Monkey pox now?? Give me a break!

Dear Member,

This past Thursday the federal government made monkeypox a public health emergency. This will free up funding to help improve their response to this growing outbreak. There have been many conflicting reports about the virus. Hopefully this newsletter will help alleviate some fears and keep you informed as to how to avoid contraction of the monkeypox virus.

Monkeypox is far less contagious than COVID. Right now, it is being seen to be transmitted by prolonged intimate contact, 90% sexually.

What are the signs and symptoms of monkeypox?

Monkeypox has a long incubation period of 5 - 21 days. Once someone is infected, they can be sick for up to 4 weeks. There seems to be very little asymptomatic transmission. The first stage of the disease is having flu like symptoms of fever and body aches and swollen glands (may not be seen in everyone). Then a distinctive rash occurs, typically on the face and then extremities but not always. Thankfully this strain is usually mild compared to the past strains.

Risk for contracting monkeypox: While anyone can contract monkeypox, the greatest risk *currently* is in men who have sex with men especially those who have multiple partners and have anal sex. Transmission via semen is still unclear. Early data is supportive that this is the case. People are considered infectious five days prior to onset of rash and continuing until the lesions have crusted and separated, and a fresh layer of skin has formed underneath. 

What about daily life? How likely are you to contract monkeypox?

• Having sex with someone who has monkeypox -
  HIGHLY LIKELY

• Cuddling for extended periods of time with someone who has monkeypox -
  HIGHLY LIKELY

• Speaking to someone in close proximity who has active mouth lesions -
  HIGHLY LIKELY (have them and you wear a mask)

• Kissing or sharing drinks with someone who has monkeypox:
  LIKELY (mouth sores are common, saliva may be transferred)

• Skin on skin close dancing in a club with someone who has monkeypox -
  POSSIBLE

• Touching clothing or bedding of a person with lesions -
  POSSIBLE

• Going to festivals, theater events and concerts where everyone is fully clothed -
  UNLIKELY (but be aware of respiratory transmission by kissing and close talking)

• Trying on clothes in a store -
  UNLIKELY

• Casual contact with others, going on train, going to coffee shop, etc -
  UNLIKELY

• Touching a door handle-
  UNLIKELY

Remember - The monkeypox virus is hardy but very susceptible to soap and UV light. You need a high dose of the virus to be infected so just being exposed does not mean you will be infected. Even if you live with someone who has monkeypox, the risk of household transmission by living with someone (and not engaging in sexual contact) is under 3%. It is not like COVID-19 in terms of transmissibility. 

What if you're at high risk? What should you do?  Get vaccinated! They believe this is the best protection. The monkeypox vaccine is currently in short supply. Text monkeypox to 692692 to get updates as to vaccine availability. Vaccine appointments are usually filled within 5 minutes of postings so be quick. The FDA is now studying giving 1/5th the dose intradermally (slightly under the skin) to help alleviate this shortage. The current vaccine being used is Jynneos - it is a live attenuated virus (same as what they use for MMR, chicken pox and yellow fever vaccines). Jynneos was originally authorized for use against smallpox which is closely related to monkeypox (smallpox is more severe). It has only been tested in animals against monkeypox but considered to be highly effective (around 85%). There is a 2nd vaccine that was used against smallpox which can be used against monkeypox. The federal government has over 200 million doses stockpiled in case of bioterrorism. This vaccine is not as preferred as has more side effects. We are expecting more Jynneos being available by the end of the year. Jynneos is a 2 shot vaccine, usually 14 days apart, but for now no one is eligible for the 2nd dose due to supply issues. For those who had the smallpox vaccine in the past it is unclear if you have protection. Given how long it has been, immunity has likely waned. 

Remember: masking helps avoid transmission of monkeypox and COVID-19. Also wash hands well when touching surfaces.

What if I contract monkeypox? Firstly, contact your doctor right away. There is a treatment for monkeypox called tecoviromat or Tpoxx (a medication that has never been used to fight monkeypox in humans). It has been shown to be safe in humans as a treatment for smallpox. However, because it is considered an investigational drug by the FDA extensive paperwork needs to be completed to have it released from the national stockpile. It is reserved for those who have or who are at risk for severe disease. Due to these constraints, for now only a fraction of those with monkeypox have been able to get Tpoxx. Thankfully this strain is a milder strain of monkeypox and most people recover in 2 - 4 weeks without specific treatment.

Polio - There has been a case of Polio in Rockland county, NY. It was found to be in the wastewater. Polio is transmitted via fecal/oral transmission. For transmission you need to eat something or drink something that has it in it. This case was transmitted by someone who had the oral Polio vaccine (no longer given in the United States and Canada but given worldwide especially in poorer countries). That vaccine is live, and they can shed it in their stool. If someone doesn’t wash their hands well when preparing your food or drink, you can be exposed to it. Most of you, if not all of you, were vaccinated against Polio as a child. As we all know not all vaccines last a lifetime. It is always recommended when traveling to specific international countries to get one Polio booster as an adult. If you are worried about Polio transmission, it would be wise to get one booster as an adult. The vaccine used here is not live and you cannot get polio nor transmit polio from the vaccine. All children who attend public school or private school have been vaccinated against polio as required by the school system.

COVID-19 - Unfortunately it is still very much present and our current most transmissible disease. We expect a new re-formulated booster (against omicron) to come out in the early fall. We will send out a notification when we have it on hand. 

Stay safe and healthy!

Sincerely,
Flatiron Family Medical
@flatironfamily