You’ve probably been hearing a lot about monkeypox in the news lately. But what is it exactly, where does it come from, how is it transmitted, and how dangerous is it? This week, Ben talks with University of Iowa infectious diseases experts Michael Pentella and Christine Petersen about monkeypox.

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Ben Sindt:

Hello, everyone, and welcome back to From the Front Row. You’ve probably heard a lot about monkeypox outbreaks in the news over the past few months and there are cases across the U.S. and across the globe. With that comes many questions. To answer those questions, we are speaking with two of our resident infectious disease experts today, Dr. Michael Pentella, director of Iowa’s State Hygienic Laboratory, and Dr. Christine Petersen, director of University of Iowa’s Center for Emerging Infectious Diseases. And I’m Ben Sindt. If you’re here, welcome. We’re a student run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside of the field of public health. Welcome to the show, guys. So let’s get this started. At a very microscopic level, what is monkeypox and do you know where it’s from? Or is it actually from monkeys? Or what’s the basic questions here to get us started?

Michael Pentella:

Well, I think monkeys have bad rap in this. It’s not from monkeys, but this is a relatively large virus and it is a DNA virus. It has a double stranded DNA as its genetic material and it belongs to the genus Orthopoxvirus and the family poxviridae. So there’s a lot of other pox viruses. We’re most familiar with smallpox, so it’s a relative of smallpox. And monkeypox is also related then to cowpox. Jenner worked with cowpox virus to vaccinate against smallpox because there was a cross reaction there. But there’s also things like horsepox, there’s raccoon pox, volpox. All these other pox viruses are members of the same family.

Christine Petersen:

So in terms of where it comes from, just because this is my literal neck of the woods, I guess, this is one of those diseases that is believed to exist in animal populations. We don’t know exactly what small creature is likely to be the number one. But based on outbreaks that have occurred in the past, we think it’s probably small rodents.

Michael Pentella:

In Iowa in 2003, we saw monkeypox imported in the Gambian pouched rats, that then also transmitted it to other animals. And pocket pets were the source of transmission to humans.

Ben Sindt:

Thank you for that very brief intro there on monkeypox. Obviously COVID-19’s been the big virus that’s been in the news. Maybe you’ve heard of it the past few years. So how is monkeypox then different say than to things where more the layman person is used to then?

Christine Petersen:

Well, most of us have had a different virus, which actually isn’t a pox virus at all, but it does cause similar pustules or raised bumps that don’t feel so good. And that is of course chicken pox. Really the only thing that they have in common is the variable pox upon you. But that’s the whole idea is that all of these viruses can cause that raised skin lesion. And that’s really what most people will think about when they hear pox. So the big message is chicken pox isn’t a pox.

Ben Sindt:

So how worried should I, you, me, or anyone really be about it then?

Michael Pentella:

I wouldn’t be worried at all because there’s very few cases in the state. So the best thing is to take precautions when you might have a risk of exposure. And right now it seems to be concentrated in the men who have sex with men population. But there’s no reason why the virus can’t infect anyone. So consequently anyone who’s going to experience close contact with another person should be alert to avoid those kinds of lesions, in contact with those lesions. And it’s also thought it could be spread by close contact and speaking with someone, but that really hasn’t been well established yet.

Michael Pentella:

As we learn more throughout this epidemic will know more about transmission. But avoiding contact with the lesions and also contaminated clothing, towels, those kinds of items that could be cross contaminated. Sheets, for example, could be cross contamination that could expose one. But there’s very few cases in the state right now. I believe we’re less than 25 cases, either 24 or 25 today. And it’s progressing very slowly throughout the country. There’s over 8,000 cases throughout the country and throughout the world there’s over 60,000 cases. So what really needs to happen now is containing it and preventing transmission so that it doesn’t become pandemic.

Ben Sindt:

So you just answered my next question of who’s most susceptible to it. It sounds like there’s no one in particular most susceptible. Males having sex with males seem like it’s higher right now. But anyone can get it is what you’re trying to say. Right?

Michael Pentella:

Right. It’s not going to be exclusively in one population or one group of people. It has the potential to infect all people.

Christine Petersen:

And in fact, there was a case report of a pair of partners who also, like a lot of people, share their bed with their dog. And the dog actually got it just from the pox virus material being on the sheets and coming into contact with that. It was a little Italian greyhound that has really thin hair. So that skin to skin contact with those sheets could happen quite easily.

Ben Sindt:

All right. So clearly we know the best thing to do is avoid contact, but what are the signs and symptoms? How do I know what to avoid outside of lesions? What should I be looking for? What should the general public be looking for?

Michael Pentella:

Well, it’s primarily the lesions that you’re worried about at this point, but an individual would have a number of signs and symptoms of that. So watch for rashes, scabs and body fluids as well. And look for people who have those kinds of signs and symptoms after an exposure. The incubation period can be anywhere from a week to two weeks. So it’s a relatively long incubation period. And you’re going to have people who may have some additional signs and symptoms like fevers, headaches, muscle aches, those kinds of symptoms as well can occur. So it’s a mixture of symptoms that you would expect from somebody, but primarily look for the lesions. There’s some thought that some individuals may not have visible lesions. They may be hidden from view, but we don’t know how infectious those individuals would be at this point.

Ben Sindt:

So you’re saying though, incubation period’s about a week or two. Is that about similar for how long you become infectious to other people then? Or am I getting it backwards? Or how long until you start showing very visible symptoms?

Michael Pentella:

Well you’re going to be infectious as long as you have those lesions and scabs. So it could take you up to a month to resolve all the lesions and scabs falling off. But individuals will have a full recovery. The strain of the virus that seems to be circulating right now throughout the world has very, very few deaths associated. And the only death that I’ve heard about in the U.S. was in an individual who was immunocompromised. So they had a weakened immune system and they were more susceptible. And unfortunately, they did succumb to the viral infection. But most individuals, once they heal, they’ll be completely better and they won’t be transmitting the virus. As far as we know, an individual does not harbor the virus past those lesions healing and the scabs falling off. But the scab material itself contains viruses, so you have to watch out for that.

Ben Sindt:

So are there any complications? You mentioned the one person who died who was immunocompromised, but are there generally other complications with monkeypox besides just having the lesions?

Christine Petersen:

So in those people who are at risk of higher, more severe signs, those immunocompromised folks, you can have secondary infections. So like a pneumonia on top of it, get a blood infection with that bacterial pathogen, encephalitis. And you actually can have your cornea get infected and that can cause loss of vision.

Michael Pentella:

With people reporting those, severe pain with the lesions. They’re very painful lesions.

Ben Sindt:

My parents are optometrists, so I guess I’ll have to talk to them about the vision part there. But let’s start moving into how can we slow the spread of monkeypox? I’ve been hearing a lot of talk about the vaccines already developed. How did we do that?

Michael Pentella:

Well, the vaccine was developed way back in 2019, that they’re currently distributing. JYNNEOS vaccine was developed, though, to protect us against smallpox, which is something that we worry could be a biological threat agent. But they developed this vaccine. It works against monkeypox and is protective. And so individuals who could be exposed to someone, once that person has been identified to have monkeypox, they’re being offered the vaccine to protect them from developing the disease. And some people are discussing when more vaccine is available, will they have pre-exposure prophylaxis? Some communities will be able to do that when the vaccine is available to do it. And they’re also concerned about healthcare workers, of course. So healthcare workers will be in a group that would be offered the vaccine too. Right now, for example, people in our laboratory who work with the samples have been offered the vaccine. Plus we use other precautions of course, like using personal protective equipment, working inside a biological safety cabinet, et cetera, to protect us from getting the infection.

Christine Petersen:

And there is, as you heard, because of this cross reaction of immunity between smallpox and monkeypox, there are older vaccines that are also being put to use now, like AMCAM 2000. This was first approved in 2007, and that was right around the time that those anthrax letters had been sent. So we were worried about all those bio-terror agents. So there was a lot of increased awareness and desire to be protected against such agents. So at that time they came up with the next generation of vaccines that were particularly pushed out to the military and groups at really high risk. So that’s the good thing is since the very first vaccine, where we were looking at cross reaction across these different pox viruses, that’s been the beauty is to be able to use them to protect against each other. But the flip side is that might be why we’re having bigger outbreaks right now. Because we used to have widespread smallpox vaccination and we now have a much more naive population because smallpox was eradicated.

Ben Sindt:

So basically what I got out of is this vaccine is safe and effective, that it’s been tested for quite a long time.

Michael Pentella:

Well, there’s something you have to realize in that too, Ben, in that statement. We know it’s safe. We know that it is effective, but we don’t know how effective. No vaccine’s a hundred percent. So I wouldn’t think if I’m vaccinated for something, it’s a hundred percent going to protect me and I shouldn’t still take other precautions. Because it’s only one tool in your arsenal. You still want to avoid someone with lesions. You still want to take the precautions not to get exposed, but it’s good that you have the vaccine.

Christine Petersen:

Yeah. So here, because of the current risk population, it’s really talking about safe sex, condom use, something that can avoid that skin to skin contact where those lesions are.

Ben Sindt:

So you guys are much more experts than most people in the state. What’s the monkeypox situation looking like here in Iowa, then? Is it overblown in the media just for something to talk about? Or is it a growing problem we should be concerned about right now?

Michael Pentella:

Well, I don’t know if I’d call it overblown in the media. It’s something that people need to be concerned about. But it’s not something that you should be overly concerned about because it’s not increasing at an exponential rate. So we’re not climbing the epidemic curve. We’re seeing a few more cases each week, one or two more cases. And we’re testing. We’ve tested over 300 people so far, but we only have about 25 positives. So low occurrence. And I think that taking precautions all the time, having safe sex practices is really what’s necessary here.

Michael Pentella:

The good news is that people who are at high risk want to get vaccinated. People who have been exposed want to receive the vaccine. And according to an MMWR article, people are changing their behaviors, having less risky exposures than they had in the past because they know this is out there and they want to protect themselves. So it’s a really good sign that people who could be at risk are taking the public health message seriously and adapting their behaviors accordingly. Because that’s what’s going to control this. Having a vaccine is great, but adapting behaviors to take less risk is really key.

Christine Petersen:

And of course those behaviors won’t just help prevent monkeypox, but they’ll also help spread of HIV, syphilis, gonorrhea, chlamydia, all the STIs. So it’s one of those things that will have benefits across the board.

Ben Sindt:

Awesome. So our final question here, pretty up in the air. Answer it however you want. It can be about your career as a whole or monkeypox specifically. But what’s one thing you thought you knew but maybe later you came out that you were wrong about it and had to learn and adapt? This question can be for both of you too.

Christine Petersen:

Well, I think with each passing day, what I learn, particularly with infectious diseases, is the more I spend time on this planet, the less I think I know because there’s always some twist. There’s always something new. It’s great because it keeps me on my toes. But yeah, it keeps me humble because I’m not always a good batting average, let’s say.

Michael Pentella:

Same here, Christy. The more I study infectious diseases, the more I recognize that microbes do what microbes do best. They reproduce. They infect other people. They get transmitted to other individuals. It’s only through human behavior modification that we can make progress with prevention. So let’s count on the microbes being transmitted and count on them being reproduced. And there’s so many microbes that we don’t even know about that cause disease. And there’s also the sequela of infectious diseases that we’re learning more and more about all the time, that we understand that we do not know everything about infectious diseases.

Christine Petersen:

And then the last caveat I would give is usually trying to do interventions with people is a lot more complicated than doing them with our other animal friends. So that’s why it’s important to figure out what other creatures are in these life cycles. Because we might be able to do things, for instance, with our different pocket pets that we can’t do with people.

Michael Pentella:

Yeah. That’s what makes mice such great animals to use for studies. They’re so close to human. Wouldn’t know that from looking at them.

Christine Petersen:

Yeah. So it’s definitely true that studies in laboratory mice have been really helpful for human health and for veterinary health. But of course, we love to do studies where it benefits both the animals and the humans.

Ben Sindt:

Yeah, it’s definitely good to consider what role animals can play in research and prevention of infectious diseases. Before we wrap up, is there anything you guys would like to say about monkeypox?

Christine Petersen:

I don’t think so. I mean, all the curves are looking pretty good that it’s coming down, but just because we’ve controlled it doesn’t mean that we know how it started in the first place. And I think that’s what we have to get back to is how do we protect our populations better from this? And I think that’s going to be maybe going back to at least in certain groups, maybe in Nigeria and the Congo, and actually vaccinating people for it.

Ben Sindt:

That’s an important thing to consider and a good note to end on. Thank you both for taking the time to inform us about monkeypox and I hope you both have a great rest of your day.

Anya Morozov:

And that’s it for our episode this week. Big thanks to Dr. Michael Pentella and Dr. Christine Petersen for coming on with us today. This episode was hosted by Ben Sindt, written by Anya Morozov and Ben Sindt, and edited and produced by Anya Morozov. Our podcast is available on Spotify, Apple podcasts and SoundCloud. And you can learn more about the University of Iowa College of Public Health on Facebook. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can always reach us at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.