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Smallpox vaccines may not protect against monkeypox for life | Monkeypox

Smallpox vaccinations may not protect against monkeypox for life, research suggests, with experts saying HIV may play a role in eroding protection from the jab over time.

Monkeypox outbreaks are ongoing around the world, with the World Health Organization declaring the disease a public health emergency of international concern. At present, the majority of cases in current outbreaks are among men who have sex with men.

Vaccination with a jab initially developed to protect against smallpox, a related but more serious disease, is among the measures being taken to control infections.

However, while experts stress that it is important for those at risk of monkeypox to take up the offer of a vaccination, as it reduces the chance of symptomatic infection and severe illness, protection offered by a smallpox jab may decline over time. A study into monkeypox cases in Spain revealed that 32 of the 181 patients had previously received a childhood vaccination against smallpox.

Dr Oriol Mitja, co-author of the research, said that since most participants who had been vaccinated against smallpox received the jab more than 45 years ago, it is reasonable to predict that their protection would have waned. “All I can say is that childhood vaccinations may not protect 100% for life,” he said.

Jimmy Whitworth, professor of international public health at the London School of Hygiene & Tropical Medicine, and who was not involved with the work, agreed.

He suggested that there could be a number of reasons at play, including that while the viruses are similar they are not identical, “so the cross-protection provided may not absolute”, he said.

Furthermore, Whitworth noted that the study relied largely on self-reported smallpox vaccination, meaning there may have been inaccuracies.

However, Mitja said most clinicians had also checked scars, vaccination cards, or the patient had asked his mother.

Another possibility, said Whitworth, is that HIV may play a role. According to the study, 40% of the monkeypox cases were in people who were HIV positive. Mitja said the figure was 60% among those who had childhood smallpox vaccination but still got monkeypox. “[People with HIV] may have had some immunodeficiency, eroding away the protection from the vaccine,” said Whitworth.

Laura Waters, the chair of the British HIV Association, agreed. “Though it is likely smallpox vaccine effectiveness wanes in everyone, it’s feasible that this would occur to a greater degree in people with HIV, even those with well-controlled HIV on treatment,” she said.

Research from scientists in the US, published in 2020, found immune responses to childhood smallpox vaccination declined faster among people who subsequently became infected with HIV.

Prof Mark Slifka, of Oregon Health & Science University, said: “This is a potential concern that may explain why there could be more monkeypox breakthrough cases in these current outbreaks.”

But he urged caution in interpreting the data from Spain, noting that the childhood smallpox vaccine might still have provided partial immunity towards monkeypox.

“We also don’t know if the cases among previously vaccinated individuals was less severe compared to those who were not previously vaccinated,” Slifka said, noting another study by his team looking at an earlier monkeypox outbreak in the US suggested childhood smallpox vaccination reduced the chance of catching monkeypox.

A spokesperson for the Terrence Higgins Trust said more research is needed on the effectiveness of the vaccine in people with HIV, adding that the charity is calling for the UK Health Security Agency to investigate whether people with HIV need a second dose of the vaccine. Limited supplies of the vaccine mean that at present only one dose is being offered to those at risk of monkeypox.

The smallpox vaccine being used in many countries, including in the UK, is not the same as the one given decades ago. Known as Imvanex in the UK and Jynneos in the US, the jab does not contain live virus, unlike earlier vaccines, making it safe for people with HIV.

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Dr Carlos Maluquer de Motes, a virologist at the University of Surrey, said the current monkeypox outbreak would offer important data on how long immunity offered by the smallpox vaccine lasts.

“No studies have been able to measure ‘real’ protection from [smallpox] simply because there was no disease once smallpox was eradicated,” he said. With monkeypox closely related to smallpox, the current outbreak could offer fresh insights.

Dr Maluquer de Motes added: “Whilst we think most individuals are protected, natural individual-to-individual variation in vaccine response efficacy is to be expected and some individuals may still be susceptible to monkeypox disease. This picture will emerge as numbers increase and larger studies are conducted.”

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Key Differences According To Doctors

In the rainy season, chickenpox cases are largely on the rise.

New Delhi:

Skin rashes and fever, the common symptoms in both monkeypox and chickenpox have caused confusion among people although doctors have stressed that there is a difference in the way the symptoms of both viral diseases manifest in patients.

They have also advised to consult a doctor to dispel any doubts.

Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe.

In the rainy season, people are more prone to viral infections, and chickenpox cases are largely seen during this time along with other infections that also show symptoms like rashes and nausea, said Dr Ramanjit Singh, visiting consultant, dermatology, Medanta Hospital.

“Due to this situation, some patients are getting confused and misinterpret chickenpox with monkeypox. The patient may determine whether they have monkeypox or not by understanding the sequence and the onset of symptoms,” Dr Ramanjit Singh said.

Explaining further, he said monkeypox usually starts with fever, malaise, headache, sometimes sore throat and cough, and lymphadenopathy (swollen lymph nodes) and all these symptoms appear four days prior to skin lesions, rashes and other problems which primarily start from hand and eyes and spread to the whole body.

Other experts agree and say that apart from skin involvement, there are other symptoms too in the case of monkeypox, but it is always better to consult a doctor to dispel any doubts.

In a couple of instances reported recently, two suspected cases of monkeypox turned out to be chickenpox.

A suspect case of monkeypox admitted to the Lok Nayak Jai Prakash Narayan Hospital (LNJP) Hospital in Delhi last week with fever and lesions, tested negative for the infection but was diagnosed with chickenpox. Similarly, an Ethiopian citizen, who had gone to Bengaluru was tested for monekypox after he showed symptoms but his report confirmed that he had chickenpox.

India has so far reported four cases of monkeypox – three from Kerala and one from Delhi. Dr Satish Koul, Director, Internal Medicine, Fortis Memorial Research Institute said, “In monkeypox, the lesions are bigger than chickenpox. In monkeypox, the lesions are seen on palms and soles. In chickenpox, lesions are self-limiting after seven to eight days but not so in monkeypox. The lesions are vesicular and itchy in chicken pox. In monkeypox the lesions are broad vesicular and non-itchy.” Dr Satish Koul also said the duration of fever is longer in monkeypox and such a patient has enlarged lymph nodes.

Elaborating on the virus that causes chickenpox, Dr S C L Gupta, medical director of Batra Hospital, said chickenpox is a Ribonucleic acid (RNA) virus which is not as severe but it too leads to rashes on the skin. “This is the season of chickenpox. Usually, during monsoon, there is this dampness, rise in temperature, water logging, formation of moisture and wet clothes, all these leads to growth of the virus.

“Also, there is a religious aspect associated with the disease. People treat it like a ‘goddess’ and so such patients are not treated with any sort of medicines. They are kept in isolation and are given time to heal,” he said.

Talking about monkeypox, Dr S C L Gupta explained that such virus requires an animal host but is self-limiting with sore throat, fever and normal virus signs.

“The main sign of this virus is the rashes on the body which have liquids inside. This leads to viral infection which weakens the body resistance. But problems arise due to its complication. In case, any bacterial infection and gets pusses and leads to blisters leading further complication into the body. “Right now, monkeypox is at its juvenile stage. We do not have a proper treatment. We are just following the method of isolation and treating the suspected patient according to their symptoms. If there is a throat infection, we use the generic medicines that we usually take. So, here it is a case of symptomatic treatment,” he said.

Doctors have also received queries that whether previous chickenpox infection makes a patient immune to monekypox to which the answer is an emphatic no.

Dr Rajinder Kumar Singal, Senior Director and Head of Department, Internal Medicine, BLK Max Hospital, New Delhi, said both are caused by different viruses, the mode of transmission is different, and previous infection does not ensure any protection against the new one. But those who have received the smallpox vaccination have lesser chances of contracting monkeypox, he asserted.

“The small pox vaccine was discontinued after the World Health Organisation (WHO) said the disease had been completely eradicated around 1979-80. People born before 1980 who have taken smallpox vaccine have lesser chances of contracting monkeypox. Both smallpox and monkeypox are caused by viruses of the same family,” Dr Rajinder Kumar Singhal added.

Due to this similarity between small pox and monkeypox, many countries have allowed the ‘small pox’ vaccines to be given but in India, it is still not allowed. “The virus is at its juvenile stage and doctors are still figuring it out,” Dr S C L Gupta added.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

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The U.S. Is Rolling Out Monkeypox Vaccines to the Public

Image: Shutterstock (Shutterstock)

The U.S. will soon greatly expand its vaccination program for monkeypox. On Tuesday evening, the Biden administration announced that it is planning to release a stockpile of over a million vaccine doses to the public by the end of fall. The vaccines will primarily be given to close contacts of confirmed cases and others with a higher risk of exposure, such as gay and bisexual men who have had multiple recent sex partners in areas where the emerging disease has been spotted.

The updated strategy announced by the U.S. Department of Health and Human Services Tuesday will call for a gradual rollout of the country’s supply of the JYNNEOS vaccine. Nearly 300,000 doses will be distributed nationwide in the coming weeks, including 56,000 doses immediately. Another 750,000 doses will be made available during the summer. And up to 500,000 doses should be released later in the year, assuming that they pass the inspection process. All in all, around 1.6 million doses of the two-dose vaccine are expected to be available through the stockpile this year.

The vaccines became available so quickly because the monkeypox virus is closely related to the now-extinct smallpox virus, which was eradicated through a massive global vaccination campaign in 1980. Countries have still maintained a stockpile of smallpox vaccines to this day, however, in part because there’s always the small possibility that the virus could be resurrected as a bioweapon agent. And these vaccines are also thought to be effective against closely related viruses like monkeypox. Indeed, smallpox vaccines do not contain the virus itself, but another related virus called vaccinia.

The U.S. does have a much larger stockpile of the ACAM2000 smallpox vaccine available as well, and the HHS has said that it will release doses to jurisdictions that request it. But the ACAM2000 vaccine comes with more significant side effects than JYNNEOS, making it less suitable for mass distribution, the agency said. In 2019, JYNNEOS became the first vaccine in the U.S. to be approved for both smallpox and monkeypox. It’s estimated to be 85% effective against monkeypox, but that estimate is based on limited real world data. The vaccine can also be given to people soon after a suspected exposure, which should reduce the risk of illness.

In announcing the expanded rollout of its stockpile, the U.S. is following in the footsteps of other countries like the UK. Like these countries, the U.S. will be allocating doses on a priority basis, depending on people’s risk of exposure. At the top will be people known to be in close, prolonged contact with confirmed or suspected cases, followed by those whose sexual partners have been diagnosed with monkeypox, and finally “men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading.” Within these tiers, considerations like a person’s existing health will be taken into account as well.

“Our goal right now is to ensure that the limited supply of JYNNEOS vaccine is deployed to those who can benefit from it most immediately, as we continue to secure additional vaccine doses,” said HHS Assistant Secretary for Preparedness and Response Dawn O’Connell, in a statement.

Monkeypox is thought to primarily infect rodents. Until recently, it had only occasionally spread from animals to humans following its discovery in the 1950s. But there have been more than 4,000 confirmed or suspected cases reported globally in humans this year, including over 300 in the U.S., which is a caseload far above the sporadic outbreaks previously seen in some parts of Africa. Though it may have been circulating in humans at low levels for several years now, its current spread appears to be fueled by close contact during sex. So far, outbreaks have primarily involved men who sleep with men, but the virus can spread to anyone through close contact with someone’s infected rashes and possibly respiratory particles.

Last weekend, the World Health Organization declined to declare a public health emergency of international concern over monkeypox for the time being, though they continued to stress that greater international cooperation and action will be needed to contain the virus before it can permanently become endemic in more parts of the world.

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We Are Not Ready for Monkeypox

Photo: Pablo Blazquez Dominguez (Getty Images)

Monkeypox is here, and it’s spreading. The couple of dozen cases in a few countries that we told you about last month are now up to over a thousand cases worldwide, with 35 reported in the United States. But the U.S. almost certainly has more cases than the statistics suggest, and there is reason to suspect that we’re already fucking up the response to the epidemic in some ways that will feel uncomfortably familiar.

We aren’t testing enough

For the first few months of the COVID pandemic, when we had the chance to contain the virus if only we could locate all the cases and their contacts, testing was woefully inadequate. Plenty of people who had the virus were never tested for it, and people who wanted a test couldn’t always get one. The way we knew at first that the virus was spreading unnoticed was that there were cases in the U.S. that were not related to each other. The genetics of different clusters of a disease outbreak can show that the virus must have been spreading undetected for a while.

That’s what’s beginning to happen here: There are small clusters of monkeypox cases that are genetically different enough from each other that we know there must be far more than the 35 reported U.S. cases. So a lot of cases must be going undetected.

One reason for under-testing is that people who have monkeypox may not realize that they have it. Normally, monkeypox lesions are widespread across the body. In the current outbreak, sometimes a person may only have lesions in one part of the body, and may even have a single lesion. When that happens, you don’t think, “oh my god, this must be monkeypox,” you think, “huh, I wonder what that spot is.” And maybe you’ll see a doctor, or maybe not.

Doctors also aren’t necessarily looking for monkeypox, and might not recognize it at first. It’s not a common disease in the U.S. (or in many of the other areas where it’s spreading) and the symptoms in this outbreak don’t always follow the textbook sequence. Normally you would expect a fever first, and then the rash; but some of the known cases got the rash before the fever. Some people have the lesions only in the anal or genital area, which may look confusingly similar to STIs like herpes or syphilis. (Molecular microbiologist Joseph Osmundson has put together a fact sheet that includes photos of anal and genital monkeypox lesions here.)

So the first obstacle in testing is that not enough tests are being done in the first place. Testing for monkeypox involves collecting secretions or scabs from the lesions, and sending them to one of a few specific laboratories. Former FDA commissioner Scott Gottlieb tweeted that the current bottleneck is the lack of sampling.

But if awareness gets better, we may soon run into a bigger problem: labs’ testing capacity. Currently there is a network of 74 labs that can run a test for orthopoxviruses, and they can process an estimated 7,000 tests per week. Monkeypox is the only orthopoxvirus of concern at the moment, since smallpox has been eradicated and other viruses in the family, like cowpox, are rare. If a sample tests positive for orthopoxvirus, the CDC will do further testing to confirm that it is monkeypox.

People with monkeypox (or orthopoxvirus that is suspected to be monkeypox) are supposed to isolate for 21 days, and in the meantime, health authorities will contact-trace, and offer vaccines to the affected person and their close contacts. There are also antivirals that may be helpful. But the vaccine brings another problem.

We have a vaccine, but we don’t know how well it works

The good news about the vaccine is that we already have one. More than one, actually: Smallpox vaccination dates back hundreds of years, with several modern vaccines still available. (Smallpox was declared to be eradicated worldwide in 1980, the only human virus to have that honor.) People could occasionally have fatal reactions to some of the older smallpox vaccines, so those—the ones that use live virus—aren’t being considered for monkeypox.

In the U.S., there is one vaccine that is licensed for use against monkeypox. It’s known as MVA (for Modified Vaccinia Ankara) and its brand name here is Jynneos. It doesn’t replicate in humans, but it does still trigger an immune response against smallpox. According to a 1988 study, vaccination is 85% effective against monkeypox transmission—but that was a small study and we don’t know if that’s the efficacy we can expect from the current vaccine and the current strain of monkeypox.

We also don’t know if we’ll have enough of it. The U.S. Strategic National Stockpile says they have 36,000 doses and have ordered 36,000 more. The company that makes the vaccine also has lots of recent orders from other countries, for obvious reasons, and they plan to ship out small batches to the various countries so that everybody can start vaccinating quickly.

That’s not enough vaccine to start vaccinating everybody, so the current strategy is “ring vaccination,” in which vaccine is offered to people who were close contacts of a person known to have monkeypox. (Monkeypox vaccine may also be given to the person with monkeypox, since it can reduce the severity of illness if caught early enough.) But contact tracing isn’t perfect, and in many recent cases, people didn’t have names or contact information for all their close contacts. Another possible strategy would be offering the vaccine to everybody in high-risk groups, which currently include men who have sex with men. So far, that strategy is only being tried in Canada.

People are already misunderstanding how it’s transmitted

Many of the recent cases have been in men who have sex with men. This has led to some people assuming that it’s sexually transmitted, like HIV or other STIs; I’ve already seen social media posts from people misunderstanding this and saying that you can only catch monkeypox from sex with somebody who has it.

Knowing that a virus is sexually transmitted is helpful to know if sexual transmission is the main way that virus spreads, like with HIV. But we know that monkeypox can spread with close contact of any kind, including contact with an infected person’s lesions, or with their respiratory droplets (like from a cough or sneeze) and possibly even with aerosols.

And on that note: The CDC briefly published a recommendation that travelers wear masks to avoid catching monkeypox, and then took down that recommendation saying that it “caused confusion.” Can monkeypox be airborne? Maybe! But if you’re concerned about catching a virus when you travel, you should be wearing a mask anyway. We already know that masks (especially well-fitting N95 style masks) are effective at protecting us against COVID, and COVID cases are on the upswing again—not that they ever went away. So, yes, wear a mask. But also be on the lookout for symptoms of monkeypox, and don’t be afraid to ask for a test or a vaccine if you think you have monkeypox or may have been exposed.

   



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Monkeypox Is Here and COVID Truthers Are Losing It

Public health experts and most mainstream media outlets have spent much of the last week or two assuring people that monkeypox is not the new COVID-19.

Sure, the global outbreak of a couple hundred cases of a disease usually confined to clusters in Africa is odd and not yet well understood, and after two years of COVID, news of a virus potentially doing something new inevitably has people on edge. But unlike the novel coronavirus, several experts on the disease told The Daily Beast, monkeypox is a known entity. It doesn’t spread all that easily between humans, nor, to experts’ current understanding, asymptomatically. So few see any cause for widespread concern—and no actual experts or officials of any note appear to be calling for COVID-style control measures.

As Grant McFadden, a poxvirus expert at Arizona State University, put it, “For a virologist, this transmission is worth study, and it’ll probably teach us a few new things about monkeypox. But for the average person, on a worry meter from 0 to 10, it’s probably below a 1.”

But over in the bizarro world of pandemic truthers and far-right conspiracy theorists, many folks have been spreading a drastically different message: Monkeypox is clearly “Covid 2.0.” Naturally, this crowd baselessly believes, global elites will soon enact a new wave of supposedly inane and harmful mass lockdowns, vaccinations, and more.

“Soon: Just 2 weeks to flatten the monkeypox curve,” a member of a conspiratorial Reddit group with over 1.7 million users posted last week. “Msm [mainstream media] will push monkeypox lockdowns within the next month……….here we go again,” reads another post from Monday.

Or, as one recent article in a popular truther publication put it, “We might be in for an epic summer of scare-mongering, panic-buying & bucket loads of cringe…”

The contrast between experts’ measured accounts of the realities of this strange—yet likely manageable—outbreak and the conspiracists’ frenzied predictions about a pandemic repeat is striking. But according to several experts on anti-vaxxers, pandemic truthers, and conspiracy theorists The Daily Beast spoke to for this article, it’s hardly surprising. After all, these communities have spent years now arguing that the pandemic is the centerpiece of a grand (if vague) sinister plot, and finding ways to shoehorn anything and everything they find suspicious or distasteful into those narratives.

…within hours of reports on Biden’s statements on the outbreak, Donald Trump Jr. tweeted out, “How long till the WHO and CDC lock us down again for the coming #Monkeypoxalypse?”

As Michael Barkun, an expert on conspiracy thinking at Syracuse University, put it, “People who see the world through this lens would never accept that monkeypox is a separate disease. For them, it necessarily has to be part of a larger picture that includes COVID.”

Pandemic truthers started jumping on every story about a new or unusual disease last year, tagging them all as a potential new chapter in the so-called pandemic madness that had supposedly grappied the world.

Twice in 2021, figures in this space actually latched onto isolated cases of monkeypox detected in America, among people who’d recently traveled to Africa.

“Monkeypox plandemic coming soon?” a truther Telegram channel with over 95,000 followers wrote last July, linking to a mainstream story about a man who traveled from Lagos to Dallas and then wound up in the hospital with the disease.

A few days later, the channel noted that the FDA had just, as of 2019, approved a vaccine for use in protection against monkeypox, suggesting that this was potentially suspicious, given the obscurity of the disease in America. Over the last few weeks, truthers have revived this point, and cited other recent developments in monkeypox research and vaccine procurement deals as major red flags.

It’s worth noting that, no, recent monkeypox product developments and purchases are actually not odd. As David Evans, a University of Alberta poxvirus researcher, explained to The Daily Beast, experts have long known that smallpox vaccines are about 85 percent effective against monkeypox, too. (Both are members of the same family of viruses.) Large-scale smallpox vaccination stopped after humanity eradicated the disease in the wild. However, vials still exist in a few labs; some workers at these facilities still need regular precautionary vaccinations. And public health and security experts have long feared that an accident, terror attack, or something else could re-release the disease. So limited smallpox vaccine production never stopped.

Alex Jones, left, and Donald Trump Jr. have both amplified conspiracy theories about monkeypox. Memes and videos about the origins and severity of the virus have also made their way around far right parts of the internet.

Photo Illustration by Luis G. Rendon/The Daily Beast/Getty/Twitter/TikTok

But old smallpox treatments had what Evans called “nasty” side effects; they killed one in a million recipients. So researchers also never stopped developing new and potentially safer smallpox treatments and cures, which governments routinely purchase to maintain strategic stockpiles. Researchers also noticed a steady increase in the frequency and spread of monkeypox outbreaks starting several years ago, a phenomenon likely partially explained by the slow fade-out of smallpox vaccine immunity in the general population. So the niche world of poxvirus experts has had its eye on monkeypox for years, and folks developing a treatment or vaccine against smallpox have started explicitly angling their products towards that disease, as well.

Of course, this context never seems to find its way into truther- and conspiracy-theorist posts about this pox.

Truther posts about monkeypox cases in 2021 never took off. (Although a few folks now point to them as supposed proof that the mainstream media was, as one Telegram channel recently put it, “seeding the monkeypox narrative last year.”) Observers monitoring this space suspect that’s due to the fact that these well-isolated cases never turned into a larger story they could latch onto. Meanwhile, there were still plenty of novel COVID developments for them to fixate on.

In recent weeks, however, “the public has tried to unmask and get back to engaging in normal activities,” noted Kathleen Hall Jamieson, an expert on misinformation and conspiracy theories at the University of Pennsylvania who monitors pandemic-skeptical chatter online. It’s unclear if this return to a sense of normalcy will last in the face of an apparent surge of cases, and the ever-present threat of a new strain ripping across the nation. But as COVID slowly fades out of the headlines for now, while conspiracy theorists’ darkest prophecies of a dystopian future remain unfulfilled, some have seemingly started to scramble to identify a new pandemic that they can paint as the next phase in, or a second attempt at advancing, a sinister elite master plan.

The truther sphere has a penchant for jumping on any issue that sparks a critical mass of state, media, or popular attention, Matthew Motta, an Oklahoma State University expert on conspiracy thinking, pointed out. So by the time President Joe Biden addressed monkeypox last weekend, flagging it as a cause for concern, the story was so big it was probably inevitably going to get sucked into wild COVID narratives.

Sure enough, within hours of reports on Biden’s statements on the outbreak, Donald Trump Jr. tweeted out, “How long till the WHO and CDC lock us down again for the coming #Monkeypoxalypse?”

But Jamieson suggested that the portrayal of monkeypox as “Covid 2.0” has spread particularly quickly and gained notable traction within pandemic conspiracy circles because it lines up with many elements of COVID-19 they’ve fixated on over the last two years. It’s a disease that jumped from animals to humans—and then acted weird. Some nations are talking about isolating affected people and vaccinating those at risk of transmissions. Which, to be clear, are tried-and-true containment tactics; America employed them to contain a major monkeypox outbreak that hit the Midwest in 2003. And they don’t come anywhere near the sorts of measures instituted to control COVID-19.

Conspiracy theorists even zeroed in on reports about a simulation, run by the Nuclear Threat Initiative in March 2021 for health and security experts, modeling a strange outbreak of monkeypox spreading across the globe starting in mid-May 2022.

Marjorie Taylor Greene has jumped on the monkeypox truther bandwagon.

Photo Illustration by Luis G. Rendon/The Daily Beast/Getty/Twitter

To many truthers, this last link seemed like a direct repetition of Event 201, a simulation of a novel coronavirus outbreak run in late 2019 that conspiracy theorists paint as a smoking gun showing that elites knew about or planned COVID-19 before it broke out. “The timeline for the (((pandemic))) in the pdf literally matches” the current monkeypox outbreak, one of many truther Telegram channels that shared stories about the 2021 exercise wrote in a post last weekend. (Those parentheses are a well known anti-Semitic dog whistle, meant to subtly yet clearly imply Jewish involvement or leadership in some sort of vague monkeypox-related plot.)

In truth, the NTI’s exercise was one of many biosecurity games held every year.

Jaime Yassif, one of the individuals at NTI involved in the scenario, told The Daily Beast that they picked an arbitrary near-future starting date for the scenario. And while many such exercises focus on smallpox, as it’s a classical concern in the field, NTI opted for monkeypox because they “wanted to present a novel scenario,” while still focusing on a known health concern.

Neither their timeline nor the details actually line up as well with the current monkeypox outbreak as conspiracists insist. Notably, the scenario outlines a bio-terror attack in a fictional nation using a genetically modified version of a different strain of monkeypox than the one circulating now. Although some conspiracy theorists insist the current outbreak involved genetic engineering, or a lab leak (and a few have even tried to link it back to the Wuhan lab implicated in COVID conspiracy theories), there is no evidence for these claims. In fact, the circulating virus looks like a standard strain of West African monkeypox, several experts who’ve reviewed its genome, recently sequenced from a sample collected from a patient, told The Daily Beast. The virus involved in this outbreak also isn’t spreading anywhere near as fast, nor causing as many or as severe of cases, as the fictive one outlined in the NTI exercise.

But as Webster University conspiracy-theory expert Daniel Hellinger noted, details rarely matter to conspiratorial communities. They’re just hunting for cherry-picked “evidence” they can use to confirm their narratives. In this case, they seem to feel it’s particularly easy to find threads from monkeypox to COVID; they’ve made a slew of other cases for apparent connections, which it’d take a monograph to unpack in detail. Suffice it to say each is more spurious than the last.

Beyond these supposed resonances, Jamierson pointed out that monkeypox has a few unique characteristics that may appeal to truthers: Notably, it involves a striking rash that they can use to stir up fear.

Its name also allows them to make memes featuring monkeys, animals Americans usually think of as silly, playing into the running truther notion that COVID plots are all obvious and absurd. The truther sphere is currently awash in weird memes, like an orangutan on a tricycle, labeled “Monkeypox,” chasing a screaming child labeled, “The 11 People Who Still Believe The Media.”

For all the consensus in truther world that monkeypox is “Covid 2.0,” no one seems to agree on what that label actually means, nor the implications of a new pandemic.

Notably, many truthers claim monkeypox is clearly a hoax or a minor issue blown out of proportion by global elites to sow chaos they can exploit. “As inflation soars and the cost of living crisis only gets worse, it’s probably handy for them to have a new ‘public health’ reason to ban protests and clampdown on civil unrest,” a major truther blog recently suggested.

However, others argue monkeypox is real and dangerous, and is being deployed in the wake of weaknesses created by COVID or the COVID vaccines to depopulate the globe. “They are progressing to stage 2 where they drop an ACTUALLY dangerous virus. Except [sic] 10x the death toll of COVID,” a poster in a large conspiratorial Reddit community recently argued.

Others still claim monkeypox is actually a side effect of the COVID vaccines being passed off as a new condition, making it a direct COVID sequel. “‘Monkeypox’ is just the new name given to shingles side effects caused by the covid injections,” a truther Telegram channel recently argued. (It’s not.) Or that monkeypox is a distinct condition, but people are only getting it now because vaccines weakened their immune systems. (They didn’t.) “If you never took the covid shot you have nothing to worry about,” a conspiratorial Telegram channel recently noted within a post speculating about potential dire effects of the supposedly imminent monkeypox pandemic.

It’s also unclear how long these discordant theories will maintain their prominence within truther spaces. As Jamieson noted, they gained rapid traction and are “now circulating… among people who have potentially substantial reach.” Alex Jones and Marjorie Taylor Greene have notably jumped on the monkeypox panic bandwagon. But truther attention is fickle, experts on the space agreed. Even a big story can fade quickly in these spheres, if it doesn’t gain the traction its proponents hoped for, or find the right fuel within mainstream reporting to sustain itself.

A few members of conspiratorial communities online have already started raising concerns about whether they’re putting too much focus on monkeypox—perhaps more than the mainstream media that their theories often accuse of overhyping the outbreak as part of a mission to foment fear. “If Monkeypox turns out to be nothing, will this sub collectively agree that we are the only place freaking out about it?” a poster in a major Reddit conspiracy group recently asked.

However, even if the current monkeypox is Covid 2.0 theories collapse as the outbreak fades and internecine squabbles over their details and validity expand, every expert The Daily Beast spoke to for this story suspects conspiracy theorists will just find something new to paint as the new pandemic. Because undergirding this conspiracy theory is one underlying, universal, unshakable belief. As a popular conspiratorial blog wrote on its Telegram channel in a post speculating about how monkeypox might unfold, “One thing is for sure, they aren’t done with us just yet.”

As ever, it’s unclear who “they” refers to.

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Genetic Clues and How It Might Be Spreading

Monkeypox samples are being studied at the University of Minnesota’s Veterinary Diagnostic Laboratory.
Photo: JUDY GRIESEDIECK/Star Tribune (Getty Images)

Cases of monkeypox continue to climb across the globe, with more than 200 confirmed and suspected cases documented in over 20 countries. Scientists are starting to gather their first clues about these outbreaks, including how the virus may have begun spreading farther than it ever has before.

According to a tracker from the group Global.health, there have been 174 confirmed and 93 suspected cases reported from 21 countries as of Tuesday afternoon. The UK and Spain have reported the most cases, and at least seven cases have been found in the U.S., including one in New York City. No deaths are reported so far; the type of monkeypox virus associated with these cases is known to have a fatality rate around 1%.

The viral disease tends to cause large bumpy rashes throughout the body, along with flu-like symptoms. It can take up to three weeks following exposure for symptoms to start and two weeks for the illness to clear. The virus primarily spreads through direct contact, though it may also be spread through contaminated surfaces as well as respiratory droplets and aerosols. Infected people aren’t considered contagious until after they start showing symptoms.

Monkeypox, closely related to the now-extinct smallpox virus, is endemic to parts of Africa and is thought to typically infect rodents. Following its discovery in the 1950s, it has occasionally jumped from animals to humans, causing localized outbreaks with limited transmission between humans. That makes these newest cases far different from past incursions of the virus. But we may have some early indications of what’s going on.

An electron microscope image of a single monkeypox virus.
Photo: Cynthia S. Goldsmith, Russell Regner/CDC via AP (AP)

Some researchers have been able to genetically sequence samples of the virus collected from patients. These results suggest that the strains in these cases are closely related to strains recently collected from Nigeria, where outbreaks have been ongoing since 2018. So far at least, there doesn’t seem to be evidence that the virus has mutated in any significant way since then, which is reassuring. But further research will be needed to rule out the possibility that it somehow became more inherently transmissible between humans.

“In the past, human to human spread has occurred but has been quite limited. We don’t know that it is spreading more easily from person to person yet. That is one possible explanation, but I am not aware of any evidence to support that idea yet,” Andrew Pavia, an infectious disease doctor at the University of Utah, told Gizmodo last week.

If the virus hasn’t changed intrinsically, then these outbreaks may be the result of other factors, including how it’s now being caught. Many cases have been found in young gay and bisexual men who were recently sexually active. And a World Health Organization adviser has argued that its spread may have been amplified by two recent raves in Spain and Belgium where casual sex was common.

Even if this does turn out to be true, though, it wouldn’t mean that gay or bisexual men are the only people at risk, since the virus can spread through direct contact between any sexual partners. It’s also possible that these cases were first found simply because these individuals tend to be more cognizant about the risk of sexually transmitted infections in general and are more likely to regularly see a doctor as a result. On Tuesday, popular dating app Grindr sent out an alert about monkeypox to its users, advising them to seek medical help if they or a recent sexual partner develop unusual sores or rashes.

Other experts have argued that the virus may be spreading more now because of declining immunity to the related smallpox virus, following its eradication in 1980. Poxviruses often cause cross-immunity to other poxviruses, but this protection has faded over time in the general population for various reasons, according to Jo Walker, an infectious disease epidemiologist and modeler at the Yale School of Public Health.

“This ‘declining immunity’ is less due to waning immunity at the individual level, and more due to people with immunity dying, and people without immunity being born and then staying non-immune,” Walker told Gizmodo last week.

The risk of monkeypox to the general public is still considered to be low. And for now, Pavia says, there is no reason to panic or for most people to have any worries. “But it is early days, so that may change,” he noted.

Indeed, health officials in Europe have warned that if these outbreaks aren’t contained quickly and effectively enough, the virus could establish itself in new parts of the world and regularly cause outbreaks from here on out. And while monkeypox can be managed with preventative vaccines and treatments, the last thing the world needs right now is trouble from another emerging infectious disease.

This article has been updated with comments from Andrew Pavia and Jo Walker.

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African scientists baffled by monkeypox cases in Europe, US

LONDON — Scientists who have monitored numerous outbreaks of monkeypox in Africa say they are baffled by the disease’s recent spread in Europe and North America.

Cases of the smallpox-related disease have previously been seen only among people with links to central and West Africa. But in the past week, Britain, Spain, Portugal, Italy, U.S., Sweden and Canada all reported infections, mostly in young men who hadn’t previously traveled to Africa.

There are about 80 confirmed cases worldwide and 50 more suspected ones, the World Health Organization said. France, Germany, Belgium and Australia reported their first cases Friday.

“I’m stunned by this. Every day I wake up and there are more countries infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science and who sits on several WHO advisory boards.

“This is not the kind of spread we’ve seen in West Africa, so there may be something new happening in the West,” he said.

To date, no one has died in the outbreak. Monkeypox typically causes fever, chills, rash and lesions on the face or genitals. WHO estimates the disease is fatal for up to one in 10 people, but smallpox vaccines are protective and some antiviral drugs are being developed.

Nigeria reports about 3,000 monkeypox cases a year, WHO said. Outbreaks are usually in rural areas, when people have close contact with infected rats and squirrels, Tomori said. He said many cases are likely missed.

Dr. Ifedayo Adetifa, head of the country’s Center for Disease Control, said none of the Nigerian contacts of the British patients have developed symptoms and that investigations were ongoing.

WHO’s Europe director, Dr. Hans Kluge, described the outbreak as “atypical,” saying the disease’s appearance in so many countries across the continent suggested that “transmission has been ongoing for some time.” He said most of the European cases are mild.

On Friday, Britain’s Health Security Agency reported 11 new monkeypox cases, saying “a notable proportion” of the infections in the U.K. and Europe have been in young men with no history of travel to Africa and who were gay, bisexual or had sex with men.

Experts have stressed they do not know if the disease is being spread through sex or other close contact related to sex.

Nigeria hasn’t seen sexual transmission, Tomori said, but he noted that viruses that hadn’t initially been known to transmit via sex, like Ebola, were later proven to do so after bigger epidemics showed different patterns of spread.

The same could be true of monkeypox, Tomori said.

In Germany, Health Minister Karl Lauterbach said the government was confident the outbreak could be contained. He said the virus was being sequenced to see if there were any genetic changes that might have made it more infectious.

Rolf Gustafson, an infectious diseases professor, told Swedish broadcaster SVT that it was “very difficult” to imagine the situation might worsen.

“We will certainly find some further cases in Sweden, but I do not think there will be an epidemic in any way,” Gustafson said. “There is nothing to suggest that at present.”

Scientists said that while it’s possible the outbreak’s first patient caught the disease while in Africa, what’s happening now is exceptional.

“We’ve never seen anything like what’s happening in Europe,” said Christian Happi, director of the African Centre of Excellence for Genomics of Infectious Diseases. “We haven’t seen anything to say that the transmission patterns of monkeypox have been changing in Africa. So if something different is happening in Europe, then Europe needs to investigate that.”

Happi also pointed out that the suspension of smallpox vaccination campaigns after the disease was eradicated in 1980 might inadvertently be helping monkeypox spread. Smallpox vaccines also protect against monkeypox, but mass immunization was stopped decades ago.

“Aside from people in west and Central Africa who may have some immunity to monkeypox from past exposure, not having any smallpox vaccination means nobody has any kind of immunity to monkeypox,” Happi said.

Shabir Mahdi, a professor of vaccinology at the University of Witwatersrand in Johannesburg, said a detailed investigation of the outbreak in Europe, including determining who the first patients were, was now critical.

“We need to really understand how this first started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, we really need to understand why.”

———

Geir Moulson in Berlin, Jan M. Olsen in Copenhagen, Chinedu Asadu in Lagos, Nigeria, and AP reporters across Europe contributed to this report.

———

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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African scientists baffled by monkeypox cases in Europe, US

LONDON (AP) — Scientists who have monitored numerous outbreaks of monkeypox in Africa say they are baffled by the disease’s recent spread in Europe and North America.

Cases of the smallpox-related disease have previously been seen only among people with links to central and West Africa. But in the past week, Britain, Spain, Portugal, Italy, U.S., Sweden and Canada all reported infections, mostly in young men who hadn’t previously traveled to Africa.

France, Germany, Belgium and Australia confirmed their first cases of monkeypox on Friday.

“I’m stunned by this. Every day I wake up and there are more countries infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science and who sits on several World Health Organization advisory boards.

“This is not the kind of spread we’ve seen in West Africa, so there may be something new happening in the West,” he said.

Monkeypox typically causes fever, chills, a rash and lesions on the face or genitals. WHO estimates the disease is fatal for up to one in 10 people, but smallpox vaccines are protective and some antiviral drugs are also being developed.

One of the theories British health officials are exploring is whether the disease is being sexually transmitted. Health officials have asked doctors and nurses to be on alert for potential cases, but said the risk to the general population is low.

Nigeria reports about 3,000 monkeypox cases a year, WHO said. Outbreaks are usually in rural areas, where people have close contact with infected rats and squirrels, Tomori said. He said many cases are likely missed.

Tomori hoped the appearance of monkeypox cases across Europe and other countries would further scientific understanding of the disease.

The WHO’s lead on emergency response, Dr. Ibrahima Soce Fall, acknowledged this week that there were still “so many unknowns in terms of the dynamics of transmission, the clinical features (and) the epidemiology.”

On Friday, Britain’s Health Security Agency reported 11 new monkeypox cases, saying that “a notable proportion” of the most recent infections in the U.K. and Europe have been in young men with no history of travel to Africa who were gay, bisexual or had sex with men.

Authorities in Spain and Portugal also said their cases were in young men who mostly had sex with other men and said those cases were picked up when the men turned up with lesions at sexual health clinics.

Experts have stressed they do not know if the disease is being spread through sex or other close contact related to sex.

Nigeria hasn’t seen sexual transmission, Tomori said, but he noted that viruses that hadn’t initially been known to transmit via sex, like Ebola, were later proven to do so after bigger epidemics showed different patterns of spread.

The same could be true of monkeypox, Tomori said.

In Germany, Health Minister Karl Lauterbach said the government was confident the outbreak could be contained. He said the virus was being sequenced to see if there were any genetic changes that might have made it more infectious.

Rolf Gustafson, an infectious diseases professor, told Swedish broadcaster SVT that it was “very difficult” to imagine the situation might worsen.

“We will certainly find some further cases in Sweden, but I do not think there will be an epidemic in any way,” Gustafson said. “There is nothing to suggest that at present.”

Scientists said that while it’s possible the outbreak’s first patient caught the disease while in Africa, what’s happening now is exceptional.

“We’ve never seen anything like what’s happening in Europe,” said Christian Happi, director of the African Centre of Excellence for Genomics of Infectious Diseases. “We haven’t seen anything to say that the transmission patterns of monkeypox have been changing in Africa. So if something different is happening in Europe, then Europe needs to investigate that.”

Happi also pointed out that the suspension of smallpox vaccination campaigns after the disease was eradicated in 1980 might inadvertently be helping monkeypox spread. Smallpox vaccines also protect against monkeypox, but mass immunization was stopped decades ago.

“Aside from people in west and Central Africa who may have some immunity to monkeypox from past exposure, not having any smallpox vaccination means nobody has any kind of immunity to monkeypox,” Happi said.

Shabir Mahdi, a professor of vaccinology at the University of Witwatersrand in Johannesburg, said a detailed investigation of the outbreak in Europe, including determining who the first patients were, was now critical.

“We need to really understand how this first started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, we really need to understand why.”

___

Geir Moulson in Berlin, Jan M. Olsen in Copenhagen and AP reporters across Europe contributed to this report.

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NYC Health Department investigating possible monkeypox case in NYC after first case in U.S. recorded in Massachusetts

NEW YORK CITY (WABC) — The New York City Department of Health and Mental Hygiene is investigating a possible monkeypox case.

A patient being treated at Bellevue hospital could potentially have a rare illness.

Outside of Africa, cases of monkeypox are relatively rare, but right now, there are about a hundred suspected or confirmed cases in eight countries outside Africa, including the United States.

There are currently six Americans being monitored by the CDC for the illness. They were all on the same flight as a British person who tested positive for monkeypox earlier this month.

The disease is similar to chickenpox and smallpox but less contagious, according to the CDC.

The virus starts out with a fever and a rash, usually on the face, but it spreads. Muscle and backaches follow, along with chills and extreme fatigue.

Most people recover in less than a month, but it can be fatal in up to 6% of the people who contract it.

Some of the recent spate of cases have been among gay men.

There were only two cases of monkeypox recorded in the U.S. last year.

RELATED | 1st monkeypox case in US this year reported in Massachusetts, health officials confirm

ALSO READ | Homemade baby formula could be dangerous: What parents can do amid shortage

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Britain offers smallpox shot as monkeypox cases spread in Europe

LONDON, May 19 (Reuters) – A smattering of monkeypox cases in Britain has prompted authorities to offer a smallpox vaccine to some healthcare workers and others who may have been exposed, as a handful more cases were confirmed in parts of Europe.

Monkeypox is a usually mild viral illness, characterised by symptoms of fever as well as a distinctive bumpy rash.

There are two main strains: the Congo strain, which is more severe – with up to 10% mortality – and the West African strain, which has a fatality rate of about 1%.

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First identified in monkeys, the viral disease typically spreads through close contact and largely occurs in west and central Africa. It has rarely spread elsewhere, so this fresh spate of cases outside the continent has triggered concern.

In the United Kingdom, nine cases of the West African strain have been reported so far. read more

There isn’t a specific vaccine for monkeypox, but a smallpox vaccine does offer some protection, a UK Health Security Agency (UKHSA) spokesperson said.

Data shows that vaccines that were used to eradicate smallpox are up to 85% effective against monkeypox, according to the World Health Organisation.

“Those who have required the vaccine have been offered it,” the UKHSA spokesperson added, without disclosing specifics on how many people have been vaccinated so far.

Some countries have large stockpiles of the smallpox vaccine as part of pandemic preparedness, including the United States.

Copenhagen-based drugmaker Bavarian Nordic (BAVA.CO) on Thursday said it had secured a contract with an undisclosed European country to supply its smallpox vaccine, Imvanex, in response to the monkeypox outbreak.

CASES

The first European case was confirmed on May 7 in an individual who returned to England from Nigeria, where monkeypox is endemic.

Since then, Portugal has logged 14 cases, and Spain has confirmed seven cases. The United States and Sweden have also reported one case each. Italian authorities have confirmed one case, and suspect two more. read more

Several monkeypox outbreaks in Africa have been contained during the COVID pandemic while the world’s attention was elsewhere, Africa’s top public health agency said on Thursday.

“We are however concerned at the multiple countries outside, especially in Europe, that are seeing these outbreaks of monkeypox,” the acting director of the Africa Centres for Disease Control and Prevention, Ahmed Ogwell Ouma, said.

“It would be very useful for knowledge to be shared regarding what the source of these outbreaks actually are,” he said. read more

Meanwhile, in Britain, the UKHSA has highlighted that the recent cases in the country were predominantly among men who self-identified as gay, bisexual or men who have sex with men.

This unusual spike in cases outside of Africa could suggest a novel means of spread or a change in the virus, said Anne Rimoin, an epidemiology professor at UCLA in California. “But this is all to be determined”.

“This isn’t going to cause a nationwide epidemic like COVID did,” cautioned Jimmy Whitworth, professor of international public health at the London School of Hygiene and Tropical Medicine.

“But it’s a serious outbreak of a serious disease – and we should take it seriously.”

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Reporting by Jennifer Rigby and Natalie Grover in London; Twitter @NatalieGrover; additional reporting by Anna Ringstrom in Stockholm and Agnieszka Flak in Milan; Editing by Elaine Hardcastle

Our Standards: The Thomson Reuters Trust Principles.

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