Q & A with Houston Health Department’s Dr. David Persse
In an effort to respond to the devastating impact of the monkeypox virus, the Biden administration declared the outbreak as a public health emergency after cases spread to the U.S. and Europe.
Characterized as a virus which causes excruciating pain, monkeypox is a pox virus which induces an itchy rash of pimples or blisters covering the body—more markedly seen on the chest, face, feet and hands. The World Health Organization has also declared monkeypox a public health emergency of international concern in July 2022.
As of September 2, the Centers for Disease Control and Prevention (CDC) reported that 19,465 cases of monkeypox have been identified in the U.S. California has reported the most cases with 3,629 followed by New York with 3,367. In an informative, one-on-one interview, UH’s HEALTH Center for Addictions Research and Cancer Prevention (PI, Ezemenari Obasi) reached out to Houston Health Department’s Chief Medical Officer, Dr. David Persse to learn more about the symptoms of the virus and how to prevent the spread of monkeypox.
How contagious is monkeypox and how does it spread?
Dr. David Persse: “It is easily spread if you have vigorous skin to skin contact. We’re seeing the virus predominantly now in men who have sex with men community. The risk there is that they’re not only having intimate skin to skin contact, but they’re also having multiple partners. So, if you’re a man who has sex with men, but you’re in a monogamous relationship, then your chances of contracting it are essentially zero. Similarly, if you’re a heterosexual man but you’re having sex with multiple partners, then at some point you run the risk of running across someone who has monkeypox.
The virus can also be spread by respiratory droplets. The third way it can be spread is by fomite, which is essentially a piece of cloth, blanket, or bedsheets or an article of clothing that an infected person has had on them. We have small handful of cases, less than a dozen households where cases are spread to children--either through fomite or respiratory droplets or physical contact.”
Could you explain more about the severity of the infection from the monkeypox virus? How deadly is it?
Dr. David Persse: “Monkeypox is a DNA virus, and there are two clades of the monkeypox virus that exist. We’re seeing 8 to 10 percent of people who become infected with monkeypox here are reporting hospitalization, simply for pain control. The skin lesions are extremely painful. I’ve had patients describe this to me, as feeling like ‘it feels like there’s herpes everywhere.’ Or ‘I have shingles everywhere.’ Here’s the other thing, most viral illnesses like the common cold or flu—they’ll last 5-10 days at the worst, but Monkeypox is generally a 3-week illness, from 21 days on average up to 28 days.
Again, it lasts much longer. The real risk is the severely painful skin lesions. Those folks who are immuno-compromised—whether they be HIV-transplant patients, chemotherapy patients, or even patients who have more common immuno-compromised illnesses such as diabetes, you run the risk of having the worst complications. The more impaired your immune system is, the more severe and high-risk the complications will be. We’re absolutely seeing that. If you have any compromising underlying illnesses immuno-compromised illnesses, sometimes there are other problems. The virus itself can attack any organ system. If someone dies from monkeypox, it’s from encephalitis. Again, the numbers are very small. Encephalitis is one of the terminal events of this virus.”
What are some of the early symptoms of Monkeypox?
Dr. David Persse: “The challenges we have with monkeypox is that often the person will have their common viral symptoms, like body aches, fever and exhaustion. What we’re seeing a lot of this time, because it’s spread by skin-to-skin contact. We’re seeing the rash as an early symptom. The rash could start very innocently. It could look a small innocent pimple on your body, then it becomes a deep pimple. People will have varying degrees of these interruptions which will then turn into a large blister with a thick skin--a full thickness covering it. It goes from a clear blister to a white, thick milky blister before they unroot. They can be painful before they unroot and scab over. The entire time from the beginning when it starts as a pimple with a dot in the center, it is contagious. The skin has lots of active viruses on the outside. The skin is rather deep. It grows and eventually ruptures and scabs over. It will be contagious until new healthy skin grows in. That is when the infection stops.”
According to the Centers for Disease Control and Prevention, common monkeypox symptoms include:
· Swollen lymph nodes
· Muscle aches and backache
· Respiratory symptoms (ex: sore throat, nasal congestion or cough)
How will monkeypox impact college campuses? What advice would you give college students about this virus?
Dr. David Persse: “For college students, you will be at a low risk by just going to class. What you’re doing on your own time, you need to be careful. Let’s face it--college students, it’s a time in your life where you are exploring your body and other people’s bodies. The reality is that there are a lot of sexually-transmitted illnesses that you need to be concerned about—there's chlamydia, monkeypox, HIV, syphilis, gonorrhea.
Now you need to be concerned with monkeypox. We have outbreaks of all of those routinely here in an urban center and now you need to add to that--monkeypox. If you wear a mask, it provides little protection against monkeypox unfortunately. If you’re going to have an intimate relationship with someone, you need to have an intimate conversation. They need to talk about how many sexual partners they have. It is a very awkward conversation, but important to have. the stakes have just gotten higher.”
Which groups are most at risk? How do you prevent monkeypox from spreading?
Dr. David Persse: “At this point, we’re seeing predominantly the men who have sex with men community. If you are an individual who has multiple sexual partners, especially if you’re having multiple new partners or anonymous sex, I would say you are at a high risk for coming up with this virus. In that case, you need to get the vaccine. You need to consider curtailing your behavior for a while--and then if you get vaccinated, it will take six weeks after your first shot to have maximal protection of your vaccine. And the vaccine is 85 percent effective, it’s not 100 percent effective. It’s the combination of risk management.
If you want to eliminate your risk, then don’t have contact with anyone other than in a monogamous relationship. If you want to have low risk, really cut down on how many sexual partners you have, especially if you have anonymous sex and sexual partners, and go ahead and get vaccinated.”
How do I take action now to prevent infection from monkeypox?
Dr. David Persse: “The one piece of advice that I would like to add about this illness—it’s never the time for anyone to panic. It is the time for people to get educated and take a mature look at your situation. Make some healthful decisions about how you’re going to manage your situation. COVID-19 is out there—if you’re young and otherwise healthy, you are not likely to have a big problem with it, but you can infect someone who’s elderly and immune-compromised. So, you have a responsibility to get vaccinated, so you won’t infect others. Monkeypox is completely different. Right now, we’re worried about your health. Remember that about 8-10 percent of people who are getting infected are lying in the hospital because of pain control. You don’t want this.
The chances of someone dying from this are not 0, but they are really small. Again, educate yourself based upon mature, healthful decisions about what you are going to do to manage your health. Monkeypox will not impact the entire community, but those who it will impact will wind up in a world of hurt. I’ve seen some of the patients who are in the hospital for pain, and they’re miserable. They’re getting high-powered pain medication. They’re very uncomfortable and this goes on for 3 weeks.”
By Alison Medley