Coronavirus & Monkeypox Tidbits #209 9/4/22

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.

Election volunteer opportunities:

NOPE Neighbors: https://www.nopeneighbors.org/volunteer

Power the Vote https://www.powerthevote.org//. I'm a fellow volunteer.
Are you interested in voter protection research? Battleground states including Arizona, Michigan and Texas need help. Volunteers would work with the voter protection program directly on research tasks. Examples include: (i) calling elections offices to get information about certain election plans, so that programs know where and when to send volunteers; (ii) calling elections offices to follow up on public records requests for needed information (such as data on ballot rejections); and (iii) reviewing elections websites to ensure information is accurate and up to date. This volunteer commitment is variable and flexible, but will require an ability to make calls during election offices' business hours. Volunteers will need to be comfortable inputting information into basic spreadsheets.
**If you are interested in joining a research team, please email volunteer@powerthevote.org.** We will be in touch with more detailed information as soon as we can.

If you like calling and talking to voters, Power the Vote is assembling weekly volunteer opportunities. These are remote opportunities that you can do from home! Click on this link to find out more: https://docs.google.com/document/d/1v3IQa3qeJMuLaa2MW0ObAoXltpLUyoKu0L7xhd-98zE/edit

~ ~ ~

New post:

I was asked to write this full feature for Medscape this week. It was challenging and fun to interview these folks. I hope you enjoy it, too.

Asymptomatic Infections Drive Many Epidemics, Including Monkeypox, Polio, and COVID

https://www.medscape.com/viewarticle/980118

News 

Covid:

CDC backs new Covid boosters. Now what?

CDC’s vaccine advisory panel yesterday backed new boosters from Pfizer and its partner BioNTech as well as from Moderna that target both the original SARS-CoV-2 virus strain that all previous vaccines have protected against, and the Omicron subvariants BA.4/BA.5. CDC Director Rochelle Walensky signed off on the recommendation hours later. Sometime this weekend or early next week, pharmacies and doctor's offices will start to receive the reformulated Covid-19 boosters. More from STAT’s Helen Branswell here on the deliberations.

Meanwhile, Helen, Matthew Herper, and Sarah Owermohle answer some questions:

  • Who can’t get the new booster? People who haven’t been vaccinated yet. Why? The boosters contain less vaccine, perhaps not enough to elicit good protection.
  • Will I need to get a booster every year? That’s the schedule many infectious disease experts want, but we’re not there yet.
  • What if I had Covid this summer? The CDC suggests waiting up to three months before getting the booster.

Read more.

~ ~ ~

37% of a group of Maryland preschoolers with COVID-19 had no symptoms

An 8-month COVID-19 screening study of 175 Maryland households with at least one child aged 0 to 4 years finds that 37% of preschoolers had no symptoms, suggesting that screening only symptomatic children may not be enough to prevent outbreaks in this age-group.

A team led by Johns Hopkins University researchers analyzed weekly symptom questionnaires, self-collected nasal swabs, and sera from 690 participants in 175 Maryland households with one or more children younger than 5 years from Nov 24, 2020, to Oct 15, 2021. The study preceded the emergence of the more transmissible Omicron variant.

Aug 31 JAMA Netw Open study

https://www.cidrap.umn.edu/news-perspective/2022/09/covid-19-scan-sep-01-2022

~ ~ ~

Study: Previous COVID-19 infection offers protection against BA.5

Infections with previous COVID-19 variants offer more protection against the Omicron BA.5 subvariant in vaccinated people compared with vaccinated people who had no previous  infections, according to a New England Journal of Medicine study yesterday.

The study was based on research conducted at the University of Lisbon in Portugal and is among the first studies to analyze protection against BA.5 among vaccinated and naturally infected people. The authors used the Portuguese national registry of COVID-19 cases to determine which variant likely caused infection based on date and variant predominance. Cases in patients age 12 and older were used.

The researchers found that while natural infections from 2020 and 2021 (when the wild-type strain and the Delta variant were predominant) offered some protection again BA.5, people infected with the BA.1 and BA.2 variants, at the beginning of 2022, who were also vaccinated had four times the protection as those who were only vaccinated.

The authors said their findings challenge the perception that protection afforded by previous BA.1 or BA.2 infection is very low.

"Our data indicate that this perception is probably a consequence of the larger pool of persons with BA.1 or BA.2 infection than with infection by other subvariants, and it is not supported by the data," they said.
Aug 31 N Engl J Med 
study
Aug 31 University of Lisbon 
press release

https://www.cidrap.umn.edu/news-perspective/2022/09/covid-19-scan-sep-01-2022

~ ~ ~

Recent findings suggest new omicron BA.2.75 is as susceptible to antibodies as the currently dominant variant

In a recent study, researchers from Karolinska Institutet and others have characterized the new omicron variant BA.2.75, comparing its ability to evade antibodies against current and previous variants. The study, published in the journal The Lancet Infectious Diseases, suggests that BA.2.75 is not more resistant to antibodies than the currently dominating BA.5, which is positive news.

https://medicalxpress.com/news/2022-09-omicron-ba275-susceptible-antibodies-dominant.html?

Monkeypox:

US schools, colleges see monkeypox cases

Across the United States a handful of college campuses, as well as high schools and middle schools, are dealing with monkeypox cases identified in students and staff.

A case was identified at a Greenwood, South Carolina, middle school yesterday, but health officials assured parents there were no close contacts or exposures and no reason for concern.

The University of Pittsburgh is the latest college to report a monkeypox case in a student. The student is recovering in isolation, and close contacts have been identified and notified of the case. Jay Darr, associate dean of students for wellness at Pitt, said the university will not issue public communications for each new case, but students will be contacted by a contact tracer if they had a possible exposure.

Yesterday, the Centers for Disease Control and Prevention (CDC) reported 572 more monkeypox cases in the United States, raising the total to 18,989. California has the highest case count, with 3,629, followed by New York (3,310), and Florida (1,922).

~ ~ ~

~ ~ ~

Occupational exposure

To date, WHO and ECDC have been informed of 84 cases of MPX infection among health workers, including three cases of occupational exposure. In all three cases of occupational exposure, health workers were wearing recommended personal protective equipment but were exposed to body fluid while collecting samples. The WHO interim guidance on clinical management and infection prevention and control for monkeypox remains valid and is available at https://apps.who.int/iris/handle/10665/355798.

~ ~ ~

Don’t lose sight of monkeypox containment

Nature Caitlin Rivers 31 August 2022

Some glimmers of hope are emerging in the global fight against the monkeypox epidemic. Weekly case counts are trending down: 6,000 were reported from 15 to 21 August, an improvement over the 7,500 reported from 8 to 14 August. These gains are thanks to concerted efforts by public-health officials and advocates globally to extend vaccination, testing and educational messaging to men who have sex with men, the subpopulation currently at highest risk of infection.

However, a major risk now is that, as the epidemic wanes, so too will the response.

A cycle of panic and neglect shadows public health: frenzied action tends to be followed by loss of interest as a threat recedes. See, for example, the reemergence of vaccine-preventable diseases such as polio. Public-health officials, governments and advocates must not let that impulse prevail again as case counts decrease and we move into the next phase of the monkeypox epidemic.

The global public-health community must fortify its resolve to beat back monkeypox, just as it did SARS and Ebola. The virus has already infected tens of thousands of people and has footholds in communities around the world. Until this year, monkeypox circulated only in limited outbreaks in endemic regions of West and Central Africa. It should not be allowed to establish a permanent beachhead in new places now.

In most of the world, ending the outbreak means eliminating the virus. In areas where monkeypox circulates in animals, it means ending sustained human-to-human transmission and preparing for rapid containment of new human infections.

https://www.nature.com/articles/d41586-022-02763-z

Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

Covid:

Pentagon OK's COVID-19 Vaccine that May Ease Some Religious Objections

The Pentagon said Monday it will now offer a new COVID-19 vaccine to the rank and file that claims not to have used fetal tissue or cells in development – a move that could help settle resistance among thousands of troops who have requested exemptions from the jab on religious and moral grounds.

Service members can request the Novavax vaccine – a two-dose series that, unlike its mRNA predecessors, is a protein-based vaccination with a lineage that has been tested for decades, according to a DoD press release. The Moderna, Pfizer and Johnson & Johnson vaccines, which have been widely available, reportedly used fetal cell lines derived from decades-old fetal tissue in the vaccines’ testing.

https://www.military.com/daily-news/2022/08/29/pentagon-oks-covid-19-vaccine-may-ease-some-religious-objections.html

~ ~ ~

Only half of eligible people in US are boosted against COVID

As of Aug. 5, approximately half of all eligible Americans aged 5 years or older had received their first COVID-19 booster vaccine, according to data published Thursday in MMWR.

According to the study, 214.4 million people in the United States were eligible for a booster by that date, having completed a primary vaccine series. Among them, only 106.3 million (49.6%) had received their first booster. This amount represents about one-third (34%) of the country’s population aged 5 years or older.

https://www.healio.com/news/pediatrics/20220901/only-half-of-eligible-people-in-us-are-boosted-against-covid19

~ ~ ~

~ ~ ~

~ ~ ~

~ ~ ~

Three COVID-19 vaccines may provide greater protection from COVID-19 infections than two

Two vaccine doses provide only limited and short-lived protection against SARS-CoV-2 infection with the omicron variant. A study publishing September 1 in the open-access journal PLOS Medicine by Mie Agermose Gram at Statens Serum Institut, Copenhagen, Denmark and colleagues suggests that a third COVID-19 vaccine dose increased the level and duration of protection against omicron infection and hospitalization.

https://medicalxpress.com/news/2022-09-covid-vaccines-greater-infections.html?

~ ~ ~

Monkeypox:

Intradermal Vaccination for Monkeypox — Benefits for Individual and Public Health

The New England Journal of Medicine

John T. Brooks, M.D., Peter Marks, M.D., Ph.D., Robert H. Goldstein, M.D., Ph.D., and Rochelle P. Walensky, M.D., M.P.H.

August 31, 2022

Intradermal vaccination delivers antigen into the space between the epidermis and the dermis. This space is an anatomically favorable site for immune stimulation, enriched in a heterogenous population of dendritic cells, macrophages, and monocytes that endow this tissue with a potent capacity to detect and respond robustly to immunologic stimuli, including those present in vaccines. For these reasons, the role of the dermis in adaptive immunity has been exploited for allergen testing and tuberculosis skin testing. And smallpox vaccination was developed by Jenner using something similar to intradermal administration: variolation, or the practice of scratching immunizing material into the skin.

Intradermal vaccination has been extensively studied for prevention of a wide range of viral diseases, including influenza (for which there is a licensed intradermal vaccine), Japanese encephalitis, hepatitis A, hepatitis B, human papillomavirus disease, polio, rabies, varicella zoster, and yellow fever. In the 1970s, Germany’s smallpox eradication campaign deployed it for vaccinating more than 100,000 persons with modified vaccinia Ankara (MVA), which forms the basis for the JYNNEOS vaccine currently being used to combat monkeypox.

Among the advantages of intradermal vaccination is that it can generate immune responses equivalent to those achieved with subcutaneously or intramuscularly administered vaccine but with as little as one fifth to one tenth the dose, while avoiding the rare risk of nerve, blood-vessel, or joint-space injury. To address the technical challenge of shallow administration with a needle, technologies have been developed to ensure proper vaccine placement in the intradermal space, and some have been approved for use by the Food and Drug Administration (FDA). However, such technologies must be tested with each specific category of vaccine before being deployed, to ensure that the vaccine’s potency and safety are maintained. The robust response generated by intradermal vaccination can also sometimes lead to increased and prolonged skin irritation, induration, granuloma formation, and discoloration, but these effects are most often temporary. Also, people who have had keloids should not receive intradermal vaccination.

JYNNEOS (also sold as Imvamune and Imvanex) vaccine contains a live but attenuated nonreplicating MVA strain and is licensed for prevention of both smallpox and monkeypox. It was developed and added to the Strategic National Stockpile specifically for smallpox vaccination of immunocompromised persons for whom the alternative smallpox vaccine, ACAM2000, may not be appropriate because it contains attenuated but replicating vaccinia. JYNNEOS was thus neither intended nor scaled up for use in a national monkeypox outbreak. But its intradermal administration at one fifth the standard dose is an attractive option that could ameliorate current supply shortages while ensuring similar levels of immunogenicity. In a randomized, controlled trial, a one-fifth dose given intradermally achieved levels of neutralizing antibodies similar to those produced with standard doses given subcutaneously on the same FDA-approved schedule,1 though by some measures cellular immunity levels were lower.2 A dose-finding study using a different but closely related MVA vaccine showed that even a one-tenth dose of MVA given intradermally was as immunogenic as the full dose given subcutaneously or intramuscularly.3

There are no data from clinical trials specifically evaluating the effectiveness of JYNNEOS against monkeypox using either route of administration, and we don’t know what level of immune response in someone given the vaccine as pre- or post-exposure prophylaxis would correlate with functional immunity against monkeypox infection or protection against severe disease. But there are no a priori reasons to doubt that JYNNEOS will be effective by the intradermal route, and we have reasonable evidence that intradermal dosing will be similarly immunizing as compared with subcutaneous dosing, at least in the short term, as a means of outbreak control to break chains of transmission.

https://www.nejm.org/doi/full/10.1056/NEJMp2211311?query=TOC&cid=NEJM%20eToc,%20September%201,%202022%20DM1402792_NEJM_Non_Subscriber&bid=1142981827

~ ~ ~

HHS providing $11M to Michigan manufacturer for domestic monkeypox vaccine production

Grand River Aseptic Manufacturing (GRAM) of Grand Rapids, Mich., secured its place as the first face of domestic manufacturing for the JYNNEOS smallpox and monkeypox vaccine this week, thanks to an award of approximately $11 million in support from the United States Department of Health and Human Services (HHS).

The vaccine is produced by Bavarian Nordic, a biotechnology company based in Denmark. While its European facilities were already working to fill supply agreements with the U.S., cooperation between Bavarian Nordic and GRAM will allow it to offload and hasten much of its vaccine production schedule and open up more possibilities for other nations. GRAM will aid the fill and finish manufacturing portion of things through a recently expanded facility. With the funding from HHS, though, it will be able to purchase even more equipment for JYNNEOS production, as well as recruit and train additional staff for operations.

BARDA estimates GRAM’s vaccine production capabilities should be online later this year, shaving months off the usual timeline.

 https://homelandprepnews.com/stories/78215-hhs-providing-11m-to-michigan-manufacturer-for-domestic-monkeypox-vaccine-production/

~ ~ ~

Polio:

Devices:

Epidemiology/Infection control:

Covid:

~ ~ ~

~ ~ ~

2/ we are finding clots in people months/years after Covid. NICE guidance says do a pro-bnp. Fine-but usually it’s negative. More important is to check for clot with d-dimer. However if clinical suspicion is still strong please arrange a CTPA.

3/ medics If GPs contact you worried about PE please take patient and do a CTPA. If a sit to stand test causes a drop of sats of 4% or more this is exertional hypoxaemia. We are seeing this months after Covid. Don’t rely on outdated VTE scoring systems. 

4/ pubmed.ncbi.nlm.nih.gov/33817609/ Dual energy CT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.

~ ~ ~

Study finds long COVID-19 in children less common than in adults

A new study conducted by the National Institutes of Health (NIH) RECOVER Pediatric Electronic Health Records (EHR) Cohort and authored by Suchitra Rao, MD, infectious disease specialist at Children's Hospital Colorado, found that the risk of post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, in children appears to be lower than what has been reported in adults. However, more children have long COVID than those kids who are hospitalized with acute COVID-19. The study is featured in JAMA Pediatrics.

"We concluded that many of the symptoms children experience post-COVID-19 are similar to what is seen in adults, but there are some features more unique to children, such as myocarditis, abnormal liver enzymes, hair loss, skin rashes and diarrhea," said Rao. "There has been a critical need to understand the impact of COVID-19 in children both in the short as well as long-term. This is one of biggest studies we know of to explore what the post-acute sequelae look like in kids. Studies using electronic health record data are a great way to explore research questions that require further confirmation in longer term prospective studies."

https://medicalxpress.com/news/2022-08-covid-children-common-adults.html

~ ~ ~

Monkeypox:

~ ~ ~

~ ~ ~

 Brazil: Domestic puppy in Minas Gerais contracts monkeypox, Lived with confirmed human case

The Ministry of Health has been notified of the first confirmed case of monkeypox, also known as monkeypox, in a domestic animal...

This is a 5-month-old puppy that lived in the same environment and had contact with a confirmed human case of the disease. The animal started to show symptoms on August 13, it started with pruritus (itching), with lesions and crusts located on the back and neck.

The Minas Gerais State Health Department instructed the Juiz de Fora Municipal Health Department to isolate the animal and disinfect the site with bleach. It was also instructed that, whenever the owner needed to come into contact with the animal (for food and hygiene of the place), to use gloves, mask, long-sleeved shirt and pants (skin protection).

There are two reports in the world about the infection being acquired through human transmission: in the United States and in France.

http://outbreaknewstoday.com/brazil-domestic-puppy-in-minas-gerais-contracts-monkeypox-lived-with-confirmed-human-case-31948/

~ ~ `

Other:

Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

~ ~ ~

~ ~ ~

~ ~ ~

Monkeypox:

 

TFG/Espionage:

~ ~ ~

~ ~ ~

~ ~ ~

~ ~ ~

~ ~ ~

Fascism:

Jan 6/Elections:

Abortion:

~ ~ ~

~ ~ ~

The doctor asked me about pregnancy, going into consolation mode. They asked me if I’d been trying to get pregnant, if I’d been pregnant before. I told them I had been pregnant, once before.

“How many kids?” they asked “None,” I answered. “Miscarriage?” they asked. “Abortion,” I answered. And the conversation shifted dramatically.

I’d had an abortion when I was 19. Upon hearing that, this doctor in Texas rattled through a list of drugs, asking if I’d taken any of them in the last six weeks. They asked about my activities, what I’d been doing, if I’d intentionally injured myself.

Intentionally or not, it felt like I’d become a suspect in the death of something I didn’t know existed.

Eventually, it stopped. They were satisfied that I hadn’t known I was pregnant and induced an illegal abortion in Texas. I left, though not without the fear that because I’d gone for medical help, I’d now be reported, per Texas law.

~ ~ ~

Guns: 

~ ~ ~

Climate:

~ ~ ~

~ ~ ~

~ ~ ~

Homelessness:

~ ~ ~

Race/Identity:

~ ~ ~

Student loans:

~ ~ ~

Florida:

~ ~ ~

Georgia:

Michigan:

~ ~ ~

Mississippi:

~ ~ ~

~ ~ ~

~ ~ ~

~ ~ ~

Oklahoma:

Pennsylvania:

~ ~ ~

~ ~ ~

Texas:

~ ~ ~

~ ~ ~

~ ~ ~

~ ~ ~

Finland:

Is Russia behind attacks on Finland's Prime Minister?

Feel good du jour:

https://twitter.com/buitengebieden/status/1563629951852724224?s=20&t=MlWfPCnCQSDGINOz_q9W4A

~ ~ ~

(Alternatively, bird wants to eat hedgehog)

~ ~ ~

~ ~ ~

~ ~ ~

Comic relief:

~ ~ ~

https://twitter.com/buitengebieden/status/1563655361176944643?s=20&t=MlWfPCnCQSDGINOz_q9W4A

~ ~ ~

https://twitter.com/TheWoofWorld/status/1563882303528570880?s=20&t=MlWfPCnCQSDGINOz_q9W4A

~ ~ ~

~ ~ ~

~ ~ ~

https://twitter.com/buitengebieden/status/1565751427737305090?s=20&t=MlWfPCnCQSDGINOz_q9W4A

Perspective/Poem

~ ~ ~

Rohan Mehta  @rohan_s_mehta  
Bees and ants use the same chemical signal to induce "clean up" when one of them dies. The ants might be trying to create the environment that they usually put dead ants into. If so, this is basically a funeral and a really cool example of emergent cross-species interaction.
~ ~ ~
Scott P. Egan @scottpegan  
I have seen other insects buried by ants, too. As per @ScottESolomon
& @Myrmecos ants bury their prey to hide it from the competition.

Bits of beauty:


 

Share this post: