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Monkeypox: an expert explains what gay and bisexual men need to know

How it spreads and how to protect yourself.

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Monkeypox is from the same virus family as smallpox. Kateryna Kon/ Shutterstock

Since early May, more than 23,000 cases of monkeypox have been reported worldwide. This is the largest ever global outbreak of the disease.

Cases have now been reported in 78 countries including the UK, Spain, Germany, France, the US and Brazil. Given the scale of the outbreak, the World Health Organization (WHO) has now declared the current monkeypox epidemic a global health emergency.

While anyone can get monkeypox, the current outbreak is overwhelmingly affecting sexually active gay, bisexual and other men who have sex with men. In fact, our recent study which looked at 528 monkeypox infections since the start of the outbreak found that 98% of these infections had occurred in this group. Here’s what these men need to know.

How it spreads

Monkeypox is a disease caused by infection with the human monkeypox virus, which comes from the same virus family as smallpox. In fact, symptoms are quite similar to smallpox and include fever, headache, muscle aches, chills, cold symptoms (such as a cough or sore throat).

Symptoms are also accompanied by a rash that appears in blisters on the face, genitals, the chest and back, and on the hands and feet. Some people also experience very painful sores in the mouth or inside the bottom. For most people, the disease usually resolves within two to three weeks.

Monkeypox spreads through close physical contact with an infected person. Typically this means skin-to-skin contact, especially contact with the rashes and skin lesions caused by the disease. But it can also be spread through large respiratory droplets (such as coughing and sneezing).

It can also spread through contact with bed sheets, towels or other fabrics that have come in contact with the infected person’s sores. We know that the virus can persist on surfaces for a long time – sometimes up to several weeks.

According to our study, 95% of monkeypox infections so far were spread as a result of sexual contact. Around 95% of the people in our study had a rash, mostly occurring on the genitals. Approximately 41% had sores inside the body (including in the anus or mouth).

Our research also revealed that the monkeypox virus was found in more than 90% of the semen samples we tested. However, we don’t yet know whether the virus is infectious in semen.

All this may explain why the virus is primarily spreading through networks of men who have sex with men.

A young man receives a vaccine from a healthcare worker. The worker is wearing white surgical gloves to administer the needle.
Many countries are now offering this at-risk groups vaccines to protect them. Africa Studio/ Shutterstock

It’s worth stressing the virus can spread through any contact with lesions or large respiratory droplets from an infected person. This means that it can spread in households through any close personal contact with an infected person – not just as a result of sexual intimacy. However, during the current outbreak, our study suggests that this kind of non-sexual transmission has so far occurred very rarely, in less than 1% of cases.

Providing protection

Many countries are offering vaccinations to sexually active gay and bisexual men who are at greatest risk of contracting the disease. Used prior to exposure, research suggests the vaccine can provide around 85% protection from infection. If given between four and 14 days after exposure to monkeypox, the vaccine may potentially reduce symptoms of the disease.

The WHO has also recommended that at-risk groups limit how many sexual partners they have and take steps to protect themselves from contact. However, recommending abstinence really doesn’t go far enough, especially given we already have a vaccine which can prevent monkeypox. This is why getting vaccinated (and making sure that everyone has equal access to these vaccines) is of such great importance.

Given that the epidemic at this time is affecting almost exclusively men who have sex with men, directing accurate and relevant public health messages and working together with the community to develop acceptable interventions is what’s needed to help prevent harm and further spread.

One of the difficulties is that gay and bisexual men represent a marginalised community that has already faced stigmatisation and discrimination, particularly during the HIV/Aids pandemic. Nobody wants to repeat that.

But public health messages are most effective when targeted at people who are most at risk of a particular condition. Some even argue that messaging hasn’t been targeted enough during this outbreak.

Although public health agencies such as the WHO, CDC, ECDC and UKHSA have already done a lot to provide clear, non-stigmatising guidance to at-risk groups, it may be important ensure this information is now disseminated in places where they will have the greatest impact – such as on dating apps, for example.

There’s a small window to contain the spread of monkeypox – and it may have already closed. There are already reports of infections in both women and children. But the fact that the disease still seems to primarily be occurring in one group means that, with the right interventions, the course of the outbreak could still be changed and that group protected.

The most important thing now is ensuring all countries have equal access to vaccines and treatment to protect against the further spread of infections. The declaration of a worldwide pandemic by the WHO will hopefully serve to co-ordinate the global response and open up the possibility of mass production of several vaccines with access for all. The question is whether it will be fast enough.

Chloe Orkin receives funding from Gilead Sciences, Viiv Healthcare, Astra Zeneca, Merck Sharpe and Dohme and Janssen for advisory boards, lectureships, travel scholarships and I have also received research grants from the same companies to my institution.

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Spread & Containment

Monkeypox: demand for vaccines is outstripping supply – this is what’s causing the shortages

Chronic weaknesses in our global vaccine manufacturing and distribution systems may broadly be to blame.

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The smallpox vaccine is currently being used to protect against monkeypox. PhotobyTawat/ Shutterstock

Over 30,000 cases of monkeypox have been reported in more than 80 countries worldwide in 2022. Most are in countries that have never previously reported monkeypox. While monkeypox is not as transmissible as many respiratory infections (such as COVID-19), it’s still important to curb the spread.

One way to control spread is by vaccinating vulnerable people. Fortunately, we already have vaccines which are very effective at preventing monkeypox. But as case numbers continue to rise, reports are emerging that demand for vaccines is outstripping supply in many parts of the world currently seeing an outbreak, including the US, UK and Europe.

Vaccine supply

There are a number of reasons why we are seeing shortages of the vaccine used to protect against monkeypox. Broadly, it’s due to chronic weaknesses in our global vaccine manufacturing and distribution systems, which make it especially difficult to supply the vaccines needed to protect against new infections and outbreaks.

The vaccine currently being used to protect against monkeypox is the smallpox vaccine, which works because the monkeypox virus is so closely related to smallpox.

Until now, the smallpox vaccine has been a niche product because it’s not been needed since smallpox was eradicated in 1980. Pharmaceutical companies can’t afford to manufacture vast numbers of doses just in case, and few governments can justify buying a vaccine that isn’t used. This means the vaccines currently being administered are from emergency stockpiles that were created to respond to an accidental (or deliberate) release of smallpox.


Read more: Monkeypox Q&A: how do you catch it and what are the risks? An expert explains


As such, there are limited stocks and production capacity globally, so demand is rapidly outstripping supply. Even the US, with one of the largest smallpox vaccine stockpiles, recently ordered 2.5 million additional doses in response to the monkeypox outbreak. But there are reports that the factory in Denmark which makes the world’s only smallpox vaccine approved for monkeypox is temporarily closed, which may further impact the world’s ability to source more vaccine doses. And unfortunately, transferring production to other facilities is not straightforward.

One particular problem for vaccine manufacturers is that it’s hard to predict when or where big outbreaks of infections may happen. Of course, there are some infections that we know consistently require a regular supply of vaccines – such as the influenza virus. But while 1 billion influenza vaccines are produced globally each year, it still takes approximately six months from picking the most important new strains to manufacturing and rolling out jabs.

So even with vaccines in high demand, it isn’t simple to manufacture more doses. This is why we are still striving to innovate ways to rapidly produce new vaccines affordably and at a very large scale.

Vaccines are inherently complicated to make. Because they are made from relatively fragile and complex biological materials (such as a virus), the product has to be exactly right every time. If the formula changes even slightly, it might not work as well – or even increase the risk of side-effects.

Adding to this challenge is the fact that different vaccine products may be manufactured by different methods. For example, the equipment needed to produce a viral vaccine (such as the smallpox vaccine used against monkeypox) will be very different to that used to make COVID-19 RNA vaccines. It’s also slow and expensive to test any necessary modifications or improvements that may be needed to make a vaccine safer and more effective.

Glass vials arranged in a row move through a conveyer belt, where they are filled with the vaccine.
It isn’t just as easy as making more vaccines to meet demand. wacomka/ Shutterstock

Surprisingly, even some simple processes common to all vaccines and other medicines – such as filling doses into vials for distribution to patients – still have a mismatch of capacity. Vaccines are usually manufactured in different locations to packaging facilities, raising logistical hurdles (such as strictly controlled refrigeration requirements) that can further delay distribution. These facilities are used for many different medicines and are usually fully booked years in advance; schedules that are still recovering from COVID-19 disruptions may now be experiencing urgent changes to package the smallpox vaccine from stockpiles.

It also isn’t just a case of developing new monkeypox vaccines that are easier to manufacture. Even with major recent scientific progress, it would take many months to develop a safe and effective new vaccine. For monkeypox, it’s far quicker and simpler to use the existing smallpox vaccine.

What can be done?

Smallpox vaccine production is likely to be increased to meet demand. But until this happens, many countries will have to make best use of what supplies they can access, and rely on other strategies to help curb the virus’s spread.

The most effective way to prevent monkeypox causing further harm is by using an integrated, locally led public health response – vaccines are just one part of this. Testing and contact tracing is vital. If enough infected people in a region can be identified and supported to isolate while they’re infectious, transmission can be blocked.

Given the vaccine shortages, we expect that people don’t need two vaccine doses to be protected against monkeypox. This is why vaccinating the most at-risk groups with one dose now, paired with other public health measures, is the most effective strategy for curbing the spread of monkeypox – especially while vaccine supplies are limited. Second doses can be administered to maximise immunity when supplies do become available.

The current monkeypox outbreak is yet another reminder of the importance of investing in global health, and ensuring there’s more equal access to vaccines and other medical interventions that can help prevent the spread of harmful diseases.

Alexander Edwards does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Ivana Trump’s Money Lessons for Older Americans.

Ivana Trump, the first wife of Donald Trump, was recently found dead in her Manhattan residence. She was 73.

Known throughout her life as a dynamo socialite…

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Ivana Trump, the first wife of Donald Trump, was recently found dead in her Manhattan residence. She was 73.

Known throughout her life as a dynamo socialite and dealmaker in heels, her death from a blunt trauma from a fall down the stairs in her multi-story townhome, was a shock to residents who perceived her as vibrant and full of life. So, her passing got me thinking about Ivana Trump’s money lessons for older Americans.

Listen, it’s tough to age, but don’t let the process get you down. It’s too hard to get back up! Get it?

Seriously, a great challenge is an acceptance of growing older. Aging can be a tough pill to swallow. Especially for those who are known for the travails of their younger days. I have friends who explain as they age, they ‘disappear.’ I hate to hear this.

Personally, I’m living my best self and wouldn’t change a thing. However, Ageism is a real societal challenge. Based on numerous surveys, white papers, and reports from health organizations, those who are 60 and older are subject to negative stereotyping and discrimination in the workplace. Also, to younger generations, they do disappear in a manner of speaking.

But I have news for you. I think that’s about to change for you ‘seasoned’ folks.

During the pandemic, the Labor Force Participation Rate collapsed and has yet to recover. For those who need a reminder, the LFPR represents the people age 16 and older employed or seeking employment. Older Americans decided to accelerate retirement. Younger cohorts decided to go out on their own or sit back – satiated by government stimulus.

I think many older Americans will seek to unravel their retirement decision and return to the workforce. Also, I believe they’ll be welcomed with open arms by employers eager for a generation that is timely, responsible, and willing to work!

Let’s kick Ageism where it hurts. Right in the work ethic!

One money lesson I’ve learned from Ivana Trump about older Americans is that the entire world is wrinkling.

According to Peter Zeihan in his latest book – The End of The World is just the Beginning, population, and spending shrinkages are realities the entire globe must embrace. Demographics outline that mass-consumption-driven economies have already peaked.

By 2030, the world will be populated with twice as many retirees. Therefore, we all better internalize the fact that we’re getting older and financially and emotionally prepare accordingly. Long-term, poor demographics are deflationary.

In my opinion, Ivana Trump refused to accept aging. Thus, I consider Ivana Trump’s money lessons for older Americans applicable to all of us. 

Regardless of her immense wealth, she must have encountered anguish when it comes to getting older. Sure having money doesn’t hurt. Suffering in luxury isn’t bad. However, aging doesn’t care about a net worth statement.

Denial of aging is real and one of Ivana Trump’s best money lessons for older Americans.

Who needs comprehensive studies to understand that denial of getting older is a reality? I see it in myself as I dramatically changed my diet and amped up my physical workouts years ago to fight or slow the inevitable.

Frankly, my graying hairline stresses me out. 

I engage with people regularly who aren’t ready to deal with how someday they may move slower, forget things often and work through periodic illness or injury. Older clients and their adult children have a tough time facing that mom and dad are grayer, smaller, and frailer than they used to be.

Per a July 2022 analysis from the Center for Retirement Research, older Americans and retirees poorly assess the risks they face in retirement. Health and longevity risks (the risk of living longer than expected and exhausting financial resources) are underestimated.

Per the study: Perceived longevity risk and health risk rank lower because retirees are pessimistic about their survival probabilities and often underestimate their health costs in late life.

I cannot tell you how many clients inform me how sure they are about dying early. How do they know? So, I always ask the following question –

“What if you don’t?”

Ivana Trump’s friends were concerned about her home’s beautiful but dangerous staircase. They were worried about her falling. She had an elevator and rarely used it. The stairs at her home were steep, the carpet was worn. Although she had trouble walking, she regularly took the stairs. She had the money to remove or replace the carpet; the elevator would have been perfect, but she rarely used it.

Why?

In her halcyon days, Ivana was New York royalty. Young, vibrant. She could accomplish anything. How can someone like that stare into the mirror and face vincibility? How can you? Can I? Acceptance is the first step to a rich life as we age, to feel comfortable in different but richer skins.

That acceptance opens the door to preparation – eating right, exercising regularly, and preparing for the risks of aging through comprehensive planning and open communication with family and friends.

If I deny aging, then I’ll force everyone around me to deny it too. Or, at the least, family members and friends will discuss issues concerning me behind my back. Who wants that? Older Americans must be open to listening.

This leads to my next financial lesson for older Americans from Ivana Trump.

Communication. Another one of the money lessons Ivana Trump has for older Americans.

I wonder how many times Ivana was advised (perhaps delicately) by Ivanka and the other kids to update her place for aging, move to a one-story, or take the damn elevator. Whatever it is, would Ivana listen or just carry on like it was the 1980s? In her mind, it may have been decades ago, but her aging body lived in the here and now.

There’s a nuance and empathy to communicating with older loved ones.

Remember, they were young like you once. Listen to your special older Americans. Never be condescending. A good idea may be to bring in an objective third party such as your financial advisor to assist with the discussions. I’ve witnessed adult children infantilize their parents, and that never works. Imagine approaching Ivana with that tone! Not good!

Remember, even mild cognitive impairment can drive a communication wedge between you, and your aging loved one. However, don’t give up sparking conversation. I work with clients who consistently need to nuance their speech with their parents. They get their points across eventually. Impaired older relatives eventually take action, but the process is like chipping away at an iceberg with a butter knife.

Don’t give up!

Genworth, a leader in long-term care insurance and research, maintains an impactful Conversation Starters page with helpful tips about what to talk about and how to maintain a dialogue. Check it out.

Use your financial plan to motivate others.

How can you discuss long-term care issues with loved ones if you’re personally in denial about aging? A risk mitigation plan as part of a comprehensive financial strategy validates your commitment to preparation. Actions forge your conversations with credibility.

According to AARP’s most recent Home and Community Preference Survey, 77% of adults 50 and older want to remain in their homes or age in place. The number has been consistent for over a decade. Aging in place requires planning – whether it’s to eventually downsize to a one-story home, renovate kitchen and baths or install easy access ramps for items of mobility such as wheelchairs. It would be worth practicing financial openness and sharing this information with aging parents. In other words, if you’re preparing for these expenses, they should be too.

Don’t forget long-term care insurance as one of Ivana Trump’s money lessons for older Americans.

Ivana didn’t need long-term care insurance. You probably need to consider it.

Unfortunately, nearly half of individuals who apply for traditional long-term care insurance after age 70 have their applications declined by an insurer, according to Jesse Slome, director of the American Association for Long-Term Care Insurance. However, loved ones in good health in their 50s and 60s can still consider long-term care insurance. The sweet spot for looking into long-term care coverage is generally between ages 55 and 65, per Jesse Slome.

Three out of every five financial plans I create reflect deficiencies in meeting long-term care expenses. Medical insurance like Medicare does not cover long-term care expenses – a common misperception. Nearly 60% of people surveyed in various studies falsely believe that Medicare covers long-term care expenses.

The Genworth Cost of Care Survey has been tracking long-term care costs across 440 regions across the United States since 2004.

Genworth’s results assume an annual 3% inflation rate. In today’s dollars, a home-health aide who assists with cleaning, cooking, and other responsibilities for those who seek to age in place or require temporary assistance with daily living activities can cost over $54,912 a year in the Houston area. We use a 4.25-4.5% inflation rate for financial planning purposes to reflect recent median annual costs for assisted living and nursing home care. Candidly, I fear that I’ll need to increase this inflation rate in 2023.

As I examine long-term care policies issued recently vs. those 10 years or later, it’s glaringly obvious that coverage isn’t as comprehensive, and costs are more prohibitive.

One option is to consider a reverse mortgage, specifically a home equity conversion mortgage. The horror stories about these products are overblown. The most astute planners and academics understand how incorporating the equity from a primary residence in a retirement income strategy can help with the burden of long-term care costs. Those who talk down these products are speaking out of lack of knowledge and falling easily for pervasive false narratives.

Reverse mortgages have several layers of costs (nothing like they were in the past), and it pays for consumers to shop around for the best deals. Also, to qualify for a reverse mortgage, the homeowner must be 62, the home must be a primary residence, and the debt limited to mortgage debt. There are several ways to receive payouts.

One of the smartest strategies is to establish a reverse mortgage line of credit at age 62, leave it untapped, and allow it to grow along with the home’s value. 

The line may be tapped for long-term care expenses if needed or to mitigate the sequence of poor return risk in portfolios. Simply, in years where portfolios are down, the reverse mortgage line is used for income while portfolios recover. Once assets recover, rebalancing proceeds or gains may be used to repay the reverse mortgage loan, restoring the line of credit.

RIA’s approach to helping older Americans age comfortably in place.

Our planning software allows our team to consider a reverse mortgage in the analysis. Those plans have a high probability of success. We explain that income is as necessary as water regarding retirement. For many retirees, converting the glacier of a home into the water of income using a reverse mortgage will be required for retirement survival and especially long-term care expenses.

Ivana Trump’s money lessons for older Americans are lessons for us all, regardless of age.

Planning to age gracefully and healthfully will lead to a prosperous retirement attitude.

As George Burns said: You can’t help getting older, but you don’t have to get old.

The longer I live, the more I realize how true that quote is.

The post Ivana Trump’s Money Lessons for Older Americans. appeared first on RIA.

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COVID-19 genomic recombination is uncommon but disproportionately occurs in spike protein region

An analysis of millions of SARS-CoV-2 genomes finds that recombination of the virus is uncommon, but when it occurs, it is most often in the spike protein…

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An analysis of millions of SARS-CoV-2 genomes finds that recombination of the virus is uncommon, but when it occurs, it is most often in the spike protein region, the area which allows the virus to attach to and infect host cells. 

Credit: Centers for Disease Control and Protection

An analysis of millions of SARS-CoV-2 genomes finds that recombination of the virus is uncommon, but when it occurs, it is most often in the spike protein region, the area which allows the virus to attach to and infect host cells. 

The study, led by scientists at UC Santa Cruz, was published August 11 in the journal Nature. It details a new software created by the researchers to search the COVID-19 phylogenetic tree, a diagram of the virus’s evolutionary history, for instances of recombination. This software is open source, allowing public health officials to use it to track instances of recombination within their communities. 

Recombination occurs when two genetically distinct forms of the virus hybridize. This study focused on detectable recombination, when the hybridization results in a sequence that is genetically new, and not on instances where two sequences combine to form a sequence identical to an already existing one. 

“It’s really important for reconstructing the virus’s evolutionary history,” said Russell Corbett-Detig, senior author on the study and an associate professor of biomolecular engineering at the Baskin School of Engineering. “When there’s recombination it’s not one tree, it’s many trees, and being able to trace that accurately is really crucial for understanding evolution of the virus.”

Findings on recombination  

The researchers analyzed 1.6 million samples of COVID-19 and found 589 recombination events, which indicates that only about 2.7% of sequenced genomes result from recombination. These sequences were sourced from the UC Santa Cruz SARS-CoV-2 Browser, a repository for COVID-19 genomic data, which is now the largest collection of genomic sequences of a single species ever assembled, currently at nearly 12 million sequences.

While results show that recombination occurs more frequently in the spike protein region, it is not yet known why this is. This could potentially be the result of a mechanistic bias, indicating it is the natural tendency of all coronaviruses to recombine toward the three-prime region of the viral genome, which contains the spike protein, or that positive natural selection for COVID-19 is favoring recombinants that occur in this region.

While recombination does occur, there is no evidence that the resulting strains are more likely to be epidemiologically important. In fact, most recombinant variants die out, as do most of the thousands of mutated variants of COVID-19.

 A new software, written primarily by UC San Diego Assistant Professor Yatish Turakhia during his postdoctoral training in Corbett-Detig’s lab, enabled the computational feat required for the analysis of millions of genomes. The software, called Recombination Inference using Phylogenetic PLacEmentS (RIPPLES), can efficiently search a massive phylogenetic tree of COVID-19 genomes to find instances where a new sequence appears to be a combination of two distinct sections of the tree. The COVID-19 phylogenetic tree, called UShER, was created by UCSC researchers and is the primary tool used by health officials worldwide to track the spread of variants in their community.

The researchers found recombination most often shows up on the COVID-19 phylogenetic tree in the form of “long branches,” making it appear that several mutations happened sequentially, which is quite rare. 

“In a tree of millions of sequences, you find these long branches, which reduce the possible instances of detectable recombination down to only about 10’s of thousands of branches,” Turakhia said. “These long branches make recombination much easier to spot on the tree, which enables the efficient performance of the new software.” 

Turakhia and his team aim to continue to improve RIPPLES’ speed and performance and to create visual tools to make it more accessible for a wider audience. 

Use for public health

Knowing when recombination occurs is crucial for understanding the evolutionary lineage of a sequence of the virus. Recombination can complicate the process of tracing back the phylogenetic tree of a particular sequence because its genetic material is a result of two joining areas of the overall COVID-19 family tree. 

This can help public officials understand when a lineage of COVID-19 which appears to be novel is truly an independent mutation introduced for the first time, or rather just a combination of two lineages that already existed in the community. Understanding when recombination occurs is also important from a public health perspective as it can potentially make the virus more adept at evading immunity.

Furthermore, the RIPPLES software’s availability and ease of use has positive implications for genomics experts and public health officials alike, who can efficiently search a set of COVID-19 genomic samples for recombination in just minutes.

This reflects a larger theme of the work of scalable translation of pathogen genomics data at Corbett-Detig’s lab and the UCSC Genomics Institute. Researchers are focused on creating tools that enable public health officials to automate and translate the questions they want to ask, and receive answers that are easy to act on and dependable. 

“A big part of the success of our work has been that the software is extremely accessible and computationally cheap in the grand scheme of things,” Corbett-Detig said. “Anybody could take their hundred new SARS-CoV-2 genome sequences and figure out if there were potentially recombinant samples in just minutes on a basic laptop. Global public health needs to be democratized, to the point that anyone can do it, even if they’re not a super wealthy lab with giant servers.”


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