super close actually, I'm not worried about it all that much. Sounds a lot like shingles but different mechanism.. Super painful rash, but not usually a serious deadly threat. Just sucks to have it...
    Go that way really REALLY fast. If something gets in your way, TURN!

  2. #102
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    Quote Originally Posted by SumJongGuy View Post
    Excellent info. Thanks. Even though I'm not that far removed from members of the gay community, super close actually, I'm not worried about it all that much. Sounds a lot like shingles but different mechanism.. Super painful rash, but not usually a serious deadly threat. Just sucks to have it...
    I would have zero worry about hanging out with gay friends.
    Quote Originally Posted by blurred
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  3. #103
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    Quote Originally Posted by summit View Post
    I would have zero worry about hanging out with gay friends.
    Or immediate family..
    Go that way really REALLY fast. If something gets in your way, TURN!

  4. #104
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    Summit - thanks for doing something useful.

    What size is this subgroup of a subpopulation, say in the US? What's the likelihood of variants emerging that spread outside this subgroup if most of that subgroup has the pleasure of hosting monkeypox? I remember for Covid, since it's a RNA virus, it's very stable and we wouldn't see immune escape variants. That didn't work out so well.

    The current monkeypox approach is the same as Covid - fuck around and find out. Pun intended. Why don't we stop the spread before we find out?

    If we have this vaccine we don't want to use, does that mean we're never going to use it for monkeypox? Or is there a threshold, once there's "enough" cases, then we use it? What I'm getting at is every month we wait, there's 10 times more people who will need it. Logically, there's really no threshold where we start to use it. If there were a threshold, surely it's best to use those vaccines now when the fewest number of people need to be vaccinated.

    Harping on the problem... it's not the current number of people infected, it's that there will be ten times more next month, hundred times more the month after that, 1000x in three months, etc. If we're going to do anything, the time to act is yesterday, and since we didn't, today is time to act. Every day we don't act, the problem is bigger.

    Based on current actions, we have accepted that all the MSMs and some of their contacts will get monkeypox. Also, we've accepted the risk monkeypox escapes that subgroup sometime during the course of all those infections and all those virus replications.

  5. #105
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    I watched CHIPS last night. And all I can think about is: when did eating ass become a thing???

  6. #106
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    Quote Originally Posted by riser4 View Post
    I watched CHIPS last night. And all I can think about is: when did eating ass become a thing???
    Ask Tom Brady...
    Go that way really REALLY fast. If something gets in your way, TURN!

  7. #107
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    Quote Originally Posted by LongShortLong View Post
    Summit - thanks for doing something useful.


    What's the likelihood of variants emerging that spread outside this subgroup if most of that subgroup has the pleasure of hosting monkeypox? I remember for Covid, since it's a RNA virus, it's very stable and we wouldn't see immune escape variants. That didn't work out so well.
    Orthopox viruses like MP are doublstranded DNA viruses that replicate in the cytoplasm (unusual). They don't mutate like RNA viruses (eg influenza or SARS-CoV-2) which are very mutation prone. COVID took hundreds of millions cases to make immune escape variants. Smallpox, the scourge of millenia, failed to escape vaccination which is why it is eradicated. Smallpox is gone because it had no animal reservoir. Monkeypox has been around for decades at least, probably for hundreds or thousands of years, and did not escape the smallpox vaccines either, and only escaped eradication because it does have an animal reservoir (mostly rodents).

    If we have this vaccine we don't want to use, does that mean we're never going to use it for monkeypox? Or is there a threshold, once there's "enough" cases, then we use it?
    Risk vs benefit.

    Traditional smallpox vaccines, including the large stockpile of ACAM2000, work like this. We take the vaccine, which is live vaccinia virus, an orthopox virus of low virulence, and we jab you in the arm a bunch with a needle covered in the live virus. You develop a localized viral infection which then becomes a permanent scar, and you are protected for 3-5 years. For most people this is merely annoying. I've had it. But some people end up on the wrong side of risk.

    A very simplified explanation of risk: if you vaccinate a million people for smallpox with a traditional live vaccine, you will kill 1-2 and perhaps another 55 will suffer extremely serious or life threatening complications, and another 240 will get pox from the virus (generalized vaccinia infection) and another 529 will get localized vaccinia infections (eg in the eyes) with potential spread to others including immunocompromised persons at higher risk. The list of adverse effects goes on and is very well documented in decades of literature.

    >1 in 200 will get myocarditis/pericarditis.

    This is a vastly higher adverse event rate compared to, say, the COVID-19 vaccines. These were absolutely acceptable risks when fighting smallpox. When we eradicated smallpox, we stopped giving the vaccine, except for soldiers and researchers.

    Smallpox kills 10% in its milder strains. Remind me again how many people have died of Monkeypox in non-endemic first world countries? We stockpiled ACAM200 for smallpox, not monkeypox.

    Jynneos is, we think, much lower risk than replication competent vaccinia variolation. Jynneos is a replication incompetent vaccinia vaccine given in two doses 4 weeks apart. No active infections. No scars. No autoinfection. The risk should be orders of magnitude lowers.

    That is why we are preferentially using the low risk, highly effective Jynneos and targeting its deployment to high risk persons and those who have been exposed.

    Risk v Benefit

    we have accepted that all the MSMs and some of their contacts will get monkeypox.
    Are you trying to be hyperbolic or do you actually believe what you are saying?
    Last edited by summit; 07-27-2022 at 09:49 AM.
    Quote Originally Posted by blurred
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  8. #108
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    Monkeypox DNA detected is multiple sewer systems in NorCal. Programs does not look for live virus.

    https://www.paloaltoonline.com/news/...ions-hot-spots

  9. #109
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    We asked CPDHE if they could look in the poop monitoring program that monitors COVID. They said they could, but are not yet doing so...
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  10. #110
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    Frustrating.

    Do infected peeps sometimes(?) shit live virus? I haven’t looked hard but also haven’t seen anything indicating yes or no or maybe.

  11. #111
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    Quote Originally Posted by summit View Post
    Are you trying to be hyperbolic or do you actually believe what you are saying?
    Exponential. The technical explanations of vaccine properties, while edifying, continue to miss the point. The observed monkeypox behavior is 10 times growth per month. If we don't quickly slow and stop that growth, most of the susceptible population will be infected, and soon. Monkeypox has already escaped its traditional hosts. We're looking at millions of additional opportunities for a beneficial mutation and further escape. Well, 10's or 100's of millions worldwide. (Implicit guess between 1% and 10% of us are MSMs or close contacts)

    The "experts" appear to not recognize the exponential growth threat. It is present, immediate, and real. On the current trajectory, the problem will be 1000 times worse in a few months. Any countermeasure that requires reaching individuals will require 1000 times the effort to implement. Maybe the susceptible population is very very small, already mostly infected, and monkeypox will burn out a few weeks hence. Doubt it. Regardless, it's unwise to base public health strategy on "maybe."

    The time to fund an effective response is now. The time to respond effectively is now.

  12. #112
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    Quote Originally Posted by bodywhomper View Post
    Frustrating.

    Do infected peeps sometimes(?) shit live virus? I haven’t looked hard but also haven’t seen anything indicating yes or no or maybe.
    I saw something suggesting the virus doesn't survive long in sewage. Presumably that means sewage detection is finding inactive virus or parts.

    However, it survives months or years on fomites. Whether that's a significant infection route, it didn't say. Maybe if we don't give away monkeypox blankets to the aboriginals, it will be ok.

    Sorry for no references, I'm sure someone will provide in a future post.

  13. #113
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    Sewage detection looks at genetic fragments, not viable virus. Sewage treatment kills anything that might still be viable at that point.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  14. #114
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    They can pry my septic tank out of my cold, pox lesioned dead hands.

  15. #115
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    Quote Originally Posted by summit View Post
    Sewage detection looks at genetic fragments, not viable virus. Sewage treatment kills anything that might still be viable at that point.
    Any risk with untreated pee? It’s sterile right?




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  16. #116
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    Quote Originally Posted by AK47bp View Post
    Any risk with untreated pee? It’s sterile right?




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    While I don't know whether there is significant virus in urine, we'd consider all fluids from an infected patient to be potentially infectious, even though that's a lower risk. Most of the infectious material comes from direct contact with lesions or drainage.

    If a patient has genital lesions or hand lesions, there is an increased chance that there is infectious material that could have been picked up by the urine stream.

    It seems a lower chance for urine versus the patients with rectal/anal lesions shedding infectious material into feces.

    All the same, I avoid contact with other people's bodily fluids, even if they don't have the pox.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  17. #117
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    Each their own I guess


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  18. #118
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    Quote Originally Posted by AK47bp View Post
    Any risk with untreated pee? It’s sterile right?

    Sent from my iPhone using TGR Forums
    https://www.eurosurveillance.org/con....27.28.2200503

    MPXV DNA found in pee, poop, semen, saliva.
    Move upside and let the man go through...

  19. #119
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    Quote Originally Posted by summit View Post
    While I don't know whether there is significant virus in urine, we'd consider all fluids from an infected patient to be potentially infectious, even though that's a lower risk. Most of the infectious material comes from direct contact with lesions or drainage.

    If a patient has genital lesions or hand lesions, there is an increased chance that there is infectious material that could have been picked up by the urine stream.

    It seems a lower chance for urine versus the patients with rectal/anal lesions shedding infectious material into feces.

    All the same, I avoid contact with other people's bodily fluids, even if they don't have the pox.
    Phew…..


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  20. #120
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    Quote Originally Posted by Mofro261 View Post
    https://www.eurosurveillance.org/con....27.28.2200503

    MPXV DNA found in pee, poop, semen, saliva.
    If you got to drop deuce and not at home, seat cover FTW!
    Go that way really REALLY fast. If something gets in your way, TURN!

  21. #121
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    Quote Originally Posted by AK47bp View Post
    Phew…..


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    Maybe take a good look at the faucet before you take a shower? No judgement.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  22. #122
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    Quote Originally Posted by summit View Post
    Maybe take a good look at the faucet before you take a shower? No judgement.
    I’m not that flexible.


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  23. #123
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    Monkey Flu

    Quote Originally Posted by Mofro261 View Post
    https://www.eurosurveillance.org/con....27.28.2200503

    MPXV DNA found in pee, poop, semen, saliva.
    Based on my skim of that write up, it was unclear if all reported detection, including previous studies, was genetic material or live virus. Sometimes it was clear, but other times it was not, at least to me.

    My question about wastewater was whether it’s known if people shit live mpx virus. I have similar question about peeing. I’ve seen what appears as wild speculation that live virus in wastewater can infect animals that have access to untreated wastewater, which can then…?
    Last edited by bodywhomper; 07-27-2022 at 03:57 PM.

  24. #124
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    With this MP it seems like now would be the time to wear latex gloves out in public because unlike Covid you can catch it from touching surfaces. I would like to think that people who have open sores would not go out in public but well... we know the public so.... yuk.
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  25. #125
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    The snozberries taste like. Snozberries.

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