Selected Podcast
How Can I Protect Myself From Monkeypox?
In this episode, we hear from Dr. Helmut Albrecht, an infectious disease expert at Prisma Health. He will focus on defining monkeypox, how it is spread, and treatment options.
Featuring:
Helmut Albrecht, MD
Helmut Albrecht, MD is Director of the Center of Infectious Diseases Research and Policy, Heyward Gibbes Distinguished Professor of Internal Medicine Medical, Prisma Health and University of South Carolina. Transcription:
Scott Webb: This podcast on monkeypox was recorded on August 25th, 2022.
Though many of us may feel like we've become experts on COVID-19 after the past couple of years, there's a lot of uncertainty about monkeypox. And joining me today to help us to understand monkeypox, how it's spread and treated and more is Dr. Helmut Albrecht. He's an infectious disease expert with Prisma Health.
This is Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about monkeypox, which of course is on people's minds. You know, people are still mindful and still thinking about COVID and now we're thinking about monkeypox and we know all of this is evolving and changing perhaps day by day, minute by minute. So it's very likely we may have you back on in the near future to kind of update things. But where we are here on August 25th, 2022, what is monkeypox and how does it spread?
Dr. Helmut Albrecht: So monkeypox is caused by a pox virus related to smallpox, camelpox, cowpox and other pox viruses. Its natural hosts are actually not monkeys at all, but mostly rodents, specifically certain western, central African rat, squirrels and mice. It can affect American rodents. And there actually was an outbreak in the US a couple years ago that was caused by prairie dogs that had gotten infected.
But generally, it's contact with these animals and we'll talk about it later, how it transmits from human to human. But I just want to mention that despite its name, chickenpox is actually not a pox virus, but a herpes virus and therefore not related at all to monkeypox.
Scott Webb: Yeah. You know, whether it's social media or the media, there's so many misconceptions out there. So, yeah, naturally you'd think, well, monkeypox is transmitted from monkeys, but apparently not the case. And chickenpox and monkeypox are not quite the same thing. So it's great to have an expert on here to kind of talk through some of this. And you mentioned the human to human transfer of monkeypox makes me wonder is monkeypox an STD?
Dr. Helmut Albrecht: This is actually an important question that, unfortunately, as many things do in our field, doesn't have an easy answer. So monkeypox is usually transmitted to humans through bites or contact with lesions of infected animals. Human to human transmission can occur usually through contact with lesions of another person through fomites, which are household objects, such as towels or bedsheets or after prolonged and close contact, also through the air especially if the affected person is yelling or chanting or singing.
This particular strain tends to have lesions in the lower body, and this is sort of different in this strain. They tend to be on the lower abdomen, on the genital and buttocks. So sexual activity can break such lesions and lead to a transmission. That transmission clearly does not require sexual activity. You could, for instance, also break such lesions in sports activities, such as wrestling or soccer or dancing closely. Furthermore, many real STDs, such as HIV or gonorrhea are transmitted through contact with genital secretions. We actually believe that in monkeypox, skin lesions are the infecting issue, not genital secretions, where we've found only very low titers of virus so far. What that means is that the usual barrier protection against sexual transmitted disease, such as condoms that contain the genital secretions well, they're not fully active against monkeypox or not expected to be as you can still have skin on skin contact even with a condom.
Scott Webb: It's very interesting. Strictly speaking, it's not an STD, but it can be transmitted that way and transmitted other ways as well. And, you know, I know with COVID, part of the confusion, I think, for many of us is that the symptoms of COVID resembled so many other things, right? So cold and flu and allergies and things like that. So what are the first symptoms of monkeypox?
Dr. Helmut Albrecht: Typically, it takes seven to 21 days, probably on average most commonly 10 to 14 days, for an exposed person to develop any symptoms. So there's fairly a long incubation period. First signs are often those of a general viral infection, such as fever, fatigue, and body aches. And then, one to five days later, the typical skin lesions appear.
Fairly typical for this is lymph node swelling. That seems to be very common, much more common than, for instance, other things that you would consider with rashes like this. Rectal pain is a new symptom, but seems to be quite common in this setting.
Scott Webb: Yeah. When we think about the rash associated with monkeypox, especially an expert like yourself, can you just look at a rash and say, "Oh, yeah. That's definitely monkeypox"? In other words, does it manifest differently than other types of rashes?
Dr. Helmut Albrecht: I've now seen enough that I have a good feel for it, but it's really difficult to tell in early disease what this should be. So, if you had an exposure, you should certainly check yourself. Typical lesions are dense, relatively thick skin blisters that then cave in and scab over. If you have those, it's very easy, but a lot of patients present with very few and atypical lesions and you just need to have additional information. So for instance, if you had a prodrome, i.e., viral infection signs such as fever before your rash appeared and you have swollen lymph nodes, you should probably see your medical provider and let them see if they can figure it out.
Scott Webb: Yeah. I was going to follow up and ask you, you know, if we think we have monkeypox or we suspect that we've been in contact with somebody who has it, I'm assuming the best course of action is to reach out to our doctors or possibly go to the emergency department, that kind of thing.
Dr. Helmut Albrecht: Yes. See a provider who's experienced with this disease. If you don't have an emergency, don't go to the emergency room. See somebody who actually knows what this could be or your primary care physician. And the best way to do this is to let them know ahead of time that you are coming and that you are afraid that you may have this as they may want to send you to a specialist directly or to give them a chance to don the correct protective equipment. And it's important that you contact a physician if you've been exposed, for instance. Within seven days of an exposure, you can actually still be vaccinated to prevent lesions from appearing.
Scott Webb: And that's interesting. I was going to ask you, you know, let's go through this. Like, what are the treatment options for monkeypox? Good to know that you can still be vaccinated, especially if the diagnosis is fairly soon after exposure, but maybe you can talk a little bit about these today again on August 25th, 2022. What are the treatment options?
Dr. Helmut Albrecht: There are actually medications that were developed for other viruses that are quite effective, and that we have used now in several more of the severe cases, such as cidofovir and tecovirimat. The latter is in the national stockpile and the providers can order it through the hospital and the hospital then needs to get it through DHEC. Any provider can order this, but it requires paperwork and begin contact with DHEC.
Scott Webb: You know, we're all sort of familiar, unfortunately, with isolating, you know, social distancing and isolating related to COVID. So when we think about monkeypox, how long is it contagious? Do we have to isolate if we've been diagnosed with monkeypox?
Dr. Helmut Albrecht: Yes. You don't need to quarantine when you've been exposed, but you do need to isolate if you have developed disease. And you are infectious to other people, need to isolate until the scabs fall off, which can actually take up to three weeks. And this is important, as when the lesions are scabbed over, patients tend to feel better and tend to disregard these dried out scabs. These scabs, however, contain a lot of virus and you therefore need to wait until they have all fallen off and the new layer of skin has emerged.
Scott Webb: Sure. Yeah. And you've talked about how it's spread to us, right? Through rodents and things like that. Can we actually spread monkeypox to like our household pets, our cats and dogs?
Dr. Helmut Albrecht: At least theoretically, we can, and there have been rare cases of that happening. So cats and dogs can be infected, but transmission is actually very, very uncommon. Pet rodents, on the other hand, are fairly easily infected. So the current recommendation is to keep pets away from infected persons. And that's probably overly careful, but there will be rare cases where other mammals can be infected.
Scott Webb: Interesting. When we think about protecting ourselves, is that our first line of defense, is to be vaccinated against monkeypox?
Dr. Helmut Albrecht: Yeah, especially people who were exposed, and people who may get an exposure such as physicians that sort of see these patients fairly regularly, you know, or you have been exposed to somebody who calls you, you may want to get the vaccine. These vaccines are available. They're actually smallpox vaccine and there's different ones of them. But they also protect against monkeypox probably at least as good as they protect against smallpox. But they are in the national stockpile and you cannot just write for them or have a provider write them for you. So DHEC needs to distribute those. And patients or exposed patients or patients at risk can actually contact DHEC directly or we can help facilitate that contact.
Scott Webb: Yeah. You know, you sort of had a sense that after childhood, after you've been fully vaccinated, all your childhood vaccinations, that as we become adults, that we wouldn't really have to do that very much. But now, between the flu vaccine, COVID, monkeypox and, unfortunately, whatever may come after monkeypox, adults are getting fairly familiar again, unfortunately, with having to get vaccinated, right?
Dr. Helmut Albrecht: Yes. Overall, in the last a hundred years, we have almost doubled our life expectancy over the last 200 years. And it's essentially clean water and vaccines. And obviously, some of these are coming back. And smallpox, we stopped vaccinating because smallpox was eradicated in 1972 in the US. So there's a significant sizeable proportion now of our population that's never been vaccinated against smallpox. We may need to, in events like this, increase our coverage again.
Scott Webb: We talked earlier about STDs and transmitting through sexual contact. Is there anything we can do to lower our risk of transmitting monkeypox during sex?
Dr. Helmut Albrecht: Don't have close physical contact with a person who has monkeypox, which is easily said than done. But the condoms, as I mentioned, do not reliably protect you, especially anonymous partners. You have to judge your own risk. And if you feel that you are at risk for this, you may want to get yourself protected through vaccination before you have your next encounters.
Scott Webb: Yeah, vaccination, perhaps abstinence for a period of time, all sounds like good advice from an expert. Doctor, this has been really educational today, and I'm sure that we're going to speak with you again. But as we wrap up here, how serious is monkeypox and is it fatal?
Dr. Helmut Albrecht: Unfortunately, it can be, but it's usually not. So the 3% mortality that was reported in Africa is clearly not seen here. And now, over 80 cases in South Carolina, we have to admit only one patient. So, it's generally a self-limited illness. We now have over 16,000 cases in the US, and I've only heard of two deaths. And even in those two patients, I don't know if they actually died of monkeypox or something else. But it can be a severe disease in young children, pregnant women and immunocompromised patients. We had a patient with uncontrolled HIV who had a very, very severe illness. We've gotten him through this, but what you shouldn't forget, just because it usually doesn't kill you, it usually is quite painful and causes significant scarring down the road. Those are very deep lesions, so they typically heal with a scar. So it's not something you want to experience if you don't have to.
Scott Webb: Right. Even if it doesn't turn out to be fatal for you, it's definitely not something you want. So good to know that there are vaccines out there. We've talked here about, you know, early diagnosis is key. So if you have a rash and it seems unfamiliar, reach out to your provider, perhaps, you know, see somebody who specializes or has more experience in monkeypox. So doctor, this has been so educational today. Thank you so much for your time. You stay well.
Dr. Helmut Albrecht: I appreciate you having me. Thank you.
Scott Webb: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.
Scott Webb: This podcast on monkeypox was recorded on August 25th, 2022.
Though many of us may feel like we've become experts on COVID-19 after the past couple of years, there's a lot of uncertainty about monkeypox. And joining me today to help us to understand monkeypox, how it's spread and treated and more is Dr. Helmut Albrecht. He's an infectious disease expert with Prisma Health.
This is Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about monkeypox, which of course is on people's minds. You know, people are still mindful and still thinking about COVID and now we're thinking about monkeypox and we know all of this is evolving and changing perhaps day by day, minute by minute. So it's very likely we may have you back on in the near future to kind of update things. But where we are here on August 25th, 2022, what is monkeypox and how does it spread?
Dr. Helmut Albrecht: So monkeypox is caused by a pox virus related to smallpox, camelpox, cowpox and other pox viruses. Its natural hosts are actually not monkeys at all, but mostly rodents, specifically certain western, central African rat, squirrels and mice. It can affect American rodents. And there actually was an outbreak in the US a couple years ago that was caused by prairie dogs that had gotten infected.
But generally, it's contact with these animals and we'll talk about it later, how it transmits from human to human. But I just want to mention that despite its name, chickenpox is actually not a pox virus, but a herpes virus and therefore not related at all to monkeypox.
Scott Webb: Yeah. You know, whether it's social media or the media, there's so many misconceptions out there. So, yeah, naturally you'd think, well, monkeypox is transmitted from monkeys, but apparently not the case. And chickenpox and monkeypox are not quite the same thing. So it's great to have an expert on here to kind of talk through some of this. And you mentioned the human to human transfer of monkeypox makes me wonder is monkeypox an STD?
Dr. Helmut Albrecht: This is actually an important question that, unfortunately, as many things do in our field, doesn't have an easy answer. So monkeypox is usually transmitted to humans through bites or contact with lesions of infected animals. Human to human transmission can occur usually through contact with lesions of another person through fomites, which are household objects, such as towels or bedsheets or after prolonged and close contact, also through the air especially if the affected person is yelling or chanting or singing.
This particular strain tends to have lesions in the lower body, and this is sort of different in this strain. They tend to be on the lower abdomen, on the genital and buttocks. So sexual activity can break such lesions and lead to a transmission. That transmission clearly does not require sexual activity. You could, for instance, also break such lesions in sports activities, such as wrestling or soccer or dancing closely. Furthermore, many real STDs, such as HIV or gonorrhea are transmitted through contact with genital secretions. We actually believe that in monkeypox, skin lesions are the infecting issue, not genital secretions, where we've found only very low titers of virus so far. What that means is that the usual barrier protection against sexual transmitted disease, such as condoms that contain the genital secretions well, they're not fully active against monkeypox or not expected to be as you can still have skin on skin contact even with a condom.
Scott Webb: It's very interesting. Strictly speaking, it's not an STD, but it can be transmitted that way and transmitted other ways as well. And, you know, I know with COVID, part of the confusion, I think, for many of us is that the symptoms of COVID resembled so many other things, right? So cold and flu and allergies and things like that. So what are the first symptoms of monkeypox?
Dr. Helmut Albrecht: Typically, it takes seven to 21 days, probably on average most commonly 10 to 14 days, for an exposed person to develop any symptoms. So there's fairly a long incubation period. First signs are often those of a general viral infection, such as fever, fatigue, and body aches. And then, one to five days later, the typical skin lesions appear.
Fairly typical for this is lymph node swelling. That seems to be very common, much more common than, for instance, other things that you would consider with rashes like this. Rectal pain is a new symptom, but seems to be quite common in this setting.
Scott Webb: Yeah. When we think about the rash associated with monkeypox, especially an expert like yourself, can you just look at a rash and say, "Oh, yeah. That's definitely monkeypox"? In other words, does it manifest differently than other types of rashes?
Dr. Helmut Albrecht: I've now seen enough that I have a good feel for it, but it's really difficult to tell in early disease what this should be. So, if you had an exposure, you should certainly check yourself. Typical lesions are dense, relatively thick skin blisters that then cave in and scab over. If you have those, it's very easy, but a lot of patients present with very few and atypical lesions and you just need to have additional information. So for instance, if you had a prodrome, i.e., viral infection signs such as fever before your rash appeared and you have swollen lymph nodes, you should probably see your medical provider and let them see if they can figure it out.
Scott Webb: Yeah. I was going to follow up and ask you, you know, if we think we have monkeypox or we suspect that we've been in contact with somebody who has it, I'm assuming the best course of action is to reach out to our doctors or possibly go to the emergency department, that kind of thing.
Dr. Helmut Albrecht: Yes. See a provider who's experienced with this disease. If you don't have an emergency, don't go to the emergency room. See somebody who actually knows what this could be or your primary care physician. And the best way to do this is to let them know ahead of time that you are coming and that you are afraid that you may have this as they may want to send you to a specialist directly or to give them a chance to don the correct protective equipment. And it's important that you contact a physician if you've been exposed, for instance. Within seven days of an exposure, you can actually still be vaccinated to prevent lesions from appearing.
Scott Webb: And that's interesting. I was going to ask you, you know, let's go through this. Like, what are the treatment options for monkeypox? Good to know that you can still be vaccinated, especially if the diagnosis is fairly soon after exposure, but maybe you can talk a little bit about these today again on August 25th, 2022. What are the treatment options?
Dr. Helmut Albrecht: There are actually medications that were developed for other viruses that are quite effective, and that we have used now in several more of the severe cases, such as cidofovir and tecovirimat. The latter is in the national stockpile and the providers can order it through the hospital and the hospital then needs to get it through DHEC. Any provider can order this, but it requires paperwork and begin contact with DHEC.
Scott Webb: You know, we're all sort of familiar, unfortunately, with isolating, you know, social distancing and isolating related to COVID. So when we think about monkeypox, how long is it contagious? Do we have to isolate if we've been diagnosed with monkeypox?
Dr. Helmut Albrecht: Yes. You don't need to quarantine when you've been exposed, but you do need to isolate if you have developed disease. And you are infectious to other people, need to isolate until the scabs fall off, which can actually take up to three weeks. And this is important, as when the lesions are scabbed over, patients tend to feel better and tend to disregard these dried out scabs. These scabs, however, contain a lot of virus and you therefore need to wait until they have all fallen off and the new layer of skin has emerged.
Scott Webb: Sure. Yeah. And you've talked about how it's spread to us, right? Through rodents and things like that. Can we actually spread monkeypox to like our household pets, our cats and dogs?
Dr. Helmut Albrecht: At least theoretically, we can, and there have been rare cases of that happening. So cats and dogs can be infected, but transmission is actually very, very uncommon. Pet rodents, on the other hand, are fairly easily infected. So the current recommendation is to keep pets away from infected persons. And that's probably overly careful, but there will be rare cases where other mammals can be infected.
Scott Webb: Interesting. When we think about protecting ourselves, is that our first line of defense, is to be vaccinated against monkeypox?
Dr. Helmut Albrecht: Yeah, especially people who were exposed, and people who may get an exposure such as physicians that sort of see these patients fairly regularly, you know, or you have been exposed to somebody who calls you, you may want to get the vaccine. These vaccines are available. They're actually smallpox vaccine and there's different ones of them. But they also protect against monkeypox probably at least as good as they protect against smallpox. But they are in the national stockpile and you cannot just write for them or have a provider write them for you. So DHEC needs to distribute those. And patients or exposed patients or patients at risk can actually contact DHEC directly or we can help facilitate that contact.
Scott Webb: Yeah. You know, you sort of had a sense that after childhood, after you've been fully vaccinated, all your childhood vaccinations, that as we become adults, that we wouldn't really have to do that very much. But now, between the flu vaccine, COVID, monkeypox and, unfortunately, whatever may come after monkeypox, adults are getting fairly familiar again, unfortunately, with having to get vaccinated, right?
Dr. Helmut Albrecht: Yes. Overall, in the last a hundred years, we have almost doubled our life expectancy over the last 200 years. And it's essentially clean water and vaccines. And obviously, some of these are coming back. And smallpox, we stopped vaccinating because smallpox was eradicated in 1972 in the US. So there's a significant sizeable proportion now of our population that's never been vaccinated against smallpox. We may need to, in events like this, increase our coverage again.
Scott Webb: We talked earlier about STDs and transmitting through sexual contact. Is there anything we can do to lower our risk of transmitting monkeypox during sex?
Dr. Helmut Albrecht: Don't have close physical contact with a person who has monkeypox, which is easily said than done. But the condoms, as I mentioned, do not reliably protect you, especially anonymous partners. You have to judge your own risk. And if you feel that you are at risk for this, you may want to get yourself protected through vaccination before you have your next encounters.
Scott Webb: Yeah, vaccination, perhaps abstinence for a period of time, all sounds like good advice from an expert. Doctor, this has been really educational today, and I'm sure that we're going to speak with you again. But as we wrap up here, how serious is monkeypox and is it fatal?
Dr. Helmut Albrecht: Unfortunately, it can be, but it's usually not. So the 3% mortality that was reported in Africa is clearly not seen here. And now, over 80 cases in South Carolina, we have to admit only one patient. So, it's generally a self-limited illness. We now have over 16,000 cases in the US, and I've only heard of two deaths. And even in those two patients, I don't know if they actually died of monkeypox or something else. But it can be a severe disease in young children, pregnant women and immunocompromised patients. We had a patient with uncontrolled HIV who had a very, very severe illness. We've gotten him through this, but what you shouldn't forget, just because it usually doesn't kill you, it usually is quite painful and causes significant scarring down the road. Those are very deep lesions, so they typically heal with a scar. So it's not something you want to experience if you don't have to.
Scott Webb: Right. Even if it doesn't turn out to be fatal for you, it's definitely not something you want. So good to know that there are vaccines out there. We've talked here about, you know, early diagnosis is key. So if you have a rash and it seems unfamiliar, reach out to your provider, perhaps, you know, see somebody who specializes or has more experience in monkeypox. So doctor, this has been so educational today. Thank you so much for your time. You stay well.
Dr. Helmut Albrecht: I appreciate you having me. Thank you.
Scott Webb: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Scott Webb. Stay well.