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Thanks for joining us at the Canadian Breakpoint, a Canadian infectious diseases podcast by
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Canadian infectious diseases physicians.
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I'm Summer Stewart, back with Dr. Rupeena Purewal, pediatric infectious diseases physician
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in Saskatoon.
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For this episode, we welcome Dr. Jason Kindrachuk from University of Manitoba to discuss monkey
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pox.
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Dr. Purewal.
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All right, welcome everyone to another episode of our podcast, the Canadian Breakpoint.
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Today we have a very special guest with us, Dr. Kindrachuk, who is an associate professor
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and Canada research chair in emerging virus pathogenesis in the Department of Medical
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Microbiology and Infectious Diseases and cross appointed in the Department of Internal Medicine
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and Manitoba Centre for Proteomics and Systems Biology, the University of Manitoba.
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His work focuses on viruses that pose the greatest threat to global health, including Ebola virus,
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orthophox viruses, coronaviruses and influenza viruses.
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His research program centers on the circulation, transmission and pathogenesis of emerging
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viruses.
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Past and present findings from these investigations will help inform emerging virus therapeutic
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treatment strategies, outbreak prediction and preparedness efforts with impacts on both
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human and animal health.
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Dr. Kinderchuck leads multiple nationally funded emerging infectious disease research
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investigations, including one health emerging zoonotic virus surveillance activities in
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Canada and Africa.
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These include as a director for the International M-Pox Response Consortium, co-lead for pillar
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two of the coronavirus variants rapid response network and ongoing investigations on the
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long-term impacts of Ebola virus infection in disease survivors in West Africa.
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Thank you so much, Dr. Kinderchuck for joining us today.
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Thank you for having me.
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Perfect.
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And so today we're going to talk about a very important topic and that's monkeypox for our
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listeners out there.
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So just so you're aware, there's pharmacists, physicians, nurses and many, many different
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other healthcare professionals that tune into the podcast.
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And so I thought monkeypox was, you know, it's an episode I've been wanting to do for
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a while.
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And I think with, you know, the recent WHO global health emergency that was reported
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just this past week, I think this is a pressing topic and all a lot of us are interested in
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kind of hearing more about this.
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Absolutely.
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All right.
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So I think for, because we have so many different types of listeners, I think it would be really
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important to kind of just start with a background and really what is this viral disease and
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you know, what is monkeypox?
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How does someone get this virus and what should we think about and when should we be thinking
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about it?
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Yeah, it's a great question, right?
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And I think for this kind of have to go back a little bit to, you know, when monkeypox
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virus was first identified, it was actually first identified in 1958 actually at really
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amongst captive non-human primates.
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We didn't see any human infections diagnosed until 1970.
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That was in democratic Republic of the Congo.
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But if we think about this from a historic perspective, that's probably not that surprising
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because there was this kind of other little thing going on in the world called smallpox
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that unfortunately had a very, very similar clinical presentation.
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So following the eradication of smallpox and obviously the cessation of the global vaccination
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program, what we've seen really from 1980 onwards, it's kind of steady increase in monkeypox
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virus infections across endemic regions of Africa.
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That's kind of been divided based on geography.
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Cameroon is the central point.
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Cameroon is the only place where we find both clade one and clade two monkeypox virus co-circulating.
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Anywhere west of Cameroon, we only find clade two monkeypox virus being endemic.
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And to the east of there is clade one monkeypox virus.
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Things get a little bit complicated when we start talking about how they differ from one
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another.
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Historically, clade one monkeypox virus has been associated with more severe disease,
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but we have to appreciate that that's also based on really kind of limited data for clade
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two infections really up until the reemergence in Nigeria in 2017 and then the subsequent
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movements out of Nigeria to the global north in 2022 and the obvious epidemic expansion.
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So historically, when we look at the disease, pre-2022, the disease looked really like a
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composite of human smallpox.
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Really the difference being the lymphadenopathy that's seen in monkeypox virus infections,
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but you still saw the fully disseminated disease, really the face, arms, legs, hands, and feet
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being the areas where you saw the most lesions.
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And the lesions tended to be all in the same stage of development.
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So whether it was on the face or on the feet, everything seemed to be fairly symmetrical
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in that regard.
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Then 2022 hits and we start seeing atypical presentation.
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So what we saw in 2022, virus moved out into Europe first and then moved globally across
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more than a hundred countries.
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Those infections were associated with dense sexual networks.
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That was something we hadn't really seen previously.
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Then there was this high overrepresentation amongst men and those that identify as gay,
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bisexual, or other men who have sex with men.
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The presentation tended to actually look a lot like other sexually transmitted or bloodborne
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infections.
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So a lot of lesions within the groin, some of the rectal lesions in men, isolated lesions
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in other regions of the body, but not the fully disseminated disease that we typically
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had seen historically and the lesions were not all in the same stage of development.
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That has complicated the picture because now you can't just do a clinical diagnosis based
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on what the disease looks like.
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So we still have virus moving through the global community.
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Clay 2b, monkeypox virus, continues to circulate.
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We've seen clusters in Canada since 2022 onwards.
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But then we saw the tipping point in DRC starting in 2023 with this massive increase in infections.
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And that's led to where we are today with the public health emergency.
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In terms of the signs and symptoms that people are seeing, is this widespread depending on
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the age group?
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Or younger children are seeing similar presentation as the adults?
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So far it really depends on the different clades.
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We almost have to take clade 2 and separate pre-2022 and almost pre-2017 versus post Nigeria
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reemergence and global reemergence.
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Prior to 2017, very few cases of clade 2 had ever been reported.
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We saw a small outbreak in the US in 2003.
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Some kids were infected.
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That was all through zoonotic transmission.
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We did see a couple of cases of severe disease there.
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But predominantly we didn't see a lot of fatal infections.
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2017, Nigeria, everything starts to skew a little bit older in terms of the average age
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group where we're seeing the infections.
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And then of course in 2022 onwards with the global outbreak, most infections in the 20
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to 40 age group in a game skewing towards men, very few infections in women and in kids.
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In DRC, very, very different.
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What we're seeing right now in really the last 20 months, even with this rapid increase
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in cases, the demographics for severe disease and infections have not really changed.
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In DRC, vast majority of infections still are based off of zoonotic contacts, mostly
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we think contact with rodents.
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Those infections tend to skew towards children under the age of 15.
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That tends to be the group that is in contact with those animals.
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And we tend to see the highest mortality and morbidity amongst those age groups.
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Now we also shift a little bit because mid 2023 we picked up, and I say weeks, it includes
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certainly at the forefront of this are Congolese colleagues and others from the US and Europe.
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We picked up a cluster of cases that were related to sexual contact in Congolese province.
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An N of five, very small, still skewing towards an older age group.
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But we saw men and women included in that.
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Since that time point, really in Selkivu province, we've seen again this massive inflection of
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cases in an area that historically had not seen much.
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Those cases over highly overrepresented among sex workers and dense sexual networks, but
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even seemingly evenly spread between men and women so far.
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We're not seeing much in terms of infections in kids, but that may change over time.
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We've seen movement of that particular type of monkeypox virus.
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What we've now termed clade 1B, more sustained human transmission.
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That virus has moved in a North Kivu and we've seen cases in internal displacement camps
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and that's included in, at least in our case investigations, in a few children.
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No severe disease so far, but we're still at the early stages.
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It's complicated.
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We're trying to follow the FD as closely as we can.
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Definitely different routes of transmission and that's been evolving as well.
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Has it been different for hosts, like host dependent as well?
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If somebody is immunocompromised, do they have more severe disease or they pick up the
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virus quicker?
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What we saw again in 2022 really opened our eyes a little bit to what monkeypox virus
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infections could look like.
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In 2022, there's a few global case series that looked at the risks for infection.
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There was an increased risk if somebody was HIV positive or a person living with HIV.
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Same thing with other STIs.
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We didn't know much at that point as to whether or not there was an increased risk for severity
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of disease.
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We've now seen with HIV that certainly people that have uncontrolled HIV can have a more
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severe course of M-pox than what we see in individuals who have control disease or otherwise
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have a normal immune response.
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But it's complicated.
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In Congo, we don't know.
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It certainly is top of mind for us.
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There's not a lot of STI testing.
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HIV rates tend to be quite low in Congo.
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That maybe has helped us a little bit, but we're hoping to deploy STI testing certainly
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in the South Kivu and some of the surrounding areas over the next few months.
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Then you talked a little bit about the common strains that are currently circulating.
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What is the predominant strain right now that you're seeing?
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Since it's Democratic Republic of the Congo, clade 1 monkeypox virus is the only type of
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monkeypox virus we've seen there before.
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We've now subdivided that into clade 1A and clade 1B.
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Clade 1A is the virus that's associated with zoonotic infections.
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Those are still making up the vast majority of the cases we see in DRC at the moment.
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Clade 1B we're seeing certainly in South Kivu starting to pick up in a few other areas now.
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That is associated with more sustained human-to-human transmission with no real zoonotic link.
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We don't know a lot about clade 1B yet in terms of severity.
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A number of factors we have to consider there, but we do know that it's certainly moving
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between people far easier.
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We think still through close contact and potentially with contaminated surfaces and shared materials
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or bedding and clothing, especially if somebody has a lesional disease.
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We haven't seen much in terms of changes in terms of things like a big respiratory component
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that's being included.
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But zoonotic infections certainly far and away are still driving the current outbreak.
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And then in terms of obviously, I think everybody is worried when they see a case like this.
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And so I guess we can divide it up into things because we can talk about prevention separately.
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And then when you do see a case, what do you do in terms of therapeutic management?
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So can you talk a little bit about how we can prevent and what kind of strategies are
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out there right now?
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Yeah, you know, the infection prevention control piece is something certainly I've been involved
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in and many others have been involved in since 2022.
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One of the things that I think we appreciate very quickly is certainly that kind of risk
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for broader airborne transmission.
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We haven't seen any FD that's suggestive of that.
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But historically, we've been able to gain a lot of knowledge, certainly from endemic
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regions of Africa.
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So really, the greatest risk for transmission we still see is that close extended contact,
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primarily through those that are providing care, whether they're health care workers
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or family members, whether they're sharing a bed, whether they're sharing clothing or
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bedding that is not being laundered.
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And we've seen the potential for transmission through things like sponges or cleaning materials.
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We've been working with a few groups, providing some guidance on looking at different disinfectants
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that are being used kind of in different areas of the world.
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The kind of good news is the majority of what we would assume continues to be the case.
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Bleach tends to work really well.
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Most good, you know, kind of, you know, antiviral disinfectants work very well.
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Soap and water work very well.
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A big piece of this is trying to ensure that anybody that has lesional disease that thinks
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that they are in contact with or bedding or clothing are getting laundered and that the
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people that are, you know, basically in contact with those things, either they're also monitoring
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their symptoms and or also using personal protective equipment.
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Okay.
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Yeah.
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So very similar to other viral diseases, encourage hand washing and inner basic hygiene and laundering.
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Absolutely.
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And our concern, I think right now with DRC, I mean, there's a big focus on certainly the
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sustained human to human transmission piece for good reason.
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But there's also a big piece of this, which is, listen, we know where really kind of the
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root of many of these infections are, and it's that zoonotic contact.
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There's a big piece of this, which I think is still, you know, kind of embedded in this
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idea of community engagement and trying to understand where infection prevention control
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practices can be implemented within communities that's done in a respectful and transparent
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manner in a way that doesn't impede people's ability to still hunt or to still be able
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to consume while game.
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And then once you have somebody who has a condition like this, who's contracted the
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virus, they have symptoms and they have signs and you're considering, you know, thinking
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about first, I guess we talk about diagnostics because if I'm an ER physician or a hospital
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physician, oftentimes as an infectious disease specialist, we'll get phone calls to send
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off.
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So what I see a patient like this, what do I send off?
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Yeah.
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So the easiest thing really is still is lesional swabs.
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OP swabs tend to work fairly well as well.
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There have been some studies that have looked at kind of longitudinal viremia in patients.
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Those I think for the most part have suggested there's not a really strong viremic component,
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at least in the majority of cases.
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So I think we're still kind of focused on lesional swabs.
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PCR by far and away is the method that still continues to be tried and true.
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There's been some changes though, because as we've seen kind of the emergence of clade
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2b coming out as a subclade out of clade 2 and now clade 1b is a subclade of clade
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1, we've also had to look at primers and whether or not those primers are still picking
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up the virus that we assume that they're recognizing.
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So for clade 1b, one of the things that we have seen recently has been that the kind
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of traditional primers that would be used normally for clade 1 infections, there's actually
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a deletion in clade 1b and those primers could potentially give a false negative.
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Colleagues in Europe have already reported primer sets that appear to recognize clade
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1b very, very well.
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But we also know that kind of like the overall kind of orthpox virus kind of centric primers
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work very, very well.
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They just don't give you that clade distinction, right?
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So PCR still works.
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We do a lot of sequencing.
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There's certainly something to be said about looking for antigens to try and identify people
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who have been previously exposed.
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We have done quite a bit of serosurveillance in this realm.
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The difficulty is pox viruses have very close antigenic similarities.
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That's why we use vaccinia for eradicating smallpox and we use it now for the M pox vaccine.
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That cross-reactivity somewhat precludes our ability to go in and say, okay, have you been
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exposed to monkey pox virus or cow pox virus or some other unknown human orth pox virus?
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That being said, in many areas that are endemic, we have a pretty good idea of what's circulating.
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And certainly if there's an outbreak situation, you can start to distinguish.
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There's questions about if somebody has been vaccinated for smallpox, what does cross-reactivity
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look like?
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But really if we use 1980 as that tipping point for people that were or weren't vaccinated,
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you can start to surmise what's going on based on that.
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That's fair.
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And then most centers, do they have the PCR testing or is this sent to National Microlab
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in Canada?
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Well, it's a good question.
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So certainly for clade 2 right now, like Cepheid has there, the gene expert is certainly widely
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being used for clade 2.
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That I think continues to be the case.
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For clade 1b, there's certainly been some questions about how we're going to be able
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to test for this and really to try and distinguish clade 1b from clade 2b.
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Using orth pox virus centric primers, you're still able to pick it up and say, okay, yeah,
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it's PCR positive.
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It's monkey pox virus, but we don't know which clade.
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For clade 1b, the issue that we have is this is a fairly recent development for the identification
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in Congo.
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So there's a lot of people that have been asking about access to nucleic acid to be
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able to validate tests within their own laboratories.
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And that's not only in Canada, but certainly well beyond and in too many different places
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across the globe.
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That's going to be a big piece.
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I think is that validation part likely, we're always a little bit behind with sharing materials
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globally unfortunately.
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I think right now, given the public health emergencies, that's going to be a big piece.
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But the confidence comes out of that the primer sets that have been reported so far that have
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been in use through Congo and in other regions.
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And then in terms of treatment, so are there antivirals out there or this is mainly supportive
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management currently?
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No, there's so for clade 2 infections, T-pox worked very, very well.
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Ticaviromat, ST246, I kind of have gone through every iteration of the name at this point,
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worked very, very well.
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And certainly in the US and Canada, that was kind of the antiviral that people were moving
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towards to try and reduce the impact of these infections.
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There's been an issue though that's come up in Congo, which is a very recent clinical
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trial for Ticaviromat on the ground failed.
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It didn't show any added benefit.
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The reality though is that it's unfortunate.
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There's probably a number of reasons why that trial may have been limited in its potential
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to be able to be successful.
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But a big piece that came out of that was you reduce the overall mortality just with
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providing good supportive care.
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And I think to me, that's a really important piece of this, which is for countries that
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have been scrambling for T-pox, certainly in 2022, maybe looking to do that for 2024.
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Blade 1B, we don't think it works, but if you provide good supportive care, you reduce
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certainly the mortality.
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I think the bigger kind of piece of all that though is saying in the areas where we see
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endemic disease, one of the things that we can do to immediately reduce the impact is
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be able to provide extra assistance for being able to give supportive care on the ground.
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So I think that's an important piece.
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Vaccination still works well.
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We have no reason to think the MDA, the very Nordic vaccine would not provide cross protection
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against Blade 1.
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It's still a vaccine based vaccine.
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So I don't think we have any concerns that way.
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A big part is still trying to get vaccines to really the hotspots of the world where
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we see circulation and that continues to be an issue.
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And so, yeah, so I would say I've had a couple of questions from physicians and colleagues
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and patients.
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Is it worthwhile for them to get vaccinated or is it something only limited to if they're
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traveling to these endemic areas?
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Even through travel, I don't know if there's a travel based vaccination program that's
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available.
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That may change because of the public health emergency.
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My lab and myself have been vaccinated because we obviously work with samples as well as
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with vaccine of virus and other pox viruses.
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I was vaccinated ages ago for ACAM2000 or with ACAM2000.
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The public availability is still pretty limited, right?
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Yeah.
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We have lots of stocks and stockpiles of ACAM2000, but that was contraindicated for certainly
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for very specific groups.
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The JYNNEOS or MBA vaccine, we don't have nearly the stockpile that we did.
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So there's still basically the push to try and get that vaccine to those populations
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where there is an increased risk for infection, close contacts of patients that have suspected
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or confirmed cases.
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That's still the focus, but as well kind of appreciating that we need to get vaccine into
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certainly in the Congo and probably now into Burundi and surrounding areas very, very quickly.
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So I think if we start seeing influx in cases, whether clade two or clade one driven in Canada,
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there's going to be a need to ensure that healthcare workers are vaccinated.
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But there's the other piece too, which is good infection prevention control also is
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very, very good at reducing those infections.
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So we just have to kind of take it at face value.
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Right.
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Okay.
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And so kind of the idea being prevention right now.
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Even if somebody does have the illness to be cautious, to not be around others, especially
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those that are immune compromised, kind of similar to what we would say with any other
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viral infections.
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100%.
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Right.
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And we know the thing is we know that the routes transmission predominantly, right?
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You know, eucosal membranes are going to be key in ensuring that we don't have any open
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wounds or abrasions.
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Those kinds of things continue to be important.
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And I think we go back to the idea of when people are vaccinating people, certainly old
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school, like CAM 2000 or even way back in the flybacks, it was about those preventative
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measures trying to remove the risk for exposure.
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Right.
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And so recently with WHO declaring this public health and global health emergency.
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And so how is situation evolving and appreciating that things are changing daily?
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I'm sure.
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Yeah.
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I mean, the situation on the ground in Congo, you know, through certainly through the work
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that we're doing, I don't think that the situation has necessarily changed.
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We're looking at from 2023 and now around 30,000 suspected cases.
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We've seen movement of virus really to 25 to 26 provinces now with local transmission.
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It continues to be widespread.
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And we're not seeing any indication that things are starting to ramp down.
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Right.
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So that continues to be a big concern for us.
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Probably as concerning of an issue though, is really the movement into Burundi and some
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of the surrounding regions.
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Burundi in particular, because of the limited resources that are available in country from
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a healthcare standpoint and just an overall standpoint, concerns about the increased circulation
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that we're now seeing there.
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You know, Uganda and Rwanda, we've seen cases.
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Kenya, we've seen cases.
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Those seem to be pretty controlled so far.
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That's assuming that people are feeling comfortable with self-reporting.
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But I think for us that the focus right now is really what's going on in Congo, what's
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going on in Burundi.
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We've seen introduction or at least the kind of the indication of cases that have been
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identified globally.
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So we've seen a case in Sweden.
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We've now seen a case in Thailand.
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That's not that surprising, right?
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People are still traveling.
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People are still living in a globalized community.
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We're likely going to see those cases continue to be identified.
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The bigger piece to me is going to be what happens afterwards?
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Do you see any additional signs of community transmission or broader transmission within
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those local populations?
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Or did you get good testing and contact tracing out and you don't see any local spread?
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So that I think continues to be important for developments.
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The other piece is we've seen, you know, really the kind of discussion about getting vaccines
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on the ground in Congo go from being a few months down the road to now kind of like within
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the next couple of weeks there will be vaccine.
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Don't know much about the deployment strategy yet, what that's going to look like, which
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groups are going to be going to be kind of the focal groups for that first round.
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But certainly we're there and others are there to help support where we can and certainly
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to try to get some clinical information out as quick as possible where and when we can.
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Okay.
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Seems like a very pressing situation, but you know, things, I think there's things are
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in the works and hopefully, you know, we don't see more spread in circulating virus because
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obviously we know what with the previous kind of virus activities we've seen over the last
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few years, we know that things can change really quickly.
398
00:26:53,560 --> 00:26:59,080
So, and then, so in terms of Canada or other countries, what are they doing in terms of
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like mitigating risks or surveillance for disease surveillance?
400
00:27:03,720 --> 00:27:04,920
Yeah.
401
00:27:04,920 --> 00:27:09,340
You know, I think one of the big pieces that, you know, that has maybe not gone as much
402
00:27:09,340 --> 00:27:14,120
presses as it's needed to over the last bit is we have this pressing situation in Central
403
00:27:14,120 --> 00:27:15,120
Africa.
404
00:27:15,120 --> 00:27:18,760
There's been a bigger question about, okay, well, what happens now if clade one moves
405
00:27:18,760 --> 00:27:21,240
more broadly and especially clade one B.
406
00:27:21,240 --> 00:27:26,000
The thing that I think we need to appreciate is, you know, two years out from 2022 to appreciate
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00:27:26,000 --> 00:27:31,160
that listen, our surveillance networks, our testing and tracing networks, the knowledge
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00:27:31,160 --> 00:27:38,840
base in our healthcare workers and as well, even within communities and community advocacy
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00:27:38,840 --> 00:27:43,560
groups, all of that has increased to a much higher level than it was pre-2022.
410
00:27:43,560 --> 00:27:46,900
So I think we're in a very good place for identifying cases.
411
00:27:46,900 --> 00:27:51,920
We continue to see, you know, cases being identified in Ontario, a little bit of a surge,
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you know, kind of coming through this summer.
413
00:27:53,940 --> 00:27:59,080
Same thing with other regions of the world, not approaching anything what we saw in 2022,
414
00:27:59,080 --> 00:28:02,960
but it should be a reminder that like clay to virus didn't disappear.
415
00:28:02,960 --> 00:28:04,940
It's still circulating globally.
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00:28:04,940 --> 00:28:07,500
It's still circulating here within Canada.
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00:28:07,500 --> 00:28:09,600
It's just at a very, very low level.
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00:28:09,600 --> 00:28:13,960
So I think we're doing very, very good in terms of our surveillance.
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00:28:13,960 --> 00:28:18,440
We now have to add the PCN about clay one B recognition, but we're in a place where
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00:28:18,440 --> 00:28:22,200
we should be able to identify those, those cases very, very quickly.
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00:28:22,200 --> 00:28:23,360
That's really good to hear.
422
00:28:23,360 --> 00:28:28,760
And so in terms of resources, cause I think that's also important for healthcare professionals
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00:28:28,760 --> 00:28:33,120
across the board, also sometimes just general public, you know, asking questions.
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00:28:33,120 --> 00:28:38,040
And so where can people find, I mean, like obviously CBC has always been a really good
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00:28:38,040 --> 00:28:41,760
resource, but are there other certain areas that we should be looking?
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00:28:41,760 --> 00:28:42,760
There, there are.
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00:28:42,760 --> 00:28:46,560
I mean, I, you know, I don't want to, you've got to shine a spotlight on work that I've
428
00:28:46,560 --> 00:28:52,120
done because I've sat on panels with far smarter people to myself to pronounce on this.
429
00:28:52,120 --> 00:28:56,680
WHO a couple of years ago had a guideline development group for clinical management,
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00:28:56,680 --> 00:28:58,480
infection prevention control.
431
00:28:58,480 --> 00:29:00,720
That's really available through, through WHO for M pox.
432
00:29:00,720 --> 00:29:05,480
I think that's still largely applies to everything that we're seeing now.
433
00:29:05,480 --> 00:29:10,240
WHO just recently updated all their information on infection prevention control, their descriptions
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00:29:10,240 --> 00:29:12,560
of M pox, those resources are good.
435
00:29:12,560 --> 00:29:17,200
And of course health Canada and public health agency of Canada continue to provide information
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00:29:17,200 --> 00:29:18,200
as well.
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00:29:18,200 --> 00:29:21,360
And of course there's, there are research groups that are doing work in this area.
438
00:29:21,360 --> 00:29:25,920
You know, all of us have a lot of information as well, but I think going to those kind of
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00:29:25,920 --> 00:29:31,880
big sources, European centers for disease control, U S T D C, WHO and, and health Canada
440
00:29:31,880 --> 00:29:34,440
are major resources.
441
00:29:34,440 --> 00:29:35,440
That's really helpful.
442
00:29:35,440 --> 00:29:39,680
Cause I think a lot of people will be starting to see more questions come through and that's
443
00:29:39,680 --> 00:29:42,560
kind of natural that happens clinically as well.
444
00:29:42,560 --> 00:29:47,160
You know, we always think about what's happening with circulating and I think awareness is
445
00:29:47,160 --> 00:29:48,160
important.
446
00:29:48,160 --> 00:29:52,480
And so that's why we're talking about this today, because I think most of us should have
447
00:29:52,480 --> 00:29:58,160
some base knowledge on monkey pox and, and you've given us some really good information
448
00:29:58,160 --> 00:29:59,160
today.
449
00:29:59,160 --> 00:30:05,360
So in terms of kind of summarizing or some key points that you'd want the public or health
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00:30:05,360 --> 00:30:11,880
professionals to really take away from today's episode, what would you kind of summarize
451
00:30:11,880 --> 00:30:13,320
in terms of that?
452
00:30:13,320 --> 00:30:17,520
Yeah, I think a big piece of this is right now that the global risk for, for clade one
453
00:30:17,520 --> 00:30:19,640
introduction continues to be quite low.
454
00:30:19,640 --> 00:30:22,340
I think also appreciating that, you know, things can change.
455
00:30:22,340 --> 00:30:25,240
We know that that happened with clay too, but we're in a different place than we were
456
00:30:25,240 --> 00:30:26,780
in, in 2022.
457
00:30:26,780 --> 00:30:28,500
We have good surveillance networks.
458
00:30:28,500 --> 00:30:30,760
We have good sharing of data and testing protocols.
459
00:30:30,760 --> 00:30:34,000
I think that piece allowed us to be able to move forward.
460
00:30:34,000 --> 00:30:38,560
The kind of piece that I think is at the heart of this though, is we want to reduce the risk
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00:30:38,560 --> 00:30:39,560
globally.
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We've got to reduce the risk locally, which still gets back to the need to not only get
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things contained in, in DRC, but also to look at other endemic areas of Africa and say,
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we need to get vaccination programs up.
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We need to get surveillance programs sustained and as well go back to this piece about healthcare
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infrastructure and certainly the need to be able to harmonize data reporting globally
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right now for M-POC.
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So we all have a good impression of what we're looking for, but I think it's going to be
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a key area.
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Yeah.
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And then just on a note that I actually forgot to ask was in terms of reporting.
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So if physicians or anybody is seeing cases, are these then like, I mean, through the lab,
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we're definitely reporting to public health, like local public health authorities.
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Is there something that a physician should be doing in terms of any surveillance network
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that they should be entering their data into?
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Not that I've seen so far, right?
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And listen, that can just be my naivety for what, what's available in Canada.
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In DRC, we've got, WHO has their centralized system for us to be able to report and upload
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data continually into.
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So we've, we've been working on that and certainly most, most of those countries have good centralized
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systems for entering in national data.
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It can be a little bit slow at times, but we continue to do that on the ground as well.
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And then of course, Africa CDC is obviously taking a much bigger role in this with trying
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to ensure that there's good data reporting, data management, and as well sharing of information
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globally.
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Okay.
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That's great.
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Definitely, I think everybody's on top of it and it's good to hear a little bit more,
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you know, about Monkeypox and, and have a bit more background.
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So I've learned a lot for sure.
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And, and I always inform my listeners that this is an informational podcast and things
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do evolve and, and over time, you know, even prevention or treatment options may change.
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So currently this is the situation with Monkeypox and, and what we know about it right now.
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So I'm sure our listeners will take a lot back from this episode and thank you Dr.
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Kindertruck for being here today on our podcast and providing us with such great information.
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It was an absolute pleasure.
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Thank you.
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Thanks.
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Take care.
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Thank you, Dr. Kindertruck for joining us today.
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Have an episode suggestion?
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00:33:01,840 --> 00:33:08,240
Email the Canadian Breakpoint at gmail.com and be sure to follow us on X at CA Breakpoint
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00:33:08,240 --> 00:33:09,240
for updates.
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00:33:09,240 --> 00:33:14,360
See you again soon at the Canadian Breakpoint.
00:00:00,000 --> 00:00:12,880
Thanks for joining us at the Canadian Breakpoint, a Canadian infectious diseases podcast by
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Canadian infectious diseases physicians.
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I'm Summer Stewart, back with Dr. Rupeena Purewal, pediatric infectious diseases physician
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in Saskatoon.
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For this episode, we welcome Dr. Jason Kindrachuk from University of Manitoba to discuss monkey
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pox.
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Dr. Purewal.
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All right, welcome everyone to another episode of our podcast, the Canadian Breakpoint.
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Today we have a very special guest with us, Dr. Kindrachuk, who is an associate professor
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and Canada research chair in emerging virus pathogenesis in the Department of Medical
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Microbiology and Infectious Diseases and cross appointed in the Department of Internal Medicine
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and Manitoba Centre for Proteomics and Systems Biology, the University of Manitoba.
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His work focuses on viruses that pose the greatest threat to global health, including Ebola virus,
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orthophox viruses, coronaviruses and influenza viruses.
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His research program centers on the circulation, transmission and pathogenesis of emerging
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viruses.
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Past and present findings from these investigations will help inform emerging virus therapeutic
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treatment strategies, outbreak prediction and preparedness efforts with impacts on both
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human and animal health.
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Dr. Kinderchuck leads multiple nationally funded emerging infectious disease research
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investigations, including one health emerging zoonotic virus surveillance activities in
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Canada and Africa.
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These include as a director for the International M-Pox Response Consortium, co-lead for pillar
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two of the coronavirus variants rapid response network and ongoing investigations on the
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long-term impacts of Ebola virus infection in disease survivors in West Africa.
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Thank you so much, Dr. Kinderchuck for joining us today.
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Thank you for having me.
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Perfect.
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And so today we're going to talk about a very important topic and that's monkeypox for our
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listeners out there.
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So just so you're aware, there's pharmacists, physicians, nurses and many, many different
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other healthcare professionals that tune into the podcast.
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And so I thought monkeypox was, you know, it's an episode I've been wanting to do for
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a while.
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And I think with, you know, the recent WHO global health emergency that was reported
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just this past week, I think this is a pressing topic and all a lot of us are interested in
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kind of hearing more about this.
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Absolutely.
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All right.
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So I think for, because we have so many different types of listeners, I think it would be really
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important to kind of just start with a background and really what is this viral disease and
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you know, what is monkeypox?
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How does someone get this virus and what should we think about and when should we be thinking
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about it?
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Yeah, it's a great question, right?
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And I think for this kind of have to go back a little bit to, you know, when monkeypox
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virus was first identified, it was actually first identified in 1958 actually at really
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amongst captive non-human primates.
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We didn't see any human infections diagnosed until 1970.
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That was in democratic Republic of the Congo.
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But if we think about this from a historic perspective, that's probably not that surprising
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because there was this kind of other little thing going on in the world called smallpox
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that unfortunately had a very, very similar clinical presentation.
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So following the eradication of smallpox and obviously the cessation of the global vaccination
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program, what we've seen really from 1980 onwards, it's kind of steady increase in monkeypox
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virus infections across endemic regions of Africa.
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That's kind of been divided based on geography.
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Cameroon is the central point.
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Cameroon is the only place where we find both clade one and clade two monkeypox virus co-circulating.
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Anywhere west of Cameroon, we only find clade two monkeypox virus being endemic.
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And to the east of there is clade one monkeypox virus.
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Things get a little bit complicated when we start talking about how they differ from one
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another.
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Historically, clade one monkeypox virus has been associated with more severe disease,
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but we have to appreciate that that's also based on really kind of limited data for clade
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two infections really up until the reemergence in Nigeria in 2017 and then the subsequent
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movements out of Nigeria to the global north in 2022 and the obvious epidemic expansion.
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So historically, when we look at the disease, pre-2022, the disease looked really like a
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composite of human smallpox.
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Really the difference being the lymphadenopathy that's seen in monkeypox virus infections,
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but you still saw the fully disseminated disease, really the face, arms, legs, hands, and feet
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being the areas where you saw the most lesions.
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And the lesions tended to be all in the same stage of development.
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So whether it was on the face or on the feet, everything seemed to be fairly symmetrical
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in that regard.
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Then 2022 hits and we start seeing atypical presentation.
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So what we saw in 2022, virus moved out into Europe first and then moved globally across
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more than a hundred countries.
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Those infections were associated with dense sexual networks.
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That was something we hadn't really seen previously.
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Then there was this high overrepresentation amongst men and those that identify as gay,
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bisexual, or other men who have sex with men.
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The presentation tended to actually look a lot like other sexually transmitted or bloodborne
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infections.
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So a lot of lesions within the groin, some of the rectal lesions in men, isolated lesions
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in other regions of the body, but not the fully disseminated disease that we typically
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had seen historically and the lesions were not all in the same stage of development.
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That has complicated the picture because now you can't just do a clinical diagnosis based
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on what the disease looks like.
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So we still have virus moving through the global community.
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Clay 2b, monkeypox virus, continues to circulate.
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We've seen clusters in Canada since 2022 onwards.
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But then we saw the tipping point in DRC starting in 2023 with this massive increase in infections.
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And that's led to where we are today with the public health emergency.
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In terms of the signs and symptoms that people are seeing, is this widespread depending on
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the age group?
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Or younger children are seeing similar presentation as the adults?
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So far it really depends on the different clades.
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We almost have to take clade 2 and separate pre-2022 and almost pre-2017 versus post Nigeria
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reemergence and global reemergence.
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Prior to 2017, very few cases of clade 2 had ever been reported.
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We saw a small outbreak in the US in 2003.
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Some kids were infected.
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That was all through zoonotic transmission.
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We did see a couple of cases of severe disease there.
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But predominantly we didn't see a lot of fatal infections.
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2017, Nigeria, everything starts to skew a little bit older in terms of the average age
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group where we're seeing the infections.
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And then of course in 2022 onwards with the global outbreak, most infections in the 20
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to 40 age group in a game skewing towards men, very few infections in women and in kids.
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In DRC, very, very different.
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What we're seeing right now in really the last 20 months, even with this rapid increase
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in cases, the demographics for severe disease and infections have not really changed.
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In DRC, vast majority of infections still are based off of zoonotic contacts, mostly
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we think contact with rodents.
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Those infections tend to skew towards children under the age of 15.
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That tends to be the group that is in contact with those animals.
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And we tend to see the highest mortality and morbidity amongst those age groups.
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Now we also shift a little bit because mid 2023 we picked up, and I say weeks, it includes
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certainly at the forefront of this are Congolese colleagues and others from the US and Europe.
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We picked up a cluster of cases that were related to sexual contact in Congolese province.
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An N of five, very small, still skewing towards an older age group.
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But we saw men and women included in that.
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Since that time point, really in Selkivu province, we've seen again this massive inflection of
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cases in an area that historically had not seen much.
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Those cases over highly overrepresented among sex workers and dense sexual networks, but
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even seemingly evenly spread between men and women so far.
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We're not seeing much in terms of infections in kids, but that may change over time.
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We've seen movement of that particular type of monkeypox virus.
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What we've now termed clade 1B, more sustained human transmission.
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That virus has moved in a North Kivu and we've seen cases in internal displacement camps
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and that's included in, at least in our case investigations, in a few children.
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No severe disease so far, but we're still at the early stages.
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It's complicated.
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We're trying to follow the FD as closely as we can.
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Definitely different routes of transmission and that's been evolving as well.
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Has it been different for hosts, like host dependent as well?
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If somebody is immunocompromised, do they have more severe disease or they pick up the
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virus quicker?
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What we saw again in 2022 really opened our eyes a little bit to what monkeypox virus
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infections could look like.
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In 2022, there's a few global case series that looked at the risks for infection.
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There was an increased risk if somebody was HIV positive or a person living with HIV.
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Same thing with other STIs.
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We didn't know much at that point as to whether or not there was an increased risk for severity
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of disease.
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We've now seen with HIV that certainly people that have uncontrolled HIV can have a more
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severe course of M-pox than what we see in individuals who have control disease or otherwise
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have a normal immune response.
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But it's complicated.
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In Congo, we don't know.
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It certainly is top of mind for us.
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There's not a lot of STI testing.
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HIV rates tend to be quite low in Congo.
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That maybe has helped us a little bit, but we're hoping to deploy STI testing certainly
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in the South Kivu and some of the surrounding areas over the next few months.
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Then you talked a little bit about the common strains that are currently circulating.
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What is the predominant strain right now that you're seeing?
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Since it's Democratic Republic of the Congo, clade 1 monkeypox virus is the only type of
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monkeypox virus we've seen there before.
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We've now subdivided that into clade 1A and clade 1B.
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Clade 1A is the virus that's associated with zoonotic infections.
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Those are still making up the vast majority of the cases we see in DRC at the moment.
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Clade 1B we're seeing certainly in South Kivu starting to pick up in a few other areas now.
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That is associated with more sustained human-to-human transmission with no real zoonotic link.
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We don't know a lot about clade 1B yet in terms of severity.
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A number of factors we have to consider there, but we do know that it's certainly moving
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between people far easier.
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We think still through close contact and potentially with contaminated surfaces and shared materials
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or bedding and clothing, especially if somebody has a lesional disease.
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We haven't seen much in terms of changes in terms of things like a big respiratory component
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that's being included.
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But zoonotic infections certainly far and away are still driving the current outbreak.
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And then in terms of obviously, I think everybody is worried when they see a case like this.
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And so I guess we can divide it up into things because we can talk about prevention separately.
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And then when you do see a case, what do you do in terms of therapeutic management?
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So can you talk a little bit about how we can prevent and what kind of strategies are
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out there right now?
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Yeah, you know, the infection prevention control piece is something certainly I've been involved
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in and many others have been involved in since 2022.
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One of the things that I think we appreciate very quickly is certainly that kind of risk
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for broader airborne transmission.
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We haven't seen any FD that's suggestive of that.
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But historically, we've been able to gain a lot of knowledge, certainly from endemic
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regions of Africa.
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So really, the greatest risk for transmission we still see is that close extended contact,
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primarily through those that are providing care, whether they're health care workers
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or family members, whether they're sharing a bed, whether they're sharing clothing or
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bedding that is not being laundered.
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And we've seen the potential for transmission through things like sponges or cleaning materials.
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We've been working with a few groups, providing some guidance on looking at different disinfectants
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that are being used kind of in different areas of the world.
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The kind of good news is the majority of what we would assume continues to be the case.
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Bleach tends to work really well.
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Most good, you know, kind of, you know, antiviral disinfectants work very well.
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Soap and water work very well.
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A big piece of this is trying to ensure that anybody that has lesional disease that thinks
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that they are in contact with or bedding or clothing are getting laundered and that the
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people that are, you know, basically in contact with those things, either they're also monitoring
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their symptoms and or also using personal protective equipment.
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Okay.
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Yeah.
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So very similar to other viral diseases, encourage hand washing and inner basic hygiene and laundering.
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Absolutely.
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And our concern, I think right now with DRC, I mean, there's a big focus on certainly the
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sustained human to human transmission piece for good reason.
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But there's also a big piece of this, which is, listen, we know where really kind of the
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root of many of these infections are, and it's that zoonotic contact.
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There's a big piece of this, which I think is still, you know, kind of embedded in this
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idea of community engagement and trying to understand where infection prevention control
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practices can be implemented within communities that's done in a respectful and transparent
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manner in a way that doesn't impede people's ability to still hunt or to still be able
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to consume while game.
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And then once you have somebody who has a condition like this, who's contracted the
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virus, they have symptoms and they have signs and you're considering, you know, thinking
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about first, I guess we talk about diagnostics because if I'm an ER physician or a hospital
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physician, oftentimes as an infectious disease specialist, we'll get phone calls to send
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off.
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So what I see a patient like this, what do I send off?
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Yeah.
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So the easiest thing really is still is lesional swabs.
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OP swabs tend to work fairly well as well.
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There have been some studies that have looked at kind of longitudinal viremia in patients.
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Those I think for the most part have suggested there's not a really strong viremic component,
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at least in the majority of cases.
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So I think we're still kind of focused on lesional swabs.
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PCR by far and away is the method that still continues to be tried and true.
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There's been some changes though, because as we've seen kind of the emergence of clade
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2b coming out as a subclade out of clade 2 and now clade 1b is a subclade of clade
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1, we've also had to look at primers and whether or not those primers are still picking
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up the virus that we assume that they're recognizing.
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So for clade 1b, one of the things that we have seen recently has been that the kind
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of traditional primers that would be used normally for clade 1 infections, there's actually
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a deletion in clade 1b and those primers could potentially give a false negative.
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Colleagues in Europe have already reported primer sets that appear to recognize clade
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1b very, very well.
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But we also know that kind of like the overall kind of orthpox virus kind of centric primers
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work very, very well.
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They just don't give you that clade distinction, right?
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So PCR still works.
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We do a lot of sequencing.
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There's certainly something to be said about looking for antigens to try and identify people
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who have been previously exposed.
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We have done quite a bit of serosurveillance in this realm.
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The difficulty is pox viruses have very close antigenic similarities.
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That's why we use vaccinia for eradicating smallpox and we use it now for the M pox vaccine.
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That cross-reactivity somewhat precludes our ability to go in and say, okay, have you been
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exposed to monkey pox virus or cow pox virus or some other unknown human orth pox virus?
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That being said, in many areas that are endemic, we have a pretty good idea of what's circulating.
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And certainly if there's an outbreak situation, you can start to distinguish.
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There's questions about if somebody has been vaccinated for smallpox, what does cross-reactivity
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look like?
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But really if we use 1980 as that tipping point for people that were or weren't vaccinated,
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you can start to surmise what's going on based on that.
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That's fair.
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And then most centers, do they have the PCR testing or is this sent to National Microlab
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in Canada?
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Well, it's a good question.
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So certainly for clade 2 right now, like Cepheid has there, the gene expert is certainly widely
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being used for clade 2.
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That I think continues to be the case.
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For clade 1b, there's certainly been some questions about how we're going to be able
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to test for this and really to try and distinguish clade 1b from clade 2b.
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Using orth pox virus centric primers, you're still able to pick it up and say, okay, yeah,
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it's PCR positive.
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It's monkey pox virus, but we don't know which clade.
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For clade 1b, the issue that we have is this is a fairly recent development for the identification
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in Congo.
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So there's a lot of people that have been asking about access to nucleic acid to be
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able to validate tests within their own laboratories.
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And that's not only in Canada, but certainly well beyond and in too many different places
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across the globe.
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That's going to be a big piece.
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I think is that validation part likely, we're always a little bit behind with sharing materials
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globally unfortunately.
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I think right now, given the public health emergencies, that's going to be a big piece.
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But the confidence comes out of that the primer sets that have been reported so far that have
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been in use through Congo and in other regions.
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And then in terms of treatment, so are there antivirals out there or this is mainly supportive
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management currently?
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No, there's so for clade 2 infections, T-pox worked very, very well.
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Ticaviromat, ST246, I kind of have gone through every iteration of the name at this point,
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worked very, very well.
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And certainly in the US and Canada, that was kind of the antiviral that people were moving
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towards to try and reduce the impact of these infections.
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There's been an issue though that's come up in Congo, which is a very recent clinical
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trial for Ticaviromat on the ground failed.
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It didn't show any added benefit.
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The reality though is that it's unfortunate.
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There's probably a number of reasons why that trial may have been limited in its potential
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to be able to be successful.
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But a big piece that came out of that was you reduce the overall mortality just with
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providing good supportive care.
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And I think to me, that's a really important piece of this, which is for countries that
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have been scrambling for T-pox, certainly in 2022, maybe looking to do that for 2024.
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Blade 1B, we don't think it works, but if you provide good supportive care, you reduce
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certainly the mortality.
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I think the bigger kind of piece of all that though is saying in the areas where we see
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endemic disease, one of the things that we can do to immediately reduce the impact is
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be able to provide extra assistance for being able to give supportive care on the ground.
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So I think that's an important piece.
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Vaccination still works well.
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We have no reason to think the MDA, the very Nordic vaccine would not provide cross protection
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against Blade 1.
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It's still a vaccine based vaccine.
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So I don't think we have any concerns that way.
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A big part is still trying to get vaccines to really the hotspots of the world where
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we see circulation and that continues to be an issue.
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And so, yeah, so I would say I've had a couple of questions from physicians and colleagues
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and patients.
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Is it worthwhile for them to get vaccinated or is it something only limited to if they're
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traveling to these endemic areas?
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Even through travel, I don't know if there's a travel based vaccination program that's
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available.
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That may change because of the public health emergency.
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My lab and myself have been vaccinated because we obviously work with samples as well as
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with vaccine of virus and other pox viruses.
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I was vaccinated ages ago for ACAM2000 or with ACAM2000.
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The public availability is still pretty limited, right?
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Yeah.
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We have lots of stocks and stockpiles of ACAM2000, but that was contraindicated for certainly
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for very specific groups.
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The JYNNEOS or MBA vaccine, we don't have nearly the stockpile that we did.
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So there's still basically the push to try and get that vaccine to those populations
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where there is an increased risk for infection, close contacts of patients that have suspected
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or confirmed cases.
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That's still the focus, but as well kind of appreciating that we need to get vaccine into
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certainly in the Congo and probably now into Burundi and surrounding areas very, very quickly.
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So I think if we start seeing influx in cases, whether clade two or clade one driven in Canada,
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there's going to be a need to ensure that healthcare workers are vaccinated.
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But there's the other piece too, which is good infection prevention control also is
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very, very good at reducing those infections.
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So we just have to kind of take it at face value.
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Right.
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Okay.
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And so kind of the idea being prevention right now.
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Even if somebody does have the illness to be cautious, to not be around others, especially
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those that are immune compromised, kind of similar to what we would say with any other
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viral infections.
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100%.
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Right.
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And we know the thing is we know that the routes transmission predominantly, right?
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You know, eucosal membranes are going to be key in ensuring that we don't have any open
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wounds or abrasions.
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Those kinds of things continue to be important.
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And I think we go back to the idea of when people are vaccinating people, certainly old
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school, like CAM 2000 or even way back in the flybacks, it was about those preventative
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measures trying to remove the risk for exposure.
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Right.
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And so recently with WHO declaring this public health and global health emergency.
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And so how is situation evolving and appreciating that things are changing daily?
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I'm sure.
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Yeah.
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I mean, the situation on the ground in Congo, you know, through certainly through the work
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that we're doing, I don't think that the situation has necessarily changed.
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We're looking at from 2023 and now around 30,000 suspected cases.
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We've seen movement of virus really to 25 to 26 provinces now with local transmission.
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It continues to be widespread.
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And we're not seeing any indication that things are starting to ramp down.
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Right.
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So that continues to be a big concern for us.
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Probably as concerning of an issue though, is really the movement into Burundi and some
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of the surrounding regions.
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Burundi in particular, because of the limited resources that are available in country from
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a healthcare standpoint and just an overall standpoint, concerns about the increased circulation
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that we're now seeing there.
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You know, Uganda and Rwanda, we've seen cases.
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Kenya, we've seen cases.
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Those seem to be pretty controlled so far.
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That's assuming that people are feeling comfortable with self-reporting.
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But I think for us that the focus right now is really what's going on in Congo, what's
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going on in Burundi.
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We've seen introduction or at least the kind of the indication of cases that have been
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identified globally.
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So we've seen a case in Sweden.
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We've now seen a case in Thailand.
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That's not that surprising, right?
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People are still traveling.
379
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People are still living in a globalized community.
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We're likely going to see those cases continue to be identified.
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The bigger piece to me is going to be what happens afterwards?
382
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Do you see any additional signs of community transmission or broader transmission within
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those local populations?
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Or did you get good testing and contact tracing out and you don't see any local spread?
385
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So that I think continues to be important for developments.
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The other piece is we've seen, you know, really the kind of discussion about getting vaccines
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on the ground in Congo go from being a few months down the road to now kind of like within
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the next couple of weeks there will be vaccine.
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Don't know much about the deployment strategy yet, what that's going to look like, which
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groups are going to be going to be kind of the focal groups for that first round.
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But certainly we're there and others are there to help support where we can and certainly
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to try to get some clinical information out as quick as possible where and when we can.
393
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Okay.
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Seems like a very pressing situation, but you know, things, I think there's things are
395
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in the works and hopefully, you know, we don't see more spread in circulating virus because
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obviously we know what with the previous kind of virus activities we've seen over the last
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few years, we know that things can change really quickly.
398
00:26:53,560 --> 00:26:59,080
So, and then, so in terms of Canada or other countries, what are they doing in terms of
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like mitigating risks or surveillance for disease surveillance?
400
00:27:03,720 --> 00:27:04,920
Yeah.
401
00:27:04,920 --> 00:27:09,340
You know, I think one of the big pieces that, you know, that has maybe not gone as much
402
00:27:09,340 --> 00:27:14,120
presses as it's needed to over the last bit is we have this pressing situation in Central
403
00:27:14,120 --> 00:27:15,120
Africa.
404
00:27:15,120 --> 00:27:18,760
There's been a bigger question about, okay, well, what happens now if clade one moves
405
00:27:18,760 --> 00:27:21,240
more broadly and especially clade one B.
406
00:27:21,240 --> 00:27:26,000
The thing that I think we need to appreciate is, you know, two years out from 2022 to appreciate
407
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that listen, our surveillance networks, our testing and tracing networks, the knowledge
408
00:27:31,160 --> 00:27:38,840
base in our healthcare workers and as well, even within communities and community advocacy
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00:27:38,840 --> 00:27:43,560
groups, all of that has increased to a much higher level than it was pre-2022.
410
00:27:43,560 --> 00:27:46,900
So I think we're in a very good place for identifying cases.
411
00:27:46,900 --> 00:27:51,920
We continue to see, you know, cases being identified in Ontario, a little bit of a surge,
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you know, kind of coming through this summer.
413
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Same thing with other regions of the world, not approaching anything what we saw in 2022,
414
00:27:59,080 --> 00:28:02,960
but it should be a reminder that like clay to virus didn't disappear.
415
00:28:02,960 --> 00:28:04,940
It's still circulating globally.
416
00:28:04,940 --> 00:28:07,500
It's still circulating here within Canada.
417
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It's just at a very, very low level.
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So I think we're doing very, very good in terms of our surveillance.
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00:28:13,960 --> 00:28:18,440
We now have to add the PCN about clay one B recognition, but we're in a place where
420
00:28:18,440 --> 00:28:22,200
we should be able to identify those, those cases very, very quickly.
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00:28:22,200 --> 00:28:23,360
That's really good to hear.
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00:28:23,360 --> 00:28:28,760
And so in terms of resources, cause I think that's also important for healthcare professionals
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00:28:28,760 --> 00:28:33,120
across the board, also sometimes just general public, you know, asking questions.
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00:28:33,120 --> 00:28:38,040
And so where can people find, I mean, like obviously CBC has always been a really good
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00:28:38,040 --> 00:28:41,760
resource, but are there other certain areas that we should be looking?
426
00:28:41,760 --> 00:28:42,760
There, there are.
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00:28:42,760 --> 00:28:46,560
I mean, I, you know, I don't want to, you've got to shine a spotlight on work that I've
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00:28:46,560 --> 00:28:52,120
done because I've sat on panels with far smarter people to myself to pronounce on this.
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00:28:52,120 --> 00:28:56,680
WHO a couple of years ago had a guideline development group for clinical management,
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00:28:56,680 --> 00:28:58,480
infection prevention control.
431
00:28:58,480 --> 00:29:00,720
That's really available through, through WHO for M pox.
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00:29:00,720 --> 00:29:05,480
I think that's still largely applies to everything that we're seeing now.
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00:29:05,480 --> 00:29:10,240
WHO just recently updated all their information on infection prevention control, their descriptions
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00:29:10,240 --> 00:29:12,560
of M pox, those resources are good.
435
00:29:12,560 --> 00:29:17,200
And of course health Canada and public health agency of Canada continue to provide information
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00:29:17,200 --> 00:29:18,200
as well.
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00:29:18,200 --> 00:29:21,360
And of course there's, there are research groups that are doing work in this area.
438
00:29:21,360 --> 00:29:25,920
You know, all of us have a lot of information as well, but I think going to those kind of
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00:29:25,920 --> 00:29:31,880
big sources, European centers for disease control, U S T D C, WHO and, and health Canada
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00:29:31,880 --> 00:29:34,440
are major resources.
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00:29:34,440 --> 00:29:35,440
That's really helpful.
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00:29:35,440 --> 00:29:39,680
Cause I think a lot of people will be starting to see more questions come through and that's
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00:29:39,680 --> 00:29:42,560
kind of natural that happens clinically as well.
444
00:29:42,560 --> 00:29:47,160
You know, we always think about what's happening with circulating and I think awareness is
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00:29:47,160 --> 00:29:48,160
important.
446
00:29:48,160 --> 00:29:52,480
And so that's why we're talking about this today, because I think most of us should have
447
00:29:52,480 --> 00:29:58,160
some base knowledge on monkey pox and, and you've given us some really good information
448
00:29:58,160 --> 00:29:59,160
today.
449
00:29:59,160 --> 00:30:05,360
So in terms of kind of summarizing or some key points that you'd want the public or health
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00:30:05,360 --> 00:30:11,880
professionals to really take away from today's episode, what would you kind of summarize
451
00:30:11,880 --> 00:30:13,320
in terms of that?
452
00:30:13,320 --> 00:30:17,520
Yeah, I think a big piece of this is right now that the global risk for, for clade one
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00:30:17,520 --> 00:30:19,640
introduction continues to be quite low.
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00:30:19,640 --> 00:30:22,340
I think also appreciating that, you know, things can change.
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00:30:22,340 --> 00:30:25,240
We know that that happened with clay too, but we're in a different place than we were
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00:30:25,240 --> 00:30:26,780
in, in 2022.
457
00:30:26,780 --> 00:30:28,500
We have good surveillance networks.
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00:30:28,500 --> 00:30:30,760
We have good sharing of data and testing protocols.
459
00:30:30,760 --> 00:30:34,000
I think that piece allowed us to be able to move forward.
460
00:30:34,000 --> 00:30:38,560
The kind of piece that I think is at the heart of this though, is we want to reduce the risk
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00:30:38,560 --> 00:30:39,560
globally.
462
00:30:39,560 --> 00:30:44,440
We've got to reduce the risk locally, which still gets back to the need to not only get
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00:30:44,440 --> 00:30:49,040
things contained in, in DRC, but also to look at other endemic areas of Africa and say,
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00:30:49,040 --> 00:30:51,640
we need to get vaccination programs up.
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00:30:51,640 --> 00:30:57,160
We need to get surveillance programs sustained and as well go back to this piece about healthcare
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00:30:57,160 --> 00:31:02,200
infrastructure and certainly the need to be able to harmonize data reporting globally
467
00:31:02,200 --> 00:31:03,360
right now for M-POC.
468
00:31:03,360 --> 00:31:08,000
So we all have a good impression of what we're looking for, but I think it's going to be
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00:31:08,000 --> 00:31:09,480
a key area.
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00:31:09,480 --> 00:31:10,480
Yeah.
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00:31:10,480 --> 00:31:16,640
And then just on a note that I actually forgot to ask was in terms of reporting.
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00:31:16,640 --> 00:31:22,760
So if physicians or anybody is seeing cases, are these then like, I mean, through the lab,
473
00:31:22,760 --> 00:31:26,840
we're definitely reporting to public health, like local public health authorities.
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00:31:26,840 --> 00:31:31,560
Is there something that a physician should be doing in terms of any surveillance network
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00:31:31,560 --> 00:31:35,400
that they should be entering their data into?
476
00:31:35,400 --> 00:31:37,160
Not that I've seen so far, right?
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00:31:37,160 --> 00:31:41,480
And listen, that can just be my naivety for what, what's available in Canada.
478
00:31:41,480 --> 00:31:46,480
In DRC, we've got, WHO has their centralized system for us to be able to report and upload
479
00:31:46,480 --> 00:31:48,280
data continually into.
480
00:31:48,280 --> 00:31:53,200
So we've, we've been working on that and certainly most, most of those countries have good centralized
481
00:31:53,200 --> 00:31:56,640
systems for entering in national data.
482
00:31:56,640 --> 00:32:00,720
It can be a little bit slow at times, but we continue to do that on the ground as well.
483
00:32:00,720 --> 00:32:06,420
And then of course, Africa CDC is obviously taking a much bigger role in this with trying
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00:32:06,420 --> 00:32:11,520
to ensure that there's good data reporting, data management, and as well sharing of information
485
00:32:11,520 --> 00:32:12,520
globally.
486
00:32:12,520 --> 00:32:13,520
Okay.
487
00:32:13,520 --> 00:32:14,520
That's great.
488
00:32:14,520 --> 00:32:19,480
Definitely, I think everybody's on top of it and it's good to hear a little bit more,
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00:32:19,480 --> 00:32:23,080
you know, about Monkeypox and, and have a bit more background.
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00:32:23,080 --> 00:32:25,160
So I've learned a lot for sure.
491
00:32:25,160 --> 00:32:30,280
And, and I always inform my listeners that this is an informational podcast and things
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00:32:30,280 --> 00:32:37,240
do evolve and, and over time, you know, even prevention or treatment options may change.
493
00:32:37,240 --> 00:32:41,760
So currently this is the situation with Monkeypox and, and what we know about it right now.
494
00:32:41,760 --> 00:32:47,480
So I'm sure our listeners will take a lot back from this episode and thank you Dr.
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00:32:47,480 --> 00:32:53,720
Kindertruck for being here today on our podcast and providing us with such great information.
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00:32:53,720 --> 00:32:55,280
It was an absolute pleasure.
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00:32:55,280 --> 00:32:56,280
Thank you.
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00:32:56,280 --> 00:32:57,280
Thanks.
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00:32:57,280 --> 00:32:58,280
Take care.
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00:32:58,280 --> 00:33:00,360
Thank you, Dr. Kindertruck for joining us today.
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00:33:00,360 --> 00:33:01,840
Have an episode suggestion?
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00:33:01,840 --> 00:33:08,240
Email the Canadian Breakpoint at gmail.com and be sure to follow us on X at CA Breakpoint
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00:33:08,240 --> 00:33:09,240
for updates.
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See you again soon at the Canadian Breakpoint.
