Vaccines will help control the monkeypox (MPX) outbreak. The bad news is that we desperately need more doses. And we don’t know how much the vaccines help and in what manner they help (prevention, duration of disease, severity of disease). This information is absolutely essential so people know how well they are protected and what behaviors they should (or should not) change. This information will also have major implications for controlling the outbreak worldwide.
Will you write a follow up on monkeypox testing? Obviously, testing is a key component of controlling the spread. I know there are saliva tests you can order by mail and lesion tests that can be conducted at a clinic. I have also read many reports of people finding it difficult to get tested. I’d love a report from you.
I've heard reports that it's less an issue of testing capacity (labs have way more capacity than tests) but administration. Because most tests are done through public health clinics along with STI screens, these clinics have little capacity to send out for testing and complete paperwork.
With respect, Dr. Jetelina, I think you are asking the wrong question. As you well know as a world-class epidemiologist/ID person, vaccination is but one part of pandemic control. I have every confidence (sadly) that our country will mess up the rest of the public health strategy for control of a pandemic just as we did with COVID-19. Hope I am wrong...but
thanks for your comment! i completely agree with you... just like covid19 and any other public health problem, it will take layers to control. including “soft” layers like communication.
Public health in this country has been woeful for decades. More so, helping third-world countries MUST be prioritized. No one is truly safe unless everyone is.
It's not that government or "bureaucracy" is inherently slow or inefficient in forming effective and coherent solutions to large scale problems. It's just that agencies have to take into account other agencies, budgets, down the road outcomes, statutory boundaries, and so forth. Everything in a society is interconnected and agencies have to keep that interconnection constantly in mind.. no small task. To which end they bring in people like YLE. I fully trust our government to equal or outperform any other govt for other nations of comparable population.
Thank you so much, especially for the heads up that protection from past smallpox vaccinations is obviously imperfect and warrants further investigation.
An infected human couple which shares their bed with their greyhound (so there was close contact of the dog with the weeping sores) appears to have infected their dog:
Alert readers will notice that 1988 was 34 years ago. If smallpox vaccinations stopped around 1972, then any effectiveness 16 years later in 1988 might be long gone by 2022. Since I got my first smallpox vax in 1960 and my first booster in 1965, I strongly suspect that any immunity I had is long gone. I never got the third dose, which would have been scheduled for 1975, since the medical community had discontinued them by then. Oh well.
You don't need a paper record to confirm you've been vaccinated; the record will be on your skin. Look for a mark about the size of a dime or maybe a nickel, which looks a bit like a burn scar. If you have one, you've been vaccinated against smallpox.
It's too late to get immunized AFTER you have the disease the immunization is supposed to protect against. That's true for pretty much every vaccine-preventable disease.
After you are symptomatic, yes, but not after you've been exposed. Because of MPX's longer incubation period (averaging a week), a vaccination within days of exposure (but before symptoms) can help give your immune system a training boost to reduce the severity of the disease.
I can fully understand the reluctance to resort to ACAM2000, particularly given the demographics of the target population most at risk. Splitting Jynneos doses is definitely the safer choice at the moment - but if we see this outbreak widening, resorting to ACAM2000 may become a necessity, even though we know it will hurt a lot more people than Jynneos does.
Update. OHA had their press conference with Dr. Sidelinger presiding. Message to public was that Oregon had a sizeable outbreak with bulk of cases in my county and that there was no reason for alarm but that everyone should take reasonable precautions since hMPXV could be transmitted outside sexual contact. No local coverage of the live conference, but good recaps on local evening news. Lots of pandemic fatigue evident here, if indoor masking is any metric.
Wondered if you could comment about college kids in NYC and other MPV hotspots — is this a mobile population with lots of close body contact that needs to be monitored and vaxxed ASAP?
I don’t think intense monitoring and vaccination is needed yet. But I do think colleges and other locations with close contact should prepare by having a plan in place in case this does jump networks
That represents a huge opportunity lost. We need to wake up and realize that public health is GLOBAL in scope in a world where a person can travel the globe in a day.
Will you write a follow up on monkeypox testing? Obviously, testing is a key component of controlling the spread. I know there are saliva tests you can order by mail and lesion tests that can be conducted at a clinic. I have also read many reports of people finding it difficult to get tested. I’d love a report from you.
I've heard reports that it's less an issue of testing capacity (labs have way more capacity than tests) but administration. Because most tests are done through public health clinics along with STI screens, these clinics have little capacity to send out for testing and complete paperwork.
With respect, Dr. Jetelina, I think you are asking the wrong question. As you well know as a world-class epidemiologist/ID person, vaccination is but one part of pandemic control. I have every confidence (sadly) that our country will mess up the rest of the public health strategy for control of a pandemic just as we did with COVID-19. Hope I am wrong...but
thanks for your comment! i completely agree with you... just like covid19 and any other public health problem, it will take layers to control. including “soft” layers like communication.
Public health in this country has been woeful for decades. More so, helping third-world countries MUST be prioritized. No one is truly safe unless everyone is.
It's not that government or "bureaucracy" is inherently slow or inefficient in forming effective and coherent solutions to large scale problems. It's just that agencies have to take into account other agencies, budgets, down the road outcomes, statutory boundaries, and so forth. Everything in a society is interconnected and agencies have to keep that interconnection constantly in mind.. no small task. To which end they bring in people like YLE. I fully trust our government to equal or outperform any other govt for other nations of comparable population.
But I forget the distorting effects of ideology driven appointees, regulatory capture, and all the other slings and arrows our govt is subjected to!
we updated the Jynneos page last night with the new CDC/FDA disclosures = https://www.precisionvaccinations.com/vaccines/jynneos-smallpox-monkeypox-vaccine
Thank you so much, especially for the heads up that protection from past smallpox vaccinations is obviously imperfect and warrants further investigation.
An infected human couple which shares their bed with their greyhound (so there was close contact of the dog with the weeping sores) appears to have infected their dog:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01487-8/fulltext#%20
BN distanced itself from the FDA's reduced dose decision... liability protection?
Serious Concerns Raised Regarding Monkeypox Vaccine Reduced Dosage Delivery: https://www.precisionvaccinations.com/breaking-news/#/2022/08/12/serious-concerns-raised-regarding-monkeypox-vaccine-reduced-dosage-delivery
Alert readers will notice that 1988 was 34 years ago. If smallpox vaccinations stopped around 1972, then any effectiveness 16 years later in 1988 might be long gone by 2022. Since I got my first smallpox vax in 1960 and my first booster in 1965, I strongly suspect that any immunity I had is long gone. I never got the third dose, which would have been scheduled for 1975, since the medical community had discontinued them by then. Oh well.
I was born in 69 and didn't get the smallpox vaccine.
I'm surprised, since they were giving them through '72, and kids usually got the first shot in their first year of life.
Me too especially since it’s NYC. I have a record of everything else, but not that.
You don't need a paper record to confirm you've been vaccinated; the record will be on your skin. Look for a mark about the size of a dime or maybe a nickel, which looks a bit like a burn scar. If you have one, you've been vaccinated against smallpox.
Not all of them were done that way
Today's CDC's COCA call clarified that once MPXV symptoms appear, Jynneos vaccination is NOT advised.
It's too late to get immunized AFTER you have the disease the immunization is supposed to protect against. That's true for pretty much every vaccine-preventable disease.
After you are symptomatic, yes, but not after you've been exposed. Because of MPX's longer incubation period (averaging a week), a vaccination within days of exposure (but before symptoms) can help give your immune system a training boost to reduce the severity of the disease.
In Oregon we have an upcoming press conference today from the Governor on our outbreak
https://katu.com/news/local/oregon-health-authority-declares-outbreak-of-monkeypox-holds-press-conference-thursday
Are the choices of vaccinations Jynneos, ACAM2000, and TPOXX?
Seems like a more than usual paucity of data , but not a blameworthy thing.
For many of us the non medical penumbra of the outbreak brings a sense of deja vu and foreboding.
The two options right now are Jynneos and ACAM2000 (TPOXX is an antiviral), but some have warned about using ACAM2000 yet. (https://www.statnews.com/2022/08/11/acam2000-full-fda-review-before-widespread-use-against-monkeypox/). This should really go to FDA and CDC first.
I can fully understand the reluctance to resort to ACAM2000, particularly given the demographics of the target population most at risk. Splitting Jynneos doses is definitely the safer choice at the moment - but if we see this outbreak widening, resorting to ACAM2000 may become a necessity, even though we know it will hurt a lot more people than Jynneos does.
For any interested, the skinny on TPOXX (Tecovirimat):
https://time.com/6203476/monkeypox-treatment-tpoxx-how-to-get/
Update. OHA had their press conference with Dr. Sidelinger presiding. Message to public was that Oregon had a sizeable outbreak with bulk of cases in my county and that there was no reason for alarm but that everyone should take reasonable precautions since hMPXV could be transmitted outside sexual contact. No local coverage of the live conference, but good recaps on local evening news. Lots of pandemic fatigue evident here, if indoor masking is any metric.
Smiling here
Wondered if you could comment about college kids in NYC and other MPV hotspots — is this a mobile population with lots of close body contact that needs to be monitored and vaxxed ASAP?
I don’t think intense monitoring and vaccination is needed yet. But I do think colleges and other locations with close contact should prepare by having a plan in place in case this does jump networks
That represents a huge opportunity lost. We need to wake up and realize that public health is GLOBAL in scope in a world where a person can travel the globe in a day.