Transcription:
Monkeypox, COVID-19, and Polio – What You Need To Know

Cheryl Martin (Host): Bergen New Bridge is leading the way with access to today's essential vaccinations. Coming up, our chief medical officer. He'll share the latest information on monkeypox, including symptoms, risk factors, and vaccination availability. He'll also discuss the COVID-19 variants, the timeframe for an updated booster this fall and what you need to know about polio.

This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Cheryl Martin. With me is Dr. Gian Varbaro, our chief medical officer and the lead physician for the vaccination programs we're discussing on this podcast. Dr. Varbaro, what's the latest information you have on the availability of the monkeypox vaccine?

Dr Gian Varbaro: So the monkeypox vaccine is more available than it had been previously. There's still not an unlimited supply. But because of some changes in how we're administering it, the amount of supply has increased pretty drastically from what it was a couple of weeks ago. What that means is that the recommendations for using the vaccine changed, so we can use a different injection technique, where it's injected kind of like when you get a PPD at the doctor's office, the tuberculosis test where they just kind of inject it right under your skin. And by doing that, it has the same effect as injecting it directly into the muscle with less vaccines. So we are able to basically create a whole lot more vaccine availability kind of out of nowhere by changing the technique and having the same effect.

Cheryl Martin (Host): That's great. Now, what are the symptoms for monkeypox and the risk factors?

Dr Gian Varbaro: So the symptoms of monkeypox include things like fevers, headaches, muscle and back aches, swollen lymph node, chills, fatigue and the big one, which is the rash, and that's the defining feature. The rash looks kind of like chickenpox, even though chickenpox is not a pox virus, it's in a different family. But it's a rash that looks like pimples or blisters. It can be on the face, inside of the mouth, other parts of the body as well. And it forms these little pimples or blisters, which can eventually fill up with pus, they don't always, and rupture. And that's the main symptom that you see.

There's also some patients, it's rare, who've gotten some very severe pain syndromes with it. Those are the patients who have suffered the most with the virus. As far as risk factors, it's basically coming in contact with somebody who has monkeypox. This had usually been transmitted from humans to animals and back. It's now transmitting between people. So it's contact either directly with the skin of somebody whose rash is erupting. And also the biggest risk factor right now has been men who have sex with men. We think that it might be transmitted in semen as well as from the rash. It's not a hundred percent sure. And unfortunately, it just started in that population, which is why it's more there, but there have been patients outside of that population who've contracted it.

Cheryl Martin (Host): And once a person has contracted it, how long will those symptoms be around?

Dr Gian Varbaro: The typical is two to four weeks for the rash to completely heal over and dry over. Obviously, it's not as severe a little bit into it, but the patient can basically be contagious from when the rash first appears until it completely heals over. And that can take anywhere from two to four weeks. The other symptoms are a lot shorter, but the rash is the main one.

Cheryl Martin (Host): Are there any projections on whether or not this fall we're going to see the number of cases decline or continue to rise?

Dr Gian Varbaro: When we look at viruses, what we worry about is how much it's replicating. Is the number of infected patients leading to more infected patients? There's a thing called the replication number. If it's above one, that means like, say it's 1.3, that means for every one patient who gets it, they spread it to 1.3 people afterwards, that means it's growing. The number for monkeypox is low. It's close to one, but it is a little above it. But it's being trending down pretty quickly just with educating people, so people are aware of it. They're looking for the rash. So people have been preventing its spreading and by people getting vaccinated. So, as long as that continues, it will likely actually start to go down in incidence. As we get that replication number below one, which I feel pretty confident we will, it will actually decline in cases and it appears to already be doing that.

Cheryl Martin (Host): Let's turn to COVID-19. What can we expect this fall? A new variant?

Dr Gian Varbaro: So we never know when a variant's going to arise because it's kind of random. But it's obviously very possible as we've learned these last couple of years, the natural course of every pandemic has always been for the virus to change, to become more infectious, so it spreads more easily, which we've seen, but also less virulent, so it makes you less sick, that's what it means. Because if you stop and think about it, it's not in the virus's interest to make you really sick. The ideal for a virus would be if you got it and never knew you had it, so you spread it to a lot of people, just from a pure evolutionary standpoint. If it makes you so sick, you can't spread it or other stuff like that, it's not a very good at being a virus.

So I would not be surprised if there's a new variant. But as more variants arise, we can probably expect it to get less and less sick-making, which is what we're seeing. It's still not flu yet, it's still a pandemic, but it's much less severe than it was two years ago and it'll continue to trend that way. Would we see an increase? Probably.

Also, the other big thing we know that we've learned over these last few years is that ventilation is a huge factor in the spread of COVID-19. It's why the cases tend to go down in the summer and go up in the winter here in the Northeast, but have kind of been reversed in Southern states, right? If you remember at the beginning, there were low cases in Florida and then they had their spikes in the summer because in Florida, people stay inside for the air conditioning in the summer. It's the same reason why flu season comes in the winter. It's because people are indoors and it spreads more easily. So as the weather gets colder, we'll probably see an increase in cases, just from the ventilation effect.

Cheryl Martin (Host): What is a status of a new booster vaccine?

Dr Gian Varbaro: So, I'm sure people have heard, it was just announced the other day that it passed through the first stages, this variant-specific booster. And what that means is that there's a new strain of the vaccine that attacks the last couple of variants. And it's what we call a bivalent vaccine. What that means is that there's still the original vaccine in there plus this new booster, this new one that hits the variants a little better. And it's similar to what we do with the flu shot, right? The yearly flu shot, it's usually what we call quadrivalent. It means that it attacks four different strains of flu and we're kind of moving that direction with COVID where the vaccine will give you protection against the most predominant strains right now and boost your immunity. Hopefully, what that will mean is that it will go back to cutting down the transmission significantly as well, like it did early in the days of the vaccines by adding that extra immunity against the current variant.

Cheryl Martin (Host): Who will need to get that?

Dr Gian Varbaro: I think most people should. Almost everybody's eligible to get it now. We have not gotten the full recommendations yet for who will be eligible to get it. But my guess is it's going to be most people at least above age 15, I would guess. But again, we won't know for certain until they give us the full information. But I think that especially a seasonal vaccine is probably wise as we spoke about as the winter and the fall months come along and people are more inside, having a boost of your protection is probably wise. It's the same philosophy on getting a yearly flu shot for people who are at risk of getting the flu. With COVID a little more prevalent right now, not everybody's recommend to get a flu shot yearly. But right now, most people would be recommended to get the COVID shot just to give them seasonal protection at the very least.

Cheryl Martin (Host): And then once again, if a person never got the first round of COVID vaccine, would they have to get that first before getting the booster?

Dr Gian Varbaro: We've not gotten full recommendation on that question yet. Right now, it looks like they would get the regular dosing first, but it's quite possible that they'll tell us we can give first shots with the new formulation, but we've not gotten that full recommendation yet.

Cheryl Martin (Host): Doctor, is there a rise in polio cases?

Dr Gian Varbaro: So, that's been in the news obviously, that there have been some cases of polio in New York. Polio has never fully went away. We had very few cases here in the US, mostly because of mandatory vaccinations. There's been a mandatory for schools polio vaccination for decades now. So, that polio vaccination has protected most people, but it still existed in other parts of the world. It's not been fully eradicated. And that's what appears to have happened, is that somebody traveling picked it up and came back with it.

Most people who have cases of polio are asymptomatic. So there's people who are carrying, who don't know it, but we do see it rising based on things like wastewater analysis. But unfortunately, there are some people who are getting the full out polio cases. So, the key is if you've not been vaccinated, you should get vaccinated right away. If you never got the mandatory vaccine, you should get it.

People keep asking me, like, "How do I know if I have protection? I got it when I was a kid," or something like that. The people who really need a booster are people who are more at high risk, people with immune compromises or who are working directly with polio patients would be the ones who should get a booster. You'll only need one booster of polio vaccine lifetime maximum. Most people don't even need the one. But the big thing is if there's somebody who never got it, they should get it as soon as possible.

Cheryl Martin (Host): What if someone doesn't remember if they got it as a child?

Dr Gian Varbaro: So it's a good question. Unfortunately, there's not a big commercially available test to test for titers for it. So what I've been recommending is, one, talk with your parents and, two, see where you kind of grew up and what years it was in. If you went to school after, I'd have to look up the exact date, but it is sometime in the 1970s, it might have even been in the 1960s, where it became mandatory. So if you went to school, unless you knew you were not vaccinated, you probably were. You just might not remember it. If you were older than that, then you might not have received it, again, unless you remember specifically getting it. In which case, as I said before, it's one. So an initial shot is multiple shots, it's an initial series, but the booster's just one shot. So it would be worth looking into and seeing if you can get information on if you did receive it when you were younger.

Cheryl Martin (Host): Anything else you'd like us to know about these three vaccinations?

Dr Gian Varbaro: Just that these vaccinations are all very safe. They've now been means tested even the COVID ones that have been around for now just only a couple of years. We've given it to so many people. We know that they're extremely safe and extremely effective. And the real key is that vaccination keeps you safe and protected and prevents you from getting potentially debilitating illnesses. Polio, it's kind of tragic that there are people who are gonna get paralytic polio when a simple shot could prevent it.

Cheryl Martin (Host): Dr. Varbaro, thanks for providing this updated information on these three critical vaccination programs. Dr. John Varbaro is the chief medical officer here at Bergen New Bridge Medical. You can visit our website newbridgehealth.org to schedule your vaccination. That's newbridgehealth.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the podcast library for other topics of interest to you. Thanks for listening to this episode of Wellness Waves.