SirBillybob

Montreal reports 39 breakthrough cases of MPXV within 15,300 mostly single-dose recent MVA-BN recipients. It does not tell us much as any or all cases may have simply been vaccinated too late following an exposure, and the proportion of those vaccinated that would have high behavioural exposure risk is not known. I cannot get a clearer slide for the histogram. Y-axis is number of persons (0-5) for each day following vaccination. X-axis is number of days up to symptom emergence following vaccination. Mostly confirmed cases (blue); a few probable (orange).

Preprint from France just dropped. MPXV PEP and breakthrough cases. Maddeningly, there were 2 SPXV-vaccinated cases (obviously historically, and they received the single MVA-BN dose in this study) but the researchers did not specify them within the individual list of the 12 cases in terms of timing of exposure/dose/infection. It appears that many of the breakthrough cases received PEP too late to offset infection following exposure. https://www.medrxiv.org/content/10.1101/2022.08.03.22278233v1.full.pdf

The graphs and charts are taken from the related literature. I have been mindful of summarizing within this thread the gist of such illustrations. Some readers here will be able to read them. Others won’t. They are added to show that I am not pulling ideas out of my ass. There are ideas presented here on the board that I believe to be inaccurate. This is often a ‘pages passed from hand to hand’ or U of Google & Facebook College phenomenon. Some readers have little tolerance for grey areas. There are some media articles in which known experts’ views are either inconsistent with the published research and with what other expert reports contain, or perhaps misrepresented by the journalists themselves. This may reflect both human error and lack of consensus. The latter reminds us that experts fall into the trap of having answers that they sometimes really don’t possess. We should appreciate lack of consensus because it behooves us to develop tolerance for ambiguity and uncertainty. We are often called upon to make nuanced judgements for our personal situations. We know how to get and how to avoid Monkeypox. Check. It’s a relatively wimpy virus transmission-wise for adults, all things considered. It may be a challenge for many to refrain from behaviour that upticks the probability of catching it, but by now there is sufficient information regarding what interaction situations should clue us in to being at the point of flirting with the virus. MVA-BN and dosing, dose dilution prospects, etc. Well, I won’t summarize or add more at the present time. I think what is reasonably known has been covered yet there is obviously more to uncover going forward. Smallpox inoculation history. In addition to small dated bodies of research supporting the notion that diagnosed cases occur more frequently (aka ‘attack rates’) among the unvaccinated (hence, younger population), we now have tracking data for some 500+ cases, as described in NEJM. The researchers did not wish to interpret attack rate differences and did not explain why. Perhaps because they would have to assume all other infection susceptibility factors were the same between the older historically vaccinated and younger unvaccinated subgroups. However, we know the general population shares of age from census demographics, and can estimate that the total number of males 18-50 is roughly twice that of males 50-70. Therefore, the 10% older male cases occurred in a population subset about half the size of the younger population subset that reflected 9 times the attack rate (prior to adjusting for population share denominators) compared to the older, presumably majority SPXV-vaccinated group. Therefore, if 10 older males out of 1,000 older males were infected while 90 younger males out of 2,000 younger males were infected, this would mean that equivalent attack rates would require 45 (not merely 10) older males within 1,000 older males to be infected. The 4-fold difference is consistent with the Congo basin findings of 35 and 15 years ago. Irrespective of proportions of total population at any time that had had Smallpox vaccination … obviously higher percentages the further back in time to the point of eradication … the attack rates are higher for the unvaccinated. Now we need to patiently wait for comparative attack rates to emerge in real time MVA-BN rollout, or unfortunately in global regions where MPXV incidence occurs across all age groups prior to MVA-BN equity. There seems to be no clear way to rate disease severity and cross-reference to vaxx history or current dosing questions. For example, one lesion may simply happen to emerge randomly in a very bad location while another person may have much more acute skin involvement and for a longer period but not threatening vision, breathing, etc. Hospitalization to manage unique challenges may not be a good marker of severity for this reason. Severity of Monkeypox in animal research is based on survival vs mortality. The research reported in NEJM did a lot of detailed quantifying but did not come up with a meaningful way to grade disease severity.

Coincidentally, as Sex in the City is mentioned, Stanley was reading A Little Life at his Friday night Table for 1 outing. I just started To Paradise.

I don’t know where you are getting B, C, D, and E. I would be inclined to put those assumptions under A. I have not used language that has not been seen in media articles or public health briefings. Some of them may be information sources separate from news reports aimed at the broader public.

Rimoin et al’s later surveillance work in DRC reveals similar findings as above but seems to receive less attention even though it is comparatively more recent …

Then the NYT reported what I wrote here on July 30th and what Canada’s NACI referenced months ago. In more detail, a team from the London School of Hygiene and Tropical Medicine and other institutions tracked MPXV in the Democratic Republic of Congo in the first half of the 1980s decade, transiently Zaire at the time. It was not a single-year outbreak. Their published work began coming out in the second half of that decade. One of the oft-cited manuscripts is dated 1988.

N of 2+. I have a childhood Vaccinia history. Last month I received MVA-BN, a SPXV vaccine booster that is hoped to protect against MPXV.

Windsor-EssexCounty is only dispensing it as PEP currently and if PrEP is eventually supplied it is unknown if foreign nationals will be able to access it as easily as in major Canadian cities. Likely same deal Sarnia-LambtonCounty. https://www.wepridefest.com/monkeypox/

I stand corrected. The research emerging on MPXV current outbreak suggests that anogenital area is the most common location of lesions, suggesting that apart from symptomatic presentation that can occur in other locations of the body some time following incubation there is a predisposition in the context of GBMSM transmission for lesions to emerge at the site of viral inoculation, ie, where anogenital body parts (often mucosal) merge … or oral-oral, oral-anogenital, what have you. That said, there is often another concurrent STI. There may also be a surveillance selection bias in which men with anogenital lesions as initial body location are presenting to STI, PrEP, etc clinics and overrepresented in such settings conducting detailed tracking. Nevertheless, supports condom use. It remains to be seen whether the pattern of lesions in the overall population would be more consistent with assumptions about MPXV pathogenesis prior to the current unique subgroup susceptibility and case incidence.

Correct. Your body doesn’t care whether you breathed in respiratory droplets from your pet prairie dog while cuddling it or sucked a guy’s dick that had a lesion.

Aha, so we do know MVA-BN PEP vaxx breakthrough can occur: Patient #3 in the table, surveillance of 7 Monkeypox cases UK recent years. What is unknown is whether there were any PEP recipients within contacts related to the 7 patients, those recipients, if any, not acquiring infection. The recent PEP-tracking study in Paris recommends PEP within 4 days of exposure, a timing reference suggested elsewhere, but the vaccination group will receive MVA-BN up to 14 days following exposure.

Of course this suggests the imperative of education of both sides of the transaction about the reality of possible differences between prime-dose and boost-dose immunity AND reciprocal candor of both players regarding dosing quantity and temporal history. It would also be up to both sides to determine risk tolerance for scenarios in which clients with Smallpox vacccination background, likely a sizeable consumer majority, have had one recent MVA-BN dose. There is little immunogenic difference between 1 and 2 doses over several months in terms of protection against Smallpox. For Monkeypox the risk assessment according to protection extrapolated from Smallpox protection will be ‘to each his own’. My sense is that regional Monkeypox incidence differences override any effectiveness differences specific to the two Orthopox varieties, assuming of course less than 100% efficacy. Anticipated (so far none explicitly reported) vaccination breakthrough infections can potentially be greater in number in high incidence regions in spite of higher vaccination uptake. Group MM is 2 doses with 4-week interval; Group PM is placebo for 1st dose followed by single MVA-BN dose at 4-weeks.

I had exactly that phenomenon. Emerged suddenly at Day6 following MVA-BN and 90% resolved by Day8.

Interesting read on perceptions of Bavarian Nordic funding source history, coupled with proportional share of bulk vaccine supply headed to fill-and-finish and delivery, as well as sensitive dynamics regarding responsibility allocation. https://healthpolicy-watch.news/exclusive-china-monkeypox-bavarian-nordics/

Credible, as you took the Jynne-oath.

Intelligent, responsible inquiring minds here want to know. Immunologists and virologists are asking the same questions among themselves.

That’s a very relevant question and the answer is easy. The answer is no. Nobody can say how much protection one gets from a single dose of MVA-BN, or for that matter the 2-dose regimen, no matter how the language is packaged. The idea that there is any benefit at all to MVA-BN is inferred from particular types of research that are far from the ‘gold standard’ efficacy research that underpinned, for example, COVID vaccination. ——- For those interested: What is known specific to Monkeypox as a virus distinct from Smallpox is that 1st generation Smallpox vaccine reduced Monkeypox attack rates in Dem Rep Congo when small outbreaks were tracked in the first half of the 1980s decade and in the middle of the 2000s decade; both periods suggesting a 5-fold susceptibility to infection among the unvaccinated that translates to 80-85% protection for the inoculated. The durability of that protection along with the assumption that MVA-BN single dose is noninferior to 1st generation Smallpox vaccine forms part of the basis that it currently offers some protection. That it is “up to 85%” is a premature S T R E T C H, when one considers the rigour of COVID vaccine research.

NYC Man is absolutely correct. Uniformity is important. I am second-guessing here, and BTW I have no role on how things are done, but various jurisdictions are juggling prospective MVA-BN supply while drawing from limited recent research on incidence trends in order to squeeze out the biggest containment bang for the buck. A willy-nilly hand-picking from, say, the recent NEJM case surveillance findings does not fly well and contributes to mayhem. That in itself does not negate the PEP++ approach. Canada, where I am, has been less rigidly aligned with dispersion factors and, as is known, has a come-one-come-all approach that commenced early in the incidence trajectory I append here. Not a robust impact on cumulative cases. Rolling incidence is fortunately beginning to level off likely due to the higher-risk more MPOX-susceptible vaccinees having been scooped into the campaign’s efforts. Among hundreds of nations Canada had, by chance and design, a fairly ample supply of MVA-BN in its decades-long Smallpox Contingency stockpile, more recently supplanting earlier vaccine supply with MVA-BN, while other nations’ stockpiles where there are contingencies reflect 1st and 2nd gen vaccine.

Current HIV PrEP uptake is highly correlated with both risk and incidence of Monkeypox infection. As such, it is a clear identifiable dichotomous variable to integrate into the eligibility hierarchy, not unlike age wrt to CoV vaccination. Similarly, age wrt CoV was correlated with cluster transmission owing to settings housing the aged. This is analogous to PrEP recipients’ trends of congregating with like and stimulating forward transmission. The HIV PrEP subgroup priority is similar to PEP ring vaccination, but it is more anticipatory than established exposure to a confirmed case. The CDC is now categorizing this as Monkeypox PEP++, not PrEP. The latter category is reduced in scope and specific to occupational exposure such as lab work directly with orthopox viruses. There is nothing odd about PEP++ if supply is limited and mitigating incidence is the goal …

The hands down the pants of the antsy guy may have reflected arousal, for sure, but maybe arousal by uncomfortable lesions.

In the interests of taking what we can get even from very small bodies of research, and applying it, a small safety/immunogenicity study of MVA-BN in eczema subjects and controls (N=60) a few years ago suggests waiting a bit longer than 2 weeks following 1st dose. For a small percentage, no difference among subgroups, the humoral immunity standard occurred some time after, maybe not 4 weeks needed but >2 weeks. No seroconversion testing between Day14 and Day28. Add this caveat to likely less than 100% efficacy even with seroconversion. I meant to crop out the 2nd paragraph in the screenshot; it’s unrelated to this post.

So reckless of the dismissive escorts for their own health security as clients would rightly assume that they themselves do not pose a risk to providers as transmission vectors. It is reasonable for clients to assume a provider would have added personal vaccination to their own hygiene playbook even if a random hook-up hasn’t.

The risk could be attenuated depending on vaccination with at least the prime dose of MVA-BN, at least 2 weeks prior, of dancer [good], dancee [good], or both [better]; same idea for total recovery from a recent Monkeypox infection.

Further to question of resident specificity, state of MASS indicates living or working in that state, so I think it may be boundaried across the nation. In Canada, it’s pretty much ‘honey badger don’t care’ where you live.