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Bio: Clinician Scientist • Infectious Diseases / Virology @univofstandrews • currently @IDIMakerere • globalhealth, TB, HIV • #vegan🌱• RT ≠ endorsement
Location: Kampala, Uganda
Concerns about outdoor transmission risk seem to be trending again. What is the risk of transmission outdoors and should we be more worried about outdoors with the new more-transmissible variant? 🧵(1/n)
When #AIDS first hit the UK in the 1980s, it was gay and bi men who carried the heaviest burden of infection, illness and death.
However more resource was put into targeting the general population than those who were most likely to have it - and who most needed information.
Madhu’s speech at the International AIDS Conference just shook global health at the core. Three excerpts here.
1) Global health structures are racist; and this is not a bug, it is a feature.
Kadınlara hakaretlerini,tehditlerini,katliamlarını çekinmeden yapıp cezasız kalanların cesaretiyle bugün size bunlar yapılabiliyor @esenol Bilimsellikten uzak,çağdışılığın hüküm sürme gayretlerine hukuk yanıt vermeli ve eylemi yapanların dilleri susmalı @bybekirbozdag
Please do not post pictures of people speculating about whether or not they have monkeypox.
It’s not “minimizing” to recognize and denounce the harm in stigmatizing people on social media.
Thank you 🙏🏼
Activism FOR and BY clinicians is so important
Please retweet this to show @CDCgov @ECDC_EU and @WHO that they should move faster to change case definitions and help clinicians recognise #monkeypox #AIDS2022
Dr Anthony Fauci (!) discusses the negative effects of the SARS-CoV-2 pandemic on the HIV response.
➡️ decrease in diagnosing HIV & fewer people on ART
➡️ harm reduction services disrupted for people who use drugs
➡️ increase in TB deaths among PLWHIV
#HIV #COVID #AIDS2022
gonna break this tweet down as an example of monkeypox misinfo, how to spot it, why it’s harmful, etc
Activists take the stage at #AIDS2022 in protest at inequity in funding and social injustice
650k people died of #HIV related illnesses last year.
These deaths were preventable.
When HIV is treated it won’t be passed on during sex (#UequalsU).
Treatment saves lives and can end this epidemic.
Let no one be left behind.
#AIDS2022
Encourage everyone who is eligible for the #monkeypox vaccine to get jabbed 💉
...But little info is being shared on effectiveness, and the time it takes to be protected.
As more MPX research is funded we'll learn more. Thanks to @SimonCollins101 @HIViBase for this info ⤵️
just read the comments on this story i wrote and wheewwwwww. absolutely wild to be accused, as a gay reporter, of being anti-gay for reporting on *practical* health advice for a virus that is currently affecting MSM in 98% of known cases, including half a dozen of my own friends
Of the 2 new #Marburg cases in Ghana, 1 has already died. That's a a 75% fatality rate so far for this outbreak.
In theory, anyone can get MPX, but the risk is not the same for every person/ exposure. The narrative that MPX can affect everyone equally diverts attention away from addressing unmet needs. It’s a good PH practice to focus resources where it’s needed the most. (n/25)
The message that anyone can get #monkeypox isn't incorrect, but it is misleading. Fomites like bedsheets don’t carry the same risk as sexual or other close skin-to-skin contact. And unclear messaging is causing unnecessary panic. My latest for @Slate. 1/
bit.ly/3PUtmgB
.@peterstaley says what I've been trying to say. We shouldn't be censoring our messages about who is getting #monkeypox & how in an effort to avoid giving ammunition to bigots. And it won't work anyway -- homophobes will always find a reason to hate LGBT people.
Agree that it’s not the time for stigma & discrimination. But we also need to give accurate info. Monkeypox has multiple modes of transmission & sexual route appears to be an efficient one. Ppl need to know how it’s transmitted, so they can make informed decisions for prevention.
This preprint may start unraveling the mysteries behind "mystery" pediatric hepatitis...and it's not SARS-CoV-2.
It's not as simple as just "here's the virus that causes it." In this study, it appears to be linked to 2 viruses plus a specific host gene variant (HLA).
If your concern about #monkeypox is that it may spread *beyond* gay and bisexual men, maybe you should ask yourself why you think it’s fine if gay and bi men have Monkeypox?
Great thread Jess! Folks concerned about more widespread transmission- have a peep at this thread too.
Saw a post being like “mpx spreads through aerosols! It’s super easy to transmit in public”— and want to direct people to this thread , which is by an expert and breaks down the patterns in transmission for the current outbreak
The other important not included points are thus; it would be remiss not to mention the context in which we are currently operating. Prior to monkey pox sexual health services were already under unprecedented demand, with soaring sti rates and against a backdrop of our budgets…
📢 Published today in @NEJM to aid #monkeypox diagnosis:
A global collaborative case series led by @ShareEastLondon @QMUL describing 528 confirmed infections from 43 centres in 16 countries + an image library.
@rcgp @RCPhysicians
bit.ly/3PGg7js @JohnPThornhill🧵
In summary, the current clinical presentation may not be distinct compared to the historical MPX description, especially the Nigerian outbreak, if we factor in healthcare access, the influence of exposure site, host factors and severity of illness on clinical presentation. (n/19)
There are many opportunities but also many challenges in controlling this outbreak. Limited testing, and the lack of resources to support self-isolation & already overburdened sexual health services to care for the increasing MPX load continue to be the biggest obstacles. (n/20)
Especially when the time to diagnosis is prolonged, patients suffer. Mainstay of treatment is supportive care, but symptoms like pain, which can be debilitating, can be successfully managed in the hospital with pain management and antivirals. Patients deserve better. (n/21)
There are big knowledge gaps in clinical management. Our recent analysis highlights a lack of up-to-date & evidence-based clinical management guidelines, which has implications for patient management. (n/22) @isaric medrxiv.org/content/10.1101/…
In summary, current outbreak continues to be the biggest MPX outbreak outside of Africa. But, important to remember that MPX is not SARS-CoV-2, and it requires a very different public health response. (n/23)
So, we should continue to inform those most at risk of MPX & that the virus can be transmitted through intimate /household contact. While we will observe infections in the non-MSM population, the risk of significant transmission in the broader public continues to be low. (n/24)
In theory, anyone can get MPX, but the risk is not the same for every person/ exposure. The narrative that MPX can affect everyone equally diverts attention away from addressing unmet needs. It’s a good PH practice to focus resources where it’s needed the most. (n/25)
Appreciation to many people working tirelessly on the ground, from clinical management, epi, and contact tracing to research and policy response. Especially great thanks to the SH/GUM teams & @UKHSA @BHIVA @BASHH & community groups leading the response in the UK. (n/26)
Ultimately still a lot to learn about the full spectrum of MPX disease, the relationship btw viral dose & disease presentation, transmission routes, MPX evolution & management. In the meantime, all resources must be directed to stop the outbreak in the most at-risk groups (n/27)
Absolutely. Understanding the duration of protection after infection/vax is critical. The role of condom use in reducing (rather than preventing) tx is important as well - pls note there are reports of cases acquiring MPX via non-penetrative sex, but it may reduce the risk.
A NEW analysis of 528 #monkeypox infections in 16 countries by @profchloeorkin: 98% were GBMSM, 95% thought to acquire it during sex, and importantly patients presented predominantly w/ mucosal lesions (mouth, genital, anal/perianal, throat). @NEJM nejm.org/doi/full/10.1056/NE…
Painful lesions in the mouth, rectum, & difficulty swallowing as primary presenting complaint likely represents the inoculation site & suggests sexual activity as the suspected transmission route. All HCPs need to be aware of this diverse symptom profile.
Fantastic thread from @mugecevik on what we know and don't know about the current MPX multi-country outbreak. Really pleased to see @UKHSA Tech Briefings directly feeding into our shared understanding.
All I’d add to this spectacular #MPX update: it is imperative to roll-out vaccine to high-risk GBMSM (target PReP users & men with multiple recent casual partners)
We must act quickly now if we are to have any chance of containing spread & preventing endemicity.
👇🏾Nuanced 🧵on #monkeypox
My expertise is limited to genomics and clinical manifestation, but I agree with Dr. Cevik: current evidence points to the current outbreaks being a result of neglected ongoing transmission rather than a sudden adaptive change.
virological.org/t/initial-ob…
For an excellent thread with the very latest information on the ongoing monkeypox outbreaks, look no further than this one by @mugecevik
Here is a long overdue update on the current status of MPX outbreak; current epidemiology, what we’ve learned about virology, transmission, clinical presentation, challenges and opportunities in controlling this outbreak. #monkeypox
