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Monkeypox: What Is It, and Should We Be Worried? An Interview with Dr. William Valenti

by Alexa Styliadis

What is Monkeypox?
Monkeypox is a member of the orthopoxvirus family that includes smallpox, orthopox and several other animal pox viruses. It's more commonly seen in countries in West and Central Africa, where the transmission goes from animals to humans.

But in general, it's a tropical virus limited to Africa. In the United States, the virus has been imported. There was a case in Texas a couple of years ago, when imported animals infected other laboratory animals.

What has changed? Why are we suddenly seeing Monkeypox in the Western Hemisphere?
There’s a new method of transmission that hasn’t been observed before - it’s being transmitted from person to person. It’s a new way of spreading virus.

Has the virus changed? If so, what contributed to the change?
Some people say that climate change changes the way that animals behave and where they live, and that may have something to do with the way that some of these infections are spread, but at this point, we just don't know. However, people were smart enough to recognize there was a new way the virus was spreading, and it put us on alert. We’re looking for it, managing it, and trying to stop the spread, before it gets to be a much bigger problem.

Could it be the next pandemic?
Viruses like this are unpredictable, so we really don't know what's going to happen. The best course of action, for now, is to be on the alert. That's the advice that I would give to my patients, to my friends, and to my medical colleagues. Be on the lookout.

What are the symptoms?
The big feature is a rash. And with this current outbreak, the rashes tend to be in the groin, around the rectum, on the trunk of the body, or on the hands and face. It’s either one small lesion or several of them together.

People also get sick. They have may have fevers, fatigue, muscle aches, and swollen glands on either the neck or the groin. It takes about two weeks for the infection to resolve. It’s what we call self-limiting - in other words, it takes care of itself. There really isn't any specific treatment for this virus, so patients wait it out.

Is this a serious illness?
I would consider it a serious condition if I had it because it can spread to others. You must isolate for about two weeks. We need to notify public health departments about new infections so we can stop the spread. It becomes disruptive.

So far we have not seen any hospitalizations or deaths as a result of these infections. Although people with HIV and AIDS may feel worse and be sick for longer, there isn't any difference, at least at this point, in terms of outcome. But one of the things we're going to learn is how immunosuppressed people react to this virus, and if there are any differences in people with immune suppression versus a normally functioning immune system. We'll learn about how this virus behaves in different populations of people.

We are seeing community spread. People have traveled to other places, acquired the virus at large events, traveled back to where they live, and spread the virus in their communities. It’s something that we want to try and mitigate, bring under control, and manage.

How does it spread?
It spreads through close contact and skin-to-skin contact. The kind of contact you have when you have sex. There's a lot of rubbing of skin and lesions. The wet, early lesions have virus in them. So with skin-to-skin contact, it sets up housekeeping in the other person. It's person-to-person, close contact.

I want to make the distinction between sexual contact and sexually transmitted infections. Monkeypox is transmitted through close contact, but there isn't any evidence that this virus behaves like the AIDS virus. It does not. And it's not in semen or blood.

Is the LGBTQ+ community at higher risk?
I want to avoid stigmatizing people. Some populations may travel to large events, and partying and sexual behavior may be part of the event, and they may bring that infection back. People meet people on social media apps, and have sex sexual contact with people who are not familiar, and they may travel to a country where the Monkeypox virus has been identified.

So, as of the moment, a large percentage of the people reported with this infection are men who have sex with men, but as we've seen in past pandemics, when things are transmitted by sexual contact, people who have sex are at risk here.

My take on all of this is that we need to wait and see. It appears to be very early in the course of this outbreak, and we have to see what's going to happen before we can say one way or the other; that it's one group or another.

But I'll tell you one thing. I'm certainly letting my LGBT patients know - my patients who are men who have sex with men - know what to look out for.

You were recently on a call with Dr. Fauci and Dr. Walensky?
Yes, the call was through the White House Office of Public Engagement. I’m in the LGBT Health and Advocacy group, with about 150 people.

But yes, I was on a phone call with Dr. Rochelle Walensky (CDC Director) and Dr. Demetre Daskalakis (CDC Director of HIV/AIDS Prevention) and my longtime colleague, Dr. Tony Fauci (NIAID Director) along with 100 or so my colleagues who are doing LGBT healthcare and advocacy work.

One subject we talked about was, how do we get the message across without misunderstanding or giving people the wrong impression? Because if you make it sound like it's men who have sex with men, then other people who may be at risk may have missed the message because “it's always somebody else's problem.” We made that mistake with HIV very early on and we don't want to do it again. It distorts the message. It's misinformation. This is transmitted through sexual contact.

The other thing we talked about was getting the word out to people, including men who have sex with people in LGBT health clinics. And encouraging more testing. Getting testing underway has always been a challenge with these kinds of public health events. It happened with COVID, it happened with HIV, and it's happening here.

But we've learned something from that. So we're going to try and move it along, so that more testing is available faster.

The other thing we discussed was the vaccine. There is a vaccine approved in the United States for both prevention and after exposure; pre and post exposure prevention of both smallpox and Monkeypox. The United States has about 110 million doses in the stockpile.

So we have to prioritize vaccines while we're waiting for more to be manufactured. And at the same time, we need to discuss who the candidates are for vaccination.

For starters, we're looking at animal care workers and people in health care - workers in areas where cases have been identified - to try and get ahead of it. We can prioritize vaccines and use the 110 million doses that are available, and use them wisely.

So stay tuned in terms of vaccination recommendations that will be coming – they’re coming down the pike at some point depending on the nature of this outbreak and how long it continues.

How does testing work?
It’s a two-step test. That's why it's a little complicated. The New York State lab tells you if it's in the orthopox family, and then it goes to the CDC, and then they tell you if it's Monkeypox. We want to do that same testing method locally through hospitals and commercial labs. So that it doesn't take so long, you get answers faster, and we can prevent opportunities for stepping spread. Now, if you suspect somebody is has has the rash of monkey pox, they need to be isolated pending laboratory testing.

How worried should we be?
Be on alert, but not on edge. We’ve learned enough from past pandemics to be able to look at this intelligently and remember that not all of these viruses are transmitted in the same way.

How does Monkeypox compare to HIV and COVID?
They’re three different viruses. The HIV virus causes AIDS. The coronavirus causes COVID-19. The Monkeypox virus causes Monkeypox. They are all transmitted in different ways.

HIV is transmitted through sexual contact in semen and blood, and needles.

The coronavirus is a respiratory virus spread though small particles and it infects large numbers of people.

Monkeypox takes a little more effort to spread from person to person, though close contact. You have to have contact with skin lesions that have virus in them.

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