Let’s Talk about Monkeypox

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University (IMU)
FACT 1
MONKEYPOX IS CAUSED BY, YES, THE MONKEYPOX VIRUS
This virus belongs to the same family (Poxviridae) as the smallpox virus.

“The monkeypox virus was first isolated from a colony of monkeys in the 1950s, hence the name. Although it is called ‘monkeypox’, monkeys and humans are incidental hosts,” explains Professor James Koh Kwee Choy, an infectious disease consultant. “The actual reservoir is unknown, but is likely to be certain rodents.”

What we know it that the virus can be transmitted from animals, such as primates and rats, to humans. From thereon, the virus can be spread by humans to other humans and even other animals.

FACT 2
MONKEYPOX IS NOT A NEW DISEASE, AND IN FACT USED TO BE PRETTY RARE… UNTIL 2022, THAT IS
Monkeypox was first identified as a cause of disease in humans in the 1970s, when it was detected among certain populations in the Democratic Republic of Congo (at that time, the country was called Zaire).

Because outbreaks were rare and the spread was limited outside of the African continent, in the years after researchers assumed that the virus spread to humans in an ‘inefficient’ way.

Well, that assumption was definitely challenged in the May 2022 monkeypox outbreak!

“This outbreak is unusual because, in the past, the number of cases were small,” shares Prof James. “This time around, there is a wider and faster spread, and the symptoms or presentations are also different.”

In light of the outbreak, the WHO has since declared monkeypox an ‘evolving threat of moderate public health concern’.

YOU MAY HAVE MONKEYPOX IF YOU…
  • Develop a rash at or near your genitals or anus; other possible locations for the rash include your hands, feet, chest, face, and mouth
  • The rash may look like pimples or blisters, but will go through several stages (including scabbing) before healing
  • The rash can be painful or itchy
  • Some people may also have symptoms such as fever, swollen lymph nodes, aches in their muscles and back, headaches, coughing, sore throat, etc
  • Symptoms can vary from person to person; some may develop a rash first before other symptoms, while others develop the symptoms first and rash later, or they only develop a rash with no other symptoms
FACT 3
MONKEYPOX ISN’T ALWAYS FATAL, BUT THAT DOESN’T MEAN WE SHOULD TAKE IT LIGHTLY

Monkeypox has a recorded fatality rate of 1% to 10%.

Without any treatment given, the disease can usually resolve on its own between 2 and 4 weeks.

However, some people with monkeypox may develop severe complications, especially if they have existing health conditions or are undergoing treatments that weaken their immune system. These people will need hospitalization and close medical care.

FACT 4
MONKEYPOX CAN BE SPREAD THROUGH CLOSE & PROLONGED SKIN-TO-SKIN CONTACT

Prof James emphasizes that it is important to remember that transmission requires prolonged exposure to the infected person.

Brushing against someone in a crowded place, for example, or quickly kissing someone are unlikely to cause transmission.

So, what are the more likely means of transmission that we should be aware of?

  1. Direct contact with the rash or body fluids of someone with monkeypox—note that this includes not just oral or penetrative sex but also touching, kissing and other face-to-face contact, hugging, massaging, and other intimate acts with the infected person
  2. Prolonged contact with items that are or have been used by someone with monkeypox, such as clothing, bedding, towels, etc.
  3. Prolonged exposure to the person’s respiratory secretions, which are produced when they talk, sneeze, cough, etc
  4. An infected pregnant woman may spread the virus to the child she is carrying
  5. It is also possible that one may contract monkeypox from eating poorly-cooked meat of infected animals, or from scratches and bites of infected animals

Someone with monkeypox can spread the virus from the time they develop their symptoms until the rash is fully healed.

FACT 5
MONKEYPOX IS NOT A ‘GAY PERSON’S DISEASE’—IT CAN AFFECT ANYONE AND EVERYONE

While it is certainly true that monkeypox currently affects a large population of men who have sex with men (MSM), it will be a mistake to assume that it is a disease that affects only these men.

As we have seen, the virus can spread through other means other than sex, so people that don’t engage in acts of intimacy with members of their own sex shouldn’t be complacent and assume that they are safe from it!

FACT 6
YES, THE SMALLPOX VACCINE MAY HELP, BUT THINGS ARE NOT SO STRAIGHTFORWARD

While smallpox and monkeypox are two different diseases, Prof James notes that the smallpox vaccine can help reduce the risk of catching the monkeypox by up to five times.

“Most Malaysians born before 1980 are vaccinated against smallpox as part of the National Immunisation Programme of that time,” Prof James notes.

Unfortunately, smallpox vaccines are not readily available. Therefore preventive strategies are important.

Click on the image to see the large version.

References:

  1. Ladnyj, I. D., Ziegler, P., & Kima, E. (1972). A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bulletin of the World Health Organization, 46(5), 593–597. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2480792/
  2. Thornhill, J. P., Barkati, S., Walmsley, S., Rockstroh, J., Antinori, A., Harrison, L. B., Palich, R., Nori, A., Reeves, I., Habibi, M. S., Apea, V., Boesecke, C., Vandekerckhove, L., Yakubovsky, M., Sendagorta, E., Blanco, J. L., Florence, E., Moschese, D., Maltez, F. M., Goorhuis, A., … SHARE-net Clinical Group (2022). Monkeypox virus infection in humans across 16 countries – April-June 2022. The New England journal of medicine, 10.1056/NEJMoa2207323. Advance online publication. https://doi.org/10.1056/NEJMoa2207323

Must-Know Facts about Respiratory Syncytial Virus

WORDS DR LEE ONN LOY

FEATURED EXPERT
DR LEE ONN LOY
Paediatrician
Mahkota Medical Centre
WHAT IS RESPIRATORY SYNCYTIAL VIRUS? 

Respiratory syncytial virus (RSV for short) is a common respiratory virus that usually causes mild flu-like symptoms, except in infants and elderly people.

There are two sub types of RSV, RSV-A and RSV-B, which co-circulate during the same season with alternating predominance.

However, we do not test for sub types in Malaysia, mainly because we do not have seasonal weather and there is no difference in disease severity between the two sub types.

WHO ARE MOST AT RISK WHEN IT COMES TO GETTING INFECTED?

Children are more prone to be infected due to their immature immune systems and first exposure to the virus.

They are often exposed to and infected with RSV outside the home such as in daycare centres or school.

WHO ARE MOST AT RISK OF DEVELOPING SEVERE COMPLICATIONS?

People who are at higher risk of severe RSV disease are:

  • Prematurely born infants
  • Children with congenital heart disease or chronic lung disease such as asthma
  • Children with compromised or weakened immune systems either due to medical conditions or medical treatments
  • Adults with compromised immune systems
  • Elderly people with existing health problems or co-morbidities
HOW DO I KNOW IF I MAY HAVE CAUGHT RSV?

Symptoms of RSV are just like those of normal flu, such as:

  • Fever
  • Cough
  • Decreased appetite
  • Lethargy
  • Wheezing and difficulty in breathing

Consult a doctor if you or a family member show these symptoms.

HOW IS RSV TREATED?

There is no ‘one size fits all’ treatment for RSV.

We usually treat it with paracetamol and antihistamines.

If a child catches the virus, the doctor will monitor the child to ensure that they are eating and drinking well.

When there is no improvements seen, and when one becomes lethargic and develops wheezing and breathlessness, they should be admitted for fluid infusion, regular nebuliser therapy, and oxygen when necessary.

WHAT CAN PARENTS DO TO PROTECT THEIR CHILDREN FROM RSV?

Firstly, we should know how RSV can spread. Common ways of transmission are:

  • When an infected person coughs or sneezes, and the virus droplets find their way into your eyes, nose, or mouth
  • When you touch a surface that has the virus on it like doorknobs, and then touch your face before washing your hands
  • When you have direct contact with an infected person, such as kissing the face of a child with RSV

There are a few things parents can do to protect their children against RSV such as:

  • Keeping them away from close contact with sick people
  • Teach them and encourage them to wash their hands often with soap and water for at least 20 seconds
  • Teach them to avoid touching their face with unwashed hands
  • Don’t send your unwell kid to school or centres, and limit the time children spend in child care centres during outbreaks if possible
CAN ONE DEVELOP RSV, FLU, AND COVID-19 ALL AT THE SAME TIME?

Yes, but this is not common. Should it happen, though, the complications are going to be very severe with a high risk of death!

Hence, people should go for influenza vaccinations yearly, especially during the COVID-19 pandemic.

Immunise2Protect Campaign Urges Parents to Protect Their Children against Chickenpox

WORDS LIM TECK CHOON

While Malaysians these days are fully aware of the importance of COVID-19 vaccination, the Immunise2Protect campaign urges parents not to overlook other important childhood vaccinations for their children, particularly the chickenpox vaccine.

Immunise2Protect is organized by Immunise4Life, an expert-driven community education initiative to promote immunisation against vaccine-preventable diseases and to address issues surrounding vaccination hesitancy and refusal. This initiative is a collaborative effort of the Ministry of Health Malaysia, the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

WHY VACCINATE OUR CHILDREN AGAINST CHICKENPOX?

Contrary to the still popular perception that chickenpox is a harmless bother, it can lead to dangerous complications that require hospitalisation or may even result in death.

Even the act of scratching the itchy lesions can lead to secondary bacterial infections of the skin and soft tissue.

Children with eczema or dermatitis may develop severe skin symptoms when they contract chickenpox.

Additionally, chickenpox may also cause infection of the lungs (varicella pneumonia), inflammation of the brain (encephalitis, cerebellar ataxia) and infection of the liver (hepatitis).

Another cause of concern is that once a child has caught chickenpox, the Varicella-zoster virus that causes the infection will continue to stay in an inactivated state in their spinal cord.

Later in life, as the child’s immune system weakens with age or stress, this virus can be reactivated to cause a very painful infection called shingles.

BENEFITS OF THE VACCINATION

The chickenpox vaccination helps prevent chickenpox.

Some people that are vaccinated against chickenpox may still get the disease. When that happens, the symptoms are usually milder with fewer or no blisters (they may have just red spots) and mild or no fever.

The chickenpox vaccination also helps protect from the serious complications that require hospitalisation.

Please Take This Short Survey about COVID-19 Vaccination and Your Child

WORDS ASSOCIATE PROFESSOR DR ERWIN KHOO JIAYUAN

The survey is now closed. All parties involved would like to express their gratitude to everyone that participated in the study.
FEATURED EXPERT
ASSOCIATE PROFESSOR DR ERWIN J KHOO
Consultant Paediatrician & Head of Paediatrics Department
International Medical University (IMU)
IT CAN BE CHALLENGING FOR A PARENT TO DETERMINE FACTS FROM FICTION WHEN IT COMES TO NEWS ON SOCIAL MEDIA

Netizens who are vaccine hesitant have an alarming footprint on social media. In a vicious cycle, their hesitance is likely to be fueled by health (mis)information obtained from a variety of sources, including news media such as the Internet and social media platforms.

As access to technology has improved, social media has attained global penetration. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns.

These worries may be magnified in the face of the ongoing COVID-19 pandemic. As the development and subsequent deployment of more vaccines are expected to play a critical role in downstream emerging pandemic control efforts, social media will remain a powerful tool. Most concerning is how (mis)information and (un)substantiated reports on its platforms will threaten to erode public confidence even well before the release of any scientific evidence.

It is not readily evident why social media is so disproportionately successful in promoting vaccine hesitancy as opposed to uptake. Social media users may represent a skewed population sample with baseline misperceptions regarding the benefits and side effects of vaccination whilst simultaneously lacking familiarity with the consequences of vaccine-preventable disease. Moreover, when evaluating the risks and benefits of vaccination in general, the risks may be overestimated and may seem more immediate, and tangible as compared to the more abstract potential benefits of disease prevention.

IF YOU ARE A PARENT WITH A CHILD UNDER 18, PLEASE SPEND 15 MINUTES TO HELP US BETTER UNDERSTAND THE SITUATION

SOcial MEdia on HesitAncy in Vaccine E-survey or in short, SOMEHAVE, is a multinational collaborative study between International Medical University (IMU), the Singapore’s National University Health System (NUHS), National University of Malaysia (UKM) and Universiti Malaya (UM)

The study uses unidentified e-survey for parents with the aim of seeking the impact of social media on vaccine hesitancy.

For the English survey form, please click here (link opens in a new tab).

For the Bahasa Malaysia version, please click here (link also opens in a new tab).

[IRB Ref No: IMU R 279/2021, UKM PPI/111/8/JEP-2021-824, NHG DSRB (Singapore) Ref: 2021/00900]