We don't know. We think that immunity is working or at least a little, but honestly don't have data on that yet. I think there's a reason it's spreading among the younger populations, in part it may be driven because of immunity among the older populations.
Wonderful post, Katelyn! Fam's concern is important for all--but especially frequent--travelers (repeated exposure to a low-probability event). Even a very low risk might quash travel plans for some people. In theory, hotels launder bedding (is that enough?); though not sure if they always launder the blankets with each stay. They also vacuum and (say they) disinfect surfaces between stays (tho I still wipe them anyway). Would leaving the windows open for an hour after arriving help? (Assuming they CAN be opened!) Or is this concern basically a tempest in a teapot?
Makes sense that college campuses might be an outbreak risk, but is there a true sense of K12? Cause I've heard the complete range of theories with little data other than demographic to back it up (and pediatric cases certainly don't help).
Thank you. For the most part this is very reassuring that the risk level for the bulk of the population is quite low given reasonable precautions. An excellent summary.
On a completely different topic, but still in the public health arena, giant kudos to the voters of Kansas on defeating that cunningly worded ballot measure. If we had a real democracy rather than a putative one, this would be the outcome in all states. A bright outcome. Now, back to the rapidly evolving monkeypox outbreak.
I’ve been getting a trickle of questions in the office from patients, not a flood yet. Everyone is so fatigued, and the idea of another virus causing mayhem is kind of too much. I get it.
I did a post about the heroic, unseen public health effort right now, the nuances of vaccination and treatment of higher risk individuals and severe syndromes - and how learning about pandemics from caustic, biased pundits like Ben Shapiro is not advisable.
Thanks for this evidence based review. I’m seeing monkeypox ghosts in shingles and herpetic outbreaks this week… this is going to be quite difficult 😞
You said, "MPV could spread to other social networks." Hasn't it already spread to people who are not men who have sex with men? While MSM are the group most at risk *right now* and being laser focused on public health outreach is warranted, there are already faulty assumptions and misinformation because of that laser focus. People who are not MSM are being gaslit by medical personnel about their MPV symptoms. While these are anecdotal instances reported via social media there is the valid concern we didn't learn from the 80's AIDS epidemic.
As with HIV, gay men are once again the proverbial canaries in the coal mine. They are the most at risk *based on the current data* which are, inevitably, delayed. So reaching them is the highest priority but certainly not the only one. But anyone with close personal contacted with an infected individual is at risk. That is abundantly clear by now. Viruses don't recognize sexual orientation.
KB - you said it has spread to other "social networks"... thats not "acknowledging that the virus does not discriminate" - thats a definitive statement. I am not sure your real meaning...
Some info I have read says only UVC and that soap may wash it away but will not break it down. Any additional information on this? It is coming out of other countries. I am using hand sanitizer in addition to washing my hands as I am immunocompromised. I too want to know if my smallpox vaccination re 1950s will afford any protection.
I like that they're starting to use wastewater surveillance for more pathogens besides Covid. I imagine the more pathogens we monitor, the better we'll be able to guage what "normal" levels are for endemic diseases versus novel ones in a given area.
Would also love for epidemiologists, actuaries, and policy wonks to put their heads together and design parametric insurance using wastewater surveillance - like we currently do for heating/cooling degree days, crop yields, etc
This looks like some encouraging data: The amount of monkeypox in sewage at two spots in San Francisco has been relatively stable for about 3 weeks. None of the different sewagesheds being monitored are showing exponential growth for monkeypox.
QUOTE Contact tracing data confirms this, thus far, by showing clear patterns of transmission among very close and prolonged contacts, like sexual encounters. UNQUOTE
The media is reporting between 96%-98% is gay sex.
What are the other patterns outside of sexual encounters?
Hi Larry, this is a rapidly evolving situation and as more people get infected it's likely if not probable that we might see newly emerging patterns of community spread. It's entirely prudent to allow for that possibility, is it not? As Stephen said earlier, viruses don't care (or know) one's sexual orientation. We should all take reasonable precautions as the virus spreads out from it's core start populations. As the picture clarifies I suspect we will see new patterns coming to view.
I asked a simple question - what are the other ways?
YLE said sex was one and continued her tone of not wanting to stigmatize people.
Well - facts are hard to argue with -
We stopped the global economy - literally - told people not to go outside because of the unknown.
We require people to wear masks - knowing they were not effective unless they were worn proper and of a specific quality (N95).
We asked people to get vaccines and lied about their effectiveness (to get the ball rolling, i understand this but its still a lie)
ALL THIS TO PROTECT OUR SOCIETY.
Right now MP is growing within ONE COMMUNITY - if it is not please share what other community is spreading the virus knowingly. We can take precautions for tomorrow but for today STOPPING THE SPREAD (sound familiar) should be the focus.
Your focus is on "reasonable precautions" for everyone as one group act "unreasonably?"
Its confusing - that STOPPING THE SPREAD is not the messaging. But lets be careful after they spread it around.
AGAIN - my question was - what are the other patterns outside of sexual encounters?
It is political pandering - not public safety that you and others are selling to people.
Isn't it amazing that no one has worked on a study to see if protection helps?
Well you said alot there! But look at it this way: assume a hypothetical virus that uses, say, an insect vector and carriers if the insect are found in grain ships from one continent where the virus resides. The crew men of those ships form the human core infected group as seen from the perspective of the people of the second continent. So the focus is on the crews. But the virus is actually moving into the second continent via the insect vector. Of course we are looking at Y. Pestis. I argue that the core group is important of course, but once the virus moves out, we all have to take reasonable precautions. Nothing political about it, save for people who filter things through that lens.
Still wondering how the virus spreads. YLE was clear -
QUOTE Contact tracing data confirms this, thus far, by showing clear patterns of transmission among very close and prolonged contacts, like sexual encounters. UNQUOTE
What other transmission has been shown? like Sexual encounters or sexual encounters.
Using your hypothetical - imagine if people were told that eating an apple could cause you to get a virus - applepox. And we find that 98% of all people infected ate an apple. Would you tell people to stop eating apples?
OR
Would you suggest that society at large go into crisis mode to stop other people from getting the virus from people who ate the apples???
Clearly your hypothetical removes the voluntary nature from which the virus is passed. As of today, we have no indication that the virus has moved to the second continent and the first continent is still sending out the virus. Seems like continent one is being irresponsible.
This is avoidable yet that is not the messaging. Its just not. As YLE said, you do not want to stigmatize anyone... If thats not political then i am lost as the irresponsibility of the messaging.
Hi Larry, you make some excellent points but they're a little off the mark. My hypothetical was only a thinly disguised revamp of the historic spread of the plague from Asia to Europe in successive waves. The 'continent" in my revamp is not a social network but an actual continent. In monkeypox, substitute Africa. The social network is the sailors on the various grain ships. We might call them Men who Sail with Men, MSM for short. So to the Europeans the sailors were the initial human network, but as history had it, the plague virus moved out of the MSM network (as it was actually being carried by the fleas on the rats that infested the ships) and into the general population
In population biology it is long known that populations live in a fractured way, called demes. Yet there is communication between these populations leading to gene exchange. But importantly, virus exchange also. Social networks in our species are like Venn diagrams. There are multiple intersection populations, not themselves always defined clearly or even forming social networks of their own.
We might call these messengers. What has got the WHO worried is the potential for movement of hMPXV into intersecting populations with the MSM and then finding ways to spread further. Not alarming but something to be careful about anyway...
I am just a regular person - if we are starting to scream the sky is falling - and Governments are calling for a State of Emergency then its something alarming.
My fear, which is tacitly explained by YLE and NEJM as well as media outlets, is how Stigmatizing the population that is behaving in a manner that spreads not mitigates the virus takes precedence over mitigation of the spread.
It would appear from all evidence - that we have to mitigate the spread. We have to stop the "eating of apples" to slow the spread.
Using your hypothetical - i would suggest stopping the ships from sailing to contain the disease instead of trying to protect the destination continent from infection.
It defies common sense not to push for mitigation at the source.
Do you have any thoughts on monkeypox in the context of contra dancing?
- On a typical evening there will generally be skin to skin contact with multiple people. More with whoever you're partnered with for a given piece. But also whoever you swing with (ballroom position, and we are often wearing short sleeves for personal comfort)
- The contra dance community is generally welcoming of all sorts of people. It's not hard to imagine monkeypox getting to at least one unwitting contra dancer
- people travel long distances to go to a contra dance. They frequently carpool on long trips to big festivals.
We are currently going all-in with Covid safety protocols (N95 masks, vaxes and boosters if eligible). Long sleeves would be a rather impractical in hot weather.
My question is whether with the current state of play (Covid still rampant, monkeypox emerging, and exteeme heat events) - is this activity irreducibly hazardous right now?
Monkeypox virus contamination in an office-based workplace environment, England 2022
Abstract
In May 2022, an office worker attended their place of work while experiencing prodromal symptoms of monkeypox infection. Environmental sampling performed four days later identified only low levels of monkeypox virus DNA contamination of the worker’s desk, and no contamination elsewhere within the office. Replication-competent virus was not identified.
how good is the original small pox vaccine which i received in the late 1940s, at fighting small pox as well as monkey pox?
We don't know. We think that immunity is working or at least a little, but honestly don't have data on that yet. I think there's a reason it's spreading among the younger populations, in part it may be driven because of immunity among the older populations.
The vacuum of information about kids, especially in daycare is what is now propelling a new version of the santanic panic.
Regarding fomite transmission....how concerned should we be staying at a hotel or renting an airbnb?
Wonderful post, Katelyn! Fam's concern is important for all--but especially frequent--travelers (repeated exposure to a low-probability event). Even a very low risk might quash travel plans for some people. In theory, hotels launder bedding (is that enough?); though not sure if they always launder the blankets with each stay. They also vacuum and (say they) disinfect surfaces between stays (tho I still wipe them anyway). Would leaving the windows open for an hour after arriving help? (Assuming they CAN be opened!) Or is this concern basically a tempest in a teapot?
Makes sense that college campuses might be an outbreak risk, but is there a true sense of K12? Cause I've heard the complete range of theories with little data other than demographic to back it up (and pediatric cases certainly don't help).
Thank you. For the most part this is very reassuring that the risk level for the bulk of the population is quite low given reasonable precautions. An excellent summary.
On a completely different topic, but still in the public health arena, giant kudos to the voters of Kansas on defeating that cunningly worded ballot measure. If we had a real democracy rather than a putative one, this would be the outcome in all states. A bright outcome. Now, back to the rapidly evolving monkeypox outbreak.
I’ve been getting a trickle of questions in the office from patients, not a flood yet. Everyone is so fatigued, and the idea of another virus causing mayhem is kind of too much. I get it.
I did a post about the heroic, unseen public health effort right now, the nuances of vaccination and treatment of higher risk individuals and severe syndromes - and how learning about pandemics from caustic, biased pundits like Ben Shapiro is not advisable.
Thanks for this evidence based review. I’m seeing monkeypox ghosts in shingles and herpetic outbreaks this week… this is going to be quite difficult 😞
You said, "MPV could spread to other social networks." Hasn't it already spread to people who are not men who have sex with men? While MSM are the group most at risk *right now* and being laser focused on public health outreach is warranted, there are already faulty assumptions and misinformation because of that laser focus. People who are not MSM are being gaslit by medical personnel about their MPV symptoms. While these are anecdotal instances reported via social media there is the valid concern we didn't learn from the 80's AIDS epidemic.
As with HIV, gay men are once again the proverbial canaries in the coal mine. They are the most at risk *based on the current data* which are, inevitably, delayed. So reaching them is the highest priority but certainly not the only one. But anyone with close personal contacted with an infected individual is at risk. That is abundantly clear by now. Viruses don't recognize sexual orientation.
What other social networks?
Do you have specifics - where did you find the data?
96-98% so far gay men - what we did not learn from the 80's AIDS epidemic was to address those spreading the disease to modify their behavior.
KB - you said it has spread to other "social networks"... thats not "acknowledging that the virus does not discriminate" - thats a definitive statement. I am not sure your real meaning...
Some info I have read says only UVC and that soap may wash it away but will not break it down. Any additional information on this? It is coming out of other countries. I am using hand sanitizer in addition to washing my hands as I am immunocompromised. I too want to know if my smallpox vaccination re 1950s will afford any protection.
I like that they're starting to use wastewater surveillance for more pathogens besides Covid. I imagine the more pathogens we monitor, the better we'll be able to guage what "normal" levels are for endemic diseases versus novel ones in a given area.
Would also love for epidemiologists, actuaries, and policy wonks to put their heads together and design parametric insurance using wastewater surveillance - like we currently do for heating/cooling degree days, crop yields, etc
This looks like some encouraging data: The amount of monkeypox in sewage at two spots in San Francisco has been relatively stable for about 3 weeks. None of the different sewagesheds being monitored are showing exponential growth for monkeypox.
https://soe-wbe-pilot.wl.r.appspot.com/charts#page=overview_mpxv
YLE - you have gone Politically correct here -
QUOTE Contact tracing data confirms this, thus far, by showing clear patterns of transmission among very close and prolonged contacts, like sexual encounters. UNQUOTE
The media is reporting between 96%-98% is gay sex.
What are the other patterns outside of sexual encounters?
Hi Larry, this is a rapidly evolving situation and as more people get infected it's likely if not probable that we might see newly emerging patterns of community spread. It's entirely prudent to allow for that possibility, is it not? As Stephen said earlier, viruses don't care (or know) one's sexual orientation. We should all take reasonable precautions as the virus spreads out from it's core start populations. As the picture clarifies I suspect we will see new patterns coming to view.
I asked a simple question - what are the other ways?
YLE said sex was one and continued her tone of not wanting to stigmatize people.
Well - facts are hard to argue with -
We stopped the global economy - literally - told people not to go outside because of the unknown.
We require people to wear masks - knowing they were not effective unless they were worn proper and of a specific quality (N95).
We asked people to get vaccines and lied about their effectiveness (to get the ball rolling, i understand this but its still a lie)
ALL THIS TO PROTECT OUR SOCIETY.
Right now MP is growing within ONE COMMUNITY - if it is not please share what other community is spreading the virus knowingly. We can take precautions for tomorrow but for today STOPPING THE SPREAD (sound familiar) should be the focus.
Your focus is on "reasonable precautions" for everyone as one group act "unreasonably?"
Its confusing - that STOPPING THE SPREAD is not the messaging. But lets be careful after they spread it around.
AGAIN - my question was - what are the other patterns outside of sexual encounters?
It is political pandering - not public safety that you and others are selling to people.
Isn't it amazing that no one has worked on a study to see if protection helps?
Well you said alot there! But look at it this way: assume a hypothetical virus that uses, say, an insect vector and carriers if the insect are found in grain ships from one continent where the virus resides. The crew men of those ships form the human core infected group as seen from the perspective of the people of the second continent. So the focus is on the crews. But the virus is actually moving into the second continent via the insect vector. Of course we are looking at Y. Pestis. I argue that the core group is important of course, but once the virus moves out, we all have to take reasonable precautions. Nothing political about it, save for people who filter things through that lens.
Still wondering how the virus spreads. YLE was clear -
QUOTE Contact tracing data confirms this, thus far, by showing clear patterns of transmission among very close and prolonged contacts, like sexual encounters. UNQUOTE
What other transmission has been shown? like Sexual encounters or sexual encounters.
Using your hypothetical - imagine if people were told that eating an apple could cause you to get a virus - applepox. And we find that 98% of all people infected ate an apple. Would you tell people to stop eating apples?
OR
Would you suggest that society at large go into crisis mode to stop other people from getting the virus from people who ate the apples???
Clearly your hypothetical removes the voluntary nature from which the virus is passed. As of today, we have no indication that the virus has moved to the second continent and the first continent is still sending out the virus. Seems like continent one is being irresponsible.
This is avoidable yet that is not the messaging. Its just not. As YLE said, you do not want to stigmatize anyone... If thats not political then i am lost as the irresponsibility of the messaging.
Hi Larry, you make some excellent points but they're a little off the mark. My hypothetical was only a thinly disguised revamp of the historic spread of the plague from Asia to Europe in successive waves. The 'continent" in my revamp is not a social network but an actual continent. In monkeypox, substitute Africa. The social network is the sailors on the various grain ships. We might call them Men who Sail with Men, MSM for short. So to the Europeans the sailors were the initial human network, but as history had it, the plague virus moved out of the MSM network (as it was actually being carried by the fleas on the rats that infested the ships) and into the general population
In population biology it is long known that populations live in a fractured way, called demes. Yet there is communication between these populations leading to gene exchange. But importantly, virus exchange also. Social networks in our species are like Venn diagrams. There are multiple intersection populations, not themselves always defined clearly or even forming social networks of their own.
We might call these messengers. What has got the WHO worried is the potential for movement of hMPXV into intersecting populations with the MSM and then finding ways to spread further. Not alarming but something to be careful about anyway...
I am just a regular person - if we are starting to scream the sky is falling - and Governments are calling for a State of Emergency then its something alarming.
My fear, which is tacitly explained by YLE and NEJM as well as media outlets, is how Stigmatizing the population that is behaving in a manner that spreads not mitigates the virus takes precedence over mitigation of the spread.
It would appear from all evidence - that we have to mitigate the spread. We have to stop the "eating of apples" to slow the spread.
Using your hypothetical - i would suggest stopping the ships from sailing to contain the disease instead of trying to protect the destination continent from infection.
It defies common sense not to push for mitigation at the source.
Do you have any thoughts on monkeypox in the context of contra dancing?
- On a typical evening there will generally be skin to skin contact with multiple people. More with whoever you're partnered with for a given piece. But also whoever you swing with (ballroom position, and we are often wearing short sleeves for personal comfort)
- The contra dance community is generally welcoming of all sorts of people. It's not hard to imagine monkeypox getting to at least one unwitting contra dancer
- people travel long distances to go to a contra dance. They frequently carpool on long trips to big festivals.
We are currently going all-in with Covid safety protocols (N95 masks, vaxes and boosters if eligible). Long sleeves would be a rather impractical in hot weather.
My question is whether with the current state of play (Covid still rampant, monkeypox emerging, and exteeme heat events) - is this activity irreducibly hazardous right now?
Please address the polio outbreak. Do adults need a booster? Are vaccinated children at risk?
In am wondering about how this will play out in long term care centers and day care centers once it is more common in the general population.
Did I read correctly that us "old fogeys" who were vaccinated against smallpox as a child are protected?
Preprint, but compared to the other study of surfaces that was shortly after use, this is what was left just 4 days later.
https://www.medrxiv.org/content/10.1101/2022.08.09.22278460v1
Monkeypox virus contamination in an office-based workplace environment, England 2022
Abstract
In May 2022, an office worker attended their place of work while experiencing prodromal symptoms of monkeypox infection. Environmental sampling performed four days later identified only low levels of monkeypox virus DNA contamination of the worker’s desk, and no contamination elsewhere within the office. Replication-competent virus was not identified.