Front Burner - Monkeypox: Everything you need to know

Episode Date: May 25, 2022

Monkeypox was first detected in humans in 1970, but it has rarely spread beyond Central and West Africa, until now. As of Tuesday, 17 countries where the virus is not endemic have reported at least one case, including Canada. Given that COVID-19 is still a part of our day-to-day lives, the threat of another infectious disease spreading at a rapid rate feels unsettling at best. While there are many reasons to be aware of monkeypox, its symptoms and how it spreads, there are also plenty of reasons not to panic. Today on Front Burner, Dr. Boghuma Titanji, an infectious diseases doctor and scientist from Cameroon who is currently based at Emory University in Atlanta, delivers a primer on what you need to know about monkeypox. She also dispels some rumours about how it spreads and explains where we go from here.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. I'm sure by now you've heard. Public health teams in Quebec are now investigating 13 cases of suspected monkeypox. Toronto is investigating its first suspected monkeypox case.

The patient is a man in his 40s who was in contact with someone who traveled to Montreal. And I don't know about you, but hearing this news, I felt this funny sense of familiarity. It is now official. Canada has its first confirmed case of the new strain of coronavirus. Canada has now reported at least 118 cases. 43 in Ontario, 19 cases in Alberta, nine in Quebec, and New Brunswick. But monkeypox is not the same as COVID-19. For starters, it's been detected in humans since the 1970s.

And there are vaccines and treatments readily available even though it is spreading rapidly. And even though it's spreading rapidly, it doesn't spread as easily as COVID. But we still wanted to know more about the disease, the risks it poses, and what to do about it. So today we've connected with Dr. Bohuma Tatanji. She's a Cameroonian-born infectious diseases doctor and a scientist, currently based at Emory University in Atlanta. Dr. Tatangy, I want to thank you so much for taking the time out of your very

busy schedule to talk with us today. Thank you. Thanks for having me, Jamie. So I wonder if we could start super basic here, and I know you're an expert, so please having me, Jamie. So I wonder if we could start super basic here. And I know you're an expert, so please forgive me. But what is monkeypox? Monkeypox is a virus that is of the same family as the virus that causes the now eradicated smallpox. And it is a virus that is endemic to Western Central Africa and is commonly usually found in small rodents like squirrels and rats and over the years has been known to cause sporadic outbreaks in humans. It was first identified in the late 1950s when it was isolated in non-human primates in Denmark that were being kept for research.

And it wasn't until 1970 that the first case was identified in a human, and that was in the Democratic Republic of Congo. Now, since that time, there have been reports of limited outbreaks happening in multiple countries in West and Central Africa. And more recently now, we are seeing clusters of outbreaks in countries that are not endemic or at least not known to be endemic for monkeypox. And what are the symptoms of monkeypox? Like, how would someone know if they had it? It usually presents with what we call a prodrome. So a prodrome is really just non-specific symptoms that may precede the onset of a rash. So individuals who have monkeypox may have leading up to the development of the rash,

fevers, chills, joint aches, muscle aches, that are really nonspecific symptoms that you can have with absolutely any other viral infection. Then the rash emerges and it starts out like a bump. rash emerges and it starts out like a bump and some of these bumps can have a central indentation and become filled with fluid so vet and form vesicles over time as the the rash progresses these vesicles can then become filled with pus and over time dries up and heals. And individuals generally, for the most part, make a full recovery. And the rash usually disappears about two to four weeks after initial onset. You said individuals generally make a full recovery. Can it be very dangerous? Can it be fatal?

It can be fatal. And I would preface this by saying that there are two strains of the virus, one that circulates predominantly in West Africa, and the other strain that circulates in Central Africa. Now, the Central African strain is known to cause more severe disease. And in some outbreaks in the DRC, in the Democratic Republic of Congo, case fatality rates have been up to 10%. However, the West African strain causes a lot milder disease and case fatality rates have been a lot lower, kind of around 1%. Now, I'll caveat this by saying that outbreaks frequently occur in quite enclaved areas in these endemic geographies. So these are usually areas that are in close proximity to forested areas where the animal reservoir may exist. not always the settings that are the most well-resourced in terms of medical access,

having access to vaccination, or even some of the experimental antiviral drugs that are available to treat monkeypox. So I would expect that even if you had one of the more severe clades circulating in better resourced settings, that case fatality rate would even be much lower than the 10% that has been reported in the literature. The outbreaks that we're seeing now in Europe and the United States and Canada, do we know which strain that is? The available sequencing data from the virus indicates that some of the isolated in Europe are infected with the West African strain, so the milder strain of monkeypox virus. Okay, and there's no cases so far of the more severe strain? Exactly, not to my knowledge. But again, I would say that this is

still very early on in the outbreak investigation, and we will get more sequence data in coming weeks that would help us better characterize what types of monkeypox virus strains are circulating in the outbreaks that are being reported. How does monkeypox spread? I'll take a couple of steps back and talk about spread in the traditionally endemic areas, right? Like I mentioned before, in cases where you've had spread in endemic countries in Western Central Africa, outbreaks are usually triggered either when populations that live in close proximity with the reservoir animals come in contact. And people could potentially get infected by manipulating an infected animal,

either through hunting or through a child playing with a squirrel that may be infected, or those sorts of animal and human contacts. infected or those sorts of animal and human contacts. Now, once it's introduced into the human population, how does it spread from person to person? Again, close contact with individuals who are infected and have active lesions. And by close contacts, it means that if you have an individual who has monkeypox and has a rash, if you have close intimate contact with them, then you can acquire the infection through those contacts. We also know that contaminated articles, so this could be clothing from someone who is infected or, you know, any other tools that they're using, if those inanimate objects are contaminated with the virus

and you manipulate them, that also could be a source of exposure. And droplets, contamination or infection through droplets is also one of the modes of transmission that we think about. Now, in the current outbreak that is evolving across Europe and North America, and now certain cases reported even in South America, the clusters that are emerging appear to be linked to social networks and large group activities, have facilitated those types of close contacts that potentially will increase the risk of transmission and getting infected with the virus if you already had the virus circulating in those communities. Yeah, I saw an advisor to the World Health Organization describe this outbreak as an event that appears to have been caused by sexual activity at two recent raves in Europe. What do you make of that? I think that the focus, unfortunately, on the side of the media has been very much honed into sexual contacts being the main culprit of the outbreaks that we're seeing in Europe.

Researchers are looking into why clusters of cases have been identified among gay or bisexual men. It's important for individuals to be aware that this could potentially be a facilitator in some of the outbreaks that are being reported. However, it's also important to highlight that sexual contact is not the only way in which you can get this. So any close contact with an individual with the right exposures and who has the infection and who has active lesions could lead to a potential transmission event as well. Right. I know that you wrote a blog piece about the potential risks or repercussions of this being labeled like a quote, gay disease. And can you just talk to me a little bit about that?

I think that when the cases emerged initially, like, you know, as the attention sort of grew around the current ongoing outbreaks. And it was reported that a lot of the cases in the clusters in the UK, in Spain, in Portugal, where in young men who identify as being gay, bisexual, or men, other men who have sex with men, it was very reminiscent of kind of the initial reports that we saw with HIV in the way it was being framed in the media. And I think that it is important when an outbreak is happening to highlight the group in which the cases are being seen. But at the same time, it is also important to be very aware of how damaging stigma can be when you're dealing with an outbreak of a new disease that we're trying to understand and trying to understand the transmission networks and how the outbreaks are

occurring. And it is always dangerous when you label a disease and tie it to a particular group of individuals. Right now, based on what we know about monkeypox, through multiple outbreaks that have occurred in history, there is nothing, absolutely nothing, that indicates that this is an infection that only spreads among gay, bisexual, or other men who have sex with men. We know that it spreads by close contacts. And the fact that the current outbreaks are being reported in these subgroups is an indication of shared social networks and events which may have facilitated outbreaks emerging. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. Canada's entrepreneurs through angel investment and industry connections. their own household income. That's not a typo, 50%. That's because money is confusing. In my

new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. You know, we talked earlier about how smallpox has been eradicated. Why has monkeypox not been eradicated? Smallpox being eradicated basically left an ecological niche for some of these other related viruses to potentially feel. We know that monkeypox is a virus that mostly circulates in animals, but can spill over into human populations. As humans become more interactive with their environments due to deforestation, climate change, we're seeing more of these spillover events. And what that does is it gives an opportunity for a virus that is typically circulating in an animal reservoir to better establish itself within a new host, in this case, in humans. So for the longest time, from the time

that monkeypox was first identified as causing human disease in the early 1970s up until now, if you look through history, there have been a total of cases in the thousands, but nothing to the scale of the millions of cases that we had with smallpox. So there was always a threat that this would become a more significant viral infection that could cause bigger outbreaks in humans. But it wasn't to the degree that people sort of felt that they needed to respond with an aggressive campaign to eradicate it. And that's why for the longest time, monkeypox was a neglected infection. And it's only now that it's demonstrating itself to be an important public health concern and having the potential to spread well beyond endemic geographies, if given the right conditions, that it's being taken a lot more seriously. I guess one question I have then is, you know, do you feel as someone

who spent so much time studying this, that this outbreak that we're seeing now could have been prevented? Were there signs? Well, I think that there was always the threat that this could cause bigger outbreaks in humans. And that is why it's always important when you have infectious disease pathogens with outbreak potential to be able to have surveillance systems in place that track these infections and better characterize the reservoirs of where these viruses are circulating and the risk of these viruses spilling over into different communities. What that sort of surveillance allows us to do is they allow us to then be able to institute measures to preemptively anticipate these

outbreaks from occurring and reducing spillover events. When I talk about measures, we know that the smallpox vaccine can provide up to 85 percent protection against monkeypox. One could could always think about, you know, a situation where populations that live in close proximity with the virus reservoir can be preemptively vaccinated so that there is sort of a wall of immunity that protects them from recurrent spillover events. And not only for monkeypox, this also extends to lots of other viruses that have similar potential to cross over into humans and cause similar outbreaks. I'm also sure it's not lost on you that we are talking about this disease spreading around the world right now in the shadow

of the COVID-19 pandemic. And I guess, do you think we would be paying as much attention to it if we hadn't been primed for the last couple of years to be just incredibly aware of diseases spreading rapidly around the world? I think that you raise an absolutely fantastic point is it's not until recently that the wider public has taken a more keen interest on diseases with pandemic potential and epidemic potential because we're still reeling from the effects of what has been an absolutely devastating COVID-19 pandemic. And I think that that is reflected in sort of the response and reaction and attention that the current monkeypox outbreak is generating within the general public. And while this

awareness is great and people now have a more heightened sense of the fact that these diseases exist and we should be taking them seriously, there are also downsides to it, right? We're now seeing outbreak investigation have to happen under the glare of the public eye and you're having to navigate informing the public with a whole barrage of misinformation and disinformation, which also doesn't really make the work of public health experts and scientists around the world much easier in terms of getting out the right information. You know, so it's about finding the right balance between the heightened awareness that means that people are probably more attuned to doing the things that they need to be doing in order to stop the spread of a potential outbreak,

but also balancing that with not fueling hysteria and panic and making sure that people get the right and correct information. So I know this is a thread that you've been pulling on throughout this entire conversation, but I wonder if it's worth me really asking you this question straight. So obviously, monkeypox is not COVID. And I wonder if you could just compare and contrast those two viruses for me. could just compare and contrast those two viruses for me. Yeah, I think that it definitely monkey pox is not is not COVID. As I mentioned before, over the past 50 years, we've had multiple outbreaks, multiple recorded outbreaks of monkey pox in history. And we have been able to contain most of these outbreaks. So we know what works in terms of being able to intervene and stop the spread of monkeypox. We know that it's important to identify cases.

And when those cases are identified, it's important to trace the immediate contacts, isolate them, monitor them for the development of symptoms. And it's also important to raise public awareness so that people are on the lookout for new cases. The second differing point with COVID is when COVID first emerged, we did not have any immunity to that virus and there were no available vaccines. That is not the case for monkeypox. Like I mentioned before, the smallpox vaccine does provide up to 85% immunity and protection against monkeypox. And although smallpox vaccination stopped in the early 80s, there's still a significant population of people who did receive the smallpox vaccine.

We know that that immunity can be durable and these vaccines are still available today and can be used to vaccinate the vulnerable populations that may be at risk for coming in contact with monkeypox. So again, we have the tools in place that allow us to potentially contain this outbreak a lot more quickly and effectively than we did in the early days of COVID. And lastly, we also know that it's a virus that hasn't adapted to the human host in a way in which its transmission is facilitated and it can infect thousands and thousands of people in a single outbreak. So those are some of the differences that should be reassuring, but without downplaying the seriousness of the outbreak. And I still think that it's important that people are aware of what's going

on and to have a heightened sense of if you suspect something, know to seek the right medical advice so that you can be tested if it's indicated and that case isolated and your contacts traced as appropriate. Dr. Tuti-anji, this was incredibly helpful. Thank you so much for taking us through it. You're welcome. I hope it's helpful to your listeners. All right, that's allbc.ca slash podcasts.