The 3 Things You Need to Know About Monkeypox
Dr. Jeremy Faust breaks down who exactly is at risk, what’s going on with the vaccine and what the outlook is...
It’s been a minute since I’ve sat down with Dr. Jeremy Faust.
Source: Jeremy Faust
Top ER Doctor, fellow Bulletin writer and my go-to doctor on all things medical.
For months, it was all about COVID-19.
But earlier this month, the US government declared monkeypox a public health emergency.
Source: The New York Times
So, what’s going on?
Here are the top three things you need to know.
WHO’S AT RISK?
DR. JEREMY FAUST: Monkeypox probably has been circulating in people for 60 years. There are outbreaks every once in a while. And there's a handful of countries where it's endemic, meaning that it's around and it's not unexpected to have some cases and outbreaks. What makes 2022 different is that you've got dozens and dozens of countries for the first time having documented infections.
ALINA CHO: Got it.
DR. JEREMY FAUST: Some of these countries probably had an occasional case here and there over the years, but none of them had a routine spread within their countries. And the question is whether that reflects something that's changed about this virus or whether it's just something that happened because of the behavioral patterns of the highest risk groups.
ALINA CHO: Which are...
DR. JEREMY FAUST: It's really a subset of gay men.
ALINA CHO: What do you mean by that?
DR. JEREMY FAUST: The virus spreads in a lot of ways, but the way it spreads the most rapidly is through intimate contact. And it's important to point out that it's not truly a sexually transmitted disease because a sexually transmitted disease requires actual intercourse, like HIV is sexually transmitted. You can't get HIV from sharing a bed with someone and cuddling naked or making out or kissing. But you can get monkeypox that way. So, Monkeypox is sort of a sexually transmitted plus intimate contact.
ALINA CHO: Oh, okay. I did not realize that.
DR. JEREMY FAUST: Right now, and I really stress that it’s right now, the highest risk group is men who have sex with men — MSM. And I say a subset because it's really a community that's a series of very active sexual networks. So, these are...
ALINA CHO: … men having sex with multiple partners.
DR. JEREMY FAUST: That's right, multiple partners, mass settings, events. By all means, there are a lot of gay couples who...
ALINA CHO: ... are monogamous.
DR. JEREMY FAUST: They are monogamous, couples that look indistinguishable from Ozzie and Harriet, if you will.
ALINA CHO: What kinds of concerns should the wider public have? Doesn't it have the capacity to go wider, so to speak?
DR. JEREMY FAUST: It does. The way I think about this is really it doesn't have anything to do with the sexual preference or the sexuality of the person. It really has to do with the number of partners.
HOW DOES MONKEYPOX SPREAD?
ALINA CHO: So, can I ask you a more specific question about how it spreads? Because if you don't have to have sexual intercourse, but you have to be intimate with someone, and it has to do with having multiple partners, scientifically, how is it spreading?
DR. JEREMY FAUST: It’s mostly thought to spread from skin-to-skin contact. So, it’s the lesions. And those lesions have a lot of virus in them.
ALINA CHO: Ah, got it.
DR. JEREMY FAUST: A lesion that is visible to the naked eye has tons and tons of virus. That’s extremely contagious, so if you touched that or got near that, and it got to a mucous membrane or anywhere…
ALINA CHO: You mean like an open wound or something?
DR. JEREMY FAUST: Yeah, or like the mouth or eyes.
ALINA CHO: Got it, I see.
DR. JEREMY FAUST: And so those lesions are very, very painful.
ALINA CHO: That's what I've been hearing.
DR. JEREMY FAUST: So, what's interesting there is that implies something really important that I think has not gotten enough attention. If these lesions are really, really painful, then how can anyone who has that be out there having fun in bed with anybody? It's just too painful.
ALINA CHO: Right.
DR. JEREMY FAUST: And so, the answer is they probably aren't. What this implies is there's probably some degree of spread from the skin, from these lesions, before they are really obvious, before they are painful, earlier in the disease course.
ALINA CHO: In the before-you-even-know-you-have-it period?
DR. JEREMY FAUST: Exactly.
WHAT ABOUT THE VACCINE? IS THERE ENOUGH?
ALINA CHO: What's the latest on the vaccine front and who should get vaccinated?
Source: STAT News
DR. JEREMY FAUST: Yeah, the vaccine that we have is called JYNNEOS. This is absolutely a vaccine that was approved for smallpox, which is not the problem we have. And yet interestingly enough, tested on monkeypox in animals…
ALINA CHO: ... it works.
DR. JEREMY FAUST: It works. But I don't think we know very much about it, because there were not large human trials. We don't know how effective it is at preventing severe disease, over what timeframe. It's really unlike COVID where the vaccines were tested quickly and we learned so much, we don't have that information for this. So, it's a much bigger question mark.
ALINA CHO: Interesting.
DR. JEREMY FAUST: Now, I think it probably is effective. We had 400,000 doses, apparently, but [almost two weeks ago], the FDA announced that, by changing the way it's administered, getting it into the skin instead of under the skin…
ALINA CHO: … you can get more doses.
DR. JEREMY FAUST: You can get five doses for every one we thought we had.
ALINA CHO: Yeah.
DR. JEREMY FAUST: And get the same effect.
ALINA CHO: And how many doses do you need?
DR. JEREMY FAUST: It's a two-dose vaccine.
ALINA CHO: Spread weeks apart like the COVID vaccine?
DR. JEREMY FAUST: I believe it's 28 days. Yeah.
ALINA CHO: Got it.
DR. JEREMY FAUST: What’s interesting is right now the only people who can get it are people who have been exposed or already have it. Because it's a longer period when people get sick, it's a vaccine that can be given after you think you've been exposed.
ALINA CHO: So, that's primarily how it's being used now?
DR. JEREMY FAUST: That's almost exclusively how it's being used right now.
ALINA CHO: And how do you get tested for it? You have to go to a hospital?
DR. JEREMY FAUST: Yeah, or a clinic. The test that most people are using is a swab of the rash itself.
THE BOTTOM LINE
ALINA CHO: Bottom line it for me. Does the average person have to worry about monkeypox?
DR. JEREMY FAUST: Here's what's going to happen. We're going to hear stories of a preschool kid getting it from someone who had an early case and didn't know it. We're going to hear a case of someone in the heterosexual community getting it who really can't quite figure out how they got it. We're going to hear these cases. For the foreseeable future, those will be exceptions to the rule. The average person who doesn't have multiple sex partners in a short period of time is highly unlikely to get this just by going about their business in daily life.