There are now seven cases of hMPXV, colloquially known as monkeypox, identified in Oregon. The disease spreads by prolonged skin-to-skin contact, and the treatment options are fairly robust. A vaccine can be effective if given within 14 days of exposure. Pre-exposure vaccines can also be given to high-risk populations. And there is an effective antiviral drug for people experiencing severe disease. We hear more about monkeypox from Richard Leman, a public health physician at the Oregon Health Authority.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: Monkeypox is in Oregon. The first probable case of what’s officially known as hMPXV was reported about a month ago. There have now been seven confirmed or presumptive cases in the state. Monkeypox is less contagious than COVID-19 and there are treatment options for it but it’s causing questions and concerns in a pandemic weary society. Richard Leman is a public health physician at the Oregon Health Authority and he joins us now with more details. What is monkeypox?
Richard Leman: It’s an infection from a virus that causes a disease and the virus has double stranded DNA. So it tends to be more stable and less likely to change than those RNI viruses like COVID.
Miller: I’ve seen that this is described as a relative of smallpox. scary words. What does that mean?
Leman: That is kind of scary. But yeah it’s in the same genus as Orthopox. So it’s related, it’s in the same genus, Orthopox, as smallpox is. But happily it is not smallpox. There are two strains of this MPXV and fortunately it’s the milder one that is currently circulating during this outbreak.
Miller: Milder meaning? I mean how deadly is this strain that is circulating in general?
Leman: Yeah it’s certainly not something you want to catch and we don’t want anybody to have this. But historically, when it’s circulating in areas where it is endemic, that is where it’s in animals and it gets in and people get infected that way. That’s sort of the historic way of getting this infection. It’s been like maybe 1% of people die. But during this outbreak, in part because it’s in countries with potentially more robust health systems, that’s been a lot less.
Miller: How does monkeypox spread?
Leman: Traditionally it’s been spread by contact with animals, either eating contaminated meat or being in contact with infected animals, usually rodents. That’s the way it’s typically spread in the countries where it is more common. During this particular outbreak. It’s been mainly close prolonged skin to skin contact. And often that’s been during sexual relations.
Miller: Globally, the majority of cases in this outbreak have been in gay bisexual and other men who have sex with men. Has that been the case in Oregon as well?
Leman: It has, and we are doing our best to provide information to folks who might be at higher risk because of activities and give them the information so that they can help protect themselves from getting this infection.
Miller: But technically this is not a sexually transmitted disease, right? We’re talking about skin to skin contact, which can happen in any number of ways?
Leman: True. And so, as it happens, many of these cases involve sexual activity, but that’s not the only way. That being said, this is not an easy infection to catch. So it does take pretty prolonged contact.
Miller: Good news in a society where we’ve been dealing with a pandemic where the virus is actually getting easier and easier to to be transmitted. You’re saying that that’s not the case really for this particular virus?
Leman: That’s right Dave. To put this in perspective, for every one case of this mPXV, if you didn’t do anything to try to stop it from spreading, you might expect two additional cases. When we’re talking about omicron COVID, that’s like eight additional cases. And when you’re talking about measles, that’s like 12-18 additional cases, so much tougher to catch.
Miller: What are the most common symptoms? I mean what should people be on the lookout for?
Leman: Well, the hallmark of this is a rash. And some people start with a fever, they may have swollen lymph nodes, they may feel muscle aches. But the hallmark of this is a rash that starts as flat patches on the skin. And then that forms sometimes fairly large firm lumps. The parks. That’s where the pox word comes in. And so that then can progress to either fluid filled lumps or you can get some pus from them. And then they typically scale and fall off. And that process takes about 2 to 4 weeks.
Miller: Am I right to assume that if they do get those lesions that have passed, that’s a time when people are particularly contagious?
Leman: We think that from the start of when somebody is sick until the rash goes away, there’s at least the potential for spread. That’s right.
Miller: So what should someone do if they either think they have monkeypox or have been told that they’ve been exposed?
Leman: I would call my health care provider if if somebody thinks they have monkeypox, they ought to call their healthcare provider and just say I have this concern. The health care provider can work with them in order to get testing to figure out whether or not they have it. If somebody has heard that they have been exposed to someone who has known monkeypox or they were in a place where a lot of monkeypox is circulating and were in contact with someone with a rash, they can also contact public health. And there is a vaccine actually, Dave, that you can take after you’ve been exposed and it may actually help prevent illness.
Miller: So this is a vaccine? That sounds almost like medicine people are given the vaccine after exposure and it can reduce the symptoms or the severity of the disease?
Leman: Yeah, if you get it within four days of when a person is exposed, it may prevent disease completely. If you get it within 14 days, if they’re going to get sick, they’re probably not going to get as sick. Which is pretty neat. That’s a pretty neat thing in a vaccine.
Miller: My understanding is there’s also an antiviral medicine that has proven to be effective. Is that also available in Oregon?
Leman: Yes it is. And we get that through the CDC. Not everybody needs that because most people are recovering fine, not having to go in the hospital. They don’t necessarily need that other medicine. It’s called tecovirimat . We can make it available though and that’s particularly for somebody who is so sick that they have to be hospitalized. Or if they’re at higher risk for severe disease either because they are children under the age of eight for instance, somebody who’s pregnant, or somebody who has immune compromise.
Miller: As of last week, according to another official from Oregon Health Authority, Oregon only had 193 doses of the vaccine in the state. Has that changed? I mean are more vaccine doses available now or on the way?
Leman: Yeah. Actually we just got notification a couple of days ago that we’re getting an additional about 1400 and so we’ve already ordered some of that.
Miller: Vaccines obviously have become really politicized during COVID over the last year and a half. Has that affected people’s willingness to take the monkey pox vaccine?
Leman: It’s a good question. That doesn’t seem to be the case, in part, because this isn’t like we’re asking everybody to get vaccinated. If somebody, though, has had contact with a person who had monkeypox, I think people kind of get it that, ‘oh, I may be at risk for this’. And so, in general, they’ve been more interested.
Miller: If and when more vaccine doses do become more widely available, should the general public take them prophylactically? How do you decide, as a public health physician, when it makes sense to actually recommend that much more broadly as opposed to on a case by case basis?
Leman: Sure. And, you know, with COVID it was pretty easy to decide because, as you pointed out, that is something that can spread very easily and, in particular people, it can be pretty severe or deadly. And in this case, in general, people are not gonna get exposed to monkeypox. Or even if they get like they pass somebody in the hall or they just happen to shake hands or something like that, that is not likely to lead to transmission.
So, you know, you gotta weigh the risks and the benefits. And the risks are just not there to say that it’s a benefit for everybody to use this vaccine. If there are folks who are at higher risk because of work that they do, for instance, if they work in a lab with this virus or if they’re engaging in activity that puts them at risk with a lot of close skin to skin contact with people in the same social network where this is circulating, then I think it would makes sense for us to promote vaccine and we will be doing that as the supply increases.
Miller: Just briefly, how would you gauge the public’s uptake of the public health information you’re trying to distribute these days. This has been a major theme for two and a half years of the COVID-19 pandemic. I’m curious, the extent to which you think people trust you right now?
Leman: Yeah. And I think that what we need to do, and this is my job, is to present information that’s objective and that people have the information they need to make an informed decision. That’s my job. And so that’s what I’m going to strive to do. And if I do that right, I think that trust will take care of itself.
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