Coronavirus & Monkeypox Tidbits #205 8/14/22

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

New posts:

CDC Says More Is Needed to Protect Infants From Hepatitis B

https://www.medscape.com/viewarticle/979110?

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Don’t Let Infections Dampen Your Summer Water Fun. Here’s How To Avoid Splash Pad Infections

https://www.forbes.com/sites/judystone/2022/08/10/dont-let-infections-dampen-your-summer-water-fun-heres-how-to-avoid-splash-pad-infections/

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How Can We Vaccinate People More Quickly Against Monkeypox? Dose-Sparing

https://www.forbes.com/sites/judystone/2022/08/08/how-can-we-vaccinate-people-more-quickly-against-monkeypox-dose-sparing/

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Climate Change Can Worsen More Than Half of Infectious Diseases

https://www.medscape.com/viewarticle/978813

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Antibiotic-Resistant Bacteria Emerging in Community Settings

https://www.medscape.com/viewarticle/978627

News 

 Covid:

CDC capitulates in their new Covid guidance...forgets about prevention and protecting vulnerable

Simplified measures for contacts, infected people

One of the biggest changes is quarantine guidance for people exposed to the virus. Instead of quarantining, the CDC recommends wearing a high-quality mask, watching for symptoms for 10 days, and getting tested on the fifth day.

People who are mildly sick with COVID-19 should still isolate for at least 5 days while wearing a high-quality mask. After isolating, people who are recovering should avoid contact with vulnerable people for 11 days.

The CDC recommends longer isolation periods for people with moderate and severe illness.

Another major change is that the CDC no longer recommends screening asymptomatic people who don't have known exposures.

The agency urged people to consider their risks in particular settings, keeping in mind community transmission levels and ventilation, when gauging needed distancing measures.

New guidance also targets schools

In updated guidance for schools and childcare settings, the CDC removed the recommendation to cohort students and to conduct screening tests, except when community levels are high or in response to outbreaks. It also removed the quarantine recommendation, except for in high-risk congregate settings.

Also, the CDC removed information about test-to-stay, which was originally designed to allow school-linked close contacts who aren't fully vaccinated to attend school during quarantine.

https://www.cidrap.umn.edu/news-perspective/2022/08/cdc-unveils-streamlined-covid-19-guidance

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COVID-19 neuro complications, long-term symptoms in kids

Two new US studies describe pediatric COVID-19, one finding that 7.0% of hospitalized children developed neurologic complications such as seizures, and the other showing that even mild infections can lead to long COVID.

7% have seizures, brain damage

In a large, multicenter study published today in Pediatrics, a team led by Vanderbilt University researchers followed 15,137 COVID-19 patients aged 2 months to 17 years released from 52 US children's hospitals participating in the Pediatric Health Information System database from March 2020 to March 2022.

Seven percent of patients developed a neurologic complication, the most common of which were fever-triggered seizures (3.9%), non–fever-related seizures (2.3%), and encephalopathy (brain damage or disease) (2.2%).

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Monkeypox:

Dose-sharing of Jynneos vaccine:

I wrote about this plan to use smaller, intradermal vaccination to => 5x extra doses: https://www.forbes.com/sites/judystone/2022/08/08/how-can-we-vaccinate-people-more-quickly-against-monkeypox-dose-sparing/?sh=62f2146d1b75

FDA's Peter Marks acknowledged the critics who point out that fractional dosing is based on one trial published in 2015, but he said the trial was well-constructed and offered very reassuring results.

Bavarian Nordic, the manufacturer, expresses serious reservations [perhaps unsurprisingly]

But there is an urgent need for more vaccines, as the US now has 10,392 confirmed monkeypox cases in all states but Wyoming. With a global total of 33,333, the US represents one-third of the world's cases.

Less than half the doses we need in US would be available by Dec. OTOH, Africa still does not have any doses of monkeypox vaccine, despite being the historical home of the virus.

ACAM2000, a smallpox vaccine, was also considered but ultimately decided against because it carries with it a significant risk of myocarditis (1 case out of 175 recipients), and causes a scab that sheds live virus, which is unsuitable for immunocompromised individuals.

https://www.cidrap.umn.edu/news-perspective/2022/08/fractional-monkeypox-vaccine-dosing-comes-under-scrutiny

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[Note: Dose sharing is untested for monkeypox and could be a disaster--ineffective. It has been used for other diseases, as I wrote. And Jynneos is only 85% effective to begin with. It, like the mRNA Covid vaccines, seems better at preventing sever disease rather than any disease.]

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Hurdles to antiviral treatment for monkeypox leave people suffering

Infectious disease doctors say there are maddening barriers to monkeypox treatment with one medication, Tpoxx, that can ease patients’ pain, fever, and fatigue. The antiviral isn’t approved for monkeypox, so it’s available only under a compassionate use policy that requires a “Kafkaesque amount of paperwork,” 90-minute appointments, and two follow-up visits, even after CDC streamlined the process. That leads to further delays in care, especially in short-staffed or emergency settings, New York City health department member Mary Foote said on a call with reporters yesterday. “We really cannot be complacent about this needless suffering.”

With support on monkeypox hard to come by, queer communities turn to one another

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Polio:

In addition to the case of paralysis in Rockland county, there is now polio in NYC wastewater, suggesting it is much more widespread.

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https://twitter.com/dgurdasani1/status/1557349114458914818?s=20&t=R1S1TuExxL4ExQiUWIQDrA

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Other:

New ‘Langya’ virus identified in China: what scientists know so far

The henipavirus can cause respiratory symptoms and is related to Nipah and Hendra viruses, but cannot spread easily in people.

Nature Smriti Mallapaty 11 August 2022

A new animal virus that can infect people has been identified in eastern China. But scientists say they are not overly concerned because the virus doesn’t seem to spread easily between people, nor is it fatal.

The virus, named Langya henipavirus (LayV), can cause respiratory symptoms such as fever, cough and fatigue, and is closely related to two other henipaviruses known to infect people — Hendra virus and Nipah virus. These also cause respiratory infections, and can be fatal. Researchers think LayV is carried by shrews, which might have infected people directly or through an intermediate animal. The virus was described in the New England Journal of Medicine1 on 4 August.

Researchers say LayV has infected only 35 people since 2018, and none of the cases seems to be linked. “There is no particular need to worry about this, but ongoing surveillance is critical,” says Edward Holmes, an evolutionary virologist at the University of Sydney in Australia. Regularly testing people and animals for emerging viruses is important to understand the risk of zoonotic diseases — those that can be transmitted from other animals to humans, he says.

Large outbreaks of infectious diseases typically take off after a lot of false starts, says Emily Gurley, an infectious-diseases epidemiologist at Johns Hopkins University in Baltimore, Maryland. “If we are actively looking for those sparks, then we are in a much better position to stop or to find something early.”

https://www.nature.com/articles/d41586-022-02175-z

Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

COVID-19 mRNA vaccines are safe in pregnancy, large study

by Lancet  AUGUST 11, 2022

COVID-19 mRNA vaccines are safe to use in pregnancy and pregnant women experienced lower rates of health events post vaccination than similarly aged, non-pregnant vaccinated people, suggests a large Canadian study published in The Lancet Infectious Diseases journal.

The COVID-19 pandemic has disproportionately affected pregnant women, who are at higher risk of severe COVID-19 disease than similarly aged non-pregnant individuals.

https://medicalxpress.com/news/2022-08-covid-mrna-vaccines-safe-pregnancy.html

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Poll on vaccines for kids

recent poll from the Kaiser Family Foundation that assessed parents' views on vaccinating their children against COVID-19 found that many were reluctant owing to worries about safety and not enough testing. Others expressed concerns about access barriers. Nearly half of Black parents said they were concerned about taking time off work to get their young children vaccinated, and nearly half of Hispanic parents had concerns about getting their child vaccinated at locations they trust.

Also, a majority of parents of children under 5 said messaging about the vaccine from federal officials is confusing, especially where to get to the vaccine.

https://www.cidrap.umn.edu/news-perspective/2022/08/omicron-subvariants-gain-more-ground-including-ba46-midwest

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Monkeypox:

A Patient’s Guide to TPOXX Access

https://docs.google.com/document/u/0/d/1IWfKdXYvT8iWwQEAc-OsgcTxW_5OlmtkpUwcgOI8L6Q/mobilebasic

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How effective is the monkeypox vaccine? Scientists scramble for clues as trials ramp up

Exactly how well MVA protects against monkeypox and for how long is not known. Nor is it clear how much protection is lost by giving just a single dose rather than the recommended two doses, as some countries are doing to stretch supply, or how much protection a vaccine given after exposure can offer.

But the ethical and logistical complexities of the monkeypox crisis, which is overwhelmingly affecting men who have sex with men (MSM), are making these questions hard to answer. Placebo-controlled clinical trials are fraught because MVA is already licensed and people are clamoring to get it. And vaccine clinics are often set up at short notice as doses become available, making it harder to organize a trial and enroll subjects. Researchers are responding with a plethora of inventive trial designs....[see full article for interesting details]

MVA was licensed for monkeypox based on data from animal experiments and the immune response it triggers in humans. But its efficacy has barely been tested in people, and not at all for preventing sexual transmission, which results in “very significant mucosal exposure, which is not the same thing as just brushing up against somebody,” says Anne Rimoin, an epidemiologist at the University of California, Los Angeles.

So far, there’s scant data on how well the vaccine is working in the current outbreak.

https://www.science.org/content/article/how-effective-monkeypox-vaccine-scientists-scramble-clues-trials-ramp

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Devices:

Epidemiology/Infection control:

COVID rebound is surprisingly common — even without Paxlovid

Viral levels resurge in more than 10% of untreated people with COVID-19, but early data hint that the rebound is even more pronounced after antiviral treatment.

https://www.nature.com/articles/d41586-022-02121-z

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Monkeypox

Racial disparities in monkeypox infections are stark in some locales

The current monkeypox outbreak has many unknowns, but in one respect it’s familiar: In some states and localities, racial disparities are alarming. In Georgia, 82% of people with the disease are Black. In North Carolina, it’s 70%. But in other places that released detailed demographic data, there are fewer and sometimes no apparent racial or ethnic disparities in cases.

Some experts told STAT’s Usha Lee McFarling, Katherine Gilyard, and Akila Muthukumar the disparities come as no surprise. That’s because they track with the early days of the HIV epidemic — and the more recent emergence of Covid-19. “We saw it with HIV among marginalized communities in the 1980s just as we saw the tepid response to Covid-19 that disproportionately impacted people of color and those living in poverty,” said Joia Mukherjee, the chief medical officer for Partners in Health. “It’s inexcusable.” Read more about access to vaccine, health care, and data.

https://www.statnews.com/2022/08/11/new-data-from-several-states-show-racial-disparities-in-monkeypox-infections/

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More on How Monkeypox is spread

Prolonged contact, especially with a person’s skin lesions, is emerging as the top transmission route.

Early predictions that the virus transmits primarily through repeated skin-to-skin contact between people have largely borne out, according to a tranche of new studies.

Several studies2,3, including Mitjà’s, show that few people contract the disease from an infected household member with whom they didn’t have sexual contact. This finding, paired with the data about viral load, suggests that respiratory droplets and airborne particles probably aren’t the primary transmission route, Titanji says. If corroborated by further research, it could call into question whether people should isolate for the entire duration of infection, which might be difficult because the illness seems to take up to a month to resolve, she adds.

https://www.nature.com/articles/d41586-022-02178-w

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Researchers add monkeypox to wastewater surveillance

Monitoring and testing for the monkeypox virus is a relatively simple add-on to the current wastewater surveillance program for SARS-CoV-2, said Rob Knight, Ph.D., professor and director of the Center for Microbiome Innovation at University of California San Diego.

But with a twist.

"It's the same process as SARS-CoV-2 qPCR monitoring, except that we have been testing for a different virus. Monkeypox is a DNA virus, so it is a bit of a surprise that our process optimized for SARS-CoV-2, which is an RNA virus, works so well," he said.

https://medicalxpress.com/news/2022-08-monkeypox-wastewater-surveillance.html

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Full paper on Monkeypox is here: thelancet.com/action/showPdf

Worryingly, 32 patients had had smallpox vaccination in their childhood. As the authors note, this “warrants further investigation to better understand the protection provided by vaccination in the context of the current outbreak”

Polio:

UK to offer polio vaccine for London children amid more wastewater detections

offering a booster dose of inactivated polio vaccine (IPV). The step is part of the response to the detection of type 2 vaccine-derived poliovirus in sewage.

The HSA said it is working with health officials in New York and Israel to investigate links between the viruses detected in London and those in the other two countries.

https://www.gov.uk/government/news/all-children-aged-1-to-9-in-london-to-be-offered-a-dose-of-polio-vaccine

 

Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

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Good luck getting this adopted:

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Monkeypox

Trump Espionage:

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Abortion/Reproductive care:

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Book bans/libraries

GoFundMe: https://www.gofundme.com/f/legal-fees-for-librarian-amanda-jones?

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GOP/Magats

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Alex Jones

https://twitter.com/Angry_Staffer/status/1556695617057038336?s=20&t=R1S1TuExxL4ExQiUWIQDrA

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Guns

Climate:

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California


Florida

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Georgia

Indiana

Oklahoma

Ukraine/Russia

Feel good du jour:

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Comic relief:

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Perspective/Poem

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Bits of beauty:

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