New Mpox wave?

[SirBillybob]

On 3/2/2024 at 6:27 PM, mike carey said:

The clinician who saw me at the ACT government-run sexual health clinic asked whether I had considered the mpox vaccination (and HPV, which they will administer, but I'd have to buy for myself at a chemist's). She said they advise it's worth getting the mpox one, although it wasn't a hard sell. I had a vaccination against the variola virus (smallpox), which would provide some residual protection but I'm considering it.

I had also been Vaccinia-experienced (Smallpox vaccinated), long before your travel-related uptake, and chose to receive only the single dose of MVA-BN some 24 months ago although I had access to the booster, administered subQ, if so desired. Along with the historical residual protection concept was the existence of evidence at the time suggesting that a delayed 2nd dose of MVA-BN yielded a stronger immunogenic response.

Currently a very detailed paper has come out supporting the idea that a 2nd dose taken at this time two years on, obviously depending on whether a new incidence wave emerges, is actually better than having followed the initial recommended two-dose regimen. The single- vs two-dose efficacy difference at the current two-year point is not enormous because antibody decay following the second dose is more rapid. 

The above may be an important consideration for those MVA-BN-naive and considering vaccination uptake with or without the re-emergence of problematic new incidence. Interestingly, for those spared infection to date due to lack of pathogen exposure, two doses in 2022 appears to be less beneficial and to have been somewhat superfluous compared to an as yet delayed second dose, the benefit equivalence of which may justify a third upcoming dose some 23 months following second dose.

I am still holding off on the second MVA-BN dose, balanced delicately against prospective case incidence patterns. 

D below is efficacy trajectory projected over a decade of time; shading is confidence interval.

A, B, C are immunogenicity graphs with y axis demarcation gaps depicted on a log scale 0, 10, 100, 1,000.

Edited May 21, 2024 by SirBillybob

[menaughty]

I took both vaccines (1st & 2nd dose) in 2022. 
 

should I be getting another shot now? 

Edited May 22, 2024 by menaughty

[SirBillybob]

17 hours ago, menaughty said:

I took both vaccines (1st & 2nd dose) in 2022. 
 

should I be getting another shot now? 

At this point, consensus is lacking, although early in the outbreak the Canadian guidelines included authorization for a 2-year booster dose following summer of 2022 primary series of two doses, if infection risk still applied. But then that provision was de-emphasized a few months later, seemingly in the context of worries about limited supply and, well, it appeared the incidence curve was flattening and it was impossible to predict the state of affairs for 2 years forward, but here we are.

That said, there is no strong indication of a secondary wave at present that would trigger the need for a booster dose. The likely priority if a repeat outbreak occurs would be vaccination for a majority of the at-risk population with no doses obtained; and a 2nd dose for single-dose recipients to enhance herd coverage at the higher level of immunogenicity, clearly a substantial minority of those having receiving any MVA-BN; followed by considerations of a booster dose particularly for those that received one or two fractioned intradermal doses in their primary series. 

If you are engaging in a high-risk sexual network microcosm where Mpox is less contained, even if case incidence is low within the total population, it wouid be more important to consider the additional dose if you could access it. 

Edited May 22, 2024 by SirBillybob

[56harrisond]

The World Health Organization on Wednesday declared the ongoing mpox outbreak in Africa a global health emergency.

WHO convened its emergency committee amid concerns that a deadlier strain of the virus, clade Ib, had reached four previously unaffected countries in Africa. This strain had previously been contained to the Democratic Republic of Congo.

WHO declares mpox outbreak a global health emergency | CNN

AMP.CNN.COM

---

The World Health Organization on Wednesday declared the ongoing mpox outbreak in Africa a global...

 

[Luv2play]

I had stopped screening providers about mpox vax status but will start again. I took two doses in 2022 but am open to a booster later this year if that seems advisable. 

[SirBillybob]

There is no Clade II 2nd wave affecting us. Portugal had a minor 2nd wave last summer that petered out.

For upcoming Europe travel I track incidence trends. Up to early July; next review early Oct. ‘Circuit’ may elevate Spain incidence but I won’t know as early as I’d like. 

965 De Maisonneuve East continues Imvamune offering on walk-in basis. I am single-dosed but likely will get 2nd dose soon. One reason is that impending pilots strike may strand me against booked return date and I’ll get more piggy over there being aggravated with sched disruption. It’s already in the past few days been a challenge to build a back-up flight plan to travel back home. I guess I’ll wing it and see what happens with my AC booking. 

NACI thoroughly updated guidance in May but 2-year booster recommendations have not been formulated yet for obvious reasons.

PHAC constructed a complex algorithm for possible Clade Ib incursion and it’s unlikely anybody landing here and infected would not have it contained, diaspora households and whatnot. Jumping into GBMSM community a very remote possibility.

If Canada officials could get their heads out of their asses there would be an attempt to donate some of our abundant MVA-BN supply to African LMICs.

Edited August 15, 2024 by SirBillybob

[EZEtoGRU]

I had my 2 x M-Pox vaccines in Michigan back in 2022.  I have no plans to do anything further unless experts suggest something more.  Hoping this current outbreak in Africa doesn't spread further.

[Luv2play]

20 minutes ago, EZEtoGRU said:

I had my 2 x M-Pox vaccines in Michigan back in 2022.  I have no plans to do anything further unless experts suggest something more.  Hoping this current outbreak in Africa doesn't spread further.

Given that the new strain is more virulent and has spread to a dozen or so African countries I would say it’s only a matter of time for it to show up on our shores. I also don’t project future trends based on past behaviour of new emerging virus. COVID showed us that. 

[+ Vegas_Millennial]

I had two smallpox vaccines which were supposed to prevent monkeypox.  I hadn't read anything about different vaccines for mpox.

Edited August 15, 2024 by Vegas_Millennial

[SirBillybob]

Just touched down in Stockholm, as case possibility beyond Africa was expected eventually. Clade I; the b now seems to be unnecessary given the phylogenetic tree structure. Person travelling from the endemic area. Contained thus far, Sweden reports. Public Health Agency of Canada had weeks ago estimated a 10% chance of arrival here by September, without the same expected spread that had been attributable to GBMSM network transmission of Clade IIb. Preparedness now an obvious benefit. 

Edited August 15, 2024 by SirBillybob

[SirBillybob]

1 hour ago, Vegas_Millennial said:

I hadn't read anything about different vaccines for mpox.

There are 3, and a 4th in development by Moderna. We all got MVA-BN which is one of the 3 but has 3 brand names according to global location, not to be confused with the trifecta of distinct products. 

Edited August 15, 2024 by SirBillybob

[Luv2play]

3 hours ago, SirBillybob said:

Just touched down in Stockholm, as case possibility beyond Africa was expected eventually. Clade I; the b now seems to be unnecessary given the phylogenetic tree structure. Person travelling from the endemic area. Contained thus far, Sweden reports. Public Health Agency of Canada had weeks ago estimated a 10% chance of arrival here by September, without the same expected spread that had been attributable to GBMSM network transmission of Clade IIb. Preparedness now an obvious benefit. 

It’s interesting you just arrived in the first country outside Africa to report a new case of Mpox from someone who had recently travelled to an Africa. This is exactly what I predicted yesterday in my post on the subject, that it was only a matter of time before this arrived on our shores.

Given that its estimated only 1 in 4 Canadians at risk have been vaccinated against Mpox, we are going to see an upsurge in cases very soon, probably within months.

[mike carey]

2 hours ago, Luv2play said:

It’s interesting you just arrived in the first country outside Africa to report a new case of Mpox from someone who had recently travelled to an Africa.

That's how I read @SirBillybob's comment initially but as I read on concluded that he meant 'it' not he had touched down in Stockholm.

[SirBillybob]

3 hours ago, Luv2play said:

It’s interesting you just arrived in the first country outside Africa to report a new case of Mpox from someone who had recently travelled to an Africa. This is exactly what I predicted yesterday in my post on the subject, that it was only a matter of time on our shores.

Spain and Israel, being closest in proximity to the Africa with which I am familiar (I didn’t know there were additional Africas) have experienced Mpox. I will be in Spain again this year. I think that the country reports cases officially but if I catch Mpox I will report it in some way. If I go somewhere to report it you may have clairvoyantly predicted that movement, that my Swatch is waterproof, and whether Canada had been annexed by Scandinavia or vice versa along with a merger of any shores not geographically specific to an Africa.

Edited August 16, 2024 by SirBillybob

[SirBillybob]

4 hours ago, Luv2play said:

Given that it’s estimated only 1 in 4 Canadians at risk have been vaccinated against Mpox, we are going to see an upsurge in cases very soon, probably within months.

Have you not been reading in the public domain media simple summaries on the science, surveillance, and logic regarding the two clades of relevance?

For Canada, the ratio of vaccinated to those susceptible to Clade I is negligible. MVA-BN uptake rate to date confers extremely minimal overall population coverage. 

Mpox Clade I does not potentiate Clade IIb incidence. The latter does not piggy-back on the former. I wouldn’t conflate Clade I concerns with the unique Mpox strain related to the current estimated completed subpopulation vaccination uptake you referenced, a 1:3 ratio of those vaccinated to those susceptible to a disease that is essentially in abeyance. The emergence of the more lethal Clade does not poke a different sleeping giant.

There is minimal evidence that predicts an upsurge specific to those not yet vaccinated against the originally targeted Clade IIb. Again, any latent residual spread over two years has been very self-limiting and the phenomenon of a few cases that were followed by a substantial peak in 2022 has not recurred. There has been an association between level of behavioural risk and either natural or artificial immunity that accounts for relative control. Moreover, further softening of CoV pandemic boundaries since 2022 has had no effect on Mpox incidence. 

Therefore, Mpox vaccination to date, even if it had been much more widespread for those at risk, should have very little bearing on an impending Mpox incursion as the total susceptible population is a vastly larger denominator. Any level of uptake and infection shielding among GBMSM would just be absorbable within a scenario of the revised targeted population at risk.

Edited August 16, 2024 by SirBillybob

[SirBillybob]

1 hour ago, mike carey said:

That's how I read @SirBillybob's comment initially but as I read on concluded that he meant 'it' not he had touched down in Stockholm.

Glad you didn’t fall into the syndrome trap.😉 Oops, I mean I’m. 

Edited August 16, 2024 by SirBillybob

[marylander1940]

On 8/15/2024 at 3:46 PM, Vegas_Millennial said:

I had two smallpox vaccines which were supposed to prevent monkeypox.  I hadn't read anything about different vaccines for mpox.

The vaccine is good for at least 2 years, possibly more according to how much exposure you have. I wouldn't be surprised if we have a new vaccination campaign soon for those who didn't get it last year. 

 

[+ Vegas_Millennial]

[SirBillybob]

There are a few post-peak reviews of MVA-BN effectiveness, but any article that suggests the benefits of older age is always welcome in my books. Interestingly, a single recent dose among Vaccinia-experienced was just as good as two doses for immune antibody response temporal waning in this small sample, as Bavarian Nordic had already indicated two years ago. 

I went and received my second dose latently yesterday anyway, due to upcoming travel, screening that could evolve due to possible Clade I seepage globally, and the possible benefit of recorded doses in one’s immunization booklet. I wouldn’t go as far as blithely broadcasting uptake history to any border control agent, however, due to possible overreactive stigmatizing. In a scenario of being detained due to unrelated but elevated body temperature it might come in handy. 

Study reveals waning antibody response to monkeypox vaccine over time

WWW.NEWS-MEDICAL.NET

---

New research to be presented at this year's European Congress of Clinical Microbiology and Infectious Diseases...

 

Edited August 24, 2024 by SirBillybob

[SirBillybob]

Madrid airport is screening for Mpox from Clade I endemic areas.

Thailand border control, a bit oddly, has confirmed a single Clade I case and launched flight contact tracing with respect to a European traveller that had been in Africa, yet has mapped ‘high risk’ foreign nationals entering as subject to screening according to the list of about 45 countries for which it requires Yellow Fever vaccination for entrants.

This could also mean a traveller not from a YF high risk nation but having recently been in transit. However, there seems to be no scientific basis for the broadening of screening foreign nationals from select South and Central America nations.

Also a few more Asian nations initiating arrival screening. 

Edited August 24, 2024 by SirBillybob

[Rohit]

Not vaccinated, but just pondering the risks regarding getting a massage (in London) and whether there’s anything I can do to help mitigate these risks. Thanks! 

[+ FrankR]

1 hour ago, Rohit said:

Not vaccinated, but just pondering the risks regarding getting a massage (in London) and whether there’s anything I can do to help mitigate these risks. Thanks! 

Yes, there is always risk, even if it is relatively low. But you can mitigate the risk by getting vaccinated. 

[Twinkslover]

I took both two shots do I need anymore ? I did 2 yrs ago 

[+ Vegas_Millennial]

5 hours ago, Twinkslover said:

I took both two shots do I need anymore ? I did 2 yrs ago 

Was is the smallpox vaccine, monkeypox vaccine, or mpax vaccine?

[SirBillybob]

8 hours ago, Twinkslover said:

I took both two shots do I need anymore ? I did 2 yrs ago 

Time can fly on us. Are you sure 2 years ago and not when vaccine uptake peaked 3 years ago? 

In any case Canada’s national immunization guidance entity did not rule out booster doses of MVA-BN a year ago because of Mpox evolution trends at that time. However, just recently revised the guidance to state that a follow-up dose to the initial 2-dose series is not indicated at this time. In fact I took the 2nd dose last August because any time span between doses is permissible and I had been historically Smallpox vaccinated, as well as intending to escalate interaction 2024-25. 

However, you would be advised to pursue consultation about vaccine immediately if you have a suspected or known Mpox-infected contact, for post-exposure prophylaxis purposes, irrespective of your MVA-BN dosing in the context of the outbreak. As it’s often unclear it would be discretionary and depend on factors such as community incidence at the time. I doubt you would be denied if anxious following an occasion of intimacy.

With trade I customarily inquire about vaccination because it makes sense when you are purchasing enjoyment accompanied by safety and offers an entry point for educating those at high risk yet poorly informed. What I do behaviourally, beyond PrEP to prevent HIV, and to mitigate STI potential crosses over to reduce Mpox transmission risk.

Edited June 7 by SirBillybob