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Hello and welcome to another episode of the Business of Life.
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Today we have a very special guest, Dr Mohamed Sheikh Hussain.
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Welcome, sir.
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How are you?
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Thank you very much for giving me this opportunity to join your podcast.
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It's a great pleasure.
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My name is Mohamed Shaq Hussain, professor of Global Public Health, and my special interest is emerging and re-emerging infection disease and the vaccine preventable diseases, and in general, public health, emerging and re-emerging infection disease and vaccine preventable diseases, and in general public health.
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Fabulous, Thank you.
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So much Can you tell us?
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I know that you have such a very big and broad history all over the world, so I'd love our audience to know more just about your history in the various countries you've been and the various projects that you've been involved in.
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Thank you very much.
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This is really very interesting.
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I did my medical degree in Italy, university of Burma and also did my training of infection disease University of Milan.
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I had a wonderful time.
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It was near the Cathedral Milan, so I used to wonderful time.
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It was near the Cathedral in Milan, so I used it to live there.
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Then from Italy I went to the United States, new York, where I did my master's degree at Columbia University.
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After I did my master's degree in public health at Columbia University, I got a scholarship and I went to UK.
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One of the historical schools of tropical medicine maybe the first one Liverpool School of Tropical Medicine, where I did infection and disease tropical medicine.
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As I am coming from Africa, my plan was to go back and to work just by having one small stethoscope and microscope.
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So this was my dream and I was having a lot of Western doctors from interestingly from Germany and Netherlands, finland, australia, italy Also.
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They were interested in missionary work in Africa.
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So we had an excellent time in that period.
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But unfortunately I didn't go to Africa.
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I went to United Arab Emirates in the Gulf of countries where I was head of the Department of Public Health and I spent most of the time in United Arab Emirates.
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While I was in UAE, in United Arab Emirates, I did apply to a doctorate in public health at University of Houston, texas, and where I spent a two-year full-time to do my basic work and then, after I passed my comprehensive exam, I went to collect my research data in United Arab Emirates and it was very interesting.
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At that time I did hepatitis B, hepatitis C among pregnant women.
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At that time there was no medication, there was no vaccine and it was really very bad.
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In UA, uae, there was no high prevalence of, in that time, hepatitis C among pregnant women.
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So this is the whole my history.
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Now I am a professor of global health in United Arab Emirate University College of Medicine Institute of Public Health.
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I also have a agent associate professor at the University of Limaimo Linda School of Public Health, california.
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Also, I spent a couple of months at Harvard School of Public Health with Professor David William.
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Still, I am connected.
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I have a great collaboration with this group and later on maybe I explain how many interesting people I met in that area to collaborate on malaria, on tuberculosis, on HIV.
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So so far it is in summary of my background.
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It absolutely sounds so fascinating and what's interesting to me, that's literally in most parts of the background.
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It absolutely sounds so fascinating and what's interesting to me, that's literally in most parts of the world.
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So you've covered most parts of the world with what you're doing and all of your research is absolutely incredible.
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You have so much.
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May I ask what is your interest now?
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What is the biggest infectious disease or disease that you're working on now that you think is quite important to speak about?
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I think.
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As we know, we came through the COVID pandemic, which I don't know was very challenging, since 2019.
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Until now it is evolving.
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Until now it is considered one of the most.
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Now, again, we have a monkeypox which is again affected half of the African continent, maybe in Europe, generally in Europe, and the cases is really significant, like if you look in Spain, in UK, in Germany and same thing in United States and in Australia.
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So again the infection disease is emerging and re-emerging and it's becoming a global threat because disease known to be endemic in African region, not only monkeypox or Marburg or Zika known in Africa, now it's everywhere.
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So we know the virus doesn't need to go to get a passport or to
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have a visa?
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No, it doesn't.
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It cross borders.
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I love that without passports.
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For those of us that are not in medicine or public health, can you in lay terms explain what exactly is what we call monkeypox?
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How do you get it, what are the symptoms and how is it treated?
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Yes, absolutely.
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It's fascinating because monkeypox it is close related with smallpox.
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As you know, smallpox has been eradicated worldwide in 1980.
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The only disease which has been eradicated worldwide.
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So monkey box is a close relative to smallpox.
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What happened was historically was known to be endemic in Africa, especially in Central Africa, in West Africa.
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But it has been discovered interestingly in a Denmark laboratory animal lab in Danish cities and interestingly, those monkeys they were from Singapore, not from Africa.
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So when a scientist, virologist, he noticed those specific monkeys brought from Singapore, they developed a skin rash and he noticed there was something unusual.
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And when he detected he found this was a virus related with smallpox and they call about monkeypox.
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So this is the interesting and fascinating about smallpox.
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Then this was in 1958.
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But in 1970, the first human case was detected in Zaire now it's called the Democratic Republic of Congo and this was a child of a nine-month-old.
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And interestingly, the doctors they were thinking why only this child of nine months?
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They said, oh, everybody is vaccinated with smallpox, so this guy, their child, is the only one so not immune of smallpox.
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This is what the hypothesis.
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But going back again the question you asked me, this is zoonotic disease and endemic in the forest and it was a wild animal.
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Zoonotic diseases means like a disease with an animal.
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And then what happened was something we call spillover.
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The spillover means when the disease is endemic, between animal to animal and then by the deforestation and human, from the deforestation causes those animal.
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They come from where they're habitual, they used to live, they come out of this and they come in contact with human.
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Then what happened?
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From animal to human.
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They used to live, they come out of this and they come in contact with human.
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Then what happened?
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From animal to human and then from human to human.
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So this is, the disease started to spread in Africa.
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So, as you are mentioning the symptoms, it's like initially it looks like a flu-like syndrome, the person he feels like a respiratory infection, malaise and so on.
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But the interesting thing is the skin rash and this skin rash again is a.
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You need to see a clinician or healthcare workers that he knows what is the exact diagnosis, because this is similar with chickenpox, it's similar with measles, other skin diseases, so the only clinician can distinguish this is due to with a monkey box.
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Then after the clinical assessment, clinical examination, the doctor, he understand this is a Monkey box.
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Then they do some a analysis and unfortunately in Africa that time that diagnostic and unfortunately in Africa at that time the diagnostic BCR polymerase chain reactive was not available.
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So only based on clinical assessment and the professors, the doctors, their own experience of previous.
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But currently, thank God, there is a diagnostic procedure.
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It's available in most African countries with a PCR Can be detected within two days.
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So after this, he detected the virus, the doctor.
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It is no effective treatment right now.
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What they are doing is a symptomatic treatment.
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Symptomatic treatment it means like to control the fever, the dehydration and the people to drink fully.
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Another most important one is the public health aspect.
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Like the patient, once he realizes he has a monkey box, he has to self-isolate himself and avoid to contact with other people.
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So this is also the health care advice.
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In the meantime, the health workers, they took their epidemiologic investigation to look how this patient he got the disease, what they call a case and contact tracing.
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They will find where the patient he get, how do you get how many other people they are exposed in this outbreak.
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So this is how they detect.
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Interestingly, we use now you hear a lot of outbreak or epidemic.
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That does mean is when the cases become more than expected.
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It means in the area of one district in Africa if they used to see one case or two cases per day, if they see 10 cases per day or 20 cases, it means there is a real issue, real problem.
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So they call outbreak and this will be detected through the public health activity to go close contact to see how the patient gets where we rehab.
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So we look about the three W who is affected, where is affected and when he is affected, then why and how to prevent.
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This is how public health we manage in this situation.
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As you are asking me, we are fortunate to have a vaccine approved by FDA and these vaccines approved by FDA.
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There are two.
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And these vaccines approved by the FDA are two, but there is one that is the most safest less side effect and high percentage of productive level of the patient who were vaccinated.
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I hope I tried to.
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That is so interesting and what I love is that you really went from the individual and you actually showed us how it also is within the town and the city and how it spreads.
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May I ask is it a virus and if so, how is it spread?
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Is it spread through the mouth, through the skin, through the hands?
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How is this virus spread?
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Do we know how it's spread?
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Fantastic.
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This is very interesting.
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The disease is spread actually through direct contact, from close, especially close personal contact.
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Through that, if I am someone in a close contact and face to face, I may also get through a respiratory infection skin to skin and, as we mentioned from the disease was a epizoonotic between animal and then become zoonotic and then become human to human.
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Very interesting, now even a mother can transmit in her child, so they call this a transparecental transmission and the children they're born with the disease.
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Oh, in utero.
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Pardon me, the mother can transmit the monkey virus or the M virus from in utero.
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Yes, Her newborn, her infant, her newborn.
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I think it is frozen, frozen.
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I think it is frozen.
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Yes, you have been frozen.
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Yes, sir.
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What were you saying sir?
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Yes, I am saying we call it transplacental.
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A pregnant woman can transmit the virus if she gets the pregnancy to her new uterus.
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We call it transplacenta.
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So this is again lately, the scientists and obstetric gynecology they are the focus to do more study.
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They have initial cases that transplacenta exists, but they are working.
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Another interesting disease is sexually transmitted diseases.
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So what happened is a common sexually has been established, the sexual transmitting of umbilicus, especially from a man who's having sex with another man.
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So most cases now has been traced that sexual contact between not only heterosexual but also homosexual.
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So again, this is this is interesting.
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May I ask a question?
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I'm sure other people are thinking the same.
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So a mother can pass it to a baby?
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People who are in close contact with each other, for example who live together not necessarily in any type of adult contact, let me say that, right, but they can also transmit it to each other.
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And then also people who have intimate contact with each other can transmit it.
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And you're saying that there's more cases, or there's a higher level of cases between men and men.
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Can you explain this idea a little bit more, because I don't quite understand.
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Is it the same?
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as everyone else, or is it different?
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Absolutely, Absolutely.
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Now the alarming situation in Europe and in North America is more between men to men who are having sex, but again in public health.
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We are trying to avoid the stigma of saying this disease is only for a man who is having sex, like initial.
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But as you said, it's not.
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This is not the issue, as you clearly stated.
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Anyone can get it from close contact A mother can also give it to her child.
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Absolutely Right, so understood.
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So you're saying that basically it can be had by close contact mother to child or close sexual contact?
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Make a stigmatizing saying oh, this is between men and women.
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I was there for that.
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I worked with HTLV3 or HIV with Dr Gallo back in 1980.
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Gallo Robert.
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Gallo, yes, I remember.
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Okay, this is interesting to know.
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So the only other question I had is the skin disease.
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So I understood, like smallpox, I know what that looks like.
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Is the skin disease something that bubbles over and that's open like an open sore, or what exactly does it look like?
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Is it almost something like that?
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I think there is a different stage.
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It will start from the face and goes, and especially through the hand.
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So what is happening is the doctors, they know how to distinguish between the symptoms.
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The rash is typically progressive, goes through several stages, as we say macula, papula, vesicula this is terminology we use and then it will take a couple of weeks from the beginning, one week, sometimes four weeks.
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So, in concomitant with other symptoms, the people feel like a general malaise and tiredness and chili.
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So it is really a some kind of basically you can see also there is some kind of swallowing of lymph, lymph nodes.
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We use it to call okay of the sign is lymphadenobatis, we call under the arms, also in the groin.
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Yeah, absolutely Also how about the throat.
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Yes, absolutely, typically the throat under the arms and the groin and it becomes swollen.
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Oh, that's really good.
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Absolutely, absolutely.
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So there is lymph nodes and that is the typical doctor's, so the healthcare workers they know.
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So there is different stages, like some people they have a mild, some people they have a moderate and some people they have really severe stage of the situation.
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So some people they recover without much issues.
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So in severity now what we have is that I haven't mentioned there is a monkey box.
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They have a subclassification, we call it Glade 1 and Glade 2.
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But the severity now is getting one.
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This Glade 1 is more severe and more fatal.
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So it's becoming more concern in research about this variant subclassification who causes more severe disease and even a high mortality.
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I had no idea about that.
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So may I ask?
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So there are those that get it and it's almost like a cold or a flu and it can pass several stages and then they seem to recover.
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But, as you said, there's a second one where there's a mortality.
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Can you tell us more about that?
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And why would that be?
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What does it affect?
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And then how does that?
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Does it affect the immune system itself, or what exactly does it affect that causes a high mortality?
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Yes, there is a two distinct genetic of monkeypox.
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We used to call it GLADE1 and GLAD2 and there is again some classification.
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So the GLAD1 is the one who is really now spreading in West Africa and in general in Africa and it is really a severity of skin rash and also a severity of skin rash and fever and the people, all these general symptoms we've been considering.
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So this one, the GLAD1, has high mortality.
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The reason there is a lot of genomic study now, genetical classification, why this is becoming more severe and more deadly and more.
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There is a lot of genetics going on.
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And Africa now the good news, they are having a lot of international fund to technology to help to have their own pharmaceutical manufacturers, to have their own pharmaceutical manufacturers to have their own laboratory diagnostic.
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As to the question you are asking me, there are no facilities to know the genetic variation why this is killing, what is the genetic aspect it's causing.
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So, in general, they found.
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We don't really know.
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So they have high fever.
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Is the fever so high that the fever can't be brought down, or is it that the skin rash is so difficult to control and is so open that infection comes in?
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And then the issue is controlling the infection.
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So what exactly is the mechanism for the high mortality rate?
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I know there's always genetics involved, but why Is it the fever?
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Is it the skin rash?
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Is it an infection of the skin rash?
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What's difficult to control in the symptoms that it then goes to the possibility of mortality or death death.
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Do you know, in, in, in, in in africa, as you know, the so many other risk factors, the people they have deficiency of nutrition.
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Their immunity is already is is a very low the co-factors make a big difference.
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You're telling me yeah, yeah, the co-factors make a big difference.
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You're telling me, yeah, the co-factors.
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And the other risk makes you.
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If there are purely infection of a monkeypox can be treated as it's doing in Europe and other countries.
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But the African country and also the late stage, the people they are coming.
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No facility of the health infrastructure, public health infrastructure is poorly broken.
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So if we have early detection, early diagnosis, early treatment could be prevented this kind of high mortality we are mentioning.
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So this kind of high mortality we are mentioning.
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Thank you, sir, and may I ask are there medicines to treat?
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I know you said there are vaccines, but are there medicines to actually treat the monkeypox?
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or are we treating the symptoms until the person gets better?
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Now, as I mentioned earlier, there is no effective treatment.
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It is a supportive treatment.
00:27:52.135 --> 00:28:06.321
Sub-e-bol is a palliative, what we call but there is an antiviral approved in clinical trial at risk, but the efficacy is still we don't know.
00:28:06.321 --> 00:28:20.522
So a lot of clinical trial is going on and there is antiviral drugs, but so far it's asymptomatic treatment and a vaccine.
00:28:21.432 --> 00:28:23.670
May I ask where are the clinical trials happening now?
00:28:23.670 --> 00:28:28.579
Which countries are the clinical trials currently being looked at?
00:28:30.731 --> 00:28:46.074
I feel like the good news is African Center for Infectious Diseases are doing tremendous and if you can see on the LinkedIn Dr Casey DeHead, he's doing tremendous work.
00:28:46.074 --> 00:28:49.041
He has been in Dover, nearby.
00:28:49.041 --> 00:28:53.842
He has met with all philanthropists.
00:28:53.842 --> 00:28:58.982
He met so many presidents, so many scientists.
00:28:58.982 --> 00:29:07.890
So Africa now it is really trying to become self-sufficient to have their own manufacturer.
00:29:07.890 --> 00:29:12.701
So many epidemiologists have been trained.
00:29:12.701 --> 00:29:14.698
So many nurses have been trained.
00:29:14.698 --> 00:29:17.394
Imagine, I don't know.
00:29:17.394 --> 00:29:21.483
Africa is nearly 50 or 52 countries.
00:29:21.483 --> 00:29:24.459
50% of these have been infected.
00:29:24.459 --> 00:29:30.595
Besides, on monkeypox, they are having a Marburg disease, a saline infection disease.
00:29:30.595 --> 00:29:36.903
So they are not more depending outside assistance.
00:29:36.903 --> 00:29:47.498
They are trying to have their own highly qualified scientists, virologists and having laboratory facilities so many other things they cannot get outside.
00:29:47.498 --> 00:29:49.919
They are trying to have a self-sufficient.
00:29:51.570 --> 00:30:11.019
That's really good to know, and I know that so many of my colleagues, even when I was training in public health at the London School of Hydrogen and Tropical Medicine, came from Africa, so it's really good to know that some are actually using their training that they've received in various parts of the world in order to help this particular endemic problem.
00:30:11.019 --> 00:30:12.762
I want to thank you.
00:30:12.762 --> 00:30:14.031
Our time is almost up.
00:30:14.031 --> 00:30:15.194
We just have several minutes.
00:30:15.194 --> 00:30:23.776
Is there something specific that you would like to tell our general audience about MPOX and is there a way to avoid it?
00:30:23.776 --> 00:30:30.724
And also, if you
have symptoms, where should you go to get it checked out?
00:30:31.125 --> 00:30:44.182
Thanks, the most important thing is that we encourage the people to prevent the stigmatization and the racism.
00:30:44.182 --> 00:30:44.884
All those are as a public health.
00:30:44.884 --> 00:30:46.769
Prevent the stigmatization and the racism.
00:30:46.769 --> 00:30:48.696
All those are as a public health.
00:30:48.696 --> 00:30:56.816
We like to give a respectful with ethical integrity, with dignity and respect.
00:30:56.816 --> 00:31:13.839
We are not going to ask how we get it, but we would like to treat the people and to educate and to make awareness among the people who is really.
00:31:13.839 --> 00:31:17.605
It can be preventable.
00:31:18.750 --> 00:31:27.143
But the only thing is the stigma, the denial and also the stigmatization that the people.
00:31:27.143 --> 00:31:41.529
They say, oh okay, this disease is for this or this disease is for no, the people, they should have self-sufficient as soon as they feel they have gone to the nearest healthcare service, they should get counseling, they should get a treatment.
00:31:41.529 --> 00:31:42.796
It's a preventable.
00:31:42.796 --> 00:31:57.394
So we encourage the people to come out and to speak with the healthcare workers and to explain their symptoms and then, when they feel they're having this, they have to be self-isolate themselves.
00:31:57.394 --> 00:32:01.598
Educate them self-isolate, not to transmit the disease with this.
00:32:01.598 --> 00:32:02.559
Don't do this.
00:32:02.559 --> 00:32:17.243
So all this requires, like a public health intervention, to understand the empowering the community itself to have a self-sufficient to prevent this monkeypox.
00:32:18.730 --> 00:32:21.978
Thank you so much, dr Mohamed Sheikh Hossain.
00:32:21.978 --> 00:32:35.021
I mean that was extremely informative and we thank you for educating us on this public health issue rather than, as you said, a personal issue, and there shouldn't be stigma to health and lack of health and disease.
00:32:35.021 --> 00:32:38.252
Thank you so much for coming and to our audience.
00:32:38.252 --> 00:32:40.961
Remember, if I'm not for myself, who will be for me?
00:32:40.961 --> 00:32:43.218
If I am only for myself, what am I?
00:32:43.218 --> 00:32:45.457
If not now, then when?
00:32:45.457 --> 00:32:50.616
That was said by the great philosopher Hillel and I say if not me, then who?
00:32:50.616 --> 00:32:53.755
Thank you so much, thank you for being with us.
00:32:54.851 --> 00:32:55.836
Thank you very much.
00:32:55.836 --> 00:32:59.079
I would be pleased to have a more episode.
00:33:01.111 --> 00:33:03.239
We are looking forward to bringing you back again.
00:33:03.239 --> 00:33:04.635
30 minutes is never enough.
00:33:04.635 --> 00:33:06.141
Thank you so much, Dr Shikis.
00:33:06.829 --> 00:33:07.692
Thank you very much.
00:33:07.692 --> 00:33:09.476
Thank you very much.
00:33:09.476 --> 00:33:11.221
It's a great pleasure and have a good day.
00:33:11.221 --> 00:33:12.503
Thank you, you too.