What you need to know about monkeypox [PODCAST]

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“What is currently known is that monkeypox is transmitted primarily through close contact with skin lesions, bodily fluids, and respiratory droplets. Men aged between 20 and 50 years, many of whom have sex with other men (MSM), are notably included in a majority of the cluster cases, thereby indicating that sexual contact may be a significant route of transmission. The correlation with sexual activity does not corroborate increased contamination or virulence; it simply highlights that close contact and skin lesions may allow for monkeypox to spread most effectively.”

Divya Srinivasan is an undergraduate student. Tejas Sekhar is a graduate student.

They share their stories and discuss the KevinMD article, “What you need to know about monkeypox.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show we have Divya Srinivasan and Tejas. Divya is an undergraduate student, Tejas is a graduate student, and together they wrote the KevinMD article “What you need to know about monkeypox.” Both of you, welcome to the show.

Divya Srinivasan: Thank you for having us.

Kevin Pho: All right. So before we get into your article, I’m just going to briefly ask you to share your story and journey to where you are today. Divya, why don’t you go first?

Divya Srinivasan: Sure. So I’m from Atlanta, Georgia, and I’m now a senior at Washington University studying neuroscience and anthropology. I’m also an aspiring physician, and I’m particularly interested in global health and the environment.

Kevin Pho: Perfect. So before we get into the monkeypox article, just tell me how you got interested in co-writing that article.

Divya Srinivasan: I guess I’ll go back a little bit. I remember a class I took my freshman year called One Health. One Health is a multidisciplinary approach that links together the health of humans, animals, and the environment. So in order to protect the health of our communities, we must also ensure the health of animals and the environment. Especially when you consider COVID-19 and now monkeypox, which are both zoonotic diseases, meaning diseases that have spilled over from an animal host and now infect people, it’s just so important to understand the relationship between the environment and humans.

And so I remember, back in mid-May or so, we started to see a lot of headlines about the cluster cases of monkeypox in Europe. This was really interesting for us, especially since we’re still in the midst of the COVID-19 pandemic, and so the rise of another virus, we felt, was particularly important to discuss, and also to dispel some misconceptions that are surrounding the topic.

Kevin Pho: Excellent. And we’re going to go straight into that article, but first, Tejas, we’ve had you on the show before, but for those who didn’t listen to that episode, just briefly share your story and journey to where you are today.

Tejas Sekhar: Sure. So I’m a graduate student at Washington University in St. Louis. I’m originally from St. Louis, and I went to Northwestern for my undergrad. Right now I’m applying to medical school, but I also do research on a couple of different topics, including asthma care, atrial fibrillation, and pulmonary and critical care.

Kevin Pho: Excellent. OK, so let’s talk more about monkeypox. Very topical, of course. So, Divya, I’m going to ask you to summarize that article and walk my audience through it, for those who didn’t get a chance to read it.

Divya Srinivasan: Sure. So we actually wrote this article a few months ago, and as we’ve seen with viruses, a lot of things can change. So first of all, monkeypox, like I said before, is a zoonotic disease. Scientists think that it probably comes from rodents, but we’re not entirely sure. It’s a pox-like virus, meaning that it is characterized by rashes that develop on the skin and flu-like symptoms, and it’s transmitted primarily through direct contact with skin lesions and also can be transmitted through respiratory droplets.

One thing about this virus is that it’s not a new virus. It was actually first discovered in humans back in 1970 in the Democratic Republic of Congo and is now endemic to western and central Africa. In mid-May of 2022, we started to see a rise of cases that first started in Europe and are now spreading globally, and this is kind of the biggest outbreak that we’ve seen since we first discovered it.

Kevin Pho: Divya, we’re speaking in the second week of August now. So tell me the current impact that monkeypox has in the United States.

Divya Srinivasan: Sure. In the United States, there are roughly 10,000 confirmed cases, and to my knowledge, there are no confirmed deaths. So I think that’s one really big thing between COVID-19 and monkeypox: Although we are seeing a huge rise in cases, the death count is still very low in comparison.

Kevin Pho: And Tejas, I think Divya mentioned how monkeypox is normally presented, but go into more detail. So physicians, how are they seeing monkeypox present to them in urgent care clinics, emergency departments, or primary care clinics?

Tejas Sekhar: Yeah, it’s been really interesting, especially in relation to the COVID pandemic. What we’ve seen with COVID is that it’s been a respiratory illness, and a lot of times there are not visible external features of COVID. It can rather be classified more internally, as that respiratory disease. Whereas with monkeypox, as Divya mentioned, there are a lot of lesions, rashes, and other external features. So it’s really about being aware of those, and if you appear to be in contact with anybody with any of those features, even to suspect it, it’s always better to be more wary and more cautious.

But at the same time, there is the issue of potentially stigmatizing communities or people who might appear to have some of these issues, as they may be mistaken for things that may be more chronic, other sort of symptoms or pathologies. So it’s really an important issue to be aware of and to just be mindful of, but at the same time, not to make judgments or pass judgments on anybody who might be observed to have something similar to monkeypox but might actually be monkeypox.

Kevin Pho: So, Tejas, if you have someone who you suspect to have monkeypox, what are the next diagnostic steps?

Tejas Sekhar: So what we’ve seen is that a lot of what the CDC has recommended is, as we’ve seen with the COVID-19 pandemic as well, quarantine procedures: making sure that you’re staying inside and you’re limiting contact with other people, especially when it comes to the issue of bodily fluids. Monkeypox has been noted to be spread through bodily fluids. So, mitigating eating alongside or in near contact with somebody with monkeypox, or again, if you have monkeypox, not sharing any sort of food or drink with anybody, and also limiting bodily contact, whether that be through sexual intercourse or just other forms of communication, hugging, shaking hands, any sort of communication like that.

Kevin Pho: And Divya, in terms of treatment options, once you have a confirmed case, what are the treatment options available?

Divya Srinivasan: Yeah, so currently there are two vaccines that can be used to treat monkeypox. One of them is Jynneos, which has been created specifically for monkeypox, and then also, in the past, the U.S. has used the variola, the smallpox vaccine, to also treat monkeypox, since they are kind of in the same family. In terms of how effective they are, from what I’ve read, it’s around 85 percent effective, but I think more research is needed to really understand how effective it is for this particular outbreak.

Kevin Pho: And Divya, one thing that you mentioned was that you had brought up some misconceptions or misperceptions about monkeypox. What are some of those?

Divya Srinivasan: Yeah, so unfortunately, just like how we’ve seen with COVID-19, we’re seeing stigma against certain groups of people with monkeypox, in particular against gay and bisexual men. This has mainly come about because it just so happens that a lot of the confirmed cases also include people who are in that population, particularly men who have sex with other men. And so the general public has come to assume that monkeypox is an STI, or a sexually transmitted infection, and this is just not the case. Monkeypox spreads most effectively through close and physical contact, and so right now it just seems that it’s a coincidence that sexual contact and people in those populations have been most susceptible to being infected by monkeypox.

Kevin Pho: And Tejas, I’m getting questions from parents, because school is starting in the fall. How worried should parents be about this potential spread of monkeypox in a school environment?

Tejas Sekhar: Yeah, absolutely, especially with what we’ve seen with COVID and some of the concerning things about it and its transmissibility. I will say that we’ve noted, from the research that we’ve read and analyzed, that monkeypox appears to be less contagious than some of the variants of COVID that we’ve seen, which have been a lot more highly contagious. The fact that it’s also not a respiratory illness is of some relief, so that way it can’t be spread as easily through the air and be as transmissible that way.

But it is, again, of concern, especially for younger folks, pediatric populations that might be more inclined to touching or playing with their environment and be more in an interactive setting than older counterparts or high school students. So it is definitely of concern. But thankfully, there’s the fact that monkeypox is externalizable and visible to be seen, so with these rashes and lesions, a lot of times parents will play a role in pulling kids out of school or taking them to their primary care physician if they do know some of these features.

So I think the COVID pandemic has prepared us to be ready to take everything with a lot of caution. To that point, it is of some relief to parents, but of course, being updated with the guidelines that come through the CDC and through the WHO, and making sure to be on top of school policies as well, will always be helpful to mitigate any sort of effects of monkeypox on their children.

Kevin Pho: And Tejas, just to be clear, what kind of symptoms specifically should not only parents but just people in general be concerned about that would make them potentially suspicious of monkeypox?

Tejas Sekhar: Yeah, one of the biggest defining features that we’ve noted from patients with monkeypox is reports of pain and pus. These are typically not seen with a lot of other commonplace rashes or illnesses, especially the component of pain. So if a child, especially a younger child, is complaining of pain or having some sort of lethargy or difficulty with daily activities, this could be an indication that it could be monkeypox.

As for the general public, again, the pain isn’t too common to a lot of rashes unless irritated, but what a lot of people with monkeypox are reporting is that the pain is constant, regardless of interaction with any sort of rash or lesion on the skin. So those are some things to be aware of, and those are some potentially concerning signs that you may have been exposed to or have monkeypox.

Kevin Pho: We’re talking to Divya Srinivasan. Divya is an undergraduate student, Tejas is a graduate student, and together they wrote the KevinMD article “What you need to know about monkeypox.” Now I’m going to ask both of you the same final question, which is: What are your take-home messages to the KevinMD audience? Divya, why don’t you go first?

Divya Srinivasan: Sure. So I just want to reiterate that monkeypox is not limited to certain groups of people. Anyone can get it, regardless of sexual preference. I also want to say it’s important that we follow the health and safety guidelines of public health officials.

And one more thing that I want to add: We’ve been through COVID-19 for over two years now, and I’m sure there are a lot of people who are experiencing pandemic fatigue. I think the last thing anyone wants to hear is that there’s another virus that we have to keep track of and watch out for. And so what I want to say is that it’s OK to take care of yourself and prioritize your mental health. That is, I think, one of the best ways to keep yourself healthy.

Kevin Pho: And Tejas, what are some of your take-home messages to the KevinMD audience?

Tejas Sekhar: Absolutely. Especially as we’ve been talking about these misconceptions and stigma surrounding the topic of monkeypox, I think it’s important to be critical of where we’re consuming our media and our journalism. Always be critical of sources, and do your own investigation rather than taking things at face value. Especially, as with what we’ve seen with the pandemic, as I keep referring to, we’ve been in an age of misinformation. So it really is important to do your own due diligence here and to make sure you’re aware of what the underlying biases of the various sources of media that you’re consuming are.

Kevin Pho: Divya and Tejas, thank you so much for sharing your time and insight. Thanks again for being on the show.

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