Watch the AMA’s COVID-19 Update, with insights from AMA leaders and experts on the pandemic.
Topic presented and speakers
Topic presented and speakers
In today’s COVID-19 update, Monkeypox’s questions about transmission, testing, treatment, prevention, personal protective equipment (PPE) and more were answered by Sandra Fryhofer, MD, Chair, Board of Directors of the American Medical Association and AMA Liaison to the Advisory Committee on Immunization Practices. Todd Unger, AMA Experience Director, is the host.
Resources available on monkeypox.
Learn more at the AMA COVID-19 Resource Center.
Speaker
- Sandra Fryhofer, MD, Chair, Board of Directors, AMA; WADA Liaison, Advisory Committee on Immunization Practices
Unger: Hello, here is the American Medical Association’s COVID-19 Update video and podcast. Today’s topic – what you need to know about monkeypox with Dr Sandra Fryhofer, WADA Board Chair and WADA Liaison to ACIP, the Committee CDC advisory on immunization practices in Atlanta. This interview with Dr. Fryhofer was filmed the day before monkeypox was declared a public health emergency in the United States on Thursday, August 4. This information is therefore more important than ever.
I’m Todd Unger, Director of Experience at AMA in Chicago. Hello, Dr. Fryhofer, welcome back.
Dr. Fryhofer: Hello, Todd, and thank you for having me.
Unger: Well, we’ve seen so many recent reports of monkeypox. Let’s start with… tell us how serious it is.
Dr. Fryhofer: The AMA is focused like a laser beam on improving the lives of physicians and our patients. And we are very concerned, deeply concerned about the public health crisis that monkeypox will cause our nation if we do not act decisively and act now.
We need to learn from our experiences with COVID and not make the same mistakes. It’s not, in quotes, “over there”. It’s rare but it’s there and you have to deal with it. And, yes, it can happen to a patient in our practice. We have to think about it if we see a patient with a new rash or blister.
Doctors sometimes refer to unusual diseases and conditions as zebras. Well, be on the lookout. This zebra could be in your garden.
Unger: Now people are very used to case numbers, of course, coming out of COVID. What numbers are we talking about and why are they so significant at this point?
Dr. Fryhofer: The World Health Organization has declared monkeypox a global health emergency. Currently, the United States has more than 5,800 cases. The first case in the United States and the current outbreak was confirmed on May 18. And with community spread, those numbers are increasing every day and every hour. The CDC has an online map with the total number of confirmed monkeypox cases by state that is updated Monday through Friday. And some of the states with the highest number of cases are New York, California, Illinois, Florida, my home state of Georgia, and also Texas. The governors of New York, California and Illinois have now declared a state of emergency for monkeypox.
Unger: Who is most at risk of monkeypox right now?
Dr. Fryhofer: Many cases are in men. So, and so far, the vast majority of cases involve MSM and the LGBTQ community. But we are also seeing cases in women and now in children. Anyone and everyone, regardless of gender identity or sexual orientation, is at risk if they have had close skin-to-skin contact with someone who has it or if they have been exposed to contaminated materials, including towels, linens and other personal items. elements.
It can also be transmitted, but not as easily, in respiratory secretions, which means you can catch it from prolonged face-to-face contact with an infected person. And that includes kissing.
Prior to this current outbreak, cases were linked to travel to endemic areas or exposure to infected animals. But we are now seeing a person-to-person community spreading here in the United States and around the world. Those most at risk of serious infection include immunocompromised people, pregnant women, patients with eczema or atopic dermatitis, and children under eight years of age.
Unger: So when we talked about community spread and the importance of really trying to stop it right now, what’s the biggest obstacle to stopping the outbreak?
Unger: Unfortunately, there is a lack of understanding among the general public about the disease. And let’s face it, a lot of us doctors don’t have much experience with monkeypox and we need to change that. We must spare no expense in educating physicians and the public about the symptoms of the disease and what to do if the patient develops blisters or a rash and possible risk of exposure.
Dr. Fryhofer: Understand, monkeypox can be a charade. It can be confused with other infections, such as herpes and chickenpox or even syphilis. It can coexist with other infections. Patients can be simultaneously infected with monkeypox along with something else.
Unger: So with easily confused symptoms at times, when talking to our audience of doctors, what symptoms should they be looking for?
Dr. Fryhofer: The incubation period is approximately one to two weeks and patients may experience flu-like symptoms, fever, headache, muscle aches, fatigue, swollen lymph nodes before the start of the rash, but not always. Some patients complain of isolated rectal pain. The rash may be flat or raised and look like an ingrown hair or pimple.
The rash can be painful, painless, or itchy. It may look like spots, blisters, pustules or scabs. Skin lesions are often described as deep, firm, rubbery, and umbilical, which means they often have a small bump in the middle.
You are contagious once symptoms start and remain contagious until the scabs fall off and a new layer of skin forms. The illness usually lasts about two to four weeks.
Unger: Let’s talk about testing and treatment. There is confusion. What is the appropriate protocol?
Dr. Fryhofer: Unlike COVID, when we had to invent vaccines and antivirals, we already have two FDA-approved vaccines that can be used for monkeypox: ACAM2000 and Jynneos. These can be given to those exposed to reduce symptoms as well as to those at increased risk of exposure for prevention.
We also have FDA-approved antiviral drugs to reduce disease progression – TPOXX, aka Tecovirimat, and cidofovir, brand name Vistide. These antiviral drugs and vaccines were originally developed to treat or protect against smallpox or other infections. There are also FDA-approved vaccine immunoglobulins for the treatment of severe cases.
If you see a patient who has been exposed to monkeypox or who has an unexplained rash or blisters, think “Could this be monkeypox?” and test it. If there is any suspicion, isolate the patient first. Put them in a private room. And before collecting the sample, healthcare personnel should put on full PPE – gloves, gown, N95 mask and eye protection.
To test, vigorously swab the lesion or puncture it with a small 25-gauge needle. Soak up any fluid on a swab and send it to the health department or commercial lab. At least five major commercial labs, including Labcorp and Quest, are now able to test for monkeypox. Also, be sure to disinfect the room after the patient leaves.
If the test comes back positive, contact your local health department for vaccines and antivirals. The AMA CPT code update now includes codes for monkeypox diagnostic tests as well as vaccines.
Unger: So it can be a bit complicated. It is certainly urgent. Any final thoughts on how we can remedy this situation?
Dr. Fryhofer: We need to educate our patients and the public on how to prevent the spread of disease. Patients should avoid skin-to-skin contact with anyone who may be at risk. If someone has monkeypox, they should isolate themselves from friends and family to avoid spreading it through contact with them or with towels, sheets, etc. contaminated.
If we educate doctors and the public about how to avoid monkeypox, how to recognize symptoms, and ensure access to FDA-approved tests and treatments and vaccines, we can stop the spread. We need to get the doses of vaccine we have to the people who need them most now. We need to take the vaccines out of storage and put them in the guns.
The President has now appointed a Monkeypox Response Team to coordinate these efforts. The federal government must also increase funding to get more patients vaccinated and treated to stop this spread. If we act quickly, we can contain this disease and improve the health of the nation.
If we don’t act quickly, this outbreak will turn into another pandemic. We could then be dealing with monkeypox spreading among young children in schools and daycare centers and then bringing it home to parents and grandparents. Nobody wants that. It would be a disaster for patients and doctors, so it should be avoided.
Unger: Absolutely. And Dr. Fryhofer, thank you for being here and bringing us this perspective, this information for physicians, residents, medical students and the public looking for more information about monkeypox. The AMA has built a resource center on monkeypox accessible via the AMA website. And I encourage everyone to take a look. This includes videos like the one we’re doing right now and others with information you need.
That concludes today’s episode. We will come back to you with more information as the situation evolves. In the meantime, you can check out all of our videos at ama-assn.org/podcasts. Thanks for joining us, everyone. Please take care.
Disclaimer: The views expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of WADA.