Not possible for monkeypox to spread as a pandemic- not infectious enough - usually only infectious after symptoms - and has a vaccine
It will not be a big thing like COVID. It is much the same as the mpox outbreak in 2022. Mpox can only spread via very close contact such as skin to skin contact, sometimes also from clothing and other items, and is usually only infectious once people have the visible sores. . How It Spreads | Mpox | Poxvirus | CDC
TEXT ON GRAPHIC
Mpox is NOT a pandemic
- international but affects small subpopulation globally
- in most people quickly stopped with contact tracing OR vaccines OR both
- almost only spreading in men that have sex with many men without contact details
- can be stopped for them too by education and vaccination.
Mpox is usually only infectious AFTER symptoms appear
- Low fatality rate about 0.04% in Europe (10 out of 27,680 cases) though an unpleasant sickness in many.
Public Health Emergencies of International Concern
Swine flu (pandemic)
Polio (endemic but in process of being eradicated)
Ebola (Western Africa)
Zika
Ebola (Kivu)
COVID 19 (pandemic)
Monkeypox (clade 1 then clade 2)
N.B. mpox is the new WHO name for monkeypox
Table from here: COVID-19 is still a global health emergency. What does that mean?
This makes it easy to stop with contact tracing so long as people have contact details of anyone they have close contact with. However it is harder to stop amongst people who have prolonged close conduct with strangers they never met before and have no contact details for.
That is why it spreads amongst men who have sex with men and sex workers. The 2022 outbreak was stopped by education to look out for the symptoms and vaccination. Many of them will already be vaccinated or have had it before.
Rarely people can be infectious before they show symptoms. From the CDC about the 2022 outbreak:
QUOTE STARTS
A person with mpox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed.
New data show that some people can spread mpox to others from one to four days before their symptoms appear. It’s not clear how many people this has affected during the ongoing global outbreak that began in 2022.
[Sorry earlier version of this blog post said it is only infectious if you have symptoms]
It can be very unpleasant if you get it badly but the risk of death is very low indeed less than 0.04% in Europe.
There is no risk of a pandemic. Monkeypox already has a vaccine and it is also easily stopped with contact tracing and then “ring vaccination” of all the contacts
For more about it: Chise (@sailorrooscout) on X
The main reason it spreads in Africa is because they can't afford the vaccines there - and have the same problems of contact tracing for some groups of people such as sex workers and people who frequently have sex with others that they don't have contact details for.
You can read here about how experts want the developed countries to make vaccines more affordable for Africans to stop monkeypox spreading there. The problem is the best vaccine costs $100 per dose and takes two doses to vaccinate someone and that's not so much in a developed economy but it's a lot in a weaker economy in Africa.
. Thread by @profchloeorkin on Thread Reader App
So the developed economies could stop this epidemic as well as future mpox epidemics at source in Africa by making the vaccines more accessible there and there is work to do that to try to ramp up on vaccines and make them more available in Africa. and calls from the vaccine manufacturers to be helped to do this as you'll see in that thread.
African CDC have arranged a plan to make 10 million monkeypox vaccines available in Africa by 2025, with 2 million of them in 2024. They are helped in this by Bavarian Nordic.
. Africa CDC and Bavarian Nordic Partner to Boost Mpox Vaccine Production in Africa – Africa CDC
It makes most sense to make the vaccines available for the entire world, to stop the epidemic as soon as it crosses over into people instead of letting it spread in Africa and only reacting once it gest to the point where some cases start to appear in the developed countries.
The WHO situation report says so far that in Europe there have been
- 27,424 cases (now increased to 27,680 cases)
- 10 deaths.
- 885 cases were hospitalized (7%)
- 301 required clinical care
- 8 cases admitted to ICU.
- 10 cases died.
Global cases here
. 2022-24 Mpox (Monkeypox) Outbreak:
That fatality rate is somewhat approximate as it doesn't take account of the possibility that some of those with mpox right now might die. But even if you look at the total from 2022 to 2024 including cases in Africa with not very good health care it's
5940 cases and 48 deaths or 0.8%, less than 1%.
Also the main risk group is men who have sex with many men and with men who they have no contact details for.
It is usually only infectious if you have symptoms so contact tracing is easy if you have contact details and also education can stop it, just not to engage in the risky behaviour if they have the symptoms. Also vaccination can stop it, to vaccinate all those who do this risky behaviour.
In Europe the epidemic (NOT pandemic) is
- 98% male
- 97% of those men self identified as men having sex with men.
- 38% of those with known HIV status are HIV positive
So most people are not at risk. Just being LGBT is NOT a risk factor. Monogamous LGBT or those who have few partners who they know who don't engage in the risky behaviour either are NOT at risk. Or if they have partners who watch out for the symptoms and get vaccinated if they are at risk.
Those numbers are from here:
. Joint ECDC-WHO Regional Of. fice for Europe Monkeypox Surveillance Bulletin: 15 August 2024
Latest stats from
. 2022-24 Mpox (Monkeypox) Outbreak:
Scroll down to the section 3.4 tables, where you see this table.
(as of July 2024).
There are many more public health emergencies of international concern (PHEIC) than pandemics.
We are currently in a PHEIC for Polio, COVID and monkeypox.
We have had previous PHEICs for Ebola (two times) and Zika virus that are now over.
Only Swine flu and COVID counted as a pandemic. There isn't an official definition of a pandemic, the WHO doesn't declare a pandemic, it just starts to use the word at some point but a pandemic roughly speaking is if it affects the entire population instead of a sub population and can't be contained
.
TEXT ON GRAPHIC
Public Health Emergencies of International Concern
Swine flu (pandemic)
Polio (endemic but in process of being eradicated)
Ebola (Western Africa)
Zika
Ebola (Kivu)
COVID 19 (pandemic)
Monkeypox (clade 1 then clade 2)
N.B. mpox is the new WHO name for monkeypox
Table from here: COVID-19 is still a global health emergency. What does that mean?
Flu isn't a PHEIC but if we had flu as a new disease rather than one we've had for centuries it might well count as a PHEIC.
Hopefully eventually we get a vaccine for flu that is more effective than the one that is currently given to elderly people and vulnerable every winter in advanced economies. Also hopefully a much better vaccine for COVID.
There is no way that lockdowns are needed for monkeypox, it's just about education and contact tracing and vaccination of the most vulnerable which are mainly health workers caring for monkeypox patients and people who have sex with strangers who they don't know, to look out for the symptoms and stop this risky behaviour if they have monkeypox or the partner has monkeypox, and to get vaccinated.
It is highly unlikely that lockdowns are used in any future pandemic as COVID was an unusual disease, one that could almost be controlled by contact tracing alone but not quite needing lockdowns just in places where there were big clusters of cases.
The smallpox vaccine works and there are special mpox vaccines too.
This goes into how we can control monkeypox - one of the key tools is a vaccine though it spreads very slowly and can also be stopped with contact tracing as it also has clear symptoms.
It was stopped by using vaccines for at risk people as well as education about the symptoms to look out for.
It is very normal to use contact tracing to stop an epidemic. This is the main way we stop monkeypox, ebola, MERS and SARS.
It is highly unlikely we use lockdowns again to try to stop a pandemic.
A lockdown should be seen as an extra step ON TOP OF CONTACT TRACING.
China and Taiwan and other Asian countries did contact tracing which they already did for SARS, another respiratory coronavirus.
It worked for COVID too just as it did for SARS. But it had spread too far in Wuhan by the time they noticed it to control with just contact tracing so then they used lockdowns in Wuhan. In most of Chian they didn't need lockdowns and stopped it just with contact tracing as for SARS.
Other countries could have stopped it in the same way, the problem is they were not used to using contact tracing for a respiratory disease. They were used to flu and treated it like flu instead of SARS.
So even with lockdowns, most countries didn't do it properly. Only New Zealand, Australia, Taiwan, China, South Korea and a few other countries used lockdowns as they should be used - localized, targeted, combined with testing so you know where COVID is, with contact tracing and isolation and then you only use lockdowns if those other measures are not enough to stop it by themselves.
Since you are testing for it you know where the hot spots are and only those places need lockdown.
The UK discarded all those tools except the lockdown.
They put the entire country under lockdown but stopped all testing and all contact tracing so nobody knew where it was or who had been in contact with anyone with COVID.
So it was lockdown without contact tracing which doesn't make a lot of sense, theoretically it's hard to see it working. Their aim was just to slow down the pandemic not to control
it, to spread the sickness over a longer period of time so that the hospitals could cope better.
But surprisingly it worked to not just slow it down but control it. It brought the virus nearly under control but by the summer of 2020 the UK then when it saw the cases were low relaxed the lockdown without putting testing or contact tracing in place to replace it. If it had put testing in place right away and contact tracing we might still have been able to eliminate it.
This no longer works for COVID. It evolved to be more transmissible amongst humans. by 2022 even the Chinese, who held out the longest, gave up on contact tracing. Luckily by then COVID at the same time as evolving to be more transmissible and far harder to contain also evolved to be rarely serious.
The usual disease that causes pandemics is flu. Flu is too transmissible and has too short an incubation period to stop easily with contact tracing or lockdowns. It also has a vaccine.
So if we have another flu pandemic it's not at all credible we use lockdowns to control it. We would use vaccines.
Also one good outcome of the COVID pandemic is that we now have global production and distribution of vaccines. This will mean we can make the next flu pandemic vaccine available globally. It would only take a few months to customize the vaccine to the pandemic.
One good outcome of the pandemic is that we now have lots of research into far more effective vaccines.
That includes nasal vaccines. These may be able to block / stop COVID and Flu too. If so we may be able to stop both those diseases actually eradicate them in principle, if enough people get vaccinated. At any rate to greatly reduce the risk of getting them.
So it's not impossible we see a future without COVID and without flu, maybe a decade or so from now depending.
It is highly unlikely that we encounter another disease like COVID that can't be stopped with contact tracing like Ebolaor mpox but that can be stopped with contact tracing combined with lockdowns.
Either it can be stopped with contact tracing alone like monkeypox, or most likely it's flu and it can't be stopped even with lockdowns but can be controlled using vaccines.
It's very rare to have something between the two.
We might have a disease that can be stopped with contact tracing plus vaccines. Measles is like that.
Measles is highly infectious and can't be stopped by contact tracing without a vaccine. It couldn't be stopped by contact tracing + lockdowns either. But it has a very effective vaccine and it spreads only amongst people who are not vaccinated.
So if there is an outbreak it can be stopped by contact tracing looking for people who aren't vaccinated amongst the contacts.
BLOG: Measles guidance for primary, community care, emergency departments and hospital
Other diseases that used to be controlled by contact tracing such as mumps before we had vaccines are now just stopped by vaccinating everyone.
The reason we still use contact tracing for measles is because it is so very infectious and because a significant % of the population refuse vaccination because of viral misinformation about measles vaccines.
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