Dr Zac Turner on the biggest monkeypox concern for Australians

Welcome to Ask Doctor Zac, a weekly column from news.com.au. This week, Dr Zac Turner discusses how the stigma associated with the monkeypox outbreak is dangerous for all Australians and how the outbreak is being managed.

QUESTION:

Hello Dr Zac, I’m going to Europe to embark on a cruise, and I can’t wait! But there’s one thing that worries me. Over the past two weeks, there has been a lot of talk about monkeypox explodes across Europe in gay communities it makes me nervous.

It seems our government doesn’t care as much as others – the US government just allowed the use of vaccines, but Australia didn’t.

Is there a reason the Australian government isn’t more proactive? Haven’t we learned from the HIV/AIDS epidemic? Is their inaction because the gay community shouldn’t worry monkeypox here in australia? I hear we already have 45 cases here in Australia – is it only a matter of time before we have numbers similar to those in Europe? — Benjamin, Adelaide

ANSWER:

Let’s start by saying that while monkeypox is a virus, it’s not like HIV/AIDS. Nor is it like the human papillomavirus (HPV) – a major cause of cervical cancer, which is often transmitted from asymptomatic infected men to women. Like any virus, it spreads in unique ways and has its own symptoms and treatments. I believe at-risk groups should receive increased education and expedited treatment (in this case, a vaccine is available) to avoid unnecessary consequences, especially for immunocompromised people in our communities.

Fortunately, monkeypox requiring skin-to-skin contact makes it far less infectious and transmissible than Covid-19. It is known to be spread between infected animals (originally monkeys, hence the name and prevalence in the countries where these animals live) and infected individuals. However, compared to many other viruses in today’s society:

• it is difficult to transmit

• it often does not need treatment because it goes away on its own

• and we have current vaccines that are effective both prophylactically (before exposure) and post-exposure.

We know that many diseases, including this virus, spread more easily in part because of climate change which allows viruses normally present only in very hot and humid conditions (such as those in central Africa) to now survive in Europe, the United States and Australia. . Although we still do not know the natural reservoir of monkeypox in countries where it has existed for many years, it can be assumed that the ease of travel these days will make containment and control of the virus a higher priority.

Monkeypox has been around for more than 70 years in various countries, and with respect to the recent global outbreak, there have been no associated deaths in countries outside of those where it is endemic (i.e. where it’s been around for decades) – so that’s reassuring.

While it might sound pretty nasty when people get infected and have boils and rashes, remember, the same goes for chickenpox if you’ve ever had it. Coxsackie virus, also known as “hand, foot and mouth disease”, affects day care centers and children around the world and is terrible in appearance, highly contagious and, like monkey pox, recovers quickly with very few long-term problems.

It is unnecessary at best, and extremely harmful at worst, to paint, label or stigmatize a virus against individuals, groups, countries, cultures or genders. The fact that this virus, which has been around for so long, can and is portrayed as a “gay virus” is a very dangerous narrative. I’ll explain why in a moment. Virus misinformation has had a profound effect on people over the centuries and we must learn from these past mistakes.

Anyone can get monkeypox, but in the last outbreak the virus was mainly spreading among men who have sex with men – at this stage. Monkeypox is not considered a sexually transmitted disease although it was recently classified as a “communicable disease of national importance”, which is an important decision by health authorities as it will allow rapid dissemination of resources and vaccines available.

As I indicated in my previous article on monkeypox, prolonged skin-to-skin contact is one of the main causes of current transmission. The transmission rate of monkeypox, even through prolonged close contact, is very low – with only about 3% of contacts infected.

If you are one of those 3% infected, after 5 to 21 days after exposure you will usually have fever, headache, muscle aches, and your lymph nodes may also swell.

Soon after, rashes often appear on your hands, feet, and face. These are probably the photos you have seen on the Internet. As with most viruses, it can cause fever and upper respiratory symptoms like a cough or runny nose.

I think the Australian government should step up health communications about the virus and educate Australians on how to limit transmission. They should also eradicate any growing stigma that this is a gay virus, and as I will explain below, why accelerated vaccines are so important.

Although a high proportion of cases have occurred among men who have sex with men, this could easily have been an outbreak in other networks where there is person-to-person contact – such as a football team , a nail salon, a massage studio, a brothel, a church choir or even a daycare center. As long as there is prolonged skin contact in the network, there is a risk of a monkeypox outbreak.

The problem with letting this stigma form is that people will believe they won’t get monkeypox because they’re not gay. So if they have the virus, they will unknowingly infect their community and its vulnerable people. Or if their symptoms are really bad, they will refuse treatment and suffer alone because they fear their friends will call them gay.

Now on to your question about the Australian government’s reluctance to vaccines. Let’s start by saying that there are treatments and vaccines that work – so at this point, no need to worry about waiting a year for a vaccine to be made. As with all medicines and vaccines that work, there is a risk of side effects.

Unlike Covid-19, HPV and other viruses whose transmission is both rapid and with severe complications, people with monkeypox like those with chickenpox have in the past recovered quickly and completely. The benefit/risk balance of vaccinations should always be discussed with a healthcare professional and not with your Twitter or Facebook feed. At this stage, vaccinations will only be necessary for individual cases and groups exposed during the incubation period and their close contacts.

I think the Australian government should take stock of its monkeypox vaccines and proactively provide them accordingly to clustered areas across the country. But I don’t believe it should be publicly and directly targeted at gay people and say, “This virus only affects you, you just need to be vaccinated.

Any Australian who is infected should be vaccinated, regardless of their sexuality and gender.

How to protect yourself from monkeypox

Over the past few weeks, I have stayed in touch with several colleagues abroad about their countries’ access to vaccines and the response to this outbreak. I’m quite happy to say that I was surprised at the level of access to foreigners who contacted the vaccine and overseas medical centers.

At the time of writing, I know of Australian citizens who have been able to arrange for a vaccine while already overseas with a wait time as short as 3-4 days. I have some careful advice if you’re like some of my patients and friends who go “summer in Europe” (i.e. go to festivals, go clubbing, or hang out on cruises where you’ll be , or could potentially come into close contact with other party goers).

I would definitely recommend booking with a GP in Australia and making sure all your vaccinations are up to date. And if the monkeypox vaccine isn’t available to you yet, check online and pre-book something overseas. And do it on the first day in a country where you can get a reservation.

There are a number of measures and habits to take in order to limit cases in the community. I have worked throughout Central Africa and the Congo and although this disease is more common in these areas, we were much more aware of the need for rigorous personal hygiene. We were also vaccinated before venturing into these areas.

Wash your hands! Like all other viruses and diseases, washing your hands with soap goes a long way in limiting transmission. Hand washing with alcohol also works well. Although it can probably be assumed that the cases of monkeypox patients in Australia have not been in close proximity to monkeys or other animal vectors, we must be particularly careful at this time until we let’s know exactly how it spreads.

Remember that if you are not feeling well at all, it is time to stay home or if you have to go out, wear a mask as this will reduce the spread of droplets which can infect others. If you do end up getting monkeypox, isolate yourself from others and seek advice from medical professionals.

Benjamin, have fun on your vacation! Stay safe, get vaccinated if you can, and watch for symptoms.

You have a question:

askdrzac@conciergedoctors.com.au

Dr. Zac Turner holds a Bachelor of Medicine and a Bachelor of Surgery from the University of Sydney. He is both a doctor and co-owner of a telehealth service, Concierge doctors. He was also a registered nurse and is also a qualified and experienced biomedical scientist in addition to being a PhD candidate in biomedical engineering.

Originally published as Dr Zac Turner on the biggest monkeypox concern for Australians