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Monkeypox a new worry for gay and bi men


Luv2play

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Today for the first time the CBC radio network reported that most of the Monkeypox cases in Montreal, which now number 98 confirmed, have been traced to a sauna, which was not named. All appear to be gay men or men who have sex with men. 

Montreal has the largest number of cases by far, which yesterday totalled 112 in all of Canada including Montreal. Toronto only has 5 cases. Smallpox vaccines are now being administered to at risk individuals and those who are likely to come in contact with infected people, which includes sex workers.

I was in Montreal last weekend so am monitoring myself but I avoided saunas and stripper bars. Dud see some escorts though since a trip to Montreal wouldn't be complete without doing so.

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Today it was reported that a vaccination clinic has been set up at a bathhouse in Toronto's gay neighbourhood. Officials are worried that with Gay Pride festivities coming up soon, Monkeypox could spread and are taking steps to avert a public health crisis. So far Toronto only has a small fraction of the cases seen in Montreal.

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I received an Imvamune (MVA-BN; Jynneos in USA) dose last week in Montreal (see flyer). It is cross-approved in Canada (PHAC) and USA (FDA) for both orthopox viruses: Smallpox & Monkeypox, and on its way for MPOXX-specific authorization, if not already this week, in UK and EU. They were not rigidly grilling seekers regarding the criteria, and did not seem to be turning anybody away, more interested in the teaching part than the recipient qualification aspect. 

They instructed to return for a boost dose in 4 weeks but I had read much of the scientific literature regarding those (eg, baby boomers) with a Vaccinia inoculation history and the prospects of immunity durability, thinking I would just go with the Imvamune prime dose. Then a day later that’s what NACI recommended irrespective of previous Smallpox inoculation. 

My sense is that that one rationale, muted due to the already quickly extant stigmatization, is the influx of 15,000 International AIDS Conference attendees in 5-6 weeks. The 2020 conference went virtual for obvious reasons and it would be a shame and tough on Montreal’s recovering economy should this one be precipitously cancelled as an in-person event. AFAIK Vaccinia-naïve PHA have always been prioritized for the MVA-BN vaccine against Smallpox, as an alternative to 1st and 2nd generation inoculation products, but this one must be approved for the Monkeypox indication wherever it is administered. Even if rolled out for Smallpox specifically (nudge nudge wink wink) with the off-label intentionality of Monkeypox prophylaxis, how to organize such a convoluted scenario for conference attendees broadly abroad. 

BTW, the disease may be renamed HMPXV (H for human) and clades appropriately numbered or lettered as opposed to geo-African. 

07835874-78B4-43D9-841C-675E1E50DF86.jpeg

Edited by SirBillybob
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By coincidence I was going through my old files to update my estate planning, something my executor asked me to do several months ago, and came across my vaccination certificate for smallpox from 1966 when I was at university in Montreal. So quite old and although it was supposed to be a one time shot to last a lifetime, I wonder how much protection it still offers, assuming it also protects for Monkeypox.

I don't intend to get a booster at this point but that could change.  

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3 hours ago, SirBillybob said:

I received an Imvamune (MVA-BN; Jynneos in USA) dose last week in Montreal (see flyer). It is cross-approved in Canada (PHAC) and USA (FDA) for both orthopox viruses: Smallpox & Monkeypox, and on its way for MPOXX-specific authorization, if not already this week, in UK and EU. They were not rigidly grilling seekers regarding the criteria, and did not seem to be turning anybody away, more interested in the teaching part than the recipient qualification aspect. 

They instructed to return for a boost dose in 4 weeks but I had read much of the scientific literature regarding those (eg, baby boomers) with a Vaccinia inoculation history and the prospects of immunity durability, thinking I would just go with the Imvamune prime dose. Then a day later that’s what NACI recommended irrespective of previous Smallpox inoculation. 

My sense is that that one rationale, muted due to the already quickly extant stigmatization, is the influx of 15,000 International AIDS Conference attendees in 5-6 weeks. The 2020 conference went virtual for obvious reasons and it would be a shame and tough on Montreal’s recovering economy should this one be precipitously cancelled as an in-person event. AFAIK Vaccinia-naïve PHA have always been prioritized for the MVA-BN vaccine against Smallpox, as an alternative to 1st and 2nd generation inoculation products, but this one must be approved for the Monkeypox indication wherever it is administered. Even if rolled out for Smallpox specifically (nudge nudge wink wink) with the off-label intentionality of Monkeypox prophylaxis, how to organize such a convoluted scenario for conference attendees broadly abroad. 

BTW, the disease may be renamed HMPXV (H for human) and clades appropriately numbered or lettered as opposed to geo-African. 

07835874-78B4-43D9-841C-675E1E50DF86.jpeg

Interesting to read of your experience. Is there any sense that the supplies of vaccine are abundant, such that no criteria for qualification to receive one are required? 

Recalling the early days of 2021 and Covid, supplies of vaccine could become problematic if cases ramp up.

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21 minutes ago, Luv2play said:

came across my vaccination certificate for smallpox from 1966 when I was at university in Montreal. So quite old and although it was supposed to be a one time shot to last a lifetime

I dug out my yellow book when I had my Covid shots (book not needed) and checking it just now, I had my smallpox vax in 1976 for an overseas trip and a revaccination in 1980. The notes in the book say the certificate is valid for three years.

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4 minutes ago, mike carey said:

I dug out my yellow book when I had my Covid shots ( book not needed) and checking it just now, I had my smallpox vax in 1976 for an overseas trip and a revaccination in 1980. The notes in the book say the certificate is valid for three years.

Were you travelling to a region where smallpox is endemic? I can't remember the reason for my vaccination in 1966. I believe I had one much earlier when I was in primary school in the 50's but can't find the certificate.

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1 minute ago, Luv2play said:

Were you travelling to a region where smallpox is endemic? I can't remember the reason for my vaccination in 1966. I believe I had one much earlier when I was in primary school in the 50's but can't find the certificate.

As far as I recall it was a requirement to re-enter Australia (except for coming from NZ), not destination-specific.

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2 hours ago, Luv2play said:

Interesting to read of your experience. Is there any sense that the supplies of vaccine are abundant, such that no criteria for qualification to receive one are required? 

Recalling the early days of 2021 and Covid, supplies of vaccine could become problematic if cases ramp up.

Canada has 350,000 doses stockpiled and a new much larger order won’t be available until 2023 because Bavarian Nordic in Denmark shut down operations to do renovations prior to this outbreak.

Here’s the new guidance attached. I’m not summarizing it. The provinces/territories will need to decide their strategies as things move along. 

http://ow.ly/79n950JuVWl

Edited by SirBillybob
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2 hours ago, Luv2play said:

Were you travelling to a region where smallpox is endemic? I can't remember the reason for my vaccination in 1966. I believe I had one much earlier when I was in primary school in the 50's but can't find the certificate.

You would have the characteristic dime-sized Vaccinia scar on your upper arm due to bifurcated needle punctures, likely when in primary school. All other vaccines or boosters left no mark as were intramuscular or maybe some sub-cutaneous. 

Edited by SirBillybob
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2 hours ago, mike carey said:

I dug out my yellow book when I had my Covid shots (book not needed) and checking it just now, I had my smallpox vax in 1976 for an overseas trip and a revaccination in 1980. The notes in the book say the certificate is valid for three years.

Australia did not have mass campaign Smallpox vaccination like other parts of the world such as Canada and USA. That likely accounted for its necessity upon travel, even at a point at or close to global eradication, so you would not risk bringing it home where very few had/have immunity. As such, a non-contained global MPOXX pandemic would likely require prioritizing Australia for vaccination, since previous Vaccinia inoculation, that may crossover to confer some protection against MPOXX, was relatively rare. If you don’t have the pock scar you may received a later generation vaccine and booster; I’m not totally up on it outside of my generation in Canada.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291091/pdf/viruses-12-00554.pdf

Edited by SirBillybob
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12 minutes ago, SirBillybob said:

If you don’t have the pock scar you may received a later generation vaccine and booster; I’m not totally up on it.

I had the scar variety (my vaccination certificate has the annotation where it was read as successful after a week) but the scar has mostly faded.

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1 minute ago, mike carey said:

I had the scar variety (my vaccination certificate has the annotation where it was read as successful after a week) but the scar has mostly faded.

The fading of the scar is irrelevant. I also added an article to my previous post … we crossed in the ether. 

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12 minutes ago, SirBillybob said:

The fading of the scar is irrelevant. I also added an article to my previous post … we crossed in the ether. 

I don’t know anybody that had the multiple Vaccinia single-sitting punctures done over again in the exact same spot, or a second scar, so I don’t know what is meant by an apparent Smallpox booster apparently recorded in your certificate booklet. In Canada only lab workers involved in Smallpox research are advised to get a booster every 10 years due to unique exposure risks. I don’t know if it’s scarification in a new location each time, &c. 

Edited by SirBillybob
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4 minutes ago, SirBillybob said:

I don’t know anybody that had the multiple Vaccinia single-sitting punctures done over again in the exact same spot, or a second scar, so I don’t know what is meant by an apparent Smallpox booster apparently recorded in your certificate booklet. 

I don't know either, I don't remember what variety the revaccination (as the booklet calls it) was. I know the fading is irrelevant, it was just that its fading meant I couldn't find it as confirmation of the vaccination.

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9 minutes ago, mike carey said:

I don't know either, I don't remember what variety the revaccination (as the booklet calls it) was. I know the fading is irrelevant, it was just that its fading meant I couldn't find it as confirmation of the vaccination.

Right, me too, I noticed mine seems to have faded a lot. At the risk of stigmatizing it seems apparent to me that very light-skinned plump women have the most discernible mark, usually more indented than the BCG scarification that some folks possess.

Other than that, there’s always wild goose-chasing reading articles that often fail to contain the one or two clues or answers one is pursuing. LOL

Edited by SirBillybob
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12 hours ago, SirBillybob said:

I received an Imvamune (MVA-BN; Jynneos in USA) dose last week in Montreal (see flyer). 

 

I would be more than happy to take a Smallpox/Monkeypox vaccine myself. Especially since it appears to offer pretty strong and long-lasting protection. The CDC is not currently recommending the vaccine for MSM but perhaps as more vaccine becomes available and the close contact transmission remains, they will reconsider. As someone who does both a lot of international travel and likes to visit bathhouses for sex, I would definitely gladly take it. 

Would you all consider taking the Monkeypox vaccine if you haven't already?

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The WHO will be having an emergency meeting next week to discuss the spread of Monkeypox in dozens of countries. The CBC characterized Quebec as the epicentre of the disease, now registering more than 130 cases, most in Montreal and all amongst men who have sex with men.

While the numbers may appear small, the growth in cases is alarming. While not a fatal disease in most cases, especially in the developed world, the symptoms are not something one would want to endure. 

Edited by Luv2play
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On 6/14/2022 at 1:38 AM, keroscenefire said:

 

I would be more than happy to take a Smallpox/Monkeypox vaccine myself. Especially since it appears to offer pretty strong and long-lasting protection. The CDC is not currently recommending the vaccine for MSM but perhaps as more vaccine becomes available and the close contact transmission remains, they will reconsider. As someone who does both a lot of international travel and likes to visit bathhouses for sex, I would definitely gladly take it. 

Would you all consider taking the Monkeypox vaccine if you haven't already?

Is this a regular "shot" versus the old school pricking method with development of an active sore? Shot(s), yes. Going through the active virus application and the process of managing a pus filled lesion is far less appealing;

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Just a word of caution--if this vaccine is similar to the smallpox vaccines of yore, then it is a live, attenuated virus. It therefore probably should not be taken by anyone who is immune-suppressed, either due to health problems or due to taking medications which suppress the immune system (transplant recipients, cancer chemotherapy, certain meds for rheumatoid arthritis/psoriasis/etc.). I don't see that important warning on the flier from Quebec. 

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It appears that the new Jynneos vaccine does not have the "take" of previous smallpox vaccines. It does contain some live virus but it doesn't spread to other parts of the body and is non-replicating, unlike the original smallpox vaccine. Apparently it can cause some injection site pain and a small "lump" to form. Some people develop fever/chills/etc similar probably to the Covid vaccines.   You also have to take two doses of the vaccine to be effective. To me, worth it for what sounds like a lifetime of protection against a not-fun sounding disease. 

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4 hours ago, Unicorn said:

Just a word of caution--if this vaccine is similar to the smallpox vaccines of yore, then it is a live, attenuated virus.

From the CDC and the FDA drug insert package….
JYNNEOS is administered as a live virus that is non-replicating.
Therefore, immunosuppression would not be a contraindication to taking the vaccine.

https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html
https://www.fda.gov/media/131078/download

4 hours ago, keroscenefire said:

I don’t think you meant to imply this, but just to be clear, the lack of “take" by JYNNEOS does not make it inferior to the older vaccines. In fact, as referenced in the FDA link above, it appears to induce a stronger immune response than the older vaccines. Simply put, it doesn’t have a "take" because it’s not that type of vaccine. 

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There is no warning on the Quebec flyer viz immunocompetent versus immunocompromised because it is not contraindicated as such. In fact, the guidelines seem to prioritize immunosuppressed. Moreover, selecting and importing all of the relevant details from 25 pages of guidance does not fly well on a flyer, eg, stratifying by Simian Pox PEP versus PrEP intentionality, specific populations, Smallpox vaxx history, etc. 

However, dosing considerations, ie, single dose versus prime-boost/28+daysInterval may be relevant in terms of that aspect as well as smallpox vaccination history, and labwork-specific occupational risk factors for which regular boosters are recommended.

The just released Canadian guidelines are national and eligibility is narrowly defined,  but provinces have the prerogative to broaden eligibility based on community prevalence. Therefore Quebec has an open-door policy and, in fact, out of province or foreign nationals visiting Montreal etc may access the vaccine. In fact, the cis-/trans-MSM criterion is not rigidly applied and obviously immunosuppressed females can access it, though it has been available in Canada for a few years and medical specialty programs can dispense it as well. But based on my time observing at the walk-in site my sense is that absolutely any worried adult could get the vaccine. For example, younger parents that missed the standard Smallpox vaccination that ceased around 1972, their children similarly unprotected. Orthopox viruses are not truly eradicated. It remains to be seen what inoculation campaigns will re-emerge.

Bear in mind your categorization for one versus two (even 2 plus later booster) doses. My sense is one is better than none if you cannot come back as a person for whom 2 doses is indicated, but that is obviously not my call. 

The national guidelines came out just after I was instructed at prime dose to return in 4 weeks for the follow-up dose. I will just stick to the single dose due to Smallpox childhood vaccination. This I put together from reading; it is early in the rollout game, info kinks to be ironed out, and I am certain the 2nd dose would not be withheld and that the frontline staff may be following provincial directives and not so much up to speed on the recent national guidance or working out the apparent contradictions. There is already some hinting in some of the literature that 28 days is arbitrary based on the limited extant research, not surprising given moving temporal dosing targets that evolved for SARS-CoV-2.

For now, I feel protected. The injection is subcutaneous and I have latent swelling tenderness redness that seems to be suddenly pooling the most at 6-7 days post injection. It is likely solicited site reaction that will attenuate and not the rarer bacterial cellulitis (fingers crossed). 

Attached is the Canadian immunization guidance …

https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/guidance-imvamune-monkeypox/guidance-imvamune-monkeypox-en.pdf

 

Edited by SirBillybob
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