Episode 50! Monkeypox, how worried should we be? with Infectious disease doctor, Phil Zakowski MD

Today marks the 50th episode of Ask Dr Jessica! The podcast is joined by infectious disease expert, Dr Phil Zakowski to discuss Monkeypox.  In this episode, Dr Zakowski explains what Monkeypox is, how it is spread and how we can prevent infection.  He explains what contact tracing is, how the vaccine can help, and what antiviral treatments can be offered at this time. Dr Zakowski has over 45 years of experience in the field of infectious disease.  He has won numerous teaching awards and he is an Associate Professor of infectious disease of UCLA.  

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children.  Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. 

Do you have a future topic you'd like Dr Jessica Hochman to discuss?  Email your suggestion to: askdrjessicamd@gmail.com. 

Dr Jessica Hochman is also on social media:
Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com

The information presented in Ask Dr Jessica is for general educational purposes only.  She does not diagnose medical conditions or formulate treatment plans for specific individuals.  If you have a concern about your child's health, be sure to call your child's health care provider.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hello, everybody welcome to ask Dr. Jessica the podcast where my goal is to provide quality medical information with the hopes to help you worry less. I'm your host, Dr. Jessica Hochman. Today you will hear a conversation about monkey pox, the illness that has recently been declared a public health emergency. So today, August 8 2022, I was lucky enough to have a conversation with an incredible infectious disease Dr. Phil's a kowski. Doctors account, he has won numerous teaching awards, and he is an associate professor of infectious disease at UCLA. I feel incredibly grateful to have him on the podcast today. Thank you so much for joining today. I'm really excited to talk to my pleasure. So I wanted to talk to you about monkey pox, you're an infectious disease expert. You've seen a lot of different illnesses over the years. Can you explain what is Monkey pox? Exactly? What is all the fuss about? Is it something that we should be worrying about? What is Monkey pox? So monkey pox is actually a misnomer. It was called Monkey pox. Because in 1958, there was a group of research monkeys that developed this, and they named it monkey pox. But it's actually comes from rodents that the monkeys were exposed to. It's been around for a while it's around in both West Africa and the Congo part of Africa. And it's been infecting patients and people for decades. The difference being now is that has spread outside of Africa. And then many more cases, we don't know whether it's behaving differently, or just the rate of spread is higher. Interesting. So, so it's existed for many years. And has it been an issue in Africa? Yes, and it has been an issue in Africa. And, as is often the case, diseases in Africa tend to get a little less media play than diseases in Europe and North America. In fact, there was an outbreak in 2003 in the United States, driven by imported rodents that were in prairie dogs, but they were rapidly able to put an end to that small 2003 outbreak here. And there were only a few people who were infected. Interesting. So it just naturally ended or was there a vaccine that held How do we know that they didn't use a vaccine at the time they did what public health is really good at which is contact tracing, decide who was exposed isolation, to make sure it didn't spread to other people and then quarantine of the animals that were infected. Okay, and what does monkey pox look like exactly what should people be aware of in terms of symptoms. So as far as symptoms, the typical scenario is for a couple of days, you can have like a flu like syndrome of fevers and aches and sore throats and swollen glands. But it's either rapidly followed by skin lesions, or the skin lesions start at the time of the other symptoms. And it can be small pimples and then bigger blisters throughout the body. And one of the unique things about it is it can be quite painful. So you can see it in the hands or the feet or any part of the body, particularly in the genital area, if it was acquired via skin to skin contact that way. Okay, so it sounds like the most upsetting symptom for patients is the pain. The most upsetting symptom is the pain because that certainly gets the most attention from the patient, but also the lesions, which can be numerous and aesthetically problematic. Also, a bother for people because they don't want to be disfigured. Sure, that makes sense. And do the lesions heal nicely as far as you know, or can they leave scars? Well, they heal over time, and you're infectious as long as you have the blisters and ultimately they do heal but as with any pox virus, it can leave scars. In fact, monkey pox is in the Ortho pox virus family, which is same as smallpox, which fortunately, is the first infection eradicated from the face of the earth. And that is known to leave scars to Interesting, okay. And because of this relationship to smallpox, we can use the vaccine for smallpox Correct? Correct. And in fact, the vaccine was originally devised for smallpox. When smallpox was eradicated from the planet about 1975. It exists now and only two labs and the CDC in Atlanta and in lab in Moscow. The United States government decided to protect itself against potential future bioterrorism and devoted a significant amount of funds to developing a smallpox vaccine, which is the one that's currently been used and warehoused and currently available for monkey pox. So it's actually a smallpox vaccine that also was protective against monkey pox. That's so wonderful. I mean, I know that, from what I hear there. At this time, not everybody is able to access the vaccine that wants it. And we can talk more about this. But as far as you know, the vaccine does appear to be effective against monkey pox. Do we know if it's effective, the vaccine appears to be quite safe and effective. The data as to how protective it is, is more an extrapolation of its impact in smallpox, because nobody has actually studied it in monkeypox, right, but it appears to be very good. It's two doses separated by about four weeks. And the problem right now is supply and quantity. Because when the government funded the development and manufacture of monkeypox by a Danish company, they weren't prepared for a sudden surge. So right now they're ramping up production. So anybody can qualify for if they're felt to be at high risk. And currently, the epidemic, if you will, is spreading mainly in the gay community because that's where it appears have entered the United States, but it's just a virus that really doesn't care what your sexuality is. Okay, so as far as you know, how was the virus passed. So parents have primary mode of transmission is skin to skin contact. So it does not require any sexual act or any sense that you have to have sex to get it, or you're only at risk by having sex. So if I had a lesion on my hand, and you and I sat next to one another, and I rubbed my hand on your hand, the virus in the blister could be transmitted to you. Okay, skin to skin contact, it can also be if a towel is contaminated with the virus blister, and I use a towel, and then my wife uses a towel, it could be transmitted that way. It's also probably also by droplet, which are big drops, as opposed to aerosol, which is the way COVID spreads. As far as we know, today, aerosol transmission, which is a much more infectious way of transmitting the virus does not appear to be happening. So in your view, How worried should parents be I mean, a lot of parents that are listening, they're concerned that their kids could be potentially exposed to monkey pox, I think when they hear about, you know, touching someone else's towel, or if they're sitting next is somebody a daycare? And I wonder, how much should parents really be concerned? And how much do you think the media might be driving concern? Because for example, today, I did see a headline that said, you know, daycare exposure occurred. And I just, I wonder how much parents should be thinking about this. So I saw that same headline too. And the media is wonderful, but tends to be attracted to cases that are exciting. Right now in the United States. There's about 7500 cases of monkeypox, okay, and it's primarily limited as we speak now, to men who have sex with men and then mid 90 to high 90%. It will almost certainly spread into the heterosexual community. And really everybody is in fact, at risk. Because I said earlier, it really has nothing to do with one sexuality, it just has to do with skin to skin contact. In fact, if we look back at the beginning of HIV, we initially thought it was mainly a gay disease and turned out really not to be. And this will almost certainly is not a gay disease and an Africa, where it came from. It's not associated with homosexuality. As far as right now, what is the risk to the daycare children or the like? It's virtually zero. It requires scenario where when the daycare staff had the lesion didn't know they had the lesions were touching and hugging the kids and transmitting it that way. Right now, there's virtually no danger. It should be on everybody's radar because the world does not need another virus spreading rapidly across the planet. We've seen enough of that recently with COVID. And hopefully, with this virus, we can act cohesively and scientifically and put an end to it by contact tracing, making sure people who have and are infectious, isolate don't transmitted, vaccinate people who are at risk or have been exposed and shut this thing down before it becomes a rescue numerically to To a large percentage of the population. Absolutely, I wholeheartedly agree with everything you just said. So, can you explain also what what contact tracing means exactly. So people that are listening if they are at risk, or they think they might have monkey pox, what they should be doing. So contact trees tracing means that the public health department if they know I have monkeypox, they will call me up and say, Who have I been in touch with who lives with me who could have been exposed to the virus in the blisters on my body, either within the household or outside of the household are sexually or non sexually, they can then track that person down and isolate them to make sure that they don't get the infection and or educate them as to what signs and symptoms to look for. And that way you can prevent transmission in a broader circle. This was tried in the beginning of the COVID pandemic, but obviously, the spread was much faster and it was playing catch up. And by the time resources were allocated, it was too late. Hopefully now public health resources will be allocated to put an end to it. In fact, that is what's behind declaring a national emergency by both the World Health Organisation and the United States government. It's to allow greater resources to be spent devoted to tracking, supplying vaccine, getting testing done, and trying to corral this in to a manageable number and then hopefully extinguish it. And you mentioned that the vaccine is safe. Can you can you touch upon that just for everybody listening? I have a lot of people that reach out to me concerned about new vaccines are vaccines are not familiar with and ingredients in vaccines? Can you just reassure or explain what you know about the vaccine safety? Well, the vaccine, it's called Jenny O's. And it's manufactured in Denmark, and it's a live virus, but it's non replicating, which means it can't reproduce itself. There are side effects, and occasionally there can be adverse side effects of any vaccine. But as with all vaccines, we have to weigh the risk of the vaccine against the benefit. And if I were at great risk to get monkey pox, and I've seen several cases already, I would jump at a chance to take the vaccine and not worry about the risk of the vaccine. It's not a new product. It's not mRNA derived, it's more of an older technology that's been tried and true. And I think people's concerns about vaccines right now, we're a bit heightened by the concern about MRA, being mRNA being a new technology and by copious amounts of misinformation about the safety of all vaccines. Yes. And I agree with that. And I, which is unfortunate. But I also I think what's nice about the smallpox vaccine is that it's been around a really long time, as you mentioned. Yes, in fact, I'm old enough to have received the smallpox vaccine when I was a child. And one question I was just asked yesterday, like colleague is if I got the smallpox vaccine as he did, is he protected from monkey pox? And the answer is no, because the vaccine has long since left the body, as far as protectiveness of people who have had smallpox vaccine, if they're at risk should also get the new monkey pox slash smallpox vaccine. Okay, that's actually really helpful information, because that wasn't, I wasn't aware of that. I thought maybe that if you had had the smallpox vaccine, that you would still be protected. So that's good. That's good to know. Okay, so it sounds like there's a lot of you know, wild things are spreading. And while there's a lot of media attention on this, understandably so it does sound like there's some good news that that we've got resources being devoted now that they're trying to ramp up vaccine production that we have a vaccine that works. So hopefully, as you said, we'll be able to squash this before it becomes really a big issue. I think you're absolutely right. There is good news. I mean, the last thing the world's in the knees is another virus spreading around but we know what it looks like we know how are the acts and in fact we were deficient in knowledge in the beginning of the COVID pandemic as far as how transmissible how infectious it was, we do understand this virus, so we're better apt to put shut it down and to isolate people and to do contact tracing. There is a vaccine that can be used to prevent people from getting into or at high risk and or somebody who was exposed. And lastly, there is an anti virus drug called takeover mad or T pox, which right now is not fully FDA approved, but you can obtain it through the local health department and the CDC. And I just used it on a patient last Friday. And he was dramatically better within 36 to 48 hours, hopefully soon, it'll be released more widely. But you know, the good news is we know how this disease behaves, we know how its spread. We know what its manifestations are, we know how to track people down, make sure it's not spread elsewhere, there's a good vaccine, and what appears to be a very good anti virus medication, which once again, was developed for smallpox, not from monkey pox, but they're closely enough related that it appears to be useful for both. That's great news, actually. And question about the vaccine, you might not know the answer, but how much efficacy happens after one shot? Do you get some significant protection from one? Or do you really need both? To be really the best protection is two weeks after the second shot? Okay. After one shot, I couldn't tell you what the protection is. And in fact, what the government is now looking at is splitting the dose into smaller doses so they can give what they presently have to a greater number of people for greater good brother trying to decide is that still going to be protective enough? Okay, so it sounds like from the time you get your first dose, it takes six weeks to be fully protected? Correct. Okay. And then the medication question about the medication. Is there a timeline when it's best to be taken? You know, I know a lot of antivirals. They work best when you take it early in the illness. You're correct. Most medications, antibiotics or anti virus medications work best, sooner after exposure. But for example, the patient I treated last Friday had already had that lesions for a week, but they were growing in number. And so we've got the medication for him. The thing that's unknown is who should automatically get the anti virus medication? Because if somebody has a mild case, there's no need for it. And in fact, most people do get over it on their own. It's only if it continues to progress and worsen. Does it make sense to try and obtain the drug? Okay. And, as far as you know, for people that are listening that want to get the vaccine right now, it's distributed through the LA County Department of Public Health, and they have a website. And it's to look at that website. In fact, my partner looked at that website this morning, and was told as of right now, they have more applicants and they have vaccine, so they can't be dispensing it, but that should be corrected soon. Okay, that's good to hear. I know, there are a lot of people that I've heard of that want to get the vaccine that haven't been, you know, haven't qualified. So that's good to hear. Now, a question for you. A lot of people are talking about the debate about whether it's an STI or not a sexually transmitted infection or not. Why why is this such a hot topic? Why? Why is this a question that's coming up in your in your view? Is it an STI? Is it not an STI? Does it matter? So that's an excellent question STI would be a sexually transmitted infection or the Riester called sexually transmitted disease STD. That's sort of the New Age theme for it. It's really not a sexually transmitted infection. It can be transmitted sexually, from the con from the standpoint of skin to skin contact, but it absolutely absolutely does not require sexual activity. And I would dissuade people from considering it a sexually transmitted disease, because it tends to stigmatise those people who acquire it. And right now, since the preponderance of cases are in the gay community, I think it's a stigma that we don't need. Yes, it's just a virus. It just spreads skin, the skin. If you had the virus on your body and gave somebody a big hug, you could transmit it to them. It does not require intimate contact. Yes. Okay. You know, it reminds me of the chickenpox actually just, it's exactly, exactly. Yeah, the only difference is chickenpox is a lot more infectious and contagious and can be spread airborne aerosol, like COVID is so this is much less infectious and chickenpox but can be spread the same way. And similarly, they're both not infectious anymore when the lesions scab over as you mentioned. Correct. So the people who have active monkey pox are supposed to stay away from other people until the lesions scab and fall off, at which time they're no longer infectious. That usually takes about 10 to 14 days and sometimes a little longer. Okay, so just to clarify, let's say somebody comes to work, and they stand next to you and they have monkey pox and didn't realise it. Can you get monkey pox by being next to somebody without touching them? That's another interesting question. The CDC has broken exposure into three cattle Gary's low risk, intermediate risk and high risk, low risk would be just sitting across the table for 1520 minutes talking and the lesions were covered. High risk would be skin to skin contact. And intermediate risk would be really within six feet for a prolonged period of time. Let's say a doctor examining you and talking to you and not recognising at first his monkey pox and you're in the room together for half an hour, then that would be intermediate risk. Okay. And then question for you. A lot of people are really sensitive right now about viruses. And they're asking why why is there a new virus again, you know, we were told with COVID. This is a once in a century pandemic, and now we have a new virus that's coming up. Tell me in your mind, is this really that unusual to have another virus that we're talking about so soon after co COVID started? No, it's sort of like 1000 year flood and Kentucky, it can happen in less than 1000 years. So the terms zoonosis means infections from animals that spread to humans. And in fact, there's any number of examples over time and HIV is a zoonosis that came from animals in Africa to humans and then spread across the world, as this did. There are many other infections which go from animals to people and then spread people to people. And it's just really the side effect, if you will, of the human population growing and encroaching upon the animal's habitat, so that they can get exposed to an Ebola virus is another example like that. There's a number of other viruses, which right now is staying limited to the animals. But if man manages to encroach on their environment and catch it and spreads it to other people, then we'll see more pandemics. And I would expect that we will see more in the future. The fact that came on the heels of COVID still propagating is more of a historical Fluke than anything significant. Okay. And for parents that are concerned about children going to school, can you offer any advice here? Do you think parents should be hesitating about sending their kids back to school in the fall? No, I would not hesitate to send any child or any grandchild back to school and engage in studies and contact with other kids and have as normal social and active and intellectual and academic and play time as they can. As it stands right now. Unless it changes in the mode of transmission number of cases. I really would not worry about children, or in my case, grandchildren. Well, I hope I hope you know, after listening to you, it sounds like now I understand more why the who declared it an emergency hopefully, hopefully putting resources to this will help drive awareness up production of vaccinations, accessibility of vaccinations, and we'll be able to, to end this sooner rather than later. Yes, I'm quite hopeful. And again, the the difference, hopefully for this virus is that it's been identified early resources are being thrown at it. Hopefully it won't be as deeply politicised as of other viruses in the past, and we can all act in unison, both in the United States and across the world. To put an end to this from spreading further and impacting many other people. Thank you so much, Dr. Koski. Your your your thoughts are so helpful, and I really appreciate you coming on the podcast. My pleasure. Thank you so much for listening to this week's episode of Ask Dr. Jessica. If you are enjoying this podcast, I would be so grateful if you would help spread the word either by leaving a five star review or sharing it with a friend