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Melanie Cole (Host): Just as we think we're getting to the light at the end of the tunnel with COVID, for which we have had unprecedented times for the last two to three years. Now we come along something called monkeypox, but what do we really know about this? Welcome to Its Your Health Radio with Henry Mayo Newhall hospital. I'm Melanie Cole and joining me today is Dr. Anirudh Rai. He's a physician at Henry Mayo Primary Care. Dr. Rai, it's such a pleasure to have you join us today. Can you tell us about monkeypox? What do we know about it? How did it start? What do we know as of now?

Dr Anirudh Rai: Yeah. Well, thanks for having me on board. A couple things before we go into the subject matter. I have no conflicts of interest or any sort of pharmaceutical companies whatsoever. And, overall I'm not an expert by any regards, but I have accumulated quite a bit of knowledge. So I'd like to kind of partake that a little bit. My specific creed is at least is what Mark Twain once said is. History doesn't repeat it rhymes. So I think the best way to kind of learn this would be to get an idea of how this, virus kind of originated and where we're at right now, a quick sort of summary. So what we know about this virus is it, relies on the family of, ortho, which is a family of viruses that we've known for quite some time.

It is specifically a DNA virus and later on I will tell you why that's very specific and important for this particular virus? it was first isolated around 1950s, around 1958. If I remember we, then there had a couple of outbreaks that occurred at that time and despite its name, we only found it in monkeys. We don't know where actually originated from. So hence that name kind of stuck since then. And around 12 years later around 1970 sort of era is when the actual first case of monkey pox actually came to be. And the original report was written 1980s by a group of physicians.

And thankfully enough, I managed to get a hold of that and it showed a pretty interesting features like what we're seeing here. The clinical features of monkeypox is similar to what was seen back in the 1970s, actually, where they described it as about two to four days of what they called prodromal meaning before the actual, rash initiates, you have symptoms of fevers, of fatigue, very nonspecific symptoms. And about after two to four days, you would have this outbreak of this rash, in which. Writers described it as popular vesicular pustual.

Automatical terms were pretty much looking like either smallpox or chickenpox. So that would be the best way they described it. Interestingly enough, during this survey, they also noticed specifically two different strains of monkeypox, specifically they found one that was originating in the Republic of Congo. And this was particularly interesting because compared to the west African strain, this one's a bit more lethal. They approximate in this study that, it had a death rate about 10%, which is pretty significant for something like this. as for the west African strain, it was about one to 3%.

So it was quite a bit less. So it was something that we're be arising is what we're having right now. Just because the death rate is pretty low for this particular virus. As far as I know, we haven't had any recorded deaths by it, but that can change. going on actually in 2004, the Lance had actually did do a report on an outbreak of monkeypox. So, whether we like, or not, this is not a new disease and I think learning from history, we could kind of see what else may be going on. And in this particular strain, they found out that this case of monkey pox came from pretty much exotic animals from that endemic region.

And again, it has similar features to what we saw in the 19 70s. And they kind of describe it in that same manner. The other interesting thing about this is actually is they know that patients who've had the vaccine for smallpox actually did much better. Hence our treatment for today. Actually we are trying to get more vaccines out for smallpox per se. So it was a very interesting find. And I think that was quite informative to how we're taking action to virus today. Interesting enough to actually categorize it. It was a pretty small study about 37 patients, and they noted that about 97% of the patients had a rash 85% of fever.

So they were very specific on what maybe most likely causes, if you were to have this particular virus. Just to reiterate back to what the 1978 found out was that during that time, that was pretty much the last case 1978 of when they saw monkeypox two and three was the other case, but that was slowly taken care of thankfully enough. But then the next case actually, which was a bit more significant, which, from what I understand did kind of start off this particular state that we're in right now was in 2017, actually, where they noted like an 11 year old, patient had been infected with this.

They tested the patient out and it did look like that's what occurred. And they noted that this spread was occurring in different regions, Israel, UK, Singapore. So there was a lot of different places this was becoming a bit more, global, but we were monitoring it. For a time, to give you an idea, they did do a small study based originally on the 1970s, back in the Congo area, in the west African area. And they found out the cases have risen actually in that area as well. Originally, they had around 12, 15 at the 1970s now rise to about 500 plus cases in each area.

So this is something that was slowly rising. interesting to note is, it did appear at least in the 2017, up until now, at least of 2022. And that this virus particular was occurring in a Subec group of, a population, usually men having sex with men, and it theorized that it's likely the genital lesions that are causing it. and we could touch back on this a bit more later too is it's not really the best way to classify this as an STD per se, just because the spread is not the same as what we see in other cases.

In fact, it's the lesions and the serious material or in the discharge that the lesions have that is infectious and that's what's usually gets spread up. So theoretically you can have it spread if you have like a sheet that has it, or if any sort of clothing has it, you can spread in that way. And that's where theorizing is the mode of spread. So I did mention, and this was a study that touched on this as well, that it's a DNA virus to give you an idea, a little bit of the virology associated with this is DNA viruses tend to have a mutation rate about one to two base pairs per year, which is very slow.

So, that's something that we keep an eye on when it comes to DNA in RNA viruses. The interesting thing about this particular virus, which is the DNA is they note, at least during this study, Approximately the base [inaudible] was around like 47 or 48. So it was much higher than anticipated and it was, this was definitely something and very interesting just because when it comes to the epidemiological and virological sort of lineage, this is not normal for DNA virus to have that. So this definitely caught, the eye of, many scientists and they did further research on this.

And interestingly enough, during this paper and, I didn't know about this either. And I think this is pretty good information when it comes to just, what we know about the human body is they found out that there were any specific pairs actually within the virus that are causing these changes. And upon further research, I believe it was in 2003 where they did do a research about a particular enzyme that pretty much humans and animals may have, it's called APO Beck three. And what this enzyme does is for any virus that comes within the system that actually changes a certain base pair. of the virus itself.

So it's difficult to say whether this is a natural mutation of adaptation versus more of the best we would describe, would be battle scars of a virus that has gone through these changes. That's not saying that it's getting worse. It's more saying that we've seen the lineage of this virus and the DNA's telling us that this virus has gone through quite a bit of scarring, meaning that this enzyme, that the human body or animals produce is actively changing the virus's DNA. And that was, pretty new actually I did not know this was a system within our immune system.

And it is something that I think we're doing further research on as well. And, just to give more of an idea of, what this is going is, and right now we are mapping the DNA changes and we could kind of clearly see how things are progressing in that matter. I did touch back on transmission, rate when we said that it was the lesions and the discharge, that from those lesions that causes the spread. So it's definitely vital to monitor and have good hygiene, and to monitoring your own habits in general. In Fact, some of the studies that I've come across, particularly those ones did mention that.

Depending on the mode of transmission, sometimes via touch or eating or ingesting this particular virus, you may have different features of how fast you progress to that as well. So there are different ways to progress or transmit this virus in general. And finally, just to kind of end this up a bit, the way we measure if a virus is particularly spreading within a population, not statistics. So it's given us quite a bit of a, I guess and advantage on that, there was a number I think, in this 1980s and 1970s where they discovered something called the basic production number.

And now you probably hear it in the news, or if you were to hear any sort of podcasts or anything in general, they'd refer to as are not. And the best way to describe it is basically to see how a virus or how something in a population or in this case, a virus would be able to spread within a population if it was left its own devices like no vaccines, no immunity, no precautions. To give you an idea, COVID was around two, I think it's greater than two now, meaning that if one person gets infected, it's more likely that two will get infected.

That kind of compounds two of this Regressive sort of manner. So it tends to kind of spread pretty easily. And what our statistics have found is anything less than one. Technically it doesn't really spread within the population. It dies out anything greater than one. We kind of wanna monitor and keep an eye on. And there's many factors that go into play when we discuss R Not. For this particular virus, at least from what I found, and I think the may have changed here and there. I got around. The research shows about one to around two.

So it is definitely something that's transmissible and there are different modes of transmission as well. Given the fact that it's ox virus, you could theoretically also, have airborne transmission as well. But given that the R Not is around one to two, the scientists or virologists have determined that's not the primary mode of transmission, but I would definitely be cautious anyone who has that and is coughing. There's a drop at precautions would be the best sort of option for something like this as well.

Melanie Cole (Host): Wow. And you claim not to be an expert. That was unbelievable. You just got the whole background down and there was stuff that I have not ever heard. Fascinating. So I still have some questions doctor. So hang out with me for just a minute. So you spoke a little bit about transmission, because I think that that is the listener's biggest things, because what we didn't know about COVID was that, at the beginning, as we were all washing our groceries down, right. So first I would like to know if masks help to prevent transmission?

Dr Anirudh Rai: For my studies, at least what we know from other viruses, they do indeed help deter that. So I would highly recommend masks when it comes to this particular virus. As to say how, frequent or how much in the population it is, that has yet to be determined. But yes, for the most part masks do prevent respiratory droplet from spreading.

Melanie Cole (Host): Okay. So that's good to know. Now, some of us of a certain age and some of you of another age probably did not get the smallpox vaccine. I remember it, but I'm quite sure you probably don't and anybody under the age of probably 35 or something, didn't get it. So where does that fit into this picture now? Does the smallpox, is that going to help protect me from this? Is that going to wear off after a certain amount of time?

Tell us a little bit about the smallpox vaccine and even the chickenpox vaccine. Is that something that could help any of us or like shingles? Is now that particular form of that virus in our systems. And again, us older folks, we didn't get the chicken pox vaccine. We got chicken pox, but we did not get the vaccine. My kids got the vaccine. Tell us where these vaccines fit into this picture now?

Dr Anirudh Rai: I guess, to give you a quick sort of run through what we have right now. So overall we found out at least from the 1980 study and the 2003 and 2004 study as well is during that time. Yeah, it does appear that patients who've had the smallpox vaccine at that time did have a better prognosis to do better. And overall, it was something that, did catch our eye. And our thought was basically since the smallpox tends to be in the same family, which is the orthopox virus and our assumption, or I would say our, theory at the time was like patients who've had the vaccine or likely have immunity due to the fact that they were exposed to the same family of viruses.

As where we're at right now is, there have been at least two vaccines that I'm aware of that have been FDA approved for this. And particularly. the ACAM 2000 was the first one in 2007, which was approved for smallpox. And the issue with that particular vaccine was that it was a replicating, competent vaccine. So that was something quite dangerous and something that we would wanna be aware of, because if you were to give someone that particular vaccine, there's a chance they may actually get that disease.

So they did note that and, from time they did their tests. And overall, I believe it's fallen out of fashion because a newer one came out, which is Genos, which is a replicating deficient. Overall easier to give. And what they found out during the studies is that indeed Genos has been, shown to be effective. Which is again, a smallpox vaccine for our current population they've been effective in preventing, or even to a certain extent, I've even seen some studies that show that it's a good post exposure prophylaxis as well.

So about 14 days, postexposure actually I've come across, which has been pretty effective. When it comes to the similarities between shingles and chicken pox, it's tough to say. I'll do more research to see what the similarities of those two vaccines would be. But given that they're in the same family, but particularly shingles and chicken box are theoretically the same virus. So I think we can't make apples to apples yet, but I'll definitely do some more research on that.

But when it comes to definitely for the smallpox vaccine and its prevention of monkeypox, it has been shown in studies to my knowledge at this point that it is effective. And definitely the patient population that is needing it should definitely get it because it has been shown to be effective.

Melanie Cole (Host): So before we wrap up this absolutely fascinating podcast, Dr. Rai what do you want us to know? What do you want us to think about monkey packs? As I said with COVID, there was so much, we didn't know. There was so much at the beginning and we've learned so much more now, but with monkey packs, Is this something that we should be concerned with? Is this considered one of those things of concern by the government? should we be taking these precautions?

Obviously we learned, we learned hopefully our lesson with COVID hand washing and don't be coughing and sneezing out in public like that, mask wearing, keeping our social distances whenever possible, but because this one can be transmitted via possibly sheets or on a surface like that. If there are fluids or such on there, what do you want us to know? What do you want us to do in regards to monkey pox?

Dr Anirudh Rai: I think that's definitely a huge debate, at least within our circle, after our experience with COVID, but we do have to understand that monkeypox in general is quite a bit different than the COVID virus that came across. Just because to give you an idea, no population add to any exposure to this particular virus at all. So there was no vaccines distributed to provide for protection, the same sort of manner that we have at least the small pox vaccine, but in some form of the population available and the vaccine already available for smallpox as well.

So it is a bit different when it comes to that sort of situation. But when it comes to what I would recommend as a physician is like, you mentioned, good hygiene is vital. When you're coughing definitely or sneezing covering and mass do tend to help. What we do know at least from viruses and biology in general is generally on the outside, when you have UV radiation that tends to diminish and in fact, kill many viruses that are out in the open door. Just from that sort of prospect, I'm not too sure if outdoor masking would be if any benefit whatsoever.

But nonetheless, I think masking when it comes to crowded situation is beneficial for this particular, scenario. Just knowing the fact that COVIDs in the realm as well. As for the primary spread of monkeypox, it is not respiratory droplets, is definitely gonna be the sheets and contact. So I definitely would recommend hygiene being number one for something like this. In fact, just to give you an idea, I think the most vulnerable I guess currently in our healthcare system would be of course the front line, but more likely lab techs and patients who are drawing the blood.

Because they're the most likely to be exposed to something like this. And in fact, I think it was more recently in 2002 in the beginning, we did note that there was a physician in Israel who did contact monkeypox and they suspect it was the way he took off his gloves and he had some contact from it. So definitely hygene plays a big role in something like this in the patient population that may be most vulnerable is from what I understand would be those who are testing labs, testing specimens for this too.

So very good precautions should be taken when it comes to that. As for just the generalized public hygiene would be the number one thing to be cautious about for something specifically with monkeypox.

Melanie Cole (Host): Thank you so much, Dr. Rai for being so educated and looking up all those studies and helping to educate us because that's, what's going on in this country right now is people are getting their information from so many different sources and it really definitely makes it confusing. You hear one thing from somebody on Uncle MD, Facebook, and then something from someone else. Well, you've given us really good quality, understandable information. Thank you so very much for joining us today.

And for up to date information, we encourage you to check the Henry Mayo website at henrymayo.com. And you can also visit our free health information library at library.henrymayo.com. There's so much educational information that you can totally trust there. So use that. Get your quality information from the experts at Henry Mayo Newhall Hospital. We are all learning together, aren't we. Thank you again, Dr. Rai. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.