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Interviewer: Ever since the first case of monkeypox was first identified in the U.S. in May of 2022, there's been concern about the virus and its potential to spread. With newsfeeds featuring images of patients with rashes and lesions, as well as the news that by August, monkeypox has been seen in nearly every U.S. state, it leaves some to wonder if this could be another pandemic.

We spoke with two virologists from University of Utah Health to get their professional opinion to better understand the virus, how it spreads, and perhaps most importantly, how to protect yourself.

Dr. Sankar Swaminathan is a professor and the chief of the Division of Infectious Diseases at University of Utah Health. Dr. Adam Spivak is a researcher and physician with the Infectious Disease Clinic.

Dr. Swaminathan, let's start with the basics. What is monkeypox, and how does it impact the body?

Dr. Swaminathan: It's a viral infection caused by a virus that is related to smallpox and causes lesions or sores on the body, and really can be any part of the skin or mucus membranes. That's the inside of the mouth and the genitals. So that's the primary symptom that people have. It can also cause fever and swollen lymph nodes.

The type of lesion can be quite variable, but generally speaking, they start out as bumps, papules, and they can have a little indentation or dimple in the center of that papule. They can become pus-filled, and eventually, they scab over and they fall off, and they can leave a scar. They're fairly deep-seated, so they can be quite painful. And especially if they're in the mouth or genitals or the rectum, these places obviously can cause a lot of pain.

Interviewer: Now, where exactly did the disease come from? I've never heard of monkeypox before until just a month or two ago.

Dr. Swaminathan: It's been recognized in Africa, in various parts of Africa for quite a while, for decades in fact, and there's been very little spread outside of local populations.

Interviewer: And why are we seeing it now?

Dr. Swaminathan: That's a very good question, and I think a lot of people are trying to answer that. Like I said, we haven't seen this sort of person-to-person transmission, particularly in Western Europe, and in the U.S., and other parts of the world, and now it's become essentially a worldwide problem. The WHO has declared it to be such.

And I primarily think it's just found a niche in people who have close contact, particularly sexual contact, and it's spreading in a way that it might not have been spreading before. It doesn't necessarily mean that the virus has changed, although I think that remains to be determined, whether there've been any changes in the virus that's making it behave in a new way.

Interviewer: And speaking of that, when the World Health Organization declared it an emergency, what are these different groups so concerned about with this particular disease, with its spread, etc.?

Dr. Swaminathan: We realized that there's potential for widespread transmission. And how widespread it's going to be or can be, I think, still remains to be determined, but there's enough of a risk that the WHO has alerted everybody to this.

I think it's compounded by several factors. One is I think our capabilities in terms of testing, vaccination, and treatment have all been somewhat limited, which has allowed the disease to spread pretty rapidly in some areas like New York, and I think the concern is that this could happen elsewhere.

Interviewer: So why don't we move on a little bit to talking about how to identify this disease? So we've talked a little bit about that it looks like a lesion, but some of the things I've been seeing online is it looks like an ingrown hair, or it can be really hard to spot. For someone who is concerned or wants to know whether or not they might have monkeypox, what exactly are they going to be looking for before they go and get help?

Dr. Swaminathan: First I think is how likely it is that they've been exposed. It's people who have been in situations, parties, or group encounters, or raves, or whatever, where they are in contact with a lot of different people, so that's the risk factor.

And if you have had recent intimate contact with somebody, and you don't know exactly what their recent contacts have been as well, it's possible that they may have transmitted it to you without your realizing it.

And like you said, some of the especially initial manifestations may not be particularly alarming or severe, so that transmission could occur even though people aren't aware that they are infected.

Interviewer: Do the lesions change over time, how it expresses itself on the skin?

Dr. Swaminathan: Yeah, they usually progress or evolve. Like I said, they'll start out as a bump and then can become more liquid-filled, pus-filled, can become more painful, and they can break down so that they form an open sore. But eventually, they will scab and fall over. And this can take a couple of weeks or more for it to be fully cleared, and for the person then to not be infectious.

Interviewer: So these particular lesions are . . . like you were saying, they're full of the virus. That's a major infection vector, is the lesions themselves?

Dr. Swaminathan: Correct.

Interviewer: Okay. Are there any other vectors for this particular disease?

Dr. Swaminathan: Certainly other intimate contact like kissing and so on could spread it, but mostly it's skin-to-skin close contact. It can be spread by infected or contaminated clothing, bed sheets, towels, things like that. So any time people are living together in the same household, there's a possibility for transmission even if they're not having intimate contact with each other.

And also, we think that droplets . . . This doesn't seem to be a primary means of spread, but droplets from person-to-person who are sitting in close enough proximity that coughing, sneezing, even a lot of talking could potentially have airborne spread in that manner through respiratory droplets.

Interviewer: Now, does the disease impact anything other than the skin, or is it just a lesion-based kind of virus?

Dr. Swaminathan: Like I said, the other systemic manifestations as we call them are that you can have fever, and swollen lymph nodes, and fatigue. There haven't been any deaths in the U.S. that we know of from this, but it can be quite a severe illness in terms of . . . Usually, there's actually spontaneous recovery, but can lead to fairly severe symptoms that would make somebody not want to get up and leave their bedroom.

Interviewer: Would it require people to get hospitalized for any reason?

Dr. Swaminathan: It could, but generally speaking, we haven't seen that. Hospitalization might be required for severe intractable pain, or inability to swallow, eat, getting dehydrated, or secondary infection, an infection on top of the lesions with a regular bacterial infection, for example. Those would be unusual, but possible reasons why people would have complications and require hospitalization.

Interviewer: So how does someone keep themselves safe from monkeypox?

Dr. Swaminathan: So I think avoiding those types of encounters as much as possible is really almost the only way to protect oneself. Having multiple sexual partners and not knowing very much about what their risk has been, what are their habits, and so on.

Interviewer: In my research, I have been finding some really strange ways to protect oneself. We've had people being like, "I know it's hot in the summer, but just wear a long sleeve t-shirt, and you'll be just fine." I've seen, "Put Carmex on your lesions, and you'll be able to prevent the virus from passing to another person." Are there any known ways to prevent the spread of this disease? And is there any merit to any of these?

Dr. Swaminathan: So I think that you can take precautions if somebody in the household is known to be infected. And I think it would be straightforward, even if it wasn't easy, to make sure that there are no shared utensils, and no shared bedclothes, towels, and all that kind of thing, and that those were properly sterilized in the wash and dryer.

However, as we said, because it's not just from the act of having sex, that intimate contact would be hard to prevent with barrier methods. You'd essentially have to encase yourself from head to foot to prevent skin-to-skin transmission. And once you have lesions, there's no question that you should seek medical attention, and you should isolate. Because until those scabs are all gone, you're going to be potentially infectious, and you should really not have any type of skin-to-skin contact with other people.

Interviewer: So if someone does contract monkeypox, if they see those lesions, what is the first thing that they should do?

Dr. Swaminathan: I think if there's a concern that there's monkeypox, they can get tested. And we have started testing here at ARUP. We can generally get tests back in two to three days, and maybe sooner. And hopefully, we can keep up with the demand because I have a feeling that demand is going to continue to increase. But it's very good that ARUP . . . There are many labs that have now been approved to do this kind of testing, and we're not just depending on one or two centralized state or CDC labs.

Interviewer: So Step 1, if you think you've got something, go get tested. If that test comes back positive, what's the next step?

Dr. Swaminathan: Like we said, prevent yourself from giving it to other people. So you would need to isolate and take the precautions, which you can get detailed instructions from a healthcare provider.

And there is an oral treatment, which is approved for smallpox but is not officially approved for monkeypox because it really hasn't been tested in clinical trials against monkeypox, but we think it would work. It works in animals against monkeypox, and it certainly works in the laboratory, and it's a similar virus. So this drug called Tecovirimat, or TPOXX, should work, but it's only approved and can only be given under strict regulations.

So we're restricted in who we can give it to, and it's basically for people who have severe disease. There are various definitions for that, but it has to be severe disease, not just mild, a few skin lesions. And also for people who are at high risk, so people who are immunocompromised, whose immune system is weak, whether it's from cancer, or an organ transplant, or advanced HIV infection, or other immune deficiencies. So those people would be eligible for being treated, and we can treat them if we think that they have monkeypox, or we know that they have monkeypox.

Interviewer: But for most people, the treatment is not necessarily approved for everybody that gets monkeypox?

Dr. Swaminathan: Correct.

Interviewer: So quarantine, what does that look like in a household? Are you closing yourself off in a single bedroom?

Dr. Swaminathan: That would be the easiest way to do it, but that doesn't mean you can't come out of your bedroom. You should probably not share the same furniture as other people until you are over your period of isolation.

Interviewer: And how long is that period?

Dr. Swaminathan: Three weeks or so. All the lesions have to have been essentially healed over.

Interviewer: And how long after they've all been healed over are you good to go?

Dr. Swaminathan: Once all the lesions are healed, you shouldn't be infectious any further.

Interviewer: Is there any potential long-term consequences for a monkeypox infection?

Dr. Swaminathan: Not that I know of, but again, we're somewhat in uncharted territory. But generally speaking, recovery is thought to be complete.

Interviewer: So not super life-threatening, but you might be left with some scars?

Dr. Swaminathan: Yes.

Interviewer: Severe scars? Mild scars?

Dr. Swaminathan: Again, it depends on the number and location of the lesions.

Interviewer: So let's talk a little bit about vaccination. Is there a vaccine available for monkeypox?

Dr. Swaminathan: Yes. So the one that's currently being given is a vaccine that is based on the same virus that's used to vaccinate against smallpox. We don't routinely use that live form of vaccinia of smallpox vaccine because we've stopped vaccinating people against smallpox since the '70s. That vaccine is available and is thought to protect against monkeypox as well, but the incidence of complications with that vaccine is high enough that that older smallpox vaccine is not being used for monkeypox.

What we have is a newer vaccine that's made with a weakened or attenuated form of vaccinia that can't replicate, but it can stimulate the body to make an immune response against smallpox, and monkeypox, and so on. And that is effective both in animals that are challenged with monkeypox as well as in the laboratory. So that's the vaccine that we can give, but it is in somewhat limited supply currently. And like I said, we prioritize people who are at highest risk for it.

Interviewer: Now, speaking to you, Dr. Spivak, one of the first questions I'd like to ask you just to get it out of the way, with your experience researching viruses and treating HIV, is monkeypox a gay disease?

Dr. Spivak: Nope. It's a human disease. I don't know that there is such a thing, certainly not in virology, not in medicine, and not in existence in the world that I'm aware of such a thing as a gay disease.

And by way of background, I'm a physician caring for people living with HIV, very interested in preventing HIV, and I study HIV in the laboratory. Certainly, there's some background to my answer there, as, of course, HIV as a predecessor to this one, this latest outbreak of monkeypox, was often labeled a gay disease.

And just to elaborate a little bit because that, of course, sounds purely like opinion, the number one risk factor for acquisition of human immunodeficiency virus worldwide is heterosexual sex.

Interviewer: Heterosexual sex, really?

Dr. Spivak: Yep. So there are about 75 million people worldwide that have ever acquired HIV infection. Approximately half of them have died of the disease in the last 40 years since we first discovered it. So there's somewhere around 35 million people living today on Earth with HIV. And again, the majority of those folks acquired this disease sexually through heterosexual sex between men and women.

There's a fairly complex and really fascinating story about why HIV is prevalent among gay men, among men who have sex with men, and transgender women in Europe and in the United States. And that has to do with the transmission of the virus as it evolved, as the epidemic spread, where it first originated in West Africa, out to Haiti, and out to the Western world through sex, but also through blood products.

It's a complex story, but in any case, there are some pretty well delineated and well-understood reasons why HIV is more prevalent among men who have sex with men, again, in the United States and Europe. And that, of course, did give rise to this false notion that this was a gay disease, that heterosexual individuals were not susceptible, that this was somehow something that could be attributed to a man having sex with a man, which is entirely untrue.

And I think that the way I try to summarize that for medical students is to say that the disease actually . . . In the case of HIV, of course, it can also be transmitted through injection drug use, but by and large, we consider it a sexually transmitted disease, and that means humans having sex. The disease does not tend to discriminate, but people do.

Interviewer: And so while we are seeing more cases currently in the U.S. among men who have sex with men, that does not mean that this disease is any . . . there's not anything about the disease that specifically impacts one orientation over the other.

Dr. Spivak: No. There is zero evidence of that being the case. It does appear to be disproportionately affecting gay men at present, but the best we understand . . . And again, I think it's worth pointing out that there are a lot of unknowns here, and I certainly would not ever claim to sit here and have all the answers. In any case, the best science now seems to indicate that this virus spreads through skin-to-skin contact. And that is to say contact with your skin against the lesion on someone else's skin. Sex is a fantastic opportunity for skin to meet skin.

I don't think we really have a good answer as to why it is occurring predominantly among men who have sex with men, but as far as we know right now, there is absolutely no reason to think that this could not be spread from any type of skin contact, again, healthy skin touching against skin where there is a lesion. And we all have skin.

Interviewer: So, with that in mind, is this technically a sexually transmitted disease, or sex just happens to be a place where skin-to-skin happens?

Dr. Spivak: Yeah, I think it's a really terrific question because certainly, the biological mechanisms are exactly as you said, that sex is a great opportunity for skin to be vigorously rubbing against skin, and so a great opportunity for the disease to spread. But that's not the only way that we come into contact skin against skin.

When we call something an STD or sexually transmitted disease, that obviously implies a specific route of transmission. I think this could be categorized as an STD. There are also implications for that, around calling something an STD, because of our morals and our discomfort, I think, in our society about talking frankly about sex. That, I think, has given a lot of people in medicine pause about calling this an STD.

And I think we're trying to be sensitive to the fact that there were lessons to be learned, and there are lessons to be learned about HIV. And as I shared with you, sort of a common misconception 40 years into an epidemic that frankly should be controlled, but isn't . . . and I'm talking about HIV . . . there's still this perception that this is a gay disease. As I shared with you, that's just not born out by facts. There's nothing about this virus that indicates that it has any predilection for gay men at all.

Interviewer: So circling back to the state that we're in right now with monkeypox, we see the news every day, it's on the rise, it's scary, it leaves scars, we've done pieces about how it's transmitted, etc., but are there any steps that someone can take to make sure to protect themselves from potentially getting infected?

Dr. Spivak: Yeah, that's a great question. And the answer in some respects is similar to what we've learned, unfortunately, the hard way with COVID, though you could argue the glass is half full there, and I'm getting at vaccines. We have a vaccine against monkeypox, which is pretty remarkable that we actually had the vaccine present before the outbreak. And again, that's the glass half full.

The glass half empty is there's not a lot, not enough to go around. We don't have it here yet. That's largely because the supply is limited, but the Department of Health to their credit acquired vaccine from the federal government and tried to disperse it quickly. The Utah AIDS Foundation led by Ahmer Afroz has done a phenomenal job at getting information out and actually getting vaccine and distributing it.

I think we have a long way to go there, meaning that a lot more folks probably should be vaccinated. And frankly, anyone who wants to be, thinks they may be at risk, should be vaccinated. I don't think at this point, and we're in mid-August of 2022, that we have enough vaccine to go around. And so there have been decisions made about who gets priority, which is unfortunate from a public health standpoint because this is going to allow the disease to spread.

It is a disease that's spread skin-to-skin and spread by touching or coming in contact with these lesions, and so what that means is beyond vaccines, which are preventive, if you think you may have this, you should come and get checked out. We have a great diagnostic test.

And ARUP has been at the forefront. They're a phenomenal lab. They're an international leader, and they came out in end of July with their own monkeypox PCR test. Our clinic managers, and the urgent care staff, and people in the ERs, and people in our primary care clinics have rapidly become aware that this is out there. We're seeing more cases because people are coming in, and then physicians, and physician associates, and APCs are recognizing it. And clinic managers, and nurses, and clinic staff are taking the right maneuvers to sample the virus, meaning there are collection procedures that have to be put in place.

All this happened very quickly, and I think COVID did teach our health system how to be a little more quick to respond. And so that's been really encouraging. Working together, we can recognize this. Led by Jeannie Mayer, a hospital epidemiologist here, we can really as a system start to adapt to a new disease. So that's all encouraging.

I would say that people need to be aware that it's out there. They need to come in and get checked. We have a great test, and we actually have a great treatment. I could keep going on and on, but I'll stop there.

Interviewer: There seems to be a lot of fear out there right now, especially with limited supplies of vaccines, etc. Do you think that fear is founded?

Dr. Spivak: I do. Yeah, I do. It's scary. I've cared for a few individuals with monkeypox, and I'd say one thing. Again, I tend to be a glass-half-full, optimist-type person. It's not COVID. And what I mean by that is people are recovering. We have, to my knowledge, yet to have a monkeypox fatality, and yet it is symptomatic. People experience a lot of pain with it.

I think, obviously, it's to be avoided, but it's not quite in the same ballpark, I think, when we talk about in the intensive care units across the country where there was no vaccine, no treatment, and it was spreading like wildfire. We're really not in that situation.

But on the other hand, as I shared earlier, there are a lot of unknowns here. Maybe this is a mild strain, and we're going to see it get worse, or who knows what. But I don't think so. I think this is going to be a little bit milder.

I think the fear is justified because our public health measures aren't enough. We don't have enough vaccine, and we should be vaccinating everybody that wants a vaccine. We don't have quite enough of this therapeutic medicine to go around. It's a bit of a headache bureaucratically to get it, though I'll say that is part of my job, and we'll do it, jump through the paperwork hoops. That's fine.

The first patient I've treated with this drug called Tecovirimat, which is specifically . . . It's not FDA approved, but they have what's called an investigational new drug application, and that allows us to give it for this indication. The very first patient I've used the drug for had a really exciting turnaround in his symptoms, severe pain, and rash, and within about 48 hours, he got better. Now, that is what we call in science an N-of-1, but no side effects and a great recovery. Obviously, we have a lot more to learn, but that's encouraging.

Interviewer: You may have heard there's a new shingles vaccination, and your doctor might have recommended that you get it. Should you? Well, we'll talk about that next on The Scope.

Announcer: Access to our experts with in-depth information about the biggest health issues facing us today. The Specialists, with Dr. Tom Miller is on The Scope.

Interviewer: Let's talk about shingles. First of all, let's just set the stage. What is shingles?

Dr. Miller: Let's talk about that. So shingles is what we call recurrent chicken pox. Now, before the chickenpox vaccine was given routinely to children, most of us, probably greater than 95% of us, have had chicken pox and may not even remember it as kids. Now, once you've had it, it never goes away. The virus goes into your nerves in your spine and hides, and for reasons that are not entirely clear, probably because our immune system sort of forgets that the virus is hidden over time, chicken pox comes out again as shingles or herpes zoster. So it doesn't present as a fulminant, itchy rash like we get when we're kids, but it comes out in specific areas where the nerves innervate parts of the skin.

Interviewer: Meaning it's painful.

Dr. Miller: Well, it's painful, and what's even more concerning and more damaging, probably 10% to 20% developed what we call postherpetic neuralgia, which is a pain that continues after 90 days. And it's very severe and very hard to treat. Some people when they have postherpetic neuralgia can't even wear a shirt because it's painful.

Interviewer: Sounds miserable.

Dr. Miller: Treatments are not very good either. So the best you can do is prevent shingles.

Interviewer: And there is a shingles vaccine. And a lot of people have already gotten it, and now I'm hearing about a new shingles vaccine. So help me kind of reconcile if I should get it or not.

Dr. Miller: Well, that's right. So we say there's about a 30% lifetime chance that you'll develop shingles, and shingles rises in incidence after the age of 50, and by the time you're 80 years old, probably about 20% of people who develop shingles will have postherpetic neuralgia, which is this chronic pain that goes on and on and on.

If you vaccinate, it's basically waking up your immune system to watch out for that virus sneaking out of its hidden cave and coming back and bothering you. So the first vaccine was a live vaccine that was developed in the middle of the last decade. And it was pretty darn effective. But there's a new vaccine that is recommended even if you've had the older vaccine, that is not a live vaccine. And the advantage to that is we can now give this newer vaccine to patients who are immunocompromised. That is to say that their immune system is not quite up to par. It would have been dangerous to give them even a weakened live vaccine because they could develop full chicken pox. So we didn't we didn't give that older vaccine to folks who are immunocompromised.

Interviewer: So if you've been told you couldn't get the shingles vaccine before, now you can?

Dr. Miller: Now you can.

Interviewer: Okay.

Dr. Miller: If you have a history of being immunocompromised.

Interviewer: So that person for sure should get it. Who else should think about getting it?

Dr. Miller: Well, anyone who's over the age of 50 and certainly over the age of 60, the advantage to the newer vaccine is it is a more potent and efficacious vaccine. It works better than the older vaccine. So, in time it will become probably the sole vaccine available.

The issue with the newer vaccine is, one, it has more side effects. And two, it's costly and the older vaccine was costly, but this is a little more costly. So side effects, and what I mean by that is about 10% of the time people after getting the vaccine will develop a flu-like illness that's bad enough that they may not want to go to work.

Interviewer: So symptoms like chills, body aches . . .

Dr. Miller: Chills, aches, malaise, you just don't feel quite right. It lasts for 24 hours to 48 hours and then it's gone. This is not a reason to not get the vaccine. It's self-limited. It doesn't mean that it's going to go on. It was also a sign that this is a very immune genetic vaccine, that it is revving up the immune system and making the immune system remember that it has to go after the zoster or go after the shingles virus if it comes out of the nerves in the spine. And we know that this new vaccine is more effective in the sense that it lasts longer.

Interviewer: So if I got a shingles shot a couple years ago, and I'm 65, if I'm over 50, should I really consider turning around and getting this one?

Dr. Miller: The recommendation is to receive the new vaccination, even if you had Zostavax, the first vaccination, the live vaccination that was out.

Interviewer: At any point?

Dr. Miller: At any point.

Interviewer: Okay.

Dr. Miller: Well, I probably say, if you've had Zostavax, you would wait a year, maybe two or three years before getting the new one.

Interviewer: You can talk to your physician about that if that's the case, yeah.

Dr. Miller: You can talk to your physician. And then I think the second thing is some people assume that this particular vaccine is covered under Medicare. Certain vaccines are covered under visits during for people who have Medicare insurance, such as the flu shot and a couple of other vaccines, pneumococcal vaccine for instance. This one is not. It's covered under Part D. So you really need to find out from your insurance what the cost of this vaccine will be. The other slight disadvantage with the newer vaccine is it's a two-shot vaccine. You take the first shot and then come back in three months for the second shot.

The total course of therapy on average or treatment on average is about $340 if you were just to pay out of pocket, and for many people who don't have insurance, that's a big inhibitor. But since most of us over 65 will have Medicare and some coverage, it'll be cheaper. But again, check with your private insurance or check with Medicare to know what it's going to cost you so you don't get hit with sticker shock.

Interviewer: Yeah, and then take a look at I mean, it sounds like if it develops into the long-term chronic pain, not being able to put on a shirt, I mean, that sounds like it might be worth figuring out how you could come up with a little extra money if you're not able to.

Dr. Miller: Well, that's true. I think one of the problems that we see folks experience, they come in and they hear about it, and then they get the vaccine, but they experience the sticker shock. And either they decide not to get the vaccine or they wait.

And just as long as you know what the cost is, you can make an informed decision. And I certainly recommend it in all of my patients over the age of 50 and certainly over the age of 60.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: Meningitis can be very scary to see your child go through. What are the types of meningitis and how is it treated? I'll discuss this on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Meningitis is an infection of the tissue and the fluids that surround the brain and spinal cord. There are two types of meningitis. There's viral and bacterial. Luckily, we don't see bacterial meningitis as much as in the past and that's in a large part due to three vaccines. The Hib and pneumococcal vaccines your child gets with their baby shots protects them from several types of bacteria that cause meningitis in young kids, and the meningitis vaccine that is required for middle school and high school protects them as teenagers.

The symptoms of bacterial and viral meningitis can look very similar and they are very scary. The biggest signs are that your child will have a splitting headache which is worse if they are in a lighted area. They will be unable to move their neck without moving their entire upper body. They may be confused, or if your child is a baby, they will be very fussy and they're constantly crying like they're in pain, and sometimes, it's a really high-pitched cry. It's a very odd cry. They will also be very nauseous and vomiting, sometimes projectile vomiting. Babies who still have their soft spot can have bulging there. It's pretty noticeable, so you'll be able to tell.

Meningitis can only be diagnosed with a spinal tap. This is done in the emergency room where they can take a sample of spinal fluid and test it in the lab to see if your child has meningitis. And if so, is it bacterial or viral? Your child may also have an MRI or a CT of the brain before the spinal tap is done.

Bacterial meningitis can be deadly, so it's extremely important to have them seen as soon possible. Treatment involves IV and oral antibiotics, and your child will also have blood tests done to make sure the infection is responding to the medicines. This is most definitely a hospital admission, and it could be for days or even weeks.

There's no medicine that can be given to treat viral meningitis, unfortunately. The most important treatment is to help your child stay hydrated, give pain or fever medicines, and let them rest. Since different viruses cause meningitis, it may take from two days to make them feel better or up to two weeks.

Both viral and bacterial meningitis can be passed from person to person, which is why it's important to teach your child how to cover their cough and everyone needs to wash their hands frequently.

Remember, all kids and adults can look and feel pretty horrible when they get sick, but the signs and symptoms of meningitis are pretty specific and recognizable, especially, the severe headache and the not being able to move one's neck without significant pain or vomiting. If your child has those, go straight to the emergency room to find out if they have meningitis or not. Quick thinking on your part can save your child's life.

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Interviewer: You get bitten by some sort of animal, whether it's a dog or a wild animal, the first thing you probably are starting to worry about is, "Did I get rabies?" We're going to find out more about that next on The Scope.

Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. You get bit by an animal, I think the first thing a lot of people think after, "Ouch," is, "Ooh, do I have rabies?" Is that a real threat?

Dr. Madsen: It's a real concern. So, primarily, you're thinking about this with dog bites, cat bites, raccoons, foxes, and bats. And one of the really interesting about bats is, and this is something I've found kind of fascinating, the Centers for Disease Control, the CDC, actually recommends if you wake up and you look at the ceiling and there's a bat there, they actually recommend getting the rabies vaccine in that situation. The idea being that you may have been bitten by the bat during the night, you may not know you've been bitten, the bite marks are usually so small you can't see them. So the concern is that great.

There are certain animals that you may get bitten by and you may wonder about the concern about rabies, animals like rabbits, rats, mice. Those are not really concerns. The big thing I think about in my mind, typically, the animals that are going to transmit rabies are animals that are not necessarily vegetarian-type animals. So rabbits, those things, they don't really transmit rabies. It's more things like foxes, skunks, raccoons, these kinds of scavenger animals that may be eating some meat here and there. Those kinds of animals are sometimes those that carry rabies and those are the ones we get concerned about in saying, "Hey, if you've been bitten by one of these animals, we probably need to think about rabies."

In terms of dogs and cats, if it's an animal where you don't know the dog or you can't observe it, you don't know if it's had its shots, those are also animals where absolutely we worried about rabies and we treat you potentially to prevent a rabies infection.

Interviewer: So if it's a neighborhood dog, good idea to go talk to that neighbor, get that information and save yourself from the rabies shots, I suppose?

Dr. Madsen: Exactly.

Interviewer: If you find out, no, they haven't had their vaccinations, but they don't seem to be showing any symptoms, or you've been bitten by another animal where you're unsure, what would the next steps be?

Dr. Madsen: Then, that's a situation where you need to get the rabies vaccine. And what that involves, first of all, is giving them a medication at the site of the bite wound to prevent rabies infection. It's not necessarily the vaccine, but it's something that kind of neutralizes the virus if it is there. And then I start them on a series of basically four shots, where they'll come in, they'll get the shot that day, they'll come back in a few more days, get another shot. These are all vaccines to prevent a rabies infection.

And that's a precaution I'm going to take on anyone who comes in after a bite from any animal that could be carrying rabies. And the reason we're very, very cautious in that situation is because there's not much you can do if someone gets rabies. It's something you really want to prevent. You don't want somebody to catch it because if someone catches rabies and they actually develop the disease, it's almost universally fatal.

Interviewer: Really? So it's bad news, it's serious stuff.

Dr. Madsen: It's bad news if you get it, yeah. It's one of those things you can try and treat it and try and get them through it, but it's a horrible thing to get. So really, the treatment for rabies is prevention.

Interviewer: Gotcha. And these shots, they used to be in the stomach, right? And I heard they used to be really painful and there are a lot of them, but you're saying there's one at the site and then four more after that. Where are those four more?

Dr. Madsen: They're just in your arm or your leg. It's not in the stomach. I remember hearing that as a kid as well.

Interviewer: Has that ever been true?

Dr. Madsen: I don't know. That's . . .

Interviewer: Oh. Not since you've been in medicine.

Dr. Madsen: Not in the last 15 years that I've been in the medical profession.

Interviewer: Okay. All right.

Dr. Madsen: I don't know. I heard that too. I remember always hearing that you had to get a shot in the stomach and I thought, "Wow, if I got bitten by a dog, no way would I want to go get the rabies shot because that sounds miserable." But no, these are shots, you give them the same place you'd give a tetanus shot or something like that. They hurt a little bit, kind of like a tetanus shot would, but it's not something, like some really crazy shot that you're getting in your stomach.

Interviewer: Yeah. And better than the alternative.

Dr. Madsen: It's much better than the alternative. Exactly. You don't want to get rabies.

Interviewer: And is this an ER-only thing or could you do an Urgent Care for this?

Dr. Madsen: I think Urgent Cares can do this. I can't say I've looked into it specifically to see if they offer the rabies vaccine in most Urgent Cares, but it's a pretty straightforward thing. If you went there and they just said, "Hey, we don't have the vaccine here," then they're going to send you to the ER, but I think it's a reasonable place to start.

Interviewer: All right. And is there a time limit? After I get bit, is it a day? Six hours? Three hours?

Dr. Madsen: I would want to get in within the first 24 hours. Really, as soon as you can. I would not put it off, especially, like I said, because one of the vaccines, one of the injections we're giving, at the site of the wound is essentially neutralizing that virus if it's there, so the sooner, the better.

updated: March 10, 2021
originally published: July 22, 2016

Interviewer: What is pertussis, what can you do about and can adults get it? That's next on The Scope.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Interviewer: If you get a nasty cough that will not just go away it might be pertussis. The odds are slim but it could be. To find out more about pertussis in adults we're with Doctor Tom Miller here at University of Utah Health Care.

Pertussis; tell me a little bit about it and then tell me how an adult can get it.

Dr. Miller: Pertussis was commonly known as whooping cough and occurred most commonly in children prior to the development of an effective vaccine, and it was deadly. A lot of kids died of whooping cough in the old days.

Interviewer: Another one of these things that the vaccines have made a huge difference, and we forget about it, right?

Dr. Miller: We forget about it and actually what's happened is that kids all in the United States generally get this vaccination for pertussis and it effectively prevents it, but as we get older our immune system forgets about exposure to the vaccine and immunity wanes. And you know what? People coming into the country who are not vaccinated can bring pertussis in.

It's a very highly infective bacteria so you don't need much in the way of bacteria to become infected. And when you are infected, if you are older you could end up with not whooping cough but something called the 100 Day Cough.

For a few days you just feel real crappy. You feel very poorly, you have a sore throat and you develop a cough. It's awful. It's what we call paroxysmal cough. It's deep, it's rapid, it's unending and it's so bad sometimes that it will make you vomit, throw up. It's terrible.

So that's why the recommendation now is that as an adult you should receive a pertussis vaccine with your tetanus and diphtheria vaccine. You only need that once in adulthood but if you don't have that you then are at risk to pick up pertussis should you run into a child or even an adult who might be carrying pertussis. And again, it doesn't take much in the way of contact to develop pertussis.

Interviewer: So how is it transmitted?

Dr. Miller: It's transmitted through vapor droplets. Somebody coughing, they can pick up the bacteria in that way. And again, it's highly infective. Many times patients don't know they have pertussis when they are adults because they don't have this barking whooping cough that the kids used to get. They just start with a cold, but the severity of the cough is the thing that makes physicians think about it.

Now, you can treat the patient once they develop the cough and it can get rid of the pertussis bacteria but it doesn't get rid of the cough, and that cough goes on and on and on, and it's a devil to treat if you can even treat it.

Interviewer: So I guess the message here is if you haven't had that pertussis booster, you should get that.

Dr. Miller: Get the booster. Absolutely.

Interviewer: It is something you see on occasion.

Dr. Miller: I do see it on occasion. In Utah, we have an increase in the rate of pertussis in adults because of our immigrant population. They're not always vaccinated when they come into the country.

Interviewer: International Airport.

Dr. Miller: The simple way to protect yourself is to make sure you get that booster.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at the scoperadio.com.

updated: January 2, 2019
originally published: June 28, 2016

Interviewer: The quest for a better cancer vaccine. We'll talk about that next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research show is on The Scope.

Interviewer: I'm talking with Dr. Mingnan Chen, Assistant Professor of Pharmaceutics and Pharmaceutical Chemistry at the University of Utah. And with his graduate student Peng Zhao, he's co-author of a new study on developing a vaccine system that could one day be used against cancers and other disorders. So vaccines against cancer, I think that's a concept that a lot of people are still trying to understand. Dr. Chen, can you explain what that is?

Dr. Chen: Yes. Our body actually has a well-fired system to protect us and immune system to protect us from cancer or various infections. However this system, by nature, is not strong enough. So we want to actually use the vaccine to boost these immune responses so we can use these immune responses against cancer. One step further we are here trying to develop the vaccine delivery and the adjuvant system, to further enhance the effectiveness of the vaccines. So then we can use it to prevent the cancer or to treat the cancer if someone gets cancer.

Interviewer: So how does the vaccine work? Is it different from, say, a flu vaccine?

Dr. Chen: Largely, it is the same as a flu vaccine. So if we know a group of people who may have a high risk of some type of cancer, like breast cancer, we can give this group of people breast cancer vaccines. So later on this vaccine will protect these people from developing breast cancer. Or we can use it as a treatment, say if a person develops breast cancer, we can use the vaccine together with surgery to treat breast cancer, to prevent the metastasis, or to prevent recurrence of breast cancer.

Interviewer: What is the vaccine made from?

Dr. Chen: The vaccine can be made from cancer cells, can be made with protein from the cancers, or from peptide from cancers. In our specific case we used peptide from cancers. This peptide will be presented by the cancer cells, sort of as the label for the cancer cells. We deliver this vaccine to our bodies so our immune system can recognize the cells with this kind of label.

Interviewer: So you're kind of teaching the immune cells how to attack that cancer?

Dr. Chen: Yes. Yes. We are teaching the immune cells. We are also using this vaccine to boost the immune cells that can attack this type of cancer cells.

Interviewer: Now obviously it's not so easy or else some of us would be getting these vaccines already. So what's kind of the tricky part in developing these vaccines?

Dr. Chen: The tricky part of the vaccine, first, is efficacy. The second is safety. The third is cost. So for the efficacy. Right now, the cancer vaccine, there's still quite a large number of clinical trials on the cancer vaccines.

However, right now there are only two of them that have been actually approved for clinical use. So we want to use this very unique vaccine delivery and adjuvant system to drastically boost the effectiveness of the cancer vaccine so it can actually show the effect in the clinics. On top of that, our vaccine delivery system also has advantage in terms of safety and in terms of preparation. So it could have a very low cost to produce this type of vaccine.

Interviewer: Some of your research is focusing on optimizing this delivery and adjuvant system. Peng, could you give me a basic idea of what that is?

Peng: The basis of the delivery system, we're using a nanoparticle based system to deliver the vaccine. Comparing to the flu vaccine, which usually are delivered by peptide, this nanoparticle delivery is actually preferred by immune cells. So the uptake is actually better.

Second, and more important, we can incorporate different abnormalities with the vaccine. In nanoparticle, just by one protein, one peptide. So it kind of addresses a problem other people cannot address. So when we are incorporating abnormalities there together, they work together to immediately show effect. Other people they have to mix it, which, generally speaking, is not that effective. That's the basis of our delivery system.

Interviewer: The nanoparticle, what does that do? Does it help stabilize the vaccine?

Peng: There are multiple views of it. So peptide is much smaller than a nanoparticle. So when we inject them they diffuse everywhere, so it's kind of like the efficiency of the immune cell to take the peptide is low. Immune cells are not designed to do that. Think about, immune cells naturally like particles like viruses, bacteria. So if you put peptides on some particle, artificial particle, it will help the immune cell to recognize them, and it gets them.

Interviewer: But it turns out you can get the particle to the immune cells, but that's only half the battle.

Peng: For a vaccine to work, after they are taken by the cells they need to be processed in order to be recognized before they are presented. So our particle actually has this responsive characteristic, which means when they are taken into the cell they can dissociate and they release the peptide for the cell to further present to other immune cells.

Dr. Chen: So we said that this system has a very good contrast of changeable stability. When we want them to be stable, they are very stable. And when we want them to become unstable, they become unstable.

Interviewer: Do you intend to take this to clinical trials?

Dr. Chen: Yes. Bringing a vaccine delivery system from benchside to bedside has been our goal from the very beginning of this project. When we set out to develop this vaccine delivery and adjuvant system about four years ago. One of the most important criteria that we had was that this system has to be biocompatible and immune compatible not only to mouse but also to human beings. So then we could actually test this system preclinically in animal models, which is very important, but also clinically in human beings.

Now that we have this system we are very excited about the idea that this system could benefit patients in the near future. We are working very hard to push this system forward so this system can be tested clinically. First we are testing this system in animal melanoma models. The results are very exciting and promising now because this system did enhance the anti-melanoma immune responses. Second, we are continuing to finesse this system so this system will have the capacity to overcome the multiple barriers that are facing cancer vaccines. So, hopefully we can bring up an even stronger delivery system so that this system will have a high likelihood to be successful in the clinic.

Lastly I want to mention that we have the intellectual properties for the system. We are looking for investments that can help us bring this system from our benchside to the hospital bedside.

Announcer: Interesting. Informative. And all in the name of better health. This is The Scope Health Sciences Radio.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: If you're listening to this podcast, it's because you want to learn more about the HPV virus and the cancer that causes it and probably more specifically because you've heard that it's causing more cases of head and neck cancer. We're with Dr. Marcus Monroe. He is a head and neck cancer expert and let's talk about HPV. There is one type of HPV that maybe more people are familiar with, not so much the head/neck aspect. So first of all, what is HPV? Just give us the basics.

Dr. Monroe: Yeah, sure. So HPV stands for Human Papilloma Virus. It's actually a group of well over a hundred different viruses of which, about 40 are known to be transmitted in humans and of these, a few of these subtypes are known to cause cancer in humans. The most well-known association, which has been known for decades, is the link between HPV and cervical cancer. That's the reason why women are recommended to get yearly screening pap smears.

What is RSV and how can I protect my baby? That's today's topic. I'm Dr. Cindy Gellner for The Scope.

So RSV is a common virus that usually affects the nose, throat, and lungs. RSV stands for respiratory syncytial virus. And, normally, for kids over the age of two and adults, it's just like a bad cold. But for those under two years old, and especially preemie babies, this can be very severe.

Symptoms of RSV are usually common cold symptoms: cough, runny nose. The difference is the runny nose is going to be significantly mucusy, copious amounts of mucus. You can get some redness of the eyes, coughing, sore, scratchy throat. In kids under the age of two, especially premature babies, we worry about something called bronchiolitis.

So in bronchiolitis, the virus attacks the small airways of the lungs, and it can cause cough, wheezing, fast breathing, and trouble breathing where they are doing what's called retractions. They're breathing so hard that you can actually see them sucking in air, and you can see indentations underneath their rib cage and in between their ribs, where they're really just trying to suck in as much air as possible.

When your pediatrician listens to your baby's lungs, if they have RSV and bronchiolitis, it actually sounds like Rice Krispies in the lungs; it's just all crackly. Quite often, pediatricians are able to get a good idea if your child has RSV or not just based on the symptoms. Days three through five of an RSV illness are the worst; that's when they're the most symptomatic and again we can usually hear the crackles in the lungs. We can often take samples of mucus from the nose and test it for the virus to see if it is RSV and then we know how to be a little bit more aggressive with treating the viral illness your baby has, if it is positive.

Because RSV is a virus, and not a bacteria, antibiotics, unfortunately, will not help treat RSV. Babies under the age of one quite often will need some extra oxygen and even may be treated in the hospital if their bronchiolitis is so bad that their oxygen level is under 90 percent, and your doctor will be checking your baby's oxygen if you bring them in for these symptoms. And oftentimes if they are hospitalized, they are sent home with oxygen, and then in the office we can help you wean your baby off of the oxygen. RSV illnesses are usually lasting seven to 21 days, but again, it's worst in the first 3 to five days.

So if there's no real good medicine to treat RSV, how do I help my child? Well, there are some cases when we do need to give some medicine. If you have a family history of asthma or your child has had a history of wheezing in the past, before getting RSV, and we hear wheezes going along with those crackles, we might them a treatment of a breathing treatment called albuterol. Albuterol is also the medication that's in the fast-acting inhalers for asthma patients. If your child does well with them, with the albuterol, then we can sometimes get a breathing treatment machine sent home with you and the medication for you.

The most important thing that's going to help your child is sucking out their nose, and we all know how much they love that. Unfortunately sucking out the nose is going to be the best thing for them. You're going to need to use nasal saline before you suction out the mucus. Nasal saline will actually help loosen up thick mucus so you can get it out easier, and then your child will be able to breathe more easily. Sometimes, your physician will be able to give you a prescription to the respiratory outpatient clinic here in Salt Lake City. You can take your baby to the clinics and they are run by respiratory therapists and they are able to do deep suctioning. So they will stick a tube way down in your baby's nose and really suction everything out. It's kind of like Roto Rooter for your baby's nose. But it really helps get the mucus out.

And those prescriptions are usually good for seven days, and the clinics are open 24 hours a day. They're really good about sending your physician a note through the fax or through the computer to let them know you took your child there and what happened. Did the suctioning help? Did they need a breathing treatment? Did they need oxygen? Did they need to get admitted?

So how can you help prevent your child from getting RSV? One thing you can do is make sure that people wash their hands and sanitize before holding your child and try to keep your baby away from people who have cold symptoms.

Unlike certain other viruses that we have vaccines for, there is no vaccine that can prevent RSV. However, babies who are born very prematurely--usually before 30 weeks of the pregnancy--or babies who have certain types of heart disease or chronic lung disease, may be able to be treated with a drug called Synagis. Now Synagis is a kind of antibody which can help prevent severe RSV infections. We used to think that it would actually prevent your child from getting it, period.

Now we now that it will help your baby's immune system to fight off RSV if the baby gets it and prevent hospitalization and shorten the length of illness. Your doctor will let you know if your baby qualifies for Synagis. It's a very expensive medication and only certain babies qualify through their insurance, but those babies who do qualify, we make sure that they get the medicine that they need.

And you're going to need to keep saline and the bulb sucker and a cool mist humidifier handy to help get the mucus out of your baby's nose if they get RSV. And if you think your baby has RSV, please have them seen by your pediatrician within the first few days that they are ill so we can help you take care of them.

updated: October 25, 2022
originally published: December 1, 2014

Dr. Cindy Gellner: So when is a cough just a cough or when is it something more serious, like whooping cough? I'm Dr. Cindy Gellner and that's today on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Cindy Gellner: So whooping cough is pertussis. Pertussis is actually a bacteria called Bordetella pertussis. It's called whooping cough because of the sound that it makes. Not all kids who have whooping cough will make the whoop sound. That is why it's so important kids get vaccinated for whooping cough in the first couple sets of shots.
Kids will get vaccinated for whooping cough at two months, four months, six months, 15 months, and then finally again at age four. The whooping cough actually makes a whoop sound where you'll hear a coughing, it's called paroxysmal coughing, and that's just a big long coughing spasm where kids will just cough and cough and cough and cough and then you hear [whoop sound] and that's exactly what it sounds like.
The whoop that goes along with the whooping cough is the one that really scares most pediatricians. Whooping cough can be deadly to babies. At six months old the immune system that they got through their mom's placenta will actually start to wean off and they have to develop their own immune system.
So that's why there's so many shots for babies until they're six months old, you get a little break at nine months old, until the 12 month old vaccines but there's so many shots until six months old so they can get protected from things like pertussis, tetanus, polio, their hepatitis B vaccine, HIB, that's Haemophilus influenzae type B, that's a bacteria that causes ear infections the pneumonia and meningitis.
But pertussis is one that really scares us because babies, if they get pertussis or whooping cough, they won't cough like that sometimes. They will just stop breathing. The younger they are, the more likely they are to just stop breathing. For older kids and the kids that you're going to hear that whoop on, pertussis, or whooping cough, it actually has three different phases. So the first one is about two weeks, you just have a persistent cold, runny nose, mild cough, pink eyes, not pink eyes as in like goopy eyes, but just injected eyes. And it will seem like a lingering cold, it just won't go away.
The second phase, that's when you hear that whoop, it's just a cough that just gets worse and worse and worse. It can last up to a month. The cough can often make the kids vomit or their face will turn red or blue and it's almost always worse at night.
If your child is old enough to have had all the whooping cough vaccines, then the good news is that they probably aren't going to get whooping cough. This vaccine is very effective.
The third phase of the whooping cough is recovery. It takes about another month for the cough to improve. The good news is whooping cough is able to be detected by a swab that we will put up a child's nose and send it off to look for this particular bacteria. If the test comes positive for that bacteria, there are antibiotics that can be given to treat whooping cough.
So the good news is, this is very treatable. It's also very contagious. Again, in going back to the babies, they can't get all the shots at once, so that's why it's really important, if you have a baby that you're around, you get a whooping cough vaccine. Pregnant women get them before they leave the hospital after they have their babies, anyone that's a daycare provider needs to be sure they have them. Grandparents need to get the whooping cough vaccine too.
Treatment of pertussis, or whooping cough, again, we do the antibiotics. The other things that can help are humidifier in the room and actually that works for any cough. Cough is your body's way of getting rid of sticky mucous that's sticking in your lungs and causing you to just get that little tickle in the back of your throat. So getting rid of thick secretions in the nose and throat can be helped with a humidifier.
Also, a bulb syringe and saline for the babies, they can't blow their noses and babies cannot breathe out of their mouth until they're about nine months old.
Other things that you can use for helping with coughing, chicken soup, anything that's warm, it's a great time of year for hot chocolate. So warm liquids will actually help with those coughing spasms too.
Honey, let's talk honey. Honey is fine for children over one year old. If they are under one year old, do not give your child honey, they cannot protect themselves from something called botulism. Botulism will cause bad things, muscle spasms, very painful to watch, very painful for the child to go through, not very easy to treat. So honey, under one, is a no no.
Other things you can do to help your child with coughing spasms, make sure that they are kept away from things, like smoke, tobacco smoke, perfumes, other pollutants in the air, that is something you're going to want your child to stay away from, so that they don't have extra inventive to cough.
How can you prevent the spread of whooping cough? Well the first thing, if a child has not been vaccinated against whooping cough, and they are old enough to be vaccinated, which is anyone over two months old, make sure you vaccinate those children, get them up to date on their vaccines.
If somebody has tested positive for that pertussis bacteria, you can give antibiotics to anyone that's been exposed to the disease. Usually the health department gets involved with this because whooping cough is a bacteria that does need to be reported to the health department.
So remember, whooping cough is a very dangerous disease, especially for babies, they don't have the immunity yet. The risk of death from whooping cough is far greater than any of the possible side effects of the shot.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.