Forgive my dispondance. After the past couple years, I have zero confidence that the public would willingly or properly care for their vaccination site to prevent complications for themselves or others.
yeah i hear you, but i think i have a bit more hope. nonetheless, this is a valid point and will (or at least should) be in discussions about weighing benefits with risks.
Thank you for continuing to care and share great information with us. You have been a source of hope for those of us living in areas where public health has been ridiculed and ignored throughout the pandemic.
Since this is a choice that potentially impacts not just the person receiving the shot, but those around them, I think should be a series of hoops that people need to jump through to be allowed to get ACAM2000. Some of those hoops could also help educate people on how to avoid monkeypox.
1. A full physical exam, that would include all the issues Katelyn raised (e.g. eczema, risk factors for myocarditis, etc)
2. A written exam. Don't just assume that someone understands what they're signing. Make sure they've fully assimilated the necessary information.
3. A road test of sorts, to make sure they've got the ability to contain a rash on a very specific part of their body. Maybe use some sort of non-toxic dye? Or glitter?
Here you missed an opportunity to illustrate how unprecedentedly safe the Covid-19 vaccinations are and how wild the claims of many anti-vax scoffers are. It also shows how cautious FDA and their advisers were.
You cite that ACAM2000 vaccine could produce myocarditis/pericarditis in 1 in 175 people.
On the other hand, for Covid-19 vaccines, a study conducted in Denmark "found a higher risk for myocarditis or pericarditis following mRNA-1273 vaccination compared with BNT162b2 when evaluating the risk after dose 2 in male individuals aged 12 to 39 years. The corresponding rates of myocarditis or pericarditis within 28 days of vaccination in the Denmark study was 1.8 per 100 000 vaccinated individuals (95% CI, 0.8-3.4 per 100 000 vaccinated individuals) for BNT162b2 and 9.4 per 100 000 vaccinated individuals (95% CI, 5.0-16.0 per 100 000 vaccinated individuals) for mRNA-1273; dose 1 findings were not reported." Covid-19 vaccines are more than 600 times safer in this regard.
What scares me is how huge the bruhaha over myocarditis from mRNA vaccines became, when they are some of the safest vaccines ever marketed, and how scared people became of the adenovirus-vector COVID vaccines after a very dangerous but rare side effect was tied to them. How do we expect a public that nervous to react to a genuinely risky vaccine like ACAM2000? (Or the yellow fever vaccine if, God forbid, that disease makes a return here courtesy of global warming.)
Too many people in our society simply can't rationally weigh risks, which is why the anti-vaccine idiocy is thriving.
Until we run out of Jynneos, or have more compelling data about how risky monkeypox is in children, I don’t think ACAM is a realistic option.
As you know the mRNA vaccination rate in children in the US against Covid is shamefully low, and these vaccines are comparatively much easier and safer.
I truly hope we never learn the fatality rate of this monkeypox strain in children, or start seeing disfiguring rashes in suffering little ones. It’s good to have this conversation now, but very targeted vaccination of exposed, high risk, and ring individuals still makes sense to me.
If the risk benefit analysis someday soon favors ACAM, it’s going be a hard sell, even for vaccine lovers like myself.
Thanks for this ghost of Christmas future… I hope the story never comes to be.
PS - more likely we will rely upon TPOXX treatment I’m guessing
But do we have ENOUGH TPOXX? That worries me. I suspect we'll see shortages develop if the disease begins to spread more widely.
The fundamental problem is that no one was really expecting monkeypox to go global so very quickly, so both immunizations and therapeutics are lagging.
Good point. The company that makes TPOXX (SIGA Technologies) seems to have a better track record and logistics in place for production 🤞. I’ve been hearing chatter among infectious disease docs online that TPOXX works quite well.
The US currently has 1.7 million courses of TPOXX. We've had 14,115 known cases so far. There has been a large increase in case rates, but it's unclear if that's actual increases in cases or just simply an increase in testing. Assuming it's fully an increase in cases, that's an average 69% increase in cases week over week, it would take 5 months to exhaust that supply, even assuming 100% of cases get a course of treatment. That is the most pessimistic of scenarios, and assumes zero people are getting vaccinated that would slow down increases in grow. Obviously we're vaccinating people as fast as we can, and gracefully uptake for vaccines in the most at risk communities are high, with far more demand than there is vaccines. In all likelihood, case rate increases will start to slow and hopefully that will give manufacturers enough time to increase our supply of TPOXX.
I do think it may be time to roll out ACAM2000 to stop this monkeypox outbreak from becoming endemic in the US, but I understand the hesitation to do it. The public is generally quite intolerant of even minor vaccine complications, and ACAM2000 doesn’t just cause complications, it outright kills one to two people out of every million who receive it. How do we control the fallout from that, so that we don’t further the anti-vaccination attitudes already too prevalent in this country, and how do we decide where the threshold lies when using a dangerous vaccine is warranted?
That's part of the challenge of the foundation of vaccines we already laid (which is unstable and often rooted in misogyny). I worked as a Medical Assistant in the late 90's and early 2000's, when the a lot of the "vaccines cause autism" nuttiness and antivax mindsets were being set/gaining ground. I saw many providers approach parents (and patients) fear and concern with empowering conversations, data, and with honest dialog that vaccines are not 100% safe, they do have risks, BUT for most people those (usually minimal) risks are well worth the potential benefits. They also addressed that for some people the risks are greater, and yes there can be poor outcomes, rarely, very rarely, but they do happen, and talked about what to expect, what side effects are (ie not a vaccine caused illness). They equipped and educated us as MA's to have these conversations too and know when to bring a nurse or provider into the conversation. However, I also saw and heard health care professionals who responded with blanket statements and attitudes of "vaccines are totally safe.... I'm the doctor do as I say" and then when that person or that child experienced side effects the parent/patient's prior concerns and hesitancy were amplified instead of their having been prepared for them. Unfortunately for too long we haven't been having educational and informational conversations about vaccines, and that has negatively impacted people's trust.
We have to keep having these conversations. Providers, public health and vaccine clinics need to not just hand out the VIS, but also make/take the time to educate. I know our systems are overburdened and overwhelmed (and that is an understatement), but it's too important not to. Healthcare professionals have to treat patients and their families as part of the team.
Maybe require recipients to sign consent forms that list the risks. Most surgical procedures have them. I don't think we should limit our freedom of meeting health emergencies for fear of provoking the anti-vaxxers. They are a fixed part of the scene and in relation to polio for example have taken morally repugnant positions that outrage sensibility.
The problem is that most people sign those forms without thinking much (if at all). No one expects that the 1 out of a million bad thing will happen to THEM.
I don't worry about provoking the current anti-vaxxers. I worry about increasing their numbers.
I'm curious if we've studied the effectiveness of various routes of tranmission. Like other poxes, MPX is spread through physical contact, but I'm curious if how effective those routes of transmission are. Obviously sexual contact is some of the most intimate contact, and sexual activity appears to be the primary method of transmission. Noting this, it appears other physical contact can cause transmission, such as household transmission, but if that form of transmission has an R-eff of less than 1, then we could expect outbreaks outside of most at risk groups to pretty quickly die out. The R-eff of transmission via sexual activity does appear to be higher than 1, but the current vaccination strategy would help reduce that number, hopefully building immunity in most at risk groups and turning the tide on this outbreak.
Apparently the anti-vaxxers' idea of "personal freedom" is being reflected in statehouses and state legislatures all over the country. It's well organized and if successful will cripple public health in the states it gains traction in, replacing public health with personal health. It's hard not to feel despondent.
And when the heath care system collapses it will be all Biden's fault. Probably because antifa Communism gay marriage trans homosexuals critical race theory border crisis.
You got that straight! Health care collapsing? blame poor ole Joe. Inflation? blame poor ole Joe, Global warming? why it's Joe's fault. Sunspots, gravity waves, planet busting asteroids? Blame poor ole Joe!
And of course commie antifa trans illegal Hunter Biden laptops!
It is almost as if what state one lives in determines whether one has an intact public health system in the old sense or not. Another symptom of the chasm opening up that imperils rational public health delivery.
I remember having the smallpox vaccination as a kid (maybe in the late 1950s or thereabouts) and had that unique scar for quite a while afterwards. Do we know how long that immunity lasts?
Immunity levels do wane after time. I can tell you a friend of mine contracted monkeypox, and as an immigrant he had a smallpox vaccination as a child in the 1990s. He did contract monkeypox, but he was only symptomatic for a few days, as opposed to some weeks for the virally naive.
Repeating from another post, I can tell you a friend of mine contracted monkeypox, and as an immigrant he had a smallpox vaccination as a child in the 1990s. He did contract monkeypox, but he was only symptomatic for a few days, as opposed to some weeks for the virally naive.
You are probably immune (or at least reasonably protected from a severe case). But no one knows for certain. The fact that you have been previously immunized puts you in the back of the line as far as receiving a booster is concerned, since we are short on vaccine.
Repeating from a previous post, I can tell you a friend of mine contracted monkeypox, and as an immigrant he had a smallpox vaccination as a child in the 1990s. He did contract monkeypox, but he was only symptomatic for a few days, as opposed to some weeks for the virally naive.
You are probably immune (or at least reasonably protected from a severe case). But no one knows for certain. The fact that you have been previously immunized puts you in the back of the line as far as receiving a booster is concerned, since we are short on vaccine.
This is a very tough decision. My vote is roll it out immediately, knowing the risks. The primary consideration for me is to stop the virus from gaining a foothold. But perhaps give people a choice as to what to get if both Jynneos and ACAM are available. Maximizing gain or minimizing risk? Very tough call. It doesn't help that the Jynneos maker, Bavarian Nordic says they won't be able to meet demand.
They don't have to be 100% to prevent outbreaks. They merely have to get spread ratios to below 1.0 to stop outbreaks. We'll have to see more data about how this particular outbreak is going to play out, but if we can get enough immunity amongst those most at risk of spread, that should tamp down on that spread ratio, hopefully get it below 1.0. That's the race right now.
Forgive my dispondance. After the past couple years, I have zero confidence that the public would willingly or properly care for their vaccination site to prevent complications for themselves or others.
yeah i hear you, but i think i have a bit more hope. nonetheless, this is a valid point and will (or at least should) be in discussions about weighing benefits with risks.
Thank you for continuing to care and share great information with us. You have been a source of hope for those of us living in areas where public health has been ridiculed and ignored throughout the pandemic.
Since this is a choice that potentially impacts not just the person receiving the shot, but those around them, I think should be a series of hoops that people need to jump through to be allowed to get ACAM2000. Some of those hoops could also help educate people on how to avoid monkeypox.
1. A full physical exam, that would include all the issues Katelyn raised (e.g. eczema, risk factors for myocarditis, etc)
2. A written exam. Don't just assume that someone understands what they're signing. Make sure they've fully assimilated the necessary information.
3. A road test of sorts, to make sure they've got the ability to contain a rash on a very specific part of their body. Maybe use some sort of non-toxic dye? Or glitter?
I had similar thoughts Amanda. I want to trust people to do the right thing... Yet here I am the odd one wearing a mask in many situations, sooo 🤷♀️
Here you missed an opportunity to illustrate how unprecedentedly safe the Covid-19 vaccinations are and how wild the claims of many anti-vax scoffers are. It also shows how cautious FDA and their advisers were.
You cite that ACAM2000 vaccine could produce myocarditis/pericarditis in 1 in 175 people.
On the other hand, for Covid-19 vaccines, a study conducted in Denmark "found a higher risk for myocarditis or pericarditis following mRNA-1273 vaccination compared with BNT162b2 when evaluating the risk after dose 2 in male individuals aged 12 to 39 years. The corresponding rates of myocarditis or pericarditis within 28 days of vaccination in the Denmark study was 1.8 per 100 000 vaccinated individuals (95% CI, 0.8-3.4 per 100 000 vaccinated individuals) for BNT162b2 and 9.4 per 100 000 vaccinated individuals (95% CI, 5.0-16.0 per 100 000 vaccinated individuals) for mRNA-1273; dose 1 findings were not reported." Covid-19 vaccines are more than 600 times safer in this regard.
What scares me is how huge the bruhaha over myocarditis from mRNA vaccines became, when they are some of the safest vaccines ever marketed, and how scared people became of the adenovirus-vector COVID vaccines after a very dangerous but rare side effect was tied to them. How do we expect a public that nervous to react to a genuinely risky vaccine like ACAM2000? (Or the yellow fever vaccine if, God forbid, that disease makes a return here courtesy of global warming.)
Too many people in our society simply can't rationally weigh risks, which is why the anti-vaccine idiocy is thriving.
Until we run out of Jynneos, or have more compelling data about how risky monkeypox is in children, I don’t think ACAM is a realistic option.
As you know the mRNA vaccination rate in children in the US against Covid is shamefully low, and these vaccines are comparatively much easier and safer.
I truly hope we never learn the fatality rate of this monkeypox strain in children, or start seeing disfiguring rashes in suffering little ones. It’s good to have this conversation now, but very targeted vaccination of exposed, high risk, and ring individuals still makes sense to me.
If the risk benefit analysis someday soon favors ACAM, it’s going be a hard sell, even for vaccine lovers like myself.
Thanks for this ghost of Christmas future… I hope the story never comes to be.
PS - more likely we will rely upon TPOXX treatment I’m guessing
But do we have ENOUGH TPOXX? That worries me. I suspect we'll see shortages develop if the disease begins to spread more widely.
The fundamental problem is that no one was really expecting monkeypox to go global so very quickly, so both immunizations and therapeutics are lagging.
Good point. The company that makes TPOXX (SIGA Technologies) seems to have a better track record and logistics in place for production 🤞. I’ve been hearing chatter among infectious disease docs online that TPOXX works quite well.
yes i have a lot of hope for TPOXX, however was very surprised it wasn’t included in the EUA. not sure what’s going on there
The US currently has 1.7 million courses of TPOXX. We've had 14,115 known cases so far. There has been a large increase in case rates, but it's unclear if that's actual increases in cases or just simply an increase in testing. Assuming it's fully an increase in cases, that's an average 69% increase in cases week over week, it would take 5 months to exhaust that supply, even assuming 100% of cases get a course of treatment. That is the most pessimistic of scenarios, and assumes zero people are getting vaccinated that would slow down increases in grow. Obviously we're vaccinating people as fast as we can, and gracefully uptake for vaccines in the most at risk communities are high, with far more demand than there is vaccines. In all likelihood, case rate increases will start to slow and hopefully that will give manufacturers enough time to increase our supply of TPOXX.
I do think it may be time to roll out ACAM2000 to stop this monkeypox outbreak from becoming endemic in the US, but I understand the hesitation to do it. The public is generally quite intolerant of even minor vaccine complications, and ACAM2000 doesn’t just cause complications, it outright kills one to two people out of every million who receive it. How do we control the fallout from that, so that we don’t further the anti-vaccination attitudes already too prevalent in this country, and how do we decide where the threshold lies when using a dangerous vaccine is warranted?
That's part of the challenge of the foundation of vaccines we already laid (which is unstable and often rooted in misogyny). I worked as a Medical Assistant in the late 90's and early 2000's, when the a lot of the "vaccines cause autism" nuttiness and antivax mindsets were being set/gaining ground. I saw many providers approach parents (and patients) fear and concern with empowering conversations, data, and with honest dialog that vaccines are not 100% safe, they do have risks, BUT for most people those (usually minimal) risks are well worth the potential benefits. They also addressed that for some people the risks are greater, and yes there can be poor outcomes, rarely, very rarely, but they do happen, and talked about what to expect, what side effects are (ie not a vaccine caused illness). They equipped and educated us as MA's to have these conversations too and know when to bring a nurse or provider into the conversation. However, I also saw and heard health care professionals who responded with blanket statements and attitudes of "vaccines are totally safe.... I'm the doctor do as I say" and then when that person or that child experienced side effects the parent/patient's prior concerns and hesitancy were amplified instead of their having been prepared for them. Unfortunately for too long we haven't been having educational and informational conversations about vaccines, and that has negatively impacted people's trust.
We have to keep having these conversations. Providers, public health and vaccine clinics need to not just hand out the VIS, but also make/take the time to educate. I know our systems are overburdened and overwhelmed (and that is an understatement), but it's too important not to. Healthcare professionals have to treat patients and their families as part of the team.
Maybe require recipients to sign consent forms that list the risks. Most surgical procedures have them. I don't think we should limit our freedom of meeting health emergencies for fear of provoking the anti-vaxxers. They are a fixed part of the scene and in relation to polio for example have taken morally repugnant positions that outrage sensibility.
The problem is that most people sign those forms without thinking much (if at all). No one expects that the 1 out of a million bad thing will happen to THEM.
I don't worry about provoking the current anti-vaxxers. I worry about increasing their numbers.
I'm curious if we've studied the effectiveness of various routes of tranmission. Like other poxes, MPX is spread through physical contact, but I'm curious if how effective those routes of transmission are. Obviously sexual contact is some of the most intimate contact, and sexual activity appears to be the primary method of transmission. Noting this, it appears other physical contact can cause transmission, such as household transmission, but if that form of transmission has an R-eff of less than 1, then we could expect outbreaks outside of most at risk groups to pretty quickly die out. The R-eff of transmission via sexual activity does appear to be higher than 1, but the current vaccination strategy would help reduce that number, hopefully building immunity in most at risk groups and turning the tide on this outbreak.
Apparently the anti-vaxxers' idea of "personal freedom" is being reflected in statehouses and state legislatures all over the country. It's well organized and if successful will cripple public health in the states it gains traction in, replacing public health with personal health. It's hard not to feel despondent.
https://khn.org/news/article/anti-vaccine-state-lawmakers-gain-ground-childhood-shots/
And when the heath care system collapses it will be all Biden's fault. Probably because antifa Communism gay marriage trans homosexuals critical race theory border crisis.
You got that straight! Health care collapsing? blame poor ole Joe. Inflation? blame poor ole Joe, Global warming? why it's Joe's fault. Sunspots, gravity waves, planet busting asteroids? Blame poor ole Joe!
And of course commie antifa trans illegal Hunter Biden laptops!
Oh, and I forgot! Immigrants everywhere, blame poor ole Joe, defunded law enforcement, blame poor ole Joe. Overzealous law enforcement, it's Joe's fault! Food shortages, pandemics, mask mandates, blame poor ole Joe. Backyard gophers, tidal waves, ringworm, murder hornets. Why they're all Joe's fault of course!
It is almost as if what state one lives in determines whether one has an intact public health system in the old sense or not. Another symptom of the chasm opening up that imperils rational public health delivery.
I remember having the smallpox vaccination as a kid (maybe in the late 1950s or thereabouts) and had that unique scar for quite a while afterwards. Do we know how long that immunity lasts?
Immunity levels do wane after time. I can tell you a friend of mine contracted monkeypox, and as an immigrant he had a smallpox vaccination as a child in the 1990s. He did contract monkeypox, but he was only symptomatic for a few days, as opposed to some weeks for the virally naive.
We know it lasts a long time. But no one knows quite how long (especially when it comes to monkeypox).
Echoing a previous comment, I am 75.....received smallpox vaccination on left arm(with scar to prove it)
in early 1950s. Am I still probably immune against smallpox and, to the main point, monkeypox? Could Katelyn please address this.
Repeating from another post, I can tell you a friend of mine contracted monkeypox, and as an immigrant he had a smallpox vaccination as a child in the 1990s. He did contract monkeypox, but he was only symptomatic for a few days, as opposed to some weeks for the virally naive.
You are probably immune (or at least reasonably protected from a severe case). But no one knows for certain. The fact that you have been previously immunized puts you in the back of the line as far as receiving a booster is concerned, since we are short on vaccine.
that’s right. you probably have some level of immunity, but we aren’t sure how much. very much waiting on data. here is a previous post discussing this https://yourlocalepidemiologist.substack.com/p/how-effective-are-mpx-vaccines
Do those who received the original smallpox vaccine - late 1960s-early 1970s - have immunity to monkey pox?
Repeating from a previous post, I can tell you a friend of mine contracted monkeypox, and as an immigrant he had a smallpox vaccination as a child in the 1990s. He did contract monkeypox, but he was only symptomatic for a few days, as opposed to some weeks for the virally naive.
You are probably immune (or at least reasonably protected from a severe case). But no one knows for certain. The fact that you have been previously immunized puts you in the back of the line as far as receiving a booster is concerned, since we are short on vaccine.
Thank you
You're very welcome!
This is a very tough decision. My vote is roll it out immediately, knowing the risks. The primary consideration for me is to stop the virus from gaining a foothold. But perhaps give people a choice as to what to get if both Jynneos and ACAM are available. Maximizing gain or minimizing risk? Very tough call. It doesn't help that the Jynneos maker, Bavarian Nordic says they won't be able to meet demand.
They don't have to be 100% to prevent outbreaks. They merely have to get spread ratios to below 1.0 to stop outbreaks. We'll have to see more data about how this particular outbreak is going to play out, but if we can get enough immunity amongst those most at risk of spread, that should tamp down on that spread ratio, hopefully get it below 1.0. That's the race right now.