Post AMnmqpyzPy0hUvAYkK by Gemma@polyglot.city
(DIR) More posts by Gemma@polyglot.city
(DIR) Post #AMnmqpyzPy0hUvAYkK by Gemma@polyglot.city
2022-08-22T03:58:31Z
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This thread on human monkeypox virus (hMPXV) is up to date as of August 2022.In it, I'll be covering phylogenomics, clinical observations, modes of transmission, and protective measures.Please boost, and comment if you have questions!
(DIR) Post #AMnmqqYnGqeNHxv9YO by Gemma@polyglot.city
2022-08-22T03:59:53Z
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In June 2022, Nature Medicine published a peer-reviewed paper on a hMPXV genome sequenced in Portugal.DNA viruses are quite different from RNA viruses.RNA viruses like to replicate quickly, and they're bad spell-checkers. They thus mutate more frequently.DNA viruses are slower and more thorough, and thus mutate more slowly.
(DIR) Post #AMnmqr4LNXt4rogLjM by Gemma@polyglot.city
2022-08-22T04:00:24Z
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SARS-CoV-2 is an RNA virus, and MPXV is a DNA virus. I checked the length of MPX's genome – it's about 6 times as long as SARS2.Technically, there is much more room for MPX to make errors and mutate, but I kept in mind that DNA viruses tend to not be very good at that.I was wrong 🙃
(DIR) Post #AMnmqrVHlNREDNHriy by Gemma@polyglot.city
2022-08-22T04:02:13Z
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Isidro et al. found that their sampled variant, in addition to being more closely related to the one in Nigeria, has 50 mutations.This is at least *6-12 times* the number of mutations we'd expect to see in a variant that started infecting people in Nigeria in 2017.
(DIR) Post #AMnmqrwa7tGxa23fGq by Gemma@polyglot.city
2022-08-22T04:08:55Z
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This variant is so divergent that the authors designated a new sublineage: B.1.A month and a half later, the WHO created clade IIb, which contains B.1. That's how different it is.Isidro et al. suggest research into the possibility that this sublineage has arisen due to *takes a deep breath and squints* apolipoprotein B...mRNA-editing...catalytic...polypeptide-like 3 (APOBEC3)...enzymes.
(DIR) Post #AMnmqsMoYMFwtOKc9w by Gemma@polyglot.city
2022-08-22T04:09:41Z
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APOBEC3 enzymes are effectively hackers. They can disrupt the activity of a pathogen in your body by reconfiguring the pathogen's genes in a process called APOBEC3-mediated genome editing.Sometimes this works. Sometimes it doesn't. Sometimes it backfires and makes the pathogen better at replicating and infecting – we've seen this happen with human papillomavirus (HPV).I'm aware of new literature simulating APOBEC3-mediated genome editing in hMPXV...
(DIR) Post #AMnmqsvYTC2sd8aMJE by Gemma@polyglot.city
2022-08-22T04:10:03Z
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...I haven't yet had the chance to examine it myself, but I plan to at some point this year.So you have a bit of background now on what's going on in the field of genetic research.Let's move on to clinical observations.
(DIR) Post #AMnmqtNCoOAC0tWRPM by Gemma@polyglot.city
2022-08-22T04:10:53Z
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Historically, one of the key differences between hMPXV and variola (smallpox) virus is the presence of swollen lymph nodes.According to presenters at the National Collaborative Centre for Infectious Diseases (NCCID), it's slightly more complicated. In Canada, at least, we ARE seeing cases of MPX, confirmed by RT-PCR testing, that do not present with lymphadenopathy.
(DIR) Post #AMnmqtuApoXDf8wlnM by Gemma@polyglot.city
2022-08-22T04:11:41Z
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Symptoms in this outbreak appear to be happening out of order, compared to the outbreaks in Nigeria. Nigerian clinicians have observed an initial phase of fever and fatigue, in most cases, followed by lesions.Here, we seem to be seeing that reversed. A single lesion can appear first, followed by fever and fatigue.My money is on this being a characteristic of the virus's genetic divergence: it's a B.1 thing.
(DIR) Post #AMnmquNF5jmr7IXz6W by Gemma@polyglot.city
2022-08-22T04:14:29Z
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Some may be aware of Belgium's observation of asymptomatic cases. I had been skeptical about the possibility, especially when public health had suggested in May that hMPXV must have been circulating in Europe and North America "undetected".At this point, we don't know what the ratio of symptomatic to asymptomatic cases are, but we have confirmation of the latter. What the actual ratio is remains to be seen.
(DIR) Post #AMnmquiVoeniBGUyG0 by Gemma@polyglot.city
2022-08-22T04:15:05Z
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So we know now that we're dealing with a different animal. hMPXV cases can:- present with only one lesion- present with numerous lesions- present with no lesions- have no symptoms at all
(DIR) Post #AMnmqvE3vM2Pl7GAQy by Gemma@polyglot.city
2022-08-22T04:18:09Z
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The greater concern here, voiced by some experts, is that MPX and smallpox are clinically identical – in fact, the U.S. CDC listed MPX as a differential diagnosis for smallpox years ago. The only way to tell the difference is by PCR testing.Technically, variola could be circulating, and we wouldn't know it until enough people started dying.Not great.
(DIR) Post #AMnmqvfiGY9j8sCFX6 by Gemma@polyglot.city
2022-08-22T04:18:58Z
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The only antiviral treatment we have on hand is tecovirimat, or TPOXX. As I've noted in a past thread, TPOXX has not undergone human clinical trials, only animal trials.This was because of ethics. We didn't have smallpox, and we weren't going to infect human subjects with it to determine the efficacy of TPOXX. As a result, we don't know much about contraindications or side effects.Guess we're finding out now!
(DIR) Post #AMnmqw70d3zSVWy34y by Gemma@polyglot.city
2022-08-22T04:19:23Z
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The last topic I want to address, because it seems to be the most confusing, is transmission.There is a lot of nonsense among experts about the primary mode of transmission. I'm not going to go into that. What I will explain is all possible modes of transmission.
(DIR) Post #AMnmqwVTA7YXjOPaCm by Gemma@polyglot.city
2022-08-22T04:19:51Z
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Scientists across the world have detected:- respiratory loads of the virus- virus present on surfaces (fabrics, toilets, etc.)- transmission via direct contact with lesions- congenital transmission (parent to fetus)
(DIR) Post #AMnmqx0JJSE5H2qDHE by Gemma@polyglot.city
2022-08-22T04:20:26Z
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On that last one: at least one infection during pregnancy has resulted in a stillborn child covered in lesions.I don't have anything educational to say about that.I just want to drive home the point that this is not a disease you want to fuck with.
(DIR) Post #AMnmqxWZNW1wt5vyYi by Gemma@polyglot.city
2022-08-22T04:21:51Z
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So what can we do to protect ourselves and others?For one, we can apply the protections we already use for COVID: physically distance, avoid non-essential trips and gatherings, clean indoor air, monitor for symptoms, get vaccinated, maintain a contact tracing journal, wear a fit-tested respirator.For another, we can take what we know about orthopoxviruses and add a few more steps to our routines...
(DIR) Post #AMnmqxtxyWkI3esf1k by Gemma@polyglot.city
2022-08-22T04:22:35Z
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Obviously, now is a bad time to be getting physical with people. Condoms do not protect you from hMPXV, because MPX is not an STD.Orthopoxviruses are hardy, and can remain viable on surfaces for a long, long time. Antibacterial measures, such as disinfecting items, thorough handwashing, and using nitrile or latex gloves will stack the odds in your favor.A couple of notes on these practices:
(DIR) Post #AMnmqyBgucvKwdAoee by Gemma@polyglot.city
2022-08-22T04:23:31Z
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1. Real soap. Real soap! Sing the entire alphabet in your head and follow the surgeon's guide to handwashing. A layer of hand sanitizer immediately after drying your hands forms a protective barrier. :blobcatheart:2. Watch or read a tutorial on how to doff gloves. Don't go stripping them willy-nilly unless you want to wash your hands again :blobCatGogglyEyes:3. I like wipes for door handles, mail, and mail keys, but you can use a spray if you prefer.
(DIR) Post #AMnmqyZ5Vddg7C7V7g by Gemma@polyglot.city
2022-08-22T04:23:58Z
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That's all for now! Drop any questions or comments here, and I'll come back to it in a month or two if there are any relevant updates.Don't forget to lie to get your vaccine! :blobcatcoffee:
(DIR) Post #AMnmqyq6UNFYxy55e4 by markusl@fosstodon.org
2022-08-22T23:54:53Z
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@Gemma Thanks for an interesting and informative thread.